bluuebunny/crossref_metadata_2025 huggingface dataset:
Paper 63: Remodeling of Adolescent Displaced Clavicle Fractures: A FACTS Study
Authors: Bae Donald , Boutelle Kelly , Busch Michael , Carroll Alyssa , Edmonds Eric , Ellis Henry , Hergott Katelyn , Kocher Mininder , Li G. Ying , Nepple Jeffrey , Pandya Nirav , Perkins Crystal , Polinsky Samuel , Sabatini Coleen , Spence David , Willimon Samuel , Wilson Philip , Heyworth Benton , Pennock Andrew
Published: July 2022

Objectives:

The phenomenon of bony remodeling of healed displaced clavicle midshaft fractures in adolescents remains poorly understood. The purpose of the current study was to evaluate and quantify clavicle remodeling in a large population of adolescents with completely displaced fractures treated non-operatively to understand the factors that may influence this process.

Methods:

Patients were identified from the database(s) of a multi-center study group investigating the functional outcomes of adolescent clavicle fractures. Patients between the ages of 10 and 19 years with completely displaced mid-diaphyseal clavicle fractures that were treated non-operatively who had further imaging of the affected clavicle at a minimum of 9 months from initial injury were included. Radiographic measurements were performed on the injury and final follow-up films. Fracture remodeling was subjectively classified as ‘complete/near-complete’, ‘moderate’, or ‘minimal’ (Figure 1) and subsequently analyzed quantitively and qualitatively to determine factors associated with deformity correction.

Results:

Ninety-eight patients (mean age of 14.4±2.2 years) were analyzed at a mean radiographic follow-up of 3.4± 2.3 years. Fracture shortening, superior displacement, and angulation significantly improved during the follow-up period by 59%, 61%, and 30% respectively (p<0.001). Fracture remodeling was found to be associated with follow-up time; those with longer follow-up time demonstrate more remodeling (p<0.001). Ninety-two percent of patients <14 years and 79% of patients ³14 years-old at time of injury with a minimum follow-up of four years underwent complete/near-complete remodeling.

Conclusions:

Significant clavicle remodeling occurs in adolescent patients with displaced fractures, including older adolescents and particularly when followed for longer time intervals. This finding may help explain why symptomatic malunions are so infrequently observed in adolescent patients, even in severely displaced fractures.
Paper 79: Increasing Shoulder Osteoarthritis Severity (SOAS) Score Predicts Lower PROMIS-UE Score Following Rotator Cuff Repair
Authors: Davies Michael , Kucirek Natalie , Motamedi Daria , Ma C. Benjamin , Feeley Brian , Lansdown Drew
Published: July 2022

Objectives:

Mild to moderate glenohumeral osteoarthritis (GHOA) is a common finding among patients who are evaluated for rotator cuff (RC) tears. However, the impact of pre-operative shoulder joint degeneration on patient-reported outcomes (PROs) following RC repair (RCR) is not well-established. Certain studies have reported a negative association between radiographic findings of glenohumeral osteoarthritis (GHOA) and RCR PROs, while other studies have found no substantial association. The purpose of this study was to apply the MRI-based Shoulder Osteoarthritis Severity (SOAS) score to the evaluation of patients undergoing RCR and determine the relationship between pre-operative shoulder pathology present on MRI with post-operative PROMIS-UE scores. We hypothesized that patients with higher pre-operative SOAS scores, indicating greater shoulder pathology, would have lower post-operative PROMIS-UE scores following RCR.

Methods:

Seventy-one MRIs corresponding to 71 patients were analyzed by two independent reviewers and scored using the SOAS criteria. Intraclass correlation coefficients were calculated for total SOAS score as well as for each sub-score. Spearman’s correlations were calculated between averaged SOAS scores, patient demographics, and PROMIS-UE scores. Linear regression analysis was performed between the independent variables of patient age, sex, BMI, and significant SOAS score components determined by univariate analysis with the dependent variable of PROMIS-UE score. Significance was defined as p<0.05.

Results:

The mean PROMIS-UE score of this cohort was 51.5 ± 7.5 (Table 1), while the average total SOAS score was 21.5 ± 8.4 (Table 2). There was a negative correlation between increasing total SOAS score and worsening post-operative PROMIS-UE score (r = -0.24, p = 0.04) (Table 3). Both cartilage wear (r = -0.33, p = 0.0045) and AC joint degeneration (r = -0.24, p = 0.048) individually demonstrated negative correlations with PROMIS-UE score (Table 3). SOAS cartilage score was an independent negative predictor of PROMIS-UE score in a multiple variable linear regression with patient age and sex (β = -1.05, p = 0.038) (Table 4).

Conclusions:

In this cohort of patients undergoing RCR, increasing pre-operative total SOAS score was predictive of lower post-operative PROMIS-UE scores. SOAS sub-scores with the strongest negative correlations with PROMIS-UE scores included cartilage wear and AC joint degeneration. Cartilage subscore was negatively correlated with PROMIS-UE scores independent of patient demographic factors in multivariate analysis. Pre-operative GH cartilage wear and AC joint degeneration may warrant particular attention and counseling in patients undergoing RCR. [Table: see text][Table: see text][Table: see text][Table: see text]
Paper 80: Biomechanical Analysis of Tibial Motion and ACL Graft Forces After ACLR With and Without LET at Varying Tibial Slopes
Authors: Bryniarski Anna , Gruskay Jordan , Brady Alex , Bartolomei Christopher , Vidal Armando , Godin Jonathan , Pearce Stephanie
Published: July 2022

Objectives:

Lateral extra-articular tenodesis (LET) is being performed more frequently with anterior cruciate ligament reconstruction (ACLR) to decrease graft failure rates. Posterior tibial slope (PTS) affects ACL graft failure rates.2 The impact of LET plus ACLR on tibial motion and graft forces with increasing PTS has not been elucidated. We hypothesized LET will decrease anterior tibial translation (ATT), tibial rotation, and ACL graft force versus ACLR alone with increasing tibial slope throughout knee range of motion.

Methods:

Twelve cadaveric knees (40.5 mean age, all female) were tested in four conditions (intact, ACL cut, ACLR, ACLR + LET) with varying PTS (5°, 10°, 15°, 20°) at three flexion angles (0°, 30°, 60°). Specimens were mounted to a load frame which applied a 500-N axial load with 1 Nm of internal rotation (IR) torque (Figure 1). The amount of tibial translation, IR, and graft forces were measured.

Results:

Increasing PTS revealed a linear and statistically significant increase in graft force at all flexion angles. LET reduced graft force by 8.3% (6N) compared to ACLR alone at 30° of flexion. At the same position, slope-correcting osteotomy reduced graft force by 17-22% per 5° of slope correction, with a 46% reduction seen from 20° to 5°slope correction. For ATT, ACLR returned tibial translation to pre-injury levels, as did ACLR + LET at all flexion angles, except full extension where ACLR + LET over-reduced ATT by 2.47mm (p<0.05).

Conclusions:

Increased PTS was confirmed to increase graft forces linearly. Additionally, while the ACLR + LET reduced graft force compared to ACLR alone, slope correcting osteotomies are a more powerful method to minimize graft force. No other clinically significant differences were noted between ACLR with or without LET in regards to graft force, ATT, or IR. Many authors have proposed LET in the setting of ACLR, revision surgery, hyperlaxity, high grade pivot shift and elevated PTS, but the indications remain unclear. The biomechanical performance of LET plus ACLR at varying PTSs may impact daily practice and provide clarity on these indications.
Paper 83: Clinical Outcomes of ACL Reconstruction vs ACL Repair: A Matched-Pair Analysis
Authors: Ferreira Alexandre , Carrozzo Alessandro , Guy Sylvain , Vieira Thais , Barth Johannes , Sonnery-Cottet Bertrand , Saithna Adnan
Published: July 2022

Objectives:

Renewed interest in ACL repair is supported by promising early results from case series. However, comparative studies are currently lacking. The purpose of this study was to compare the clinical and functional outcomes of ACL repair versus ACL reconstruction, at a minimum follow-up of two years.

Methods:

A retrospective analysis of prospectively collected data was undertaken. Patients who underwent ACL repair were propensity matched (based on variables including age, gender, BMI, time between injury and surgery, knee laxity parameters, the presence of meniscal lesions, pre-operative activity level and sports participation) in a 1:1 ratio, to those who underwent ACL reconstruction during the same period. Isokinetic testing was used to evaluate strength deficits compared to the contralateral limb at 6 months post-operatively. At final follow-up, knee laxity parameters, return to sport, and outcome measures including Lysholm, Tegner, IKDC, ACL-RSI, and the Forgotten Joint Score-12 (FJS) were recorded.

Results:

75 matched pairs were evaluated. The ACL repair group had significantly better mean hamstring muscle strength (+1.7% ± 12.8, compared to contralateral limb) when compared to their counterparts who underwent ACL reconstruction (-10.0% ± 12.8, compared to contralateral limb) (p<0.0001) (Table 1). At a mean final follow-up of 30 ± 4.8 months, the ACL repair group had significantly better FJS (82.0 ± 15.1) compared to the reconstruction group (74.2 ± 21.7) (p=0.017). No significant differences were demonstrated between groups with respect to Lysholm, Tegner, and ACL-RSI scores (Table 2). Non-inferiority criteria were met for the ACL repair group, when compared to ACL reconstruction with respect to subjective IKDC scores and knee laxity parameters (side to side antero-posterior laxity difference and pivot shift). There were no significant differences in the rate of return to the pre-injury level of sport (repair group 74.7% vs reconstruction group 60%, p=0.078). However, a significant difference was observed regarding the occurrence of ACL re-rupture (failure rates: ACL repair, 5,3%; ACL reconstruction, 0%; p=0.045). Patients experiencing failure of ACL repair were significantly younger than those that did not (26.8 years vs 40.7 years, p=0.013). There was no significant difference in rupture rates between groups when only patients aged over 22 years were considered (age >22, failure rates: ACL repair 2.8%; ACL reconstruction 0%, p=0.157)

Conclusions:

ACL repair was associated with significantly better isokinetic strength tests at 6 months, better FJS at final follow-up, and non-inferior IKDC, Lysholm, Tegner, ACL-RSI and knee laxity parameters. However, the rate of re-rupture was significantly higher when compared to ACL reconstruction and younger patients were particularly at risk [Table: see text]
Paper 91: Anteroinferior Glenoid Rim Fractures in Shoulder Instability Patients Over 50: A Matched Cohort Analysis of Risk Factors, Treatment Strategies, and Outcomes
Authors: Smartt Anne , Song Bryant , Wilbur Ryan , Reinholz Anna , Till Sara , Okoroha Kelechi , Krych Aaron , Camp Christopher
Published: July 2022

Objectives: Background:

Although they are common, there remains a paucity of data regarding traumatic anterior shoulder dislocations (ASI) associated with anteroinferior glenoid rim fractures (AGRF) in older patients.

Purpose:

To describe the incidence of AGRF in this population following ASI, identify risk factors for AGRF, compare treatment strategies, and compare clinical outcomes of patients with and without an associated AGRF.

Methods:

An established geographic medical record system was used to identify patients >50 years of age with ASI between 1994 and 2016. Patients with radiographic evidence of AGRF were identified and matched 1:1 to patients without AGRF. Comparative analysis was conducted to determine differences between groups.

Results:

Overall, 186 patients were identified with a mean follow-up of 10.4 years (range, 2.0 – 25.4). Of these, 42 (22.6%) had AGRF and were matched to 42 control patients without AGRF. Average age was 58.9 and 58.2 years for the AGRF and control groups, respectively. Rates of surgical intervention (29% vs. 43%), recurrent instability (14% vs. 17%), progression of osteoarthritis (34% vs. 39%), and conversion to arthroplasty (2% vs. 5%) were similar between AGRF and control cohorts. Control patients were more likely to report recurrent pain (p=.046). For patients with AGRF, increased bone fragment size (OR 1.1) and increased BMI (OR 1.2) correlated with an increased risk for surgery. The cut-off value for surgery in patients with AGRF was a fragment size ≥33% of the glenoid width.

Conclusions:

In patients ≥ 50 years at presentation of ASI, 22.6% presented with an associated AGRF. Increased fragment size and greater patient BMI were significant factors associated with undergoing surgical intervention; however, most patients did not require surgery. Patients without AGRF were more likely to report recurrent pain, possibly due to a higher prevalence of rotator cuff derangement. Overall, the presence of an AGRF did not portend a worse prognosis as treatment strategies and long-term outcomes in terms of recurrent instability, progression of osteoarthritis, and conversion to arthroplasty were similar between patients with and without AGRF at the time of ASI diagnosis.
Poster 106: Commonly Used Orthopaedic Clinical Therapeutics Affect the Cytokine Activity of Culture-Expanded Mesenchymal Stem Cells
Authors: Bonfield Tracey , Furdock Ryan , Harrison Laurie , Fletcher David , Rudo Evan , Calcei Jacob , Voos James
Published: July 2022

Objectives:

Hyaluronic acid (HA), platelet-rich plasma (PRP), and methylprednisolone are widely used for the non-operative management of osteoarthritis (OA). More recently, human bone marrow derived mesenchymal stem cells (BM-MSCs) have garnered significant interest as a non-operative means for symptom modification of OA. Anti-inflammatory cytokine secretion is a major component of proposed BM-MSC action. We sought to describe the effect of HA, PRP, and methylprednisolone on the cytokine profile of BM-MSCs at multiple stages of culture expansion.

Methods:

Following Institutional Review Board and United States Food and Drug Administration approval, nine BM-MSC cell lines from 4 human donors underwent three stages of culture expansion: passage 2 (P2), passage 3 (P3), and passage 4 (P4). Levels of OA-related cytokines (IL-1β, IL-6, IL-8, IL-10, Stem cell Factor [SCF], Stem Cell Derived Factor-alpha [SDF-α]) were measured using Luminex multiplexing technology. Each of the BM-MSC preparations were evaluated at each passage, 24 hours following exposure to HA, PRP, or methylprednisolone. Paired T-tests and Wilcoxon signed-rank testing were performed as appropriate following assessment of normality. Significance was set at p<0.05.

Results:

Culture expansion significantly altered cytokine production, however treatment with current OA therapeutics further altered these responses implicating the potential of combined treatment of culture expanded hMSCs and OA therapeutics. Figure 1 demonstrates the behavior of selected cytokines after exposure to HA, PRP or methylprednisolone preparations. Further, we tested different concentrations of each of the therapeutics to determine optimal dosing. Exposure to increasing doses of HA led to reductions in BM-MSC expression of SCF, SDF-α, VEGF, CCL20, and adiponectin (p<0.05 for all). PRP increased IL-1 levels in P2 and P3 (p<0.05 for both), IL-6 in P2 (100 pg/mL vs 5500 pg/mL, p<0.001), and IL-8 in P3 (900 pg/mL vs 3900 pg/mL, p<0.001). PRP did not affect IL-10 expression (p>0.05). Aside from an increase in IL-6 production for P2 (200 pg/mL vs 1500 pg/mL, p<0.05), methylprednisolone did not have significant effects on cytokine expression.

Conclusions:

Orthopaedic therapeutic adjuvants influence the inflammatory cytokine profile of BM-MSCs at multiple stages of culture expansion. Although further study is needed, these therapeutics have potential to be used in tandem with BM-MSCs to create an optimal cytokine environment for treatment of degenerative joint disease. [Figure: see text]
Poster 118: The Accuracy of a Smartphone App in Measuring Shoulder Range of Motion
Authors: Borman Nicole , Shi Jing , Damodar Dhanur , Pillai Raji , Mehran Nima , Soeters Rupali
Published: July 2022

Objectives:

Measuring shoulder movements, specifically range of motion (ROM) of the shoulder joint is an important clinical parameter related to glenohumeral disorders and for functional evaluation of the shoulder before and after treatment, which may include surgery. Currently shoulder ROM measurements are performed in an office setting by the provider or alternatively may be performed by a physical therapist, traditionally with the use of a goniometer. The purpose of this study was to determine the accuracy of a smartphone-based digital ROM tool in assessing active shoulder ROM, compared to traditional goniometry measured by a physical therapist in an office setting.

Methods:

A prospective, non-blinded study was conducted at a single institution (University of St. Augustine, Austin< TX). Thirty (30) eligible and consenting participants with normal shoulder ROM were recruited. Each participant self-assessed their active shoulder ROM using the smartphone App. A physical therapist concurrently measured each participant’s active shoulder ROM using a hand-held goniometer. This concurrent data collection was designed for greater efficiency and minimal bias. Forward flexion (FF), abduction (AB) external rotation (ER), internal rotation (IR) and extension (EX) were measured. Agreement between the smartphone App and goniometric measurements, as well as intra-rater reliability (precision) was assessed using intraclass correlation coefficients (ICC) and Limits of Agreement analysis. Each measurement was performed in duplicate to assess precision. Statistical analysis was performed using R (https://www.r-project.org/)

Results:

Data were analyzed for 60 shoulders (30 right, 30 left) from 30 participants (mean age was 31.4, 92% female.) The inter-rater reliability between the two methods was excellent for all movements, with ICC ranging from 0.9 to 0.96. For all movements except AB, the mean difference in the measurements between PT and App was less than 1.3 degrees, and the difference was within 6 degrees of the mean differences for 80% of the participants. For AB, the mean difference was 2.08, and the difference was within 15 degrees of the mean difference for 80% of the participants. The intra-rater reliability or precision ranged from good to excellent. For all movements except IR, both PT and App showed excellent intra-rater reliability (ICCs > 0.90). For IR, good intra-rater reliability (ICCs >= 0.75) was observed.

Conclusions:

These data provide evidence that the smartphone App can be a reliable and valid tool for measuring shoulder ROM. Smartphone Apps enable self-assessment of ROM by patients at the convenience of their home and allow for remote monitoring at zero visit cost to the patient.
Poster 122: Characterizing Health Events and Return to Sport in Elite Collegiate Swimmers
Authors: Greig Danielle , Schroeder Grant , Kremen Thomas , Trikha Rishi
Published: July 2022

Objectives:

Competitive swimming is a common activity among pediatric, collegiate and masters-level athletic populations. It is also one of the most prestigious sports in the United States with regard to medal-winning at international competitions, however, epidemiologic studies describing the incidence of health events and outcomes in an elite swimming population are lacking. This study aimed to identify the most common injuries and illnesses among elite swimmers as well as how these injuries and illnesses affect return to sport following injury.

Methods:

This retrospective study utilized a de-identified injury and illness database of NCAA Division I collegiate swimmers in the United States from 2016 to 2020. Analysis included musculoskeletal injuries stratified by body location, as well as non-musculoskeletal injuries and illnesses. Relative risk (RR) was used to compare the percentage of athletes affected between males and females, with statistical significance being defined by a relative risk 95% confidence interval (CI) not including 1 ( P < 0.05).

Results:

641 collegiate swimmers (301 male, 340 female) who were on a collegiate roster from 2016-2020 were included for analysis. A total of 1030 health events among 277 females and 173 males were analyzed. Of these 1030 health events, 635 (61.7%) occurred in females and 395 (38.3%) in males. Females were at a significantly higher risk of suffering musculoskeletal injury than males (RR = 1.5, 95% CI: 1.22 – 1.83). Females were also at a significantly higher risk of suffering a non-musculoskeletal injury/illness than males (RR = 1.32, 95% CI: 1.04 – 1.68). The most common of the 540 musculoskeletal injuries reported involved the shoulder (126, 23.3%), spine (95, 17.6%), foot/ankle/lower leg (81, 15.0%), knee/thigh injuries (67, 12.4%) and hand/wrist/forearm (52, 9.6%). The most common of the 490 non-musculoskeletal health events were respiratory tract infections (119, 24.3%), unspecified medical illness (93, 19.0%), concussions (58, 11.8%), ear infections (25, 5.1%) and gastrointestinal illnesses (24, 4.9%). Of the 58 documented concussions, 22 (37.9%) were season-ending. Fourteen of those 22 (63.6%) concussions were career-ending. Females had significantly higher rates of concussions (RR = 2.11, 95% CI: 1.13 – 3.96), 9.1% vs. 4.3%. Five out of 67 knee injuries (7.5%) were career-ending whereas only 1 out of 126 (0.8%) shoulder injuries was career-ending.

Conclusions:

This retrospective study identifies the most common injuries and illnesses as well as the most common season-ending or career-ending injuries and illnesses among elite collegiate swimmers. Awareness of the incidence and outcome of injuries and illnesses that affect competitive swimmers may allow for more targeted analysis and injury prevention strategies. [Table: see text][Table: see text][Table: see text]
Poster 132: Long Term Outcomes of Distal Biceps Injuries: A Comparative Study of Surgical and Non-operative Management at a Mean Follow Up of 13 years
Authors: Till Sara , Song Bryant , Wilbur Ryan , Reinholz Anna , Sanchez-Sotelo Joaquin , Barlow Jonathan , Camp Christopher , Tagliero Adam
Published: July 2022

Objectives:

Distal biceps tendon tears, although rare, significantly impair patient’s elbow mobility and function. There is a paucity of contemporary literature reporting long term outcomes of distal biceps (DB) injuries. Therefore, the authors sought to identify magnetic resonance imaging (MRI) confirmed distal bicep tears and report on (1) patient demographics and injury characteristics of all patients with distal bicep pathology, (2) outcomes of all patients with non-operatively managed DB pathology, and (3) outcomes of all patients with operatively managed DB pathology.

Methods:

Patients with an MRI-confirmed distal biceps rupture from 1996 to 2016 were identified through an institutional image database. Patients from the initial search were then cross-referenced with the [REDACTED]1 to ensure record availability. Patients were included if they had complete medical records and ≥5 years of clinical follow-up. Patients with inflammatory arthritis and enthesitis, polytrauma, or incidental findings without clinical assessment were excluded. Medical records were reviewed to confirm the diagnosis of distal biceps tears and obtain further subject details.

Results:

A total of 158 patients (22 female, 136 male) with a mean age 51.5 years (44.8-61.2) were identified and included. Baseline patient demographics including BMI, smoking status, dominant-handedness, laborer occupation, and gender were gathered (Table 1). Patients had a mean clinical follow-up of almost 14 years (Table 1, range 8.4 -17.8). Outcomes of the 52 non-operative and 106 operatively managed patients, included severe complications, functional outcomes, and health-related productivity loss are reported in Table 2. There were 7 re-operations (4%), 5 re-ruptures (3%), and overall 35% of the operatively treated cohort experienced a complication.

Conclusions:

Patients with distal bicep pathology tended to be a male laborer in their 50s without clinically significantly associated risk factors. The majority of patients regained full ROM, and 83% were able to return to work without modifications, irregardless of operative or non-operative management. At long term follow up, patients treated operatively were more likely to report missing time from work and averaged more days missed than their non-operatively treated counterparts. Additionally, operative patients had no statistically significant gains functional outcomes, and were subject to potential post-operative complications. Surgeon bias may play a role in deciding treatment for distal biceps tears. As such, careful patient selection for surgical intervention for distal biceps pathology should be employed; surgeons should consider restricting surgical intervention to patients who have significant clinical symptoms or fail non-operative management. [Table: see text][Table: see text]
Poster 154: MLB Player Workload and Performance Following Arthroscopic Shoulder Labral Repair
Authors: Cotter Daniel , Lau Emily , Abbas Muhammad , Kadouh Ali , Fehmi Ziad , Jildeh Toufic , Moutzouros Vasilios , Castle Joshua
Published: July 2022

Objectives:

To investigate the impact of arthroscopic shoulder labral repair on return to play (RTP), career longevity, workload, and performance of Major League Baseball (MLB) athletes

Methods:

A retrospective review of MLB players after arthroscopic shoulder labral repair from 2004-2018 was performed. A 2:1 control group matched by demographic information was used. Demographics, workload, and performance metrics were collected. Statistical analysis examined workload/performance at one and three-years after injury compared to one-year before. Workload/performance percentage relative to baseline was also compared.

Results:

26/ 39 (66%) pitchers and 18/25 (72%) positional players RTP and were matched with 54 and 34 controls, respectively. Following surgery, players experienced shorter careers (2.3 ± 2.6 vs 5.8 ± 2.8, p<0.001, pitchers), (2.9 ± 2.5 vs 5.3 ± 2.3, p=0.002, positional players). One-year post-index, pitchers had reduced games played (GP) (22.0 ± 21.3 vs 32.1 ± 21.0, p=0.002), started (15.0 ± 14.1 vs 6.1 ± 6.5, p =0.0038), and innings (109.5 ± 73.2 vs 44.7 ± 29.3, p =0.0004), and increased walks/hits-per-inning-pitched (WHIP) (1.3 ± 0.2 vs 1.5 ± 0.3, p =0.0035). One-year post-index, positional players had reduced GP (98.0 ± 50.7 vs 75.7 ± 47.1, p =0.0399), innings (778.9 ± 431.6 vs 528.6 ± 429.9, p =0.0263), on-base-percentage (OBP) (0.3 ± 0.1 vs 0.3 ± 0.1, p =0.0116), and on-base-plus-slugging-percentage (OPS) (0.7 ± 0.2 vs 0.6 ± 0.2, p =0.0281). Both pitchers and positional players experienced no reduction in any metric at three-years post-index. Compared to controls, pitchers had decreased GP (50 ± 40 vs 150 ± 180, p <0.001) and innings (40 ± 30 vs 150 ± 190, p <0.001), with increased WHIP when calculated as a percentage from baseline (120 ± 20 vs 100 ± 20, p =0.027) one-year post-index. Positional players had decreased OBP (80 ± 30 vs 110 ± 40, p =0.017) and OPS (80 ± 30 vs 100 ± 20, p =0.019) from baseline one-year post-index and decreased OBP three-years post-index (90 ± 20 vs 100 ± 20, p =0.017).

Conclusions:

Following RTP after arthroscopic shoulder labral repair, MLB players had reduced career longevity and workload/performance one-year post-index, but these stats returned towards baseline at three-years post-index. [Figure: see text][Figure: see text][Table: see text][Table: see text]
Poster 157: Total Intravenous Anesthesia (TIVA) Compared to Traditional General Anesthesia in Shoulder Arthroscopy in the Beach Chair Position
Authors: Sharareh Behnam , Tamma Poornima , Shah Anup , Barrera Lindsay
Published: July 2022

Objectives:

Shoulder arthroscopy is commonly performed in the beach chair position, which has been linked to cerebral oxygen desaturation. Previous studies comparing general anesthesia to total intravenous anesthesia (TIVA) using propofol indicate that TIVA can preserve cerebral perfusion and autoregulation, as well as shorten recovery time and reduce the incidence of postoperative nausea and vomiting. However, few studies have evaluated the use of TIVA in shoulder arthroscopy. Thus, this study seeks to determine if TIVA is superior to traditional general anesthesia methods in terms of improving operating room efficiency, shortening recovery time, and reducing adverse events while theoretically preserving cerebral autoregulation in patients undergoing shoulder arthroscopy in the beach chair position.

Methods:

This is a retrospective study of patients undergoing shoulder arthroscopy in the beach chair position, comparing two anesthetic techniques. 150 patients were included (75 TIVA and 75 general anesthesia). Unpaired t-tests were used to determine statistical significance. Outcome measures included operating room times, recovery times, and adverse events.

Results:

Compared to general anesthesia, TIVA significantly improved total recovery time (120.3 ± 31.0 min compared to 131.5 ± 36.8 min; p = 0.048). TIVA also decreased time from case finish to out-of-room (6.5 ± 3.5 min compared to 8.4 ± 6.3 min; p = 0.021). However, the in-room to case start time was slightly longer for the TIVA group (31.8 ± 7.22 min compared to 29.2 ± 4.92 min; p = 0.012). There were fewer readmissions in the TIVA group compared to the general anesthesia group (p = 0.08), and TIVA had lower rates of postoperative nausea and vomiting (p = 0.22), and higher intraoperative MAPs (87.1 ± 11.4 mmHg in the TIVA group, compared to 85.0 ± 9.3 mmHg in the general anesthesia group; p = 0.22).

Conclusions:

TIVA may be a safe and efficient alternative to general anesthesia in shoulder arthroscopy in the beach chair position. Larger scale studies are needed to evaluate the risk of adverse events related to impaired cerebral autoregulation in the beach chair position. [Table: see text][Table: see text][Table: see text]
Poster 160: Outcomes of Revision Posterior Shoulder Capsulolabral Repair in Adolescents
Authors: Arner Justin , Bradley James , Edwards Callee , Whicker Emily
Published: July 2022

Objectives:

Posterior arthroscopic capsulolabral repair has been shown to be successful in the athletic population. Adolescents provide a unique set of challenges to the surgeon due to their young age and potential length of time remaining in competitive athletics. Small studies have identified risk factors for failure, but there a paucity of literature evaluating adolescent specifically. The purpose of this study was to determine failure rates of adolescents who underwent arthroscopic posterior capsulolabral repair and to compare clinical outcomes and return to play between adolescents who required revision versus those who did not. It was hypothesized that adolescent athletes who require revision arthroscopic posterior unidirectional capsulolabral repair will have poorer outcomes and return to play and will undergo revision surgery at a higher rate than adults.

Methods:

A total of 718 patients who underwent posterior shoulder stabilization between 2000-19 with a minimum of 2-year follow-up were reviewed. Patients <11 years and >19 years of age and those with multidirectional instability were excluded. Revision surgery was defined as repeat arthroscopic posterior capsular repair. The ability to return to play, clinical outcomes scores (American Shoulder and Elbow Surgeons scoring system (ASES) and Visual Analog Scale (VAS)), and patient reported perception of range of motion, strength, and whether the surgery was worthwhile were recorded. Comparisons were made using the Chi-square or the Mann-Whitney U tests with P <0.05.

Results:

184 patients met inclusion criteria, with an average follow-up of 6.1 years. Nineteen patients required revision surgery, for an overall revision rate of 10.3%. At final follow-up, patients who underwent revision surgery returned to sport less frequently (86.7% vs 68.4%, p=0.04) and less likely to return to their pre-surgery level of play (Table 1). Non-revision patient had higher ASES score, as well as greater strength and range of motion. However, both groups had similar pain scores and reported that surgical repair was worthwhile (93.2% vs. 89.5%, p=0.55).

Conclusions:

Adolescent patients underwent revision posterior capsulolabral repair at a slightly higher rate (10.3%) when compared with athletes of all ages. Patients requiring revision had poorer outcomes scores when compared to those who did not undergo revision surgery but were able to return to sport at a high level and had a high level of satisfaction. Adolescent athletes return to play at high levels following arthroscopic posterior capsulolabral repair with a low rate of revision; however, those that require revision have poorer outcomes but high satisfaction. [Table: see text]
Poster 162: Glenoid Bone Loss Directly Affects Hill-Sachs Morphology: An Advanced 3-Dimensional Analysis
Authors: Golijanin Petar , Peebles Annalise , Douglass Brenton , Arner Justin , Provencher Matthew , Peebles Liam
Published: July 2022

Objectives:

The purpose of this study was to 1.) qualitatively and quantitatively analyze the interplay between glenoid bone loss (GBL) and Hill-Sachs lesions (HSL) in a cohort of anterior instability patients using 3-dimensional (3-D) imaging software and 2.) assess the relationships between GBL and HSL characteristics.

Methods:

Patients with anterior shoulder instability with a minimum of 5% GBL with evidence of HSL confirmed on computed tomography were identified. 3-D models of the unilateral proximal humeral head and en face sagittal oblique view of the glenoid were reconstructed using Mimics (Materialise NV, Leuven, Belgium) software. GBL as well as surface area (SA), width, defect length, and glenoid track width was quantified. The volume, SA, width, and depth of identified HSLs were quantified along with their location (medial, superior, and inferior extent) on the humeral head. The severity of glenoid bone loss was categorized by low grade (0-10%), moderate grade (>10% to 20%), high grade (>20% to 30%), and extensive (>30%). Analysis of variance was then computed to determine significance (p < 0.05) between severity of GBL and associated HSL parameters.

Results:

100 patients met inclusion criteria (mean age: 27.9 years, range: 18 to 43 years), which included 58 right shoulders and 42 left shoulders (84 male, 16 female). Among groups, 32 patients presented with low grade GBL (μ GBL = 6.1%), 38 patients with moderate grade (μ GBL = 16.2%), 17 with high grade ( μ GBL = 23.7%), and 13 with extensive GBL (μ GBL = 34.0%), with an overall mean GBL of 18.1% (range 5% - 39%). Patients with 0-10% GBL had significantly narrower (average and max width) ( p < 0.03) and deeper (average depth) (p = 0.002) HSLs compared with all other GBL groups, while greater GBL was associated with wider and shallower HSLs. GBL width, percent width loss, defect length, and glenoid track width all significantly differed across the four GBL groups (p < 0.05).

Conclusions:

Hill-Sachs Lesions (HSLs) have different morphological characteristics depending on the amount of glenoid bone loss (GBL). GBL is directly related to the characteristics of HSLs. Smaller glenoid defect size is associated with narrower and deeper HSLs. Management of the humeral head and glenoid must be appropriately tailored given the distinct interplay between GBL severity and HSL.
Poster 163: Evaluating the Role of Subacromial Impingement in Rotator Cuff Tendinopathy: Development and Analysis of a Novel Rat Model
Authors: Deng Xianghua , Rodeo Scott , Liu Yulei
Published: July 2022

Objectives:

Subacromial impingement of the rotator cuff caused by variations in acromial anatomy is an extrinsic factor that leads to inflammation and degeneration of the rotator cuff, ultimately contributing to the development of tendinopathy. However, microscopic and molecular changes in the impinged tendon remain poorly understood, and a robust rat model for studying rotator cuff tendinopathy is still lacking.

Methods:

Our study was approved by the Institutional Animal Care and Use Committee. A total of 44 adult male Sprague-Dawley rats were included in the study. Animals were randomly allocated to one of four study groups: intact control group (Group 1, n=11); bilateral subacromial surgical clip placement to induce supraspinatus impingement for 2 weeks (Group 2, n=11), 4 weeks (Group 3, n=11) and 8 weeks (Group 4, n=11). At time of sacrifice, bilateral shoulder specimens were harvested for biomechanical testing, histological and quantitative real-time polymerase chain reaction (qRT-PCR) analysis. One-way analysis of variance (ANOVA) with the post-hoc Tukey test was used to analyze differences among groups.

Results:

Radiography confirmed that all microvascular clips remained in stable position in the subacromial space. Gross inspection of supraspinatus tendon specimens in the impingement groups revealed frayed and hazy tendon discoloration at the enthesis and mid-substance. Biomechanical evaluation demonstrated decreased supraspinatus tendon failure force and tissue stiffness at all time points compared to control group. Histologic specimens demonstrated significant, persistent tendinopathic changes over 8 weeks, with the mean modified Bonar scores significantly increased in the clip impingement groups compared to the control group (control: 1.56±0.86; 2 weeks group: 9.17±0.76; 4 weeks group: 9.11±0.65; and 8 weeks group: 6.56±0.50. P <0.001 for all comparisons). qRT-PCR analysis of impinged tendon specimens demonstrated upregulation of gene expression for Col3 and MMP14 in the impingement groups compared with control groups (P =0.001 and 0.015 respectively). In muscle samples, significant upregulation was seen in the expression of genes that are commonly associated with muscle atrophy (MURF1: P <0.001 and UBE2B: P <0.001) and fatty infiltration (FABP4: P =0.002, PPARγ2: P =0.006, and KLF15: P =0.001).

Conclusions:

In conclusion, we developed a novel rat model of subacromial impingement and found consistent and sustained histologic, biomechanical, and gene expression changes that are consistent with findings in human tendinopathy. This model will allow future studies to further evaluate the underlying cellular and molecular mechanisms of tendinopathy, as well as evaluation of novel therapeutic approaches for treatment of this common problem. [Figure: see text][Figure: see text][Figure: see text]
Poster 166: Biomechanical Evaluation of Open Bankart and Soft Tissue Bristow Procedures with 10% Glenoid Bone Loss
Authors: Griffith Rebecca , Tibone James , McGarry Michelle , Adamson Gregory , Lee Thay
Published: July 2022

Objectives:

Chronic anterior shoulder instability can be debilitating for a wide number of individuals from the general populations, high level and recreational athletes, laborers and the members of the military. Glenoid bone loss presents a more difficult problem to treat as it negates the positive results that can be achieved with arthroscopic labral repair alone. The optimal procedure for subcritical bone loss of 10% or less is undetermined. In young competitive contact athletes, there is still a high failure rate with arthroscopic procedures. Therefore, the purpose of this study was to biomechanically characterize the effects of soft tissue Bristow (conjoint tendon transfer) and open Bankart repair in a 10% glenoid defect model.

Methods:

Eight fresh cadavers were studied using a custom shoulder testing system. The rotator cuff muscles were loaded to simulate physiologic muscle conditions. Range of motion, anterior-inferior translation at 60° of external rotation with 20, 30 and 40N of force were tested in scapular and coronal planes. Stiffness and the force required to dislocate in the anterior-inferior direction were also quantified in the coronal plane. 4 different states were examined including: (1) intact capsule (2) Bankart lesion with 10% bone loss, (3) soft tissue Bristow (conjoint tendon transfer), and (4) open Bankart repair. Repeated measures ANOVA with Bonferroni correction was used for statistical analysis.

Results:

The bony Bankart (injury model) increased range of motion in both the scapular and coronal planes. The conjoint tendon transfer had little effect on range of motion, and the Bankart repair decreased the range of motion to a similar state with that of the pre-injury model. The injury state showed increased translation which was decreased with both the conjoint tendon transfer and the Bankart repair (Figure 1A). The conjoint tendon transfer shifts the humeral head posteriorly in 0° and 30° of external rotation in the scapular plane. There was no difference in stiffness during dislocation between conjoint tendon transfer and Bankart repair (Figure 1B).

Conclusions:

Both the soft tissue Bristow and the open Bankart repair were noted to decrease anterior translation in this shoulder instability model. Both open repair models significantly decreased anterior translation and are valid surgical options for the treatment of instability with 10% glenoid bone loss. Surgically, an open Bankart repair is more anatomic and may be the preferred technique.
Poster 171: No Difference in Clinical Outcomes for Arthroscopic Suprapectoral versus Open Subpectoral Bicep Tenodesis: A Randomized Prospective Analysis
Authors: Diaz Connor , Berlinberg Elyse , Korrapati Avinaash , Cole Brian , Cvetanovich Gregory , Yanke Adam , Romeo Anthony , Verma Nikhil , Forsythe Brian
Published: July 2022

Objectives:

Our group has previously reported the 1-year outcomes arthroscopic suprapectoral biceps tenodesis (ASPBT) versus open subpectoral biceps for the management of long head of the biceps tendon (LHBT) pathology. While patients had similar 1-year biceps strength and pain, any ongoing changes in functional outcomes is yet unknown. We aimed to directly compare clinical outcomes of ASPBT versus OSPBT with interference screw fixation, distal to the bony bicipital groove, at 2 years follow-up.

Methods:

Eighty-seven patients undergoing biceps tenodesis for LHBT disease were randomized into the ASPBT group or OSPBT group. Both techniques utilized polyether ether ketone (PEEK) inference screws for tenodesis fixation. Patients completed American Shoulder and Elbow Surgeon (ASES), Constant subjective, and Single Assessment Numeric Evaluation (SANE) questionnaires preoperatively, and again at 6 months, 12 months and final follow-up at minimum 24 months.

Results:

Seven-five patients (37/46 randomized to ASPBT [80%], 38/41 randomized to OSPBT [93%]) with a mean age of 50.3 ± 10.4 years and a mean body mass index of 28.9 ± 6.3 were included in clinical outcome analyses. Mean final follow-up was 35.1 months (ASPBT: 35.4 months, OSPBT: 34.9 months, range 24-63 months). Comparison of demographic characteristics and intraoperative findings showed no significant difference in age, gender, concomitant procedures, and rotator cuff disease. No statistically significant differences in ASES (P =.26), Constant subjective scores (P = .60), and SANE scores (P = .74) were found at final follow-up. Clinical outcomes scores showed no significant improvement from 12.6 months to final follow-up at 35.1 months (ASPBT: ASES, P=0.42; Constant, P=0.23; SANE, P=0.43 v. OSPBT: ASES, P=0.76; Constant, P=0.57; SANE, P=0.64). The mean SANE score in the ASPBT group had a statistically nonsignificant, 6.1-point increase from 1 to 3 years post-operatively (p = .23), which was greater than the minimal clinically importance difference (MCID). No patients required revision of biceps tenodesis in either group.

Conclusions:

No significant differences in patient-reported outcomes and complication rates were found at any time point between subjects undergoing ASPBT or OSPBT, utilizing the same interference screw technique, for the management of LHBT pathology. [Table: see text][Table: see text][Table: see text][Table: see text]
Poster 192: Femoroacetabular Impingement in Elite Skiers and Snowboarders: Return to Sport and Outcomes after Hip Arthroscopy
Authors: Waltz Robert , Comfort Spencer , Philippon Marc
Published: July 2022

Objectives:

Hip arthroscopy has been shown to be an effective treatment for femoroacetabular impingement (FAI) in high level athletes; however, limited outcomes and return to play data exists for hip arthroscopy in skiers and snowboarders. The purpose of this study is to determine the return to sport rate of elite skiers and snowboarders who have undergone hip arthroscopic surgery for FAI and to assess hip-related outcomes at a minimum 2-years follow up.

Methods:

Elite skiers and snowboarders who underwent hip arthroscopy for the treatment of FAI between 2005 and 2018 were identified through a retrospective review of prospectively collected data. Data was obtained from www.fis-ski.org, www.usskiandsnowboard.org, www.xgames.com, and www.wikipedia.org, including information on each players’ career length, participation on a national team, and time between surgery and first competition post-surgery. Patient reported outcome measures (PROs) were prospectively collected pre-operatively and at minimum 2 years post-operatively.

Results:

Twenty-six elite skiers and snowboarders (34 hips) were included. The mean age at surgery was 24.5 ± 6.7 years (range 18.7-46.8). A total of 85% returned to elite level competition at 8.9 months (range 2.9-23.7) with an average career length of 3.6 ± 2.7 years. Four athletes required revision arthroscopy with adhesions being the most frequent indication. At mean follow-up of 7.7 ± 3.2 years, significant improvement in PROs was demonstrated for HOS-ADL (76 ± 20 to 95 ±6), HOS-SSS (63 ± 28 to 92 ± 14), mHHS (70 ± 19 to 89 ± 12), and SF12-PCS (45 ± 11 to 54 ± 8). Patient acceptable symptom state (PASS) was achieved in 88% for HOS-ADL, 88% for HOS-SSS, and 83% for mHHS. Median patient satisfaction was 10.

Conclusions:

The return to competition rate in elite skiers and snowboarders after hip arthroscopy for FAI is 85% at an average of 8.9 months with a career length of 3.6 years after surgery. Significant improvement in PROs was demonstrated for HOS-ADL, HOS-SSS, mHHS, and SF12-PCS with median patient satisfaction score of 10. These findings support hip arthroscopy as an effective procedure for the treatment of FAI in elite skiers and snowboards with symptomatic activity limiting hip pain allowing them to return to their previously level of competition at a high rate.