bluuebunny/crossref_metadata_2025 huggingface dataset:
Paper 27: Return to Sport and Testing following Hip Arthroscopy For FAI in High School and Collegiate Athletes
Authors: Leary Steven , Henrichsen Jake , Schaver Andrew , Willey Michael , Paulson Amanda , Westermann Robert
Published: July 2022

Objectives:

Femoroacetabular impingement (FAI) is a known cause of hip pain and dysfunction in young, active patients and can be successfully managed with hip preservation surgery. For athletes with FAI, however, there is inconsistent data regarding the ability to return to competitive sport after surgery and how performance level is impacted. The purpose of this study is to evaluate patient factors contributing to return to sport after hip preservation surgery.

Methods:

Study Design: Retrospective cohort We retrospectively reviewed patients aged 14 to 44 who underwent hip preservation surgery between December 2018 and May 2021 and who participated in a competitive or recreational sport pre-operatively. All patients underwent formal return-to-sport (RTS) testing between 4 and 6 months after surgery. Patient-reported outcomes (PROs) were obtained at initial RTS testing using the International Knee (Hip) Documentation Committee (IKDC) questionnaire, Hip Outcome Score – Sports Specific Subscale (HOS-SSS), and Hip Return to Sport After Injury (Hip-RSI) scale. Regression analysis was performed to evaluate the relationship between RTS tests, PRO’s, BMI, pre- and post-operative alpha angles, and degree of correction. Degree of correction was the difference between pre- and post-operative alpha angles measured on Dunn view hip x-rays.

Results:

We identified 40 patients, 47 operative hips (34 females, 85%). Three patients (4 hips) were excluded for incomplete testing data. Mean age was 17.73 ± 2.7 years. All patients underwent hip arthroscopy for FAI including one case of single-stage bilateral hip arthroscopy. The most common primary sports were dance (7), softball (6), and basketball (5). Mean alpha angles were 67.15 ± 10.9° pre-operatively and 41.37 ± 4.5° post-operatively. Average time from surgery to first RTS testing was 26.79 ± 6.5 weeks (median 25.1 weeks). Mean HOS-SSS score at initial testing was 85.98 ± 11. Posteromedial (PM) and posterolateral (PL) reach on Y-balance test were significantly associated with HOS-SSS score at initial testing (PM: r=0.54, p<0.001; PL: 0.53, p<0.01). Composite Y-balance score was also significantly associated with HOS-SSS score (r=0.6, p<0.01). All other comparisons between PROs and RTS tests were not significantly associated. Similarly, there were no significant associations between time to initial RTS testing and BMI, pre-operative alpha angle, or degree of correction.

Conclusions:

Higher Y-balance scores at initial RTS testing are associated with improved PROs and perceived readiness to return to sport. This test can be easily incorporated into an assessment for safe return after FAI surgery; further prospective studies are warranted.
Paper 31: Risk factors affecting the survival rate of Collagen Meniscus Implant (CMI) for partial meniscus deficiency. An analysis of 156 consecutive cases at a mean 10 years of follow-up
Authors: Zaffagnini Stefano , Grassi Alberto , Agostinone Piero , Fabbro Giacomo Dal , Pizza Nicola , Di Paolo Stefano , Lucidi Gian Andrea
Published: July 2022

Objectives:

The present study aimed to determine the factors that predict failure of meniscus scaffold implantation in a large series of patients treated at a single institution, to better refine the indications for surgery and better inform future patients.

Methods:

156 consecutive patients with a minimum 5-year follow-up who underwent isolate CMI scaffold implantation or combined procedures were included in the analysis. Demographic and surgical information were obtained via chart review. Patients with partial meniscal deficiency requiring CMI implant, who had an Outerbridge grade of at least 3 and also underwent an additional surgery were considered as “complex cases”. Patients were asked to complete the Lyshlom questionnaire and those with a “poor” Lysholm score (<65 points) were considered a clinical failure. Patients were also inquired regarding further reoperations on the ipsilateral knee during the follow-up period to determine the incidence of surgical failure, defined as partial or total scaffold removal.

Results:

156 patients (84%) with a mean age at surgery of 42.0 ± 11.1 were included in the final analysis at an average follow-up of 10.9 ± 4.3 years. The overall survival rate from surgical failure was 87.8%. When further evaluating the different subgroups of patients, an Outerbridge grade of III-IV (HR 3.8; P =.004) and lateral scaffold (HR, 3.2; P= .0048) were identified as risk factors In the specific, the overall survival rate of the medial scaffold was 90.4%, while the survival rate of the lateral one was 77.4%. Finally, 42 patients (26.9%) were considered either a surgical or clinical failure. In this case, risk factors identified were: an Outerbridge grade of III-IV (HR, 3.1; P =.000), and time from meniscectomy to scaffold greater than 10 years (HR, 2.7; P = .042).

Conclusions:

Collagen meniscus implant for partial meniscus deficiency provided good long-term results, with 87.8% of the implants still in-situ at a mean 10.9 years of follow-up. The cartilage status, laterality of the scaffold, and time from meniscectomy to CMI surgery were identified to affect significantly clinical and/or surgical failures.
Paper 34: Kinematic Analysis of Lateral Meniscus Oblique Radial Tears in Anterior Cruciate Ligament Reconstructed Knees: Untreated versus Repair versus Partial Meniscectomy
Authors: Bezold Will , Cook Cristi , Krych Aaron , Stuart Michael , Wijdicks Coen , Cook James , Smith Patrick
Published: July 2022

Objectives:

Objectives: Previous analyses have characterized the incidence of lateral meniscus oblique radial tears (LMORT) commonly seen with ACL tears, and their impact on joint and meniscus stability in the presence of ACL deficiency.

Purpose:

To determine the clinically relevant kinematics associated with LMORT lesions untreated versus arthroscopic repair versus partial meniscectomy in combination with anterior cruciate ligament reconstruction (ACLR).

Methods:

Sixteen cadaver knees underwent robotic testing for anterior drawer (AD) and pivot shift (PS) simulations at multiple knee flexion angles in intact and ACL-deficient states, followed by sequential testing of arthroscopic ACL reconstruction (ACLR), creation of a LMORT 3 lesion, LMORT 3 repair, and partial meniscectomy (PM; n=8). The same testing sequence was performed for LMORT 4 lesions (n=8). Changes (Δ) from the intact state for anterior translation, internal rotation, and valgus displacements, as well as ultrasoundographic measurements of meniscal extrusion, were measured and comparatively analyzed.

Results:

ACLR restored kinematics in ACL-deficient knees to intact levels for all metrics tested. For AD, ACLR + LMORT3 tear and PM resulted in significantly greater anterior translation (0.8-2.1 mm differences) compared to ACL-intact at all angles ( P < 0.05) and compared to ACLR at 60o and 90o ( P < 0.014). For PS, ACLR + LMORT3 tear had significantly more anterior translation (1-1.4 mm differences) at 15o than intact knees (P=0.041), and at 0o and 15o for PM ( P < 0.03). ACLR + LMORT4 tear and PM resulted in significantly greater anterior translation (0.9-2.3 mm differences) for AD ( P < 0.04) and PS testing ( P < 0.05) compared to intact and ACLR knees at all angles tested. ACLR+LMORT 3 repair and ACLR+LMORT4 repair restored kinematics to ACLR and intact levels at all angles tested. ACLR + LMORT3 tear ( P < 0.008) and both LMORT4 tear and PM ( P < 0.05) resulted in increased meniscal extrusion (1.8-11 mm differences) compared to intact and ACLR statuses at all tested angles for AD and PS while repairs restored meniscus stability to ACLR and intact levels.

Conclusions:

Untreated LMORT 3 and 4 tears increased anterior translation, pivot shift, and meniscus extrusion even after ACLR, while partial meniscectomy further exacerbated these detrimental effects. In contrast, arthroscopic side-to-side repair of LMORT lesions effectively restored measured knee kinematics. UPLOAD- https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/6bf43418-abf1-49bd-b78b-cc0c501a2da0/1/AOSSM_Abstract_Images.docx UPLOAD- https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/b0f0bf53-a166-4cec-bf73-176ea452b905/1/AOSSM_Abstract_CHART.docx
Paper 36: Change in Humeral Anchor Position Significantly Affects Isometry in UCL Repair: A 3-Dimensional Computer Modeling Study
Authors: Fury Matthew , Liu Tianyu , Oh Luke , O’Donnell Evan
Published: July 2022

Objectives:

Medial ulnar collateral ligament (UCL) repair utilization is increasing in recent years, bolstered by shorter rehabilitation and satisfactory clinical outcomes. While previous literature has illustrated the importance of tunnel position on restoring graft isometry in UCL reconstruction, there remains a paucity of literature guiding anchor placement in UCL repair. Herein, we describe a 3-dimensional (3D) elbow model to measure and optimize anchor location during UCL repair.

Methods:

A 3D computer model of a human elbow joint was created using CT and MRI images from a single patient. The humeral and ulnar attachments of the UCL were plotted using three distinct methodologies: 1) geometric cloud mapping; 2) quantitative measurements as described by the anatomical studies by Camp et al1; and 3) Frangiamore et al2. A 3.5mm-diameter clockface was placed on each attachment site which allowed for simulation of 12 distinct, 1.75mm deviations in anchor position. The three elbow models were then ranged through 0-120 degrees of flexion at 10-degree increments, and the 3D distances were measured between the two ligament centroids. The humeral and ulnar anchors were sequentially repositioned around the clockfaces, and ligament lengths were again measured to evaluate changes in isometry. An independent t-test was performed to determine if there was a significant difference in isometry between the humeral or ulnar anchor deviations.

Results:

Using method 1, the UCL length at 90 degrees of elbow flexion was 26.8mm. This ligament underwent 13.6mm of total excursion for a 46.4% change in length throughout arc of motion. Method 2 produced a 19.3mm ligament that underwent 0.8mm of excursion for a 3.9% length change throughout the arc. Method 3 produced a 24.5mm ligament that underwent 2.3mm of excursion for a 9.4% length change throughout arc. Identifying ligament footprints using the quantitative anatomical measurements as described by Camp et al1 and Frangiamore et al2 produced better ligament isometry through 120 degrees of flexion (ligament length changes of 3.9% and 9.4%, respectively) when compared to using the geometric cloud technique (46.4% length change). Humeral anchor deviations produced a statistically significant increase in ligament excursion when compared to ulnar anchor deviations (p < 0.001).

Conclusions:

When performing UCL repair, small deviations in humeral anchor position may significantly influence graft and ligament isometry. Anchor position was most isometric while using the quantitative measurements as described in Camp et al1. Particularly when addressing detachments of the humeral footprint, surgeons should be critical of the humeral anchor position in order to restore native anatomy and optimal biomechanics.
Paper 39: Sex Mismatch Between Donor and Recipient is Associated with Decreased Graft Survivorship at 5-years After Osteochondral Allograft Transplantation
Authors: Farina Evan , Leite Chilan , Ackermann Jakob , Gortz Simon , Lattermann Christian , Gomoll Andreas , Merkely Gergo
Published: July 2022

Objectives:

Sex mismatch between donor and recipient has been considered a potential contributor to adverse outcomes following solid organ transplantation. However, the influence of sex mismatching in osteochondral allograft (OCA) transplantation is yet to be determined. Therefore, the objective of this study was to evaluate whether donor-recipient sex mismatching impacts graft survival after OCA transplantation.

Methods:

In this review of prospectively collected data, patients who underwent OCA transplantation between November 2013 and November 2017 by a single surgeon were analyzed. Cumulative survival was performed through the Kaplan–Meier method using log-rank tests to compare patients with similar donor groups. Multivariable Cox regression analysis adjusted for patient age, graft size and body mass index (BMI) were used to evaluate the influence of donor–recipient sex on graft survival.

Results:

A total of 154 patients were included, 102 (66.2%) who received OCAs from a same sex donor, and 52 (33.8%) from a different sex donor. At 5 years follow-up, a significantly lower graft survival rate was observed for different sex donor transplantation in comparison to same sex donor (63% versus 92%, p = 0.01). (Figure 1.) When correcting for age, graft size and BMI, donor-recipient sex mismatching demonstrated a 2.9 times greater likelihood to fail at 5 years compared to donor-recipient same sex (p = 0.03). A subgroup analysis showed no significant difference in graft survival between female-to-female and female-to-male groups (91% and 84%, respectively). (Figure 2.) Conversely, male-to-male demonstrated a significant higher cumulative 5-year survival (94%, p = 0.04), whereas a lower survival was found in the male-to-female group (64%, p = 0.04). Multivariable Cox regression indicated a 2.6 times higher likelihood of failure for male-to-female in comparison with other groups (p = 0.04). Male-to-male had a tendency toward decreased likelihood of OCA failure (0.33 hazard ratio), although without statistical significance.

Conclusions:

Mismatch between donor and recipient sex has a negative effect on OCA survival following transplantation, particularly in those cases when male donor tissue was transplanted into a female recipient.
Paper 51: Multiple Prior Dislocations Lead to Poorer Outcomes of Isolated Medial Patellofemoral Ligament Reconstruction: A Retrospective Chart Review
Authors: Ryskamp David , Gonzalez Roberto , Cavendish Parker , Milliron Eric , Dibartola Alex , Duerr Robert , Kaeding Christopher , Flanigan David , Magnussen Robert , Meeks Brett
Published: July 2022

Objectives:

Patellar dislocation is a common knee injury and up to 35% who dislocate can develop recurrent patellar instability. In the setting of recurrent instability, medial patellofemoral ligament reconstruction (MPFLR) often restores knee stability. There has been recent interest in the evaluation of patient and surgical factors that may influence the outcomes of isolated MPFLR. Much of the previous work has focused on influences of anatomical measures; however, patient and injury characteristics may also impact surgical outcomes. We hypothesize that patients who suffer > 2 patellar dislocations prior to MPFLR will demonstrate poorer patient-reported outcomes (PROs) than those who experience ≤ 2 prior dislocations.

Methods:

Records were reviewed to identify patients who underwent MPFLR at a single academic institution in the United States between 2008 and 2016. Patients were excluded if they underwent concomitant tibial tubercle osteotomy or fixation of an osteochondral fracture. Patient demographics (age, sex, BMI), number of prior patellar dislocations, and patient anatomical measures (Caton-Deschamps index, tibial tubercle-trochlear groove distance, and trochlear sulcus angle) were collected. PROs were assessed with Norwich Patellar Instability (NPI) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity score. Outcomes of those with > 2 or ≤ 2 patellar dislocations were compared using linear regression analysis.

Results:

A total of 160 patients were identified who underwent isolated MPFLR. Ninety-five patients (60%) were available to complete PROs at a mean follow-up of 4.8 years post-operation. Patients with < 2 dislocations were younger (≤ 2 dislocations: 20.7 ± 9.4yrs, > 2 dislocations: 27.4 ± 9.4yrs; p < 0.001), though there were no other differences between groups in terms of demographics or radiographic anatomical measures (Table 1). Controlling for age, sex, BMI, and anatomical factors linear regression analysis found that patients with > 2 dislocations had lower KOOS pain (p = 0.003), ADLs (p = 0.025), Sports/rec (p = 0.009), and knee related QOL (p = 0.008) subscales (Table 2).

Conclusions:

Patients who suffer > 2 patellar dislocations prior to MPFLR demonstrate poorer PROs at 4.8 years post-operation than those who suffer < 2 dislocations prior to surgery. To our knowledge, no other study has investigated the relationship between the number of pior patellar dislocations and outcomes following MPFLR. Our findings emphasize the role patient and injury factors may play in determining outcomes following MPFLR. [Table: see text][Table: see text]
Paper 54: MPFL Repair has a Higher Failure Rate at Long-term Follow-up compared to MPFL Reconstruction for Recurrent Patellar Instability
Authors: Wilbur Ryan , Song Bryant , Wasserburger Jory , Camp Christopher , Krych Aaron , Stuart Michael , Kruckeberg Bradley
Published: July 2022

Objectives:

The medial patellofemoral ligament (MPFL) is the primary soft tissue restraint to lateral patellar translation and is often disrupted with a lateral patellar dislocation. Surgical management for recurrent patellar instability focuses on restoring MPFL function with repair or reconstruction techniques. Recent studies have favored reconstruction over repair, but no long-term, comparative studies are available in the literature.

Methods:

A total of 55 patients (58 knees) with recurrent lateral instability were treated between 2005 and 2012 with either MPFL repair or MPFL reconstruction. Exclusion criteria included prior or concomitant tibial tubercle osteotomy or trochleoplasty, and follow-up less than 8 years. Pre- and post-operative demographic, surgical, imaging and clinical data were recorded for each patient.

Results:

MPFL repair was performed on 26 patients (29 knees; 14 females, 15 males) at a mean age of 19.1 years. MPFL reconstruction was performed on 29 patients (29 knees; 18 females, 11 males) at a mean age of 18.2 years. Mean follow-up was 12.0 years (range 8.3-18.9). The reconstruction group had a significantly lower rate of recurrent dislocation compared to the repair group (14% vs 41%, p=0.019) at final follow up. There were no differences in the number of pre-operative dislocations (greater than or less than 3), degree of patellar facet chondromalacia, TT-TG distance, or Tegner scores. The reconstruction group had significantly more time from injury to surgery compared to the repair group (median, 1,460 days vs 627 days, p =0.007). There were no differences in post-operative Tegner, Lysholm or Kujala scores at final follow-up. Additionally, there were no differences in return to play rates (repair 80.8% vs reconstruction 75.0%, p=0.610) or reoperation rates (repair 20.7% vs reconstruction 13.8%, p=0.487).

Conclusions:

Repair of the MPFL leads to nearly 3-fold higher rate of recurrent patellar dislocation (41% vs. 14%) at long term follow-up compared to MPFL reconstruction. However, MPFL repair and reconstruction provide similar clinical results, return to play rates and reoperation rates. [Table: see text][Table: see text]
Paper 57: Labral Tear Management in Patients Aged 40 Years and Older Undergoing Primary Hip Arthroscopy: A Propensity-Matched Case-Control Study Comparing Labral Reconstruction to Labral Repair with Minimum Two-Year Follow-Up. *ACCEPTED TO AJSM*
Authors: Maldonado David , Ouyang Vivian , Owens Jade , Jimenez Andrew , Saks Benjamin , Sabetian Payam , Lall Ajay , Domb Benjamin
Published: July 2022

Objectives:

To report minimum two-year patient-reported outcome (PRO) scores, survivorship, and secondary surgeries, in patients aged ≥ 40 years who underwent primary hip arthroscopy with labral reconstruction compared to a propensity-matched primary labral repair group.

Methods:

Data were prospectively collected and retrospectively reviewed for patients who underwent a primary hip arthroscopy for femoroacetabular impingement syndrome from January 2014 to June 2018. Patients aged ≥ 40 years who underwent a labral reconstruction or a labral repair and had preoperative and minimum two-year PROs for the modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale (VAS) for pain were included. Patients with prior ipsilateral hip conditions and surgery, Tonnis grade > 1, hip dysplasia, or worker’s compensation status were excluded. Patients in the reconstruction group were propensity-matched 1:2 to patients in the repair group based on age, sex, and body mass index. Secondary surgeries and the achievement of the minimal clinically importance difference (MCID), patient acceptable symptomatic state (PASS), and maximum outcome improvement (MOI) were recorded.

Results:

Fifty-three and 106 hips were included in the labral reconstruction and repair groups, respectively. The average follow-up time was 37.6 months. The average age for the reconstruction and repair groups were 48.01 ± 5.4 years and 48.61 ± 6.0 years, respectively. Both groups achieved significant improvements in all PROs at minimum two-years with similar achievements of MCID, PASS, and MOI. Both groups showed comparable secondary surgeries rates.

Conclusions:

Patients aged 40 years and older who received primary labral repair and primary labral reconstruction, achieved similar significant improvements in all PROs, VAS pain, and patient satisfaction at minimum two-year follow-up, with comparable rates of secondary surgeries and achieving MCID, PASS, and MOI. Based on these findings, labral repair remains the gold standard treatment for viable labrum in this population group, while reconstruction is a useful alternative for irreparable labrum.
Paper 68: Cannabidiol is Effective in Improving Immediate Post-operative Pain and Patient Satisfaction Following Arthroscopic Rotator Cuff Repair: A Placebo-Controlled, Randomized, Double-Blinded Study
Authors: Hurley Eoghan , Markus Danielle , Britton Briana , Vasavada Kinjal , Rokito Andrew , Jazrawi Laith , Gonzalez-Lomas Guillem , Kaplan Kevin , Alaia Michael
Published: July 2022

Objectives:

The purpose of this study is to evaluate the potential analgesic effects of buccal-absorbed cannabidiol (CBD) in patients that have undergone arthroscopic rotator cuff repair (ARCR).

Methods:

This is an FDA sanctioned, multi-center, placebo-controlled, randomized, double-blinded trial conducted in patients undergoing ARCR. Patients from 18 to 75 years of age undergoing an ARCR were prospectively enrolled. Patients were equally randomized to the control and experimental groups. The experimental group post-operatively received 25mg of CBD (Oravexx, Orcosa Pharmaceuticals, USA) TID if < 80kg and 50mg of CBD TID if > 80kg for 14 days, with control groups receiving an identical placebo. Patients were followed-up on Day 1, 2, 7, and 14, and Visual Analog Scale (VAS) for pain, opioid consumption, and satisfaction with pain control were recorded. Additionally, liver function tests (LFT) were done on Days 7 and 14 to assess safety, and nausea was monitored. A priori power analysis was performed based on the VAS score as primary endpoint, which revealed that a minimum of 39 patients would be required in each group to detect a clinically important difference in the VAS score (1.4) with a power of 0.8. A value of p < 0.05 was considered to be statistically significant.

Results:

Overall, 80 patients were recruited. There were no significant differences in age, sex, or BMI between the two groups. On Day 1, VAS pain score was significantly lower in those receiving CBD (4.1 ± 3.0 vs 6.0 ± 3.1, p = 0.01), which also meets VAS MCID for shoulder arthroscopy (1.2-1.4). Patient satisfaction with pain control trended towards significance favoring the CBD group (72% vs 60%, p = 0.072). However, there were no statistically significant differences in opioid consumption (16.4mme ± 12.7 vs 20.6mme ± 14.4, p = 0.186), which was relatively small in both groups. Notably, patients receiving 50 mg of CBD reported lower VAS scores at day 1 (3.9 ± 3.3 vs 4.6 ±2.5 ± 6.0 ± 3.1, p = 0.0394) and higher satisfaction with pain control at day 1 and 2 (8.1 ± 2.3, 5.8 ± 3.3, 5.9 vs 3.6, p = 0.0175 | 7.8 ± 1.8 vs 6.3 ± 3.0 6.0 ± 3.2, p = 0.05) compared to those receiving 25 mg of CBD and control group respectively. On Day 7 and Day 14, there were no statistically significant differences in VAS score, opioid consumption, or patient satisfaction with pain control (p>0.05 for all). There were no significant differences in nausea or LFTs post-operatively (p > 0.05).

Conclusions:

CBD is safe and effective in reducing pain in the immediate peri-operative period following ARCR and should be considered in post-operative multimodal pain control. [Table: see text]
Paper 78: Integrating PROM Collection for Shoulder Surgical Patients through the Electronic Medical Record: A Low Cost and Effective Strategy for High Fidelity PROM Collection
Authors: Fife Johnathan , McGee Anna , Swantek Alexander , Makhni Eric
Published: July 2022

Objectives:

Patient Reported Outcome Measures (PROMs) are critical measures of quality of care and treatment outcomes; however, they are challenging to collect without significant financial and administrative investment. The purpose of this study was to evaluate the efficacy and cost of an automated PROM collection through the electronic medical record for shoulder surgery patients in a large, integrated healthcare system.

Methods:

An existing, electronic medical record (EMR) based, automated, PROM scheduling system was integrated into the surgical check-in workflow for all elective primary total hip, total knee, and partial knee arthroplasty patients from November 2020 through August 2021 at 3 high volume surgical sites in a large, integrated health system. Rates of completion for Patient Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE), Patient Reported Outcomes Measurement Information System Pain Interference (PROMIS-PI) and American Shoulder and Elbow Surgeons Shoulder (ASES) surveys were determined. No additional staff were hired to assist in PROM collection. In our institution, if the patient had an ambulatory appointment within 25 days prior to surgery, their PROM scores were marked complete and were not reassigned on the day of surgery (DOS). For all other patients, PROMs were assigned by the automated system on DOS.

Results:

A total of 325 patients with a mean age of 42 + 28 years were included in this study. The vast majority, 94% (306), were assigned surveys on their day of surgery as a result of the automated system. The other 6% (19) had PROM scores completed in the ambulatory setting as they had a pre-operative visit less than 25 days prior to surgery. For patients completing PROMS on their day of surgery, 87% (266/306) completed at least 1 of PROMIS-UE or ASES, while 82% (251/306) completed both. In total 88% (285/325) of patients completed at least 1 PROM on or within 25 days prior to surgery and 85% (277/325) completed both. This entire system cost $5180 to deploy.

Conclusions:

A native PROM scheduling and collection system was successfully implemented with a survey completion rate of 82% to 95% of patients. This system serves as an efficient, low-cost model for other surgical departments to leverage existing systems to collect day of surgery PROMs.
Paper 86: Symptoms of post-traumatic osteoarthritis remain stable up to 10 years after ACL reconstruction
Authors: Spindler Kurt , Jin Yuxuan , Jones Morgan
Published: July 2022

Objectives:

ACL reconstruction (ACLR) can restore knee stability and return athletes to the field of play, but these athletes are still at risk of knee pain from post-traumatic osteoarthritis. The purpose of this study was to determine the incidence of clinically significant knee pain at 2, 6 and 10 years after ACLR in patients who had surgery using modern surgical techniques and rehabilitation protocols including early motion.

Methods:

The Multicenter Orthopaedic Outcomes Network (MOON) enrolled 3273 patients at 7 centers between 2002 and 2008. Patients completed a baseline questionnaire including demographics, injury characteristics, sports participation, and validated outcome instruments including KOOS, IKDC, and Marx Activity. Surgeons completed a questionnaire documenting physical examination, arthroscopic findings, and details of the procedure. Patients repeated the questionnaire at 2, 6 and 10 years. Patients were categorized into symptomatic versus asymptomatic at each timepoint by multiple criteria: KOOS pain <=70, KOOS pain <= 80, or answering “moderate, severe, or extreme” to any KOOS pain question (a common entry criteria for OA clinical trials). We hypothesized that incidence of knee pain would increase with increasing time since surgery. We applied McNemar’s test with a significance level of p<.05.

Results:

The median age of the cohort was 23 years (IQR 17-27) and 44 percent were female. 2798 completed the questionnaire at 2 years (85%), 2759 at 6 years (84%), and 2526 at 10 years (77%). For the 70-point cutoff, the incidence of clinically significant knee pain was 9.3% at 2 years, 8.9% at 6 years, and 9.1% at 10 years. For the 80-point cutoff, the incidence was 16.6% at 2 years, 16.3% at 6 years, and 15.7% at 10 years. For the “moderate, severe or extreme” criteria, the incidence was 26.3% at 2 years, 22.9% at 6 years, and 22.6% at 10 years. There were no statistically significant differences between the three timepoints for any of the criteria.

Conclusions:

A substantial proportion of patients develop clinically significant knee pain as early as 2 years after ACLR (as high as 26.3% by one criteria); however, this proportion remains constant at 6 and 10 years after surgery. We expected an increased proportion of patients with symptoms of PTOA by 10 years post-op; however, these findings suggest that the development of knee pain occurs early after ACLR, and that treatments should be focused on improving recovery and minimizing knee pain early to prevent symptoms of PTOA in the first 10 years after surgery.
Paper 88: The Natural History of Anterior Shoulder Instability in Patients Over the Age of 50: A Population Based Study
Authors: Wilbur Ryan , Song Bryant , Reinholz Anna , Till Sara , Okoroha Kelechi , Krych Aaron , Camp Christopher , Smartt Anne
Published: July 2022

Objectives:

Anterior shoulder instability (ASI) is a well-studied topic in young patients, however there is a dearth of knowledge about older patients with this pathology. The goals of this study were to describe patient demographics, injury characteristics and outcomes in patients >50 years old with anterior shoulder instability along with historical trends in diagnosis and treatment.

Methods:

An established geographic database was used to identify 179 patients who experienced new onset anterior shoulder instability after the age 50 between 1994-2016. Mean age was 59.7 years, mean BMI was 31.3 and 54.2% were female. The dominant arm was involved in 62.2% of instability events. 26.8% of our study population were laborers and 50% reported current or former smoking habits. The primary etiology for ASI involved trauma in 96.6% of cases. Comparative analysis was performed to identify differences between age groups. Mean follow up time was 11 years.

Results:

The overall incidence of ASI in our study population was 28.8/100,000 person years with the highest incidence in the age cohort 60-64 at 38.9/100,000 person years. At initial presentation, 73% of all patients were found to have a lesion apparent on either XR or MRI. Rotator cuff tears were found in 92.4% of all patients undergoing MRIs. 26.2% ultimately progressed to surgery at a mean time of 1.57 years after injury. 53% of all surgical procedures involved a rotator cuff repair whereas only 25% were performed for instability. In terms of historical trends, the one-year rate of obtaining an MRI after an ASI event has increased from 10% in the late 1990s to 46% in 2015-16. Similarly, the one-year rate of performing surgery has increased from 5.1% to 47% from 1994-1999 to 2015-2016.

Conclusions:

In our cohort, patients over the age of 50 with ASI were found to often have concomitant pathology on imaging, however only ¼ of all patients required surgery. Although the rate of ASI has stayed relatively stable over the last 20 years, the rate of obtaining an MRI and of surgical management has increased. [Figure: see text]
Poster 121: Inter- and Intra-Observer Agreement are Unsatisfactory when Determining Study Design and Level of Evidence
Authors: Schmitz Matthew , McKay Scott , Patel Neeraj
Published: July 2022

Objectives:

Understanding differences between types of study design (SD) and level of evidence (LOE) are important when selecting research for presentation or publication and determining its potential clinical impact. The purpose of this study was to evaluate inter- and intra-observer reliability when assigning LOE and SD as well as quantify the impact of a commonly used reference aid on these assessments.

Methods:

Thirty-six accepted abstracts from the Pediatric Orthopaedic Society of North America (POSNA) 2021 annual meeting were selected for this study. Thirteen reviewers from the POSNA Evidence Based Practice Committee were asked to determine LOE and SD for each abstract, first without any assistance or resources. Four weeks later, abstracts were reviewed again with the guidance of the Journal of Bone and Joint Surgery (JBJS) LOE chart, which is adapted from the Oxford Centre for Evidence-Based Medicine. Inter- and intra-observer reliability were calculated using Fleiss’ kappa statistic (k). Chi-square analysis was used to compare the rate of SD-LOE mismatch between the first and second round of reviews.

Results:

Inter-observer reliability for LOE improved slightly from fair (k=0.28) to moderate (k=0.43) with use of the JBJS chart. There was better agreement with increasing LOE, with the most frequent disagreement between levels 3 and 4. Inter-observer reliability for SD was fair for both rounds 1 (k=0.29) and 2 (k=0.37). Similar to LOE, there was better agreement with stronger study design. The most common disagreements were between retrospective cohort, retrospective case-control, and case series. Intra-observer reliability was widely variable for both LOE and SD (k=0.10 to 0.92 for both). When matching a selected SD to its associated LOE, the overall rate of correct concordance was 82% in round 1 and 92% in round 2 (p<0.001). Six of the 13 respondents improved in round 2, and 3 were 100% correct both times.

Conclusions:

Inter-observer reliability for LOE and SD was fair to moderate at best, even among experienced reviewers. Use of the JBJS/Oxford chart mildly improved agreement on LOE and resulted in less SD-LOE mismatch, but did not affect agreement on SD. Professional societies and journals may consider requiring more specific information on SD from authors, while authors and reviewers may benefit from improved instruments to guide SD and LOE designation.
Poster 127: Vitamin D levels and Musculoskeletal Injuries in Collegiate Athletes
Authors: Frank Alexandra , Stiffler-Joachim Mikel , Sanfilippo Jennifer , Call Cory , Dooley Matthew , Hetzel Scott , Brooks Margaret , Spiker Andrea
Published: July 2022

Objectives:

Vitamin D (Vit D) deficiency has been identified as a global epidemic, sparking numerous studies into its more detailed effects on the body. In orthopedics, Vit D deficiency has been found to correlate with an increase in a variety of musculoskeletal injuries. Although current evidence suggests a connection between the number of musculoskeletal injuries sustained and an athlete’s vitamin D level, this correlation has not yet been thoroughly investigated in the collegiate athlete population. We hypothesized that lower levels of serum vitamin D would be associated with an increased number of musculoskeletal injuries and increased recovery time.

Methods:

A retrospective study was performed on 285 student athletes at the authors’ institution, a Division I university (Table 1). Serum 25-hydroxyvitamin D (25(OH)D) levels obtained on each athlete via chart review in conjunction with the athletic department and categorized into normal (≥32 ng/mL), insufficient (20 to 31 ng/mL) and deficient (≤19 ng/mL). Additional data collected included demographics, athletic performance, injury history and bone density.

Results:

139/285 (48.8%) of athletes were Vit D insufficient, with an additional 50/285 (17.5%) being deficient (Table 2). For football players specifically (our largest cohort of athletes), 71/91 (78%) had a Vit D level below normal, with the average value falling at 24.5 ng/mL. For injury susceptibility, there was a 7% increase in injuries for those with a below normal Vit D. (40% vs 33%). For recovery length, athletes with a below normal Vit D took twice as long to recover (23.7 days vs 10.2 days).

Conclusions:

A large percentage collegiate athletes have insufficient or deficient levels of Vit D. Our results also suggest that a lower Vit. D level correlates to an increase in the number of musculoskeletal injuries sustained and an increase in recovery length. [Table: see text][Table: see text]
Poster 165: Psychosocial Factors Play a Greater Role in Preoperative Symptoms for Patients with Atraumatic Shoulder Instability: Data from the Moon-Shoulder Instability Group
Authors: Jacobs Cale , Lemaster Nicole , Ortiz Shannon , Magnuson Justin , Hettrich Carolyn , Nichols Michael
Published: July 2022

Objectives:

Previous studies have demonstrated altered brain activation patterns on functional MRI for those with shoulder instability suggesting a potential link between recurrent instability, depression, and emotional wellbeing. It is unknown whether this potential link would differ between those with traumatic vs. atraumatic instability. The purpose of this study was to determine whether psychosocial factors and/or comorbid depression play a greater role in preoperative symptoms for patients with atraumatic or traumatic mechanisms of shoulder instability. We hypothesized that when controlling age, sex, and direction of instability, psychosocial factors and comorbid depression would be more predictive of shoulder-related pain and symptoms for patients with atraumatic instability than patients with traumatic instability.

Methods:

As part of the IRB-approved Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, 1553 patients provided informed consent and completed pre- and intraoperative data collection. Patients were categorized based on self-reports of whether the mechanism of shoulder instability was traumatic (n=1267) or atraumatic (n=286). Multivariable linear regressions were performed to determine whether psychological factors (VR12, Mental Component Score (MCS), Depression Diagnosis, PAS-22) were predictive of preop ASES and WOSI score in the atraumatic group, controlling for age, sex, and the direction of instability. The same model was repeated for the traumatic instability group, and the model fit was compared between groups using the methods described by Cohen, Cohen, and West with p < 0.05 considered statistically significant.

Results:

Sex and Mental Component Scores (MCS) were significantly predictive of preop ASES and WOSI scores for the group with atraumatic instability (ASES r2=0.15, p<0.001; WOSI r2=0.17 p<0.001). The same model performed significantly worse for both ASES and WOSI scores in the group with traumatic instability (ASES r2=0.06, WOSI r2=0.07, p<0.05 for both ASES and WOSI).

Conclusions:

Preoperative psychosocial factors were found to be more predictive of shoulder-related pain and symptoms for patients with atraumatic instability. Across multiple orthopedic conditions, depression and emotional wellbeing have been associated with worse preoperative symptoms and inferior postoperative patient-reported outcomes. As opposed to medically optimizing patients prior to surgery, the current findings identify a subset of shoulder instability patients that may need to be psychologically optimized either prior to surgery or early in the postoperative period to potentially improve postoperative outcomes.
Poster 170: Preoperative Advanced Imaging Predicts Coracoid Graft Size and Restoration of the Glenoid Track in Patients Undergoing Latarjet Procedures
Authors: Godshaw Brian , Hughes Jonathan , Lin Albert , Lesniak Bryson , Boden Stephanie
Published: July 2022

Objectives:

The Latarjet procedure is commonly used in management of anterior shoulder instability with bipolar bone deficiency. Persistent off-track Hill-Sachs (HS) lesions after Latarjet procedure is associated with significantly higher rates of failure and recurrent instability. Preoperative prediction of which lesions will remain off-track is crucial for improving outcomes and decreasing failure rates. The purpose of this study was to determine if preoperative advanced imaging can predict coracoid graft size and conversion of off-track to on-track Hill-Sachs lesions in patients undergoing Latarjet procedures.

Methods:

Patients who underwent Latarjet procedure for shoulder instability at a single institution from 2012-2020 were evaluated. Inclusion criteria consisted of pre- and post-operative advanced imaging - computerized topography or magnetic resonance imaging. Glenoid diameter, HS interval (HSI), and coracoid length, depth, and height were measured on preoperative imaging. Glenoid track (GT), percent glenoid bone loss, predicted restoration of glenoid track, and the difference between HSI and GT (DHSI-GT) were calculated. These values were then compared with postoperative measurements of the glenoid diameter and coracoid graft width and height.

Results:

Seventeen patients with a mean age of 24.6 ± 8.6 years met inclusion criteria. The average glenoid bone loss preoperatively was 23.6 ± 7.3% and the average HSI was 27.2 ± 4.9mm. The Latarjet procedure was able to reconstruct 115.8 ± 7.6% of the native glenoid, and 103.8 ± 7.9% of the predicted diameter. Of the 15 patients that had off-track lesions preoperatively, 11 were successfully converted to on-track lesions (73.3%). The 4 lesions that remained off-track postoperatively had a significantly higher HSI (32.4 ± 2.4 mm vs. 25.6 ± 4.3 mm, p=0.002 ) and 3 of these had insufficient coracoid graft to convert to an on-track lesion based on the preoperative DHSI-GT values in comparison to coracoid graft size. Preoperative measurements accurately predicted postoperative glenoid track status 94.1% of cases.

Conclusions:

The Latarjet procedure was able to reconstruct 115.8 ± 7.6% of the native glenoid and converted 73.3% of off-track lesions to on-track lesions. The glenoid was reconstructed to 103.8 ± 7.9% of the predicted diameter. Preoperative advanced imaging measurements accurately predicted graft size, restoration of the glenoid track, and ability to convert off-track to on-track lesions.
Poster 178: Blood Flow Restriction Therapy Before and After Arthroscopic Rotator Cuff Repair
Authors: Castle Joshua , Jildeh Toufic , McGee Anna , Abbas Muhammad , Buckley Patrick , Okoroha Kelechi , Kolowich Patricia , Moutzouros Vasilios , Tramer Joseph
Published: July 2022

Objectives:

To evaluate the effect of blood flow restriction (BFR) therapy conducted before and after rotator cuff repair (RCR) on rotator cuff strength and patient reported outcomes.

Methods:

A total of 30 patients (22 male, 8 female; age 58.2 ± 9.0 years) presenting for surgical treatment of a rotator cuff tear were randomized into two groups, BFR (N=15) and Control (N=15). Rotator cuff strength was measured utilizing a handheld dynamometer in order to calculate peak force, average force and time to peak force. Strength measurements included supraspinatus, infraspinatus and subscapularis testing in multiple positions. Prior to surgery, patients completed a rotator cuff strengthening program, with and without the use of BFR. All patients underwent arthroscopic RCR and a standardized period of post-operative immobilization. Following surgery, patients underwent physical therapy utilizing standard post-RCR therapy protocols, with exercises performed with and without the use of BFR in each respective group. The BFR group was instructed to perform these exercises with a pneumatic cuff set to 80% of limb occlusion pressure placed over the proximal arm, under the direction of a physical therapist. Patient Reported Outcome Measurement System Upper Extremity (PROMIS-UE), American Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion were collected on the day of surgery as well as 2 weeks, 6 weeks and 3 months after surgery. Rotator cuff strength measurements were completed the day of surgery and repeated three months following RCR.

Results:

No significant differences were noted between the BFR and control groups in peak rotator cuff muscle force generation, time to peak force or average force at any timepoints (P>0.05). At six weeks post-surgery, the BFR group had significantly higher PROMIS-UE scores (30.3 ± 4.7 versus 26.3 ± 6.3, p=0.03, Figure 1) and active range of motion in abduction (82.4º ± 24.7 versus 65.1º ± 18.8, p=0.03) compared to the control group. These differences were not apparent at 3 month follow up.

Conclusions:

Blood flow restriction therapy following RCR results in improved patient reported outcomes scores and range of motion at six week follow up. At three months post-surgery, there was no noted improvement in rotator cuff strength when utilizing BFR compared to standard physical therapy.
Poster 180: Diagnostic Algorithm and Outcomes of Treatment for Neurogenic Pectoralis Minor Syndrome
Authors: McCarty Leroy
Published: July 2022

Objectives:

Neurogenic pectoralis minor syndrome can generate chronic anterior shoulder pain and a variety of non – specific neurologic symptoms in an affected upper extremity. This study presents a diagnostic algorithm used to identify neurogenic pectoralis minor syndrome and reports short-term outcomes for a series of patients who underwent either open or arthroscopic, coracoid – based, pectoralis minor tenotomy to treat the condition.

Methods:

Following IRB approval, the senior investigator’s operative records were queried for pectoralis minor release performed between January 2012 and July 2021. Demographic, surgical, and outcomes data was extracted from each subject’s medical record. Only subjects with a minimum of 30-day follow-up were considered in data analysis. Generalized descriptive statistical analysis, along with ANOVAs and post-hoc t-tests were performed to compare outcomes of pectoralis minor release.

Results:

Twenty-one subjects were identified meeting enrollment criteria. Mean age at time of diagnosis was 44.3years (range 17-70 years). Subjects had undergone prior shoulder surgery in 16/21 (76.2%) of cases and 18 (85.7%) were Worker’s Compensation related injuries. All patients had undergone a minimum of 3 months of a structured physical therapy program preoperatively. All patients underwent a diagnostic, ultrasound – guided pectoralis minor block with temporary resolution of self – reported symptoms. Symptoms prior to treatment included anterior shoulder pain and neurologic symptoms in 20/21 (95.2%) cases, with a mean duration of 15.7 months (range 3-40 months). Pretreatment ASES score was mean 41.5 (range 13.3-73.3) with mean pain of 4.9/10 (range 1-9/10). At mean 6.8 months post-release, patients reported mean 9.5 point increase in ASES score versus index score (p<0.05) and 85.0% (17/20 with pre-operative neurologic symptoms) reported complete resolution or improvement of neurologic symptoms related to neurogenic pectoralis minor syndrome.

Conclusions:

Findings of insertional pectoralis minor tenderness to palpation with or without reproduction of neurologic symptoms, a positive diagnostic, ultrasound – guided pectoralis minor block and anterior shoulder pain can be useful findings to establish the difficult diagnosis of neurogenic pectoralis minor syndrome. In select patients either open or arthroscopic release of the pectoralis minor insertion on the medial aspect of the coracoid process can alleviate symptoms.