bluuebunny/crossref_metadata_2025 huggingface dataset:
Paper 34: Midterm Outcomes of Meniscal Allograft Transplantation in the Adolescent Population
Authors: Kaiser Joshua , Wagner Kyle , Hevesi Mario , Damodar Dhanur , Swindell Hasani , Yanke Adam , Cole Brian , Quigley Ryan
Published: August 2023

Objectives:

To report midterm outcomes following primary meniscal allograft transplantation (MAT) from a single surgeon in an adolescent population.

Methods:

A retrospective review was performed to identify adolescent patients <18 years old at the time of primary MAT from 1999-2016. International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, and Lysholm scores were collected preoperatively and at 1-year, 2-years, and a minimum of 5-years follow-up.

Results:

Forty-four (female n=33; male n=11) of 62 identified patients (71%) met inclusion criteria with a mean follow-up of 9.5 ± 3.8 years (range: 5.0-17.7). Isolated MAT was performed in 27 (61.3%) patients. Common concomitant procedures included osteochondral allograft transplantation (OCA) (n=14, 31.8%), autologous chondrocyte implantation (ACI) (n=8, 18.1%), and anterior cruciate ligament reconstruction (ACLR) (n=6, 13.6%) (Table 1). Eleven patients (25%) required a reoperation an average 5.9 ± 4.5 years (range: 0.8 – 14.0) post-transplant. Three (6.8%) patients met criteria for failure, requiring revision MAT an average of 3.8 ± 1.1 years (range: 2.8-4.9) post-transplant. Graft survivability at 1, 2, 5, and 10 years was 100.0%, 100.0%, 93.2%, and 93.2%, respectively (Figure 1). When compared to preoperative scores, significant increases in Lysholm, IKDC, and KOOS subscales were observed at 1-year, 2-year, and most recent follow-up (Figure 2 and Supplemental Table 1). 90% of patients reported satisfaction with their current physical status.

Conclusions:

At midterm follow-up, primary MAT in the adolescent population resulted in predictable improvements in functional outcomes. These improvements were maintained at an average follow-up of 9.5 years. The meniscal reoperation rate was 25% with a 71.3% probability of being reoperation free at 5 years while graft survivability was 93.2% at 5 years. When compared to extant literature profiling MAT in the adult population, adolescents who undergo MAT demonstrate similar functional outcomes and graft survivability. [Table: see text] [Table: see text]
Paper 69: Do Patients Participate in Sports or Recreational Activity After Osteochondral Allograft Transplantation of the Talus?
Authors: Fiske Joseph , DALAL ALIASGAR , McCauley Julie , Bugbee William
Published: August 2023

Objectives:

Fresh osteochondral allograft (OCA) transplantation has been reported as a viable treatment option for chondral lesions of the talus, but there is insufficient data regarding patients’ participation in sports or recreational activity following the procedure. The purpose of this study was to assess the frequency of patients who participated in sports or recreational activity following OCA of the talus.

Methods:

We identified 36 ankles in 34 patients (70% well trained or highly competitive athletes) who underwent OCA transplantation of the talus. Mean age was 36 years and 50% were male. Postoperatively, participation in sport or recreational activity, foot and ankle ability measure (FAAM) scores, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, and patient satisfaction with the results of surgery were assessed. Further surgery on the ankle was captured, and OCA failure was defined as any operation that involved removal of the allograft.

Results:

At a mean follow up of 8.6 years, 67% of patients reported that they had participated in sports or recreational activity after the OCA transplantation. Among those who participated in sport or recreation, 68% returned to their pre-injury sport, 21% played in competitive sports, and 95% participated in regular exercise. Following the OCA transplantation, 17% of ankles required further surgery and 11% were classified as OCA failures (underwent revision OCA transplantation or fusion). There was significant improvement in FAAM and AOFAS ankle-hindfoot scores, and 79% of patients were either satisfied or extremely satisfied with the results of surgery. Survivorship of the OCA transplantation was 94% at five years and 85% at ten years.

Conclusions:

Fresh OCA transplantation is a reasonable surgical option for osteochondral defects of the talus for young, active patients who have failed non-operative management. Most patients participate in sports or recreational activity following OCA transplantation of the talus.
Poster 115: Patients who Underwent Primary Hip Arthroscopy for Femoroacetabular Impingement with Acetabular Microfracture Show 77% Survivorship at 10-Year Follow-Up
Authors: Maldonado David , Lee Michael , Annin Shawn , Owens Jade , Jimenez Andrew , Sabetian Payam , Domb Benjamin
Published: August 2023

Objectives:

The purpose is to report minimum 10-year follow-up survivorship, defined as non- conversion to total hip arthroplasty (THA), and patient-reported outcome scores (PROS) following primary hip arthroscopy with acetabular microfracture in the setting of femoroacetabular impingement syndrome (FAIS) and acetabular chondral lesions, respectively.

Methods:

Data was prospectively collected and retrospectively analyzed on all patients who underwent a primary hip arthroscopy and received an acetabular microfracture between June 2009 and January 2011 and included in this study. Patients with a minimum 10-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the visual analog scale (VAS) for pain were included. If available, the minimum 10-year follow-up for the Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) was reported. The demographics, intraoperative findings, surgical procedures, PROS, rate of achieving the minimal clinical important difference (MCID), and secondary surgeries were analyzed and reported.

Results:

Twenty-two hips (20 patients) were included in the study, and the mean follow-up time was 124.5 ± 2.2 months. There were 17 hips (77.3%) from males and 5 hips (22.7%) from females. The average patient age at the time of surgery was 42.3 years ± 9.6. All patients on average experienced statistically significant improvement (P < 0.05) between preoperative and minimum 10-year follow-up scores for all PROs. In total, 77.3% of the patients did not require conversion to THA. Additionally, 83.3% of the patients achieved the MCID for the mHHS, NAHS, and VAS for pain.

Conclusions:

At a minimum 10-year follow-up, survivorship of 77.3% was reported for patients that underwent primary hip arthroscopy with acetabular microfracture for the treatment of FAIS and focal/full-thickness acetabular cartilage lesions. Further, in the patients that did not require THA conversion, significant improvement in all PROS was demonstrated.
Poster 159: At-home physical therapy with a remote monitoring digital health platform leads to similar patient reported outcomes compared to traditional in-office physical therapy following shoulder surgery
Authors: Denard Patrick , Higgins Laurence , Gobezie Reuben , Shishani Yousef
Published: August 2023

Objectives:

Physical therapy (PT) following shoulder surgery has traditionally occurred via in-office supervised visits. Recently digital health tools with remote patient monitoring (RPM) have emerged as an option to enhance the ability to both monitor and encourage engagement of home PT. The appeal of such tools has been accelerated by the impact of COVID-19 on the healthcare system. The primary purpose of this study was to compare patient-reported outcomes (PROs) following shoulder surgery of patients who completed at-home PT with a digital rehab application to patients who completed in-office supervised PT. The secondary purpose was to assess engagement among patients who used digital PT.

Methods:

A retrospective matched comparative evaluation was performed of patients who underwent arthroscopic shoulder surgery or shoulder arthroplasty at a single institution between April 2020 and May 2021. Patients who underwent home-based physical therapy with a digital remote monitoring platform (PT Genie; Orland, FL) were identified and age and procedure matched (arthroscopy or arthroplasty) to a cohort of patients that underwent in-office physical therapy. The digital platform provided remote monitoring capabilities with measurement of range of motion. PROs measured preoperatively and at 1 year postoperative included visual analog scale pain score (VAS), American Shoulder Elbow Surgeons Score (ASES), and Single Assessment Numeric Evaluation (SANE). Engagement measured as the number of sessions recorded was analyzed in the digital PT based on 6 age groups (≤40, 41-50, 51-60, 61-70, 71-80, and 81+). Statistical analysis using the student t-test to compare means was performed using SPSS version 17 (SPSS Inc., Chicago).

Results:

A total of 862 patients were identified, including 396 arthroscopic surgeries (198 in each PT group) and 466 in the arthroplasty group (233 patients in each PT group). The groups were similar at baseline other than a higher preoperative ASES score in the digital PT arthroplasty group (Table 1). There was no significant difference in any PROs between the two groups at 1-year follow-up. The highest engagement in the digital PT group was observed in the arthroplasty group and over the age of 50 (Figure 1).

Conclusions:

There appears to be no difference in PROs following shoulder surgery whether physical therapy is performed in-office or at home via a digital platform. Interestingly, engagement with digital PT was highest in older patients, suggesting that the technology is not a large barrier. Although further study is needed to confirm these findings, benefits of digital PT with remote monitoring may include: 1) Decreased cost for the healthcare system, 2) Decreased travel time for the patient, and 3) Scheduling efficiency and improved access to the PT for the patient.
Poster 166: Distal Clavicle versus Traditional and Congruent Arc Latarjet: Comparison of Surface Area and Glenoid Apposition with 3-Dimensional CT and MRI
Authors: Hudson Caroline , Taylor Dean , Anakwenze Oke , Dickens Jonathan , Lau Brian , Kim Billy
Published: August 2023

Objectives:

Limited studies have compared graft-glenoid apposition and glenoid augmentation area between the latarjet and distal clavicle grafts in glenohumeral stabilization. Additionally, pre-operative planning is typically performed using computerized tomography (CT), and few studies have used 3- dimensional magnetic resonance imaging (3D-MRI) reformations to assess graft dimensions. The purpose of the study was two-fold: 1) compare bony apposition, glenoid augmentation, and graft width among coracoid and distal clavicle bone augmentation techniques and 2) to determine the viability of 3D-MRI to assess bone graft dimensions.

Methods:

Twenty-four patients with recurrent glenohumeral instability and bone loss were included in this study. 3D-CT and 3D-MRI reformations were utilized to measure pertinent dimensions for five orientations of coracoid and distal clavicle autografts: (1) standard Latarjet (SLJ), (2) congruent arc Latarjet (CLJ), and (3) distal clavicle attached by its posterior surface, (DCP) and (4) inferior surface (DCI), and (5) resected end (DCR). Glenoid augment area was defined as the graft surface area contributing to the glenoid. Bone-on-bone apposition was defined as the graft-glenoid contact area for bone healing potential, and graft width was pertinent for fixation technique. Paired t-tests were performed to compare graft sizes between patients and compare 3D-CT vs 3D-MRI measurements.

Results:

CLJ had the largest glenoid augmentation area (mean: 318mm2, sd: 74) while SLJ displayed the most apposition (mean: 318mm2, sd: 74). DCI had the largest graft width (mean: 21mm, sd: 4). Paired t- tests revealed no significant differences between Latarjet methods, whereas distal clavicle grafts varied significantly with orientation. All 3D-CT and 3D-MRI measurements were within 1mm of each other, and only two demonstrated statistically significant difference (coracoid width: 13.03 vs 13.98mm, p=0.010; distal clavicle thickness: 9.69 vs 10.77, p=0.002). 3D-CT and 3D-MRI measurements demonstrated strong positive correlation (r>0.6 and p<0.001 for all dimensions).

Conclusions:

Glenoid augmentation, bony apposition, and graft width can vary with coracoid or distal clavicle graft type and orientation. Differences between 3D-CT and 3D-MRI were small and likely not clinically significant.
Poster 168: Notching of the Greater Tuberosity Revisited: A Radiographic Indicator of Degenerative Rotator Cuff Tears
Authors: Gruenberger Eric , Kersy Cameron , Stay Rourke , Jardaly Achraf , Williams Marshall , Ponce Brent , Baker Champ , Synovec John
Published: August 2023

Objectives:

The greater tuberosity notch (GTN) is an uncommonly reported radiographic finding which has been associated with articular sided partial rotator cuff tears (RCTs) in throwing athletes. This finding has yet to be evaluated in patients with degenerative tears. The purpose of this study is to assess the GTN measurement along with five other previously described radiographic indicators for degenerative RTCs.

Methods:

After obtaining IRB approval, we prospectively collected and compared 80 standard shoulder radiograph series with an additional “notch view”, a lateral oblique radiograph showing the greater tuberosity in profile. Thirty-four patients had confirmed rotator cuff tears confirmed via arthroscopy and 46 control patients did not have suspected rotator cuff pathology. Two musculoskeletal radiologists independently reviewed radiographs for GTN size and five previously described radiographic indicators of RCTs including: greater tuberosity cyst (GTC), acromiohumeral interval (AHI), critical shoulder angle (CSA), inferior acromial sclerosis (IAS), and lateral acromial spurring (LAS). A receiver operator characteristic (ROC) curve was performed to compare the individual performance of each of the six radiographic markers. Nearest neighbor analysis based on Euclidean distances followed by clustering described the pattern of radiographic variables occurring together in the setting of a RCT.

Results:

A total of 320 radiographs were reviewed and 1920 measurements were made. RCTs were independently associated with IAS, LAS, GTCs, decreased AHI and large GTNs (P < 0.01), but not the CSA or smaller notch sizes. Overall, the GTN size predicted a RCT with moderate accuracy (AUC=0.676). Cluster analysis suggested the AHI has the strongest correlation with RCTs and is the most closely related to the GTN size (P < 0.003) compared to other indicators based on Euclidean distances.

Conclusions:

The presence of a medium-sized greater tuberosity notch alone is moderately sensitive for detecting a degenerative RCT. Additionally, the presence of at least one other indicator on radiographs dramatically increases the likelihood of finding a RCT during surgery. The size and presence of these radiographic markers in combination may represent a continuum of increasing severity of cuff pathology.
Poster 169: Severe Attrition and Poor Satisfaction in Patients Undergoing Tele-Rehabilitation Versus Standard In-Office Rehabilitation After Arthroscopic Rotator Cuff Repair and Anterior Cruciate Ligament Reconstructions: Randomized Controlled Trials That Required Cessation
Authors: Shankar Dhruv , Avila Amanda , Mojica Edward , Hurley Eoghan , Lehane Kevin , Buzin Scott , Oeding Jacob , Stein Spencer , Gonzalez-Lomas Guillem , Alaia Michael , Strauss Eric , Jazrawi Laith , Campbell Kirk , Vasavada Kinjal
Published: August 2023

Objectives:

The use of telerehabilitation after sports medicine procedures such as arthroscopic rotator cuff repair (ARCR) and anterior cruciate ligament reconstruction (ACLR) has rapidly increased in recent years; however, functional outcomes and patient satisfaction after telerehabilitation compared to in- person rehabilitation remain unclear. We hypothesized that functional outcomes and patient satisfaction would not differ significantly between the rehabilitation modalities.

Methods:

Two separate randomized-controlled trials were conducted involving patients scheduled to undergo ARCR or ACLR by one of six fellowship-trained sports medicine surgeons between October 2020 and November 2021. Initially 60 patients were included in each arm of the trial. Patients were randomized to receive telerehabilitation or in-person rehabilitation for their post-operative course. International Knee Documentation Committee Subjective Knee Form (IKDC) scores (for ACLR), the American Shoulder & Elbow Surgeons (ASES) score (for ARCR), and satisfaction metrics were collected at timepoints of baseline and at each post-operative visit. Baseline characteristics and outcomes between the in-person and telerehabilitation arms of each cohort were compared using Mann-Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. P-values less than 0.05 were considered significant.

Results:

In total, 16 ACLR patients were enrolled, of whom 10 (62.5%) were assigned to in-person rehabilitation and 6 (37.5%) to telerehabilitation. Additionally, 32 ARCR patients were enrolled of whom 20 (62.5%) were assigned to in-person rehabilitation and 12 (37.5%) were assigned to telerehabilitation. In both trials combined, of the 30 patients initially assigned to in-person rehabilitation, 24 (80%) completed the final follow-up survey and none reported crossover to telerehabilitation. Of the 18 patients initially assigned to telerehabilitation, 12 (67%) completed the final follow-up survey. Of these 12 patients, 11 (92%) reported crossover; 9 patients completed in-person rehabilitation and 2 patients completed hybrid in-person and tele-rehabilitation.

Conclusions:

Though overall satisfaction with both modalities was high, patients preferred in-person rehabilitation to telerehabilitation after undergoing ACLR and ARCR as evidenced by nearly ubiquitous crossover from telerehabilitation to in-person rehabilitation in both studies. However, a hybrid model combining in-person and tele-visits may be acceptable to most patients.
Poster 181: Dual plating as a Cost-Effective Treatment Option for Operatively Indicated Midshaft Clavicle Fractures
Authors: Kumar Praveen , Reddy Rajiv , Chen Stephen , Mittwede Peter , Moloney Gele , Sabzevari Soheil , Siska Peter , Lin Albert , Charles Shaquille
Published: August 2023

Objectives:

Many studies have highlighted lower rates of secondary operations with dual-plating compared to single-plating. Despite higher upfront costs associated with the dual-plating construct, the observed reduction in secondary operations compared to single-plating may make it a more cost- effective treatment option. The objective of this study was to assess the cost-effectiveness of dual-plate fixation compared to single-plate fixation in patients with operatively indicated displaced midshaft clavicle fractures. We hypothesized dual-plating would be a more cost-effective surgical option than single-plating, given its lower rates of postoperative complications.

Methods:

We developed a decision tree to model the occurrence of postoperative complications (hardware issues, wound healing issues, deep infection, non-union, and symptomatic hardware) associated with secondary surgeries. Complication-specific risk estimates were summarized for both plating techniques. The time horizon was two years, and the analysis was conducted from the healthcare payer’s perspective. The costs included direct medical costs, while the benefits were measured in quality-adjusted life-years (QALYs). We assumed that dual-plating would be $300 more expensive than single-plating upfront. We conducted probabilistic and one-way sensitivity analyses.

Results:

The model predicted reoperation in 6% of patients in the dual-plating arm compared to 14% of patients in the single-plating arm. In the base case analysis, the dual-plating increased QALYs by 0.007 and costs by $70 per patient yielding an incremental cost-effectiveness ratio (ICER) of $10,600 per QALY gained. The sensitivity analysis demonstrated that the cost-effectiveness of dual plating is driven by the cost of index surgery, risk of non-union, and symptomatic hardware complications in single- and dual- plating. At a willingness to pay threshold of $100,000 per QALY gained, 92% of simulations suggested dual-plating is cost-effective compared to single-plating (Figure 1).

Conclusions:

When indicated, operative management of displaced midshaft clavicle fractures with dual- plating is cost-effective compared to single-plating. Despite its higher initial upfront hardware costs, dual plating appears to offset added costs via lower rates of reoperations and improved patient quality of life.
Poster 187: Similar Clinical and Patient Recorded Outcomes Amongst Older Patients over 65 Years of Age Compared to Younger Patients undergoing Arthroscopic Rotator Cuff Repair
Authors: Castle Joshua , Jiang Eric , Wager Susan , Brown Spencer , Kasto Johnny , Gasparro Matthew , Muh Stephanie , Makhni Eric , Moutzouros Vasilios , Gaudiani Michael
Published: August 2023

Objectives:

The purpose of our study was to determine if patients 65 years and over meet the minimally clinical important difference (MCID) for Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE), Depression (PROMIS-D), and Pain Interference (PROMIS-PI) at similar rates compared to a cohort of younger patients.

Methods:

A retrospective review of a prospectively collected database of patients undergoing RCR was performed. Patients with completed preoperative and 6-month follow up postoperative PROMIS scores were included. A cohort of 65 years and older (65<) was compared to a cohort of 64 years and younger (64>=) in terms of their clinical outcomes and PROMIS scores. A propensity matched analysis was then performed, which matched patients 65+ years old 1:1 to a cohort of 50 years or younger via tear size and body mass index (BMI).

Results:

A total of 318 patients were included with 79 patients ≥ 65 years (69.2 ± 3.4 years, mean ± SD) and 239 patients <65 years (55.1 ± 3.4 years). No significant differences were found in terms of gender, tear thickness, tear size, reoperation rate, retear rate, preoperative PROMIS-UE, PROMIS-PI, and PROMIS D scores, or change in postoperative PROMIS-UE, PROMIS-PI, and PROMIS D after 6 months. In the sub-analysis, 44 patients over 65 years of age were propensity matched to 44 under 50 years of age. No differences were found in PROMIS-UE change, PROMIS-D change, proportion meeting MCID PROMIS UE, and proportion meeting MCID of PROMIS PI after 6 months. Patients in the 65+ years group experienced larger changes in PROMIS PI scores (12.5 ± 9.6 vs 7.2 ± 7.5, p=0.005) while fewer patients experienced significant declines in PROMIS D scores (26% vs 47%, p=0.03).

Conclusions:

Patients ≥ 65 years experience no differences in reoperation or retear rate when compared to younger patients. Older patients undergoing RCR were more likely to have a larger improvement in pain scores but were less likely to have significant clinical change in their depression scores. With proper patient selection, patients ≥ 65 years can achieve clinically significant improvements 6 months after RCR that is similar to their younger counterparts. [Table: see text][Table: see text][Table: see text]
Poster 192: Depressive and Anxiety Disorders Increase Risk for Continued Biceps Pain Following Arthroscopic Biceps Tenodesis
Authors: Greiner Justin , Carlos Noel Bien , Simonian Lauren , Hughes Jonathan , Lin Albert , Lesniak Bryson , Drain Nicholas
Published: August 2023

Objectives:

Arthroscopic suprapectoral biceps tenodesis (ASPBT) may result in postoperative biceps pain. Previous studies have revealed associations between demographic or intraoperative factors and shoulder pain, but with conflicting results. No study has exclusively investigated predictors of biceps pain following ASPBT. The purpose of this study was to evaluate factors associated with postoperative biceps pain following ASPBT while also determining the clinical impact of postoperative biceps pain. We hypothesized that younger age and pre-existing diagnoses of chronic pain syndromes would be associated with increased postoperative biceps pain.

Methods:

A retrospective study comprised of patients that underwent ASPBT was completed. Groups were categorized by the presence (BP+) or absence (BP-) of postoperative biceps pain. Differences between continuous variables were tested with two-sample t-tests and differences between categorical variables were tested with the chi-squared or Fisher’s exact test. Variables collected at different postoperative timepoints were first analyzed using a linear mixed model or generalized linear mixed model with fixed effects for group, timepoint, the group*timepoint interaction, and a random subject effect. Post-hoc comparisons were analyzed and p-values were adjusted for multiple testing with the Benjamini-Hochberg procedure.

Results:

A total of 461 (47 BP+, 414 BP-) patients met criteria for analysis. A lower mean age was observed in the BP+ group (p<0.01). Diagnoses of major depressive disorder (MDD) (p=0.03) and any anxiety disorder (p<0.01) were more prevalent in the BP+ group. Prescription medication with selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors (p<0.01) and atypical antidepressants (p=0.01) was more prevalent in the BP+ group. Subacromial decompression (SAD) was performed less frequently in the BP+ group (p<0.01).

Conclusions:

Younger age, diagnosis of MDD or any anxiety disorder, as well as the use of psychotropic medications were predictive of postoperative biceps pain following ASPBT. The study also observed lower odds of developing postoperative biceps pain in patients undergoing concomitant SAD. Postoperative biceps pain after ASPBT resulted in prolonged recovery, inferior PROs, and a higher incidence of repeat surgical procedures. The decision to perform ASPBT in younger patients, patients diagnosed with MDD or anxiety, and patients taking psychotropic medications should be carefully considered given the correlation to postoperative biceps pain and inferior outcomes. [Table: see text][Table: see text]
Poster 194: Arthroscopic Reconstruction of Comminuted Glenoid Fractures Using Distal Tibia Allograft Results in Excellent Post-Operative Outcomes
Authors: DE LA PEÑA JOSE CASTILLO , Wong Ivan
Published: August 2023

Objectives:

Boney Bankart injuries with a fragment from the anterior rim of the glenoid are not the most frequent ones after an anterior shoulder dislocation but can cause severe impairment of the joint and residual instability directly related with the amount of bone avulsed. Different treatment options have been described including fixation or reconstruction of the glenoid bone using distal tibia allograft. The primary objective of this study is to analyze and compare clinical outcomes, Western Ontario Shoulder Instability (WOSI) scores, complication, and re-dislocation rates.

Methods:

This study included patients who underwent arthroscopic surgery for glenoid fracture between 2012-2020. Patients were included if they sustained a type Ia glenoid fracture according to Ideberg-Goss classification and if they were treated arthroscopically within three months of injury with one of two surgical techniques; Fixation (including fracture fragment reduction and fixation with screws, buttons, or sutures and anchors), and glenoid reconstruction. Patients were excluded if they had concomitant fractures to ipsilateral humerus or clavicle during injury and history of ipsilateral shoulder instability. Demographic information, WOSI scores, and complications related to the surgery, or new dislocation events were recorded.

Results:

Thirty-eight patients were included with both the fixation and reconstruction groups had similar demographics and baseline characteristics, except for the percentage of patients with comminution which was higher in the reconstruction group (p=0.04) (Table 1). Both the fixation and reconstruction groups has similar pre- and post-operative glenoid AP measurements (Table 1). Patient-reported outcomes were similar post-operatively between the two groups (p=0.546) (Figure 1).

Conclusions:

Arthroscopic glenoid fracture fixation has good outcomes but concerns exist regarding cartilage damage. Complex comminuted fracture patterns are suitable for reconstruction with patients achieving comparable outcomes to those who undergo fracture fixation. [Table: see text]
Poster 203: Worse Postoperative Outcomes and Higher Reoperation in Smokers Compared to Nonsmokers for Arthroscopic Rotator Cuff Repair
Authors: Castle Joshua , Jiang Eric , Wager Susan , Brown Spencer , Kasto Johnny , Gasparro Matthew , Muh Stephanie , Makhni Eric , Moutzouros Vasilios , Gaudiani Michael
Published: August 2023

Objectives:

Smoking significantly impairs healing potential and is a significant risk factor for complications after various orthopaedic surgeries. The purpose of this study was to determine if a cohort of former or current smokers at time of surgery met the minimally clinical important difference (MCID) for Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS- UE), Depression (PROMIS-D), and Pain Interference (PROMIS-PI) scores in comparison to nonsmoking patients.

Methods:

A retrospective review of a prospectively collected database of patients undergoing arthroscopic rotator cuff was performed. Patients who completed preoperative and 6-month postoperative PROMIS scores were included. The MCID was calculated using a distribution technique with a threshold of 0.5 standard deviations above the mean. A cohort of nonsmokers was compared to a cohort of patients currently or former smokers at time of surgery in terms of their clinical outcomes and PROMIS scores. A sub-analysis was also performed where a cohort of nonsmokers were propensity matched 1:1 to a cohort of current/former smokers via age, body mass index (BMI), and tear size.

Results:

A total of 182 patients, 80 current or former smokers and 102 nonsmokers, who underwent rotator cuff repair were included in the study. Smokers had statistically different sized tears with more rated massive and more reoperations (16.3% vs 5.9%, P=0.02). No differences were found in preoperative PROMIS scores, change in PROMIS scores, proportion meeting MCID for PROMIS scores, and retear rate. In the sub-analysis, 74 current or former smokers were matched to 74 nonsmokers. Smokers had a lower change in PROMIS-UE (8.6 ± 9.8 vs 12.3 ± 10.0, P=0.007) and PROMIS-PI (-9.1 ± 8.5 vs -12.8 ± 10.1, P=0.03) postoperatively. Fewer met MCID for PROMIS UE postoperatively (60.3% vs 82.4%, P=0.003) and more had reoperations (16.2% vs 4.1%, P=0.02).

Conclusions:

Patients who smoke currently or had a history of smoking preoperatively demonstrated smaller improvements in function, pain scores, and were less likely to meet MCID for PROMIS-UE when compared to nonsmokers after arthroscopic rotator cuff repair. Smokers were more likely to undergo reoperations within 6 months. [Table: see text][Table: see text][Table: see text][Table: see text]
Poster 221: Revision Hip Arthroscopy Outcomes at an Average 5 year Follow-Up: FAI and Capsular Complications
Authors: Selley Ryan , Olsen Reena , Kelly Bryan , Ranawat Anil , Nawabi Danyal
Published: August 2023

Objectives:

Femoroacetabular impingement (FAI) has become an increasingly recognized diagnosis contributing to morbidity in the adolescent and young adult population over the past decade. Our ability to treat such pathology with hip arthroscopy has grown in parallel. As the number of hip arthroscopy cases performed annually continues to rise, so will the number of patients requiring revision surgery. Trending outcomes and indications for revision hip arthroscopy is essential to improve surgical techniques, facilitate accurate diagnoses and address pathology appropriately. The purpose of this study was to report outcomes for revision hip arthroscopy and assess if outcomes vary by indication.

Methods:

A single-center hip preservation registry was reviewed to identify patients who underwent revision hip arthroscopy for the treatment of FAI between 2012 and 2019. Patient demographics and primary indications for revision hip arthroscopy were determined, patient reported outcomes were collected preoperatively and at an average follow-up of 5.2 years post-operatively.

Results:

A total of 239 patients met inclusion criteria for this study. The top 4 primary indications for revision were: Residual FAI 67.8%, instability 14.6%, heterotopic ossification (HO) 4.6% and adhesions 4.2%, trends in indication did not vary over time. On average patients improved significantly from pre- to post-operatively in mHHS 20.4(95% CI: 16.6 - 24.1), HOS ADL 15.0 (95%CI: 11.9 -18.2), HOS SS 23.8 (95% CI: 18.8 – 28.9), iHOT-33 30.2 (95% CI: 26.0 – 34.3), p<0.001. Rates of achieving MCID varied from 62.9%-78.3%, SCB 44.9-56.6% and SCB by absolute value at final follow-up of 32.1-65.9%. In a subgroup analysis, significantly lower pre-operative function was noted in the instability cohort compared to the impingement cohort as measured by HOS SS only, p=0.004. Post-operatively this instability cohort demonstrated significantly worse outcomes as measured by mHHS, HOS ADL and iHOT33. Rate of re- revision arthroscopy was 6.4% and 8.7% of patients required THA or were planning soon.

Conclusions:

The most common indication for revision hip arthroscopy in the treatment of femoroacetabular impingement remains residual impingement. Capsular complications have significant consequence for function and may represent a subset of patients who demonstrate more dysfunction both before and after revision arthroscopy. Lastly, heterotopic ossification is third most common reason for revision hip arthroscopy underlining the importance of postoperative prophylaxis.
Poster 228: Hamstring Muscle Injuries in Major League Soccer: An Analysis of Injury Rate, Associated Factors, and Return to Play
Authors: Gamsarian Vahram , Mirle Vikranth , Krishnan Aditya , Levine Zachary , Berlinberg Elyse , Giza Eric , Putukian Margot , Silvers Holly , Mandelbaum Bert , Group Forsythe
Published: August 2023

Objectives:

To examine (1) the rate and time to return to play (RTP) after hamstring muscle injury, (2) investigate the rate of reinjury after RTP, and (3) investigate conditions that are associated with increased severity of injury or increased time to RTP.

Methods:

MLS Injury Surveillance database was queried for all athletes with hamstring injuries from 2010-2021 were included and categorized by severity. A hamstring injury was defined as an incident that required medical attention and involved the biceps femoris, semimembranosus, or semitendinosus. Demographic characteristics and injury characteristics (setting of injury, activity during onset, severity, management, RTS, and re-injury) were collected and used for descriptive analysis.

Results:

A total of 2865 injuries were recorded between 2010 and 2021, from 1227 individual players. The average injured player age was 26.2 +/- 4.4 years, with an isolated biceps femoris injury (75.2%), occurring during a match (47.3%). The median time missed per injury was 11.0 days, with 28.2% of injuries resulting in no days missed, 52.7% were classified mild to moderate (4-28 days), and 19.2% severe (29-744 days). Average number of games missed, and practices missed per injury, were 1.3 +/- 2.3 and 4.0 +/- 7.5, respectively. Mean days missed increased significantly from 17.6 days for a hamstring injury occuring during 2010-2015 to 23.9 days for an injury occuring during 2016-2021 (p < 0.001). Overall hamstring re-injury rate was 52.4% (643), following a previously recorded index hamstring injury. Reinjury rate between 2010-2015 and 2016-2021 did not change significantly (50.2% vs. 51.6%, p = 0.4506). Factors associated with prolonged return to sport included acute injury onset (27.8 vs 21.9, p = 0.023), and match injury (24.9 vs 13.2, p <0.001). Position, field type, weather conditions, and in-game time of injury were not statistically significant.

Conclusions:

Between 2010 and 2021, hamstring injuries were one of the most common causes of missed time in MLS athletes. Acute onset and match injuries increased time to RTP by 27% (P = 0.023) and 89% (P < 0.0001), respectively. Furthermore, days missed increased for injuries during the 2010- 2015 and 2016-2021 seasons by 35.7% (p<0.001). The current findings emphasize the need for continued prevention and post-injury rehabilitation protocols and expectations. A reinjury rate as high as 50% likely contributes to longer rehabilitation timelines before RTP, however, further study is warranted given that reinjury rates did not decrease. [Table: see text]
Poster 241: Outcomes of Trochleoplasty for Recurrent Patellar Dislocation in Adolescents with Open Physes
Authors: Barras Laurel , Diduch David , Blanchard Neil
Published: August 2023

Objectives:

Patellofemoral dislocation, the most severe presentation on the spectrum of patellar instability, is most common in adolescent populations. Trochlear dysplasia is an integral component of the disorder, and procedures aimed at correcting instability by addressing this dysplasia are often necessary. A theoretical risk of injury to the distal femoral physis exists in these surgeries. At our institution, a thick-flap sulcus deepening technique is used to re-shape the trochlear groove. The risk of injury to the physis in this procedure is not clearly delineated in the current literature. We investigated the outcomes in adolescent patients undergoing this procedure, hypothesizing that patients with open distal femoral physes and less than 2 years of remaining growth can safely and successfully undergo thick-flap sulcus deepening trochleoplasty.

Methods:

Seventeen adolescents (21 knees) with open physes underwent thick-flap trochleoplasty at our institution. Preoperative radiographs were used to evaluate leg axis and patella alta. Preoperative MRI was used to determine trochlear dysplasia (sulcus depth, spur height, patellofemoral index) and tibial tuberosity to trochlear groove distance (TTTG) distance. Preoperative and postoperative AP and lateral radiographs were used to evaluate and compare the lateral distal femoral angle (LDFA) and Blumensaat’s angle (BA). Preoperative and postoperative IKDC and Kujala outcome scores were measured to evaluate clinical improvement.

Results:

Median age at time of operation was 14.9 years for girls and 15.5 for boys. Mean follow up was 5.4 years from surgery. At two-year follow up, growth plates were closed in all but one knee. No clinical differences to the leg length or alignment were appreciated. There was no statistically significant change in lateral distal femoral angle (mean change 0.74 degrees, p = 0.1074). There was a statistically significant change in Blumensaat’s angle (mean change 0.89 degrees, p = 0.0477). Mean Kujala score improved significantly from 60.19 preoperatively to 90.36 postoperatively, p= 0.0008. Mean IKDC score improved significantly from 59.37 preoperatively to 87.21 postoperatively, p = 0.00064. There was recurrent instability in one knee, requiring revision surgery with distal femur and Fulkerson osteotomies.

Conclusions:

Adolescent patients nearing skeletal maturity can safely and successfully undergo thick- flap sulcus deepening trochleoplasty for patellar instability resulting from trochlear dysplasia. At follow- up, there was no clinical evidence of growth disturbances, and postoperative imaging demonstrated less than 1 degree difference in LDFA and BA at skeletal maturity, which are unlikely to be of clinical significance. These findings should be interpreted very carefully, as specific patient selection, trochleoplasty expertise, and extreme caution are still necessary to prevent iatrogenic injury to the distal femoral physis.
Poster 260: Influence of Donor Demographics on Graft Survival following Knee Osteochondral Allograft Transplantation
Authors: Hevesi Mario , Wagner Kyle , Frazier Landon , Meeker Zachary , Kaiser Joshua , Yanke Adam , Cole Brian , Quigley Ryan
Published: August 2023

Objectives:

To evaluate whether donor and recipient factors such as donor age, sex mismatch, and time from death to graft implantation affect graft survival following knee osteochondral allograft (OCA) transplantation.

Methods:

Patients undergoing OCA transplantation in the knee from 2003-2016 were prospectively followed. Inclusion criteria consisted of primary OCA transplantation and minimum 2-year follow-up. Patient and donor demographic data were collected. Patients were evaluated for failure, defined as (1) subchondral collapse of the OCA as confirmed on postoperative MRI scans, or via second-look arthroscopy in the setting of persistent symptoms, (2) removal or revision of the primary OCA, or (3) conversion to arthroplasty. Multivariate cox proportional hazards modelling was utilized to evaluate associations between demographic variables and graft failure.

Results:

A total of 220 patients undergoing OCA transplantation met inclusion criteria and were followed for a mean of 5.9 ± 2.8 years (range: 2.0 – 16.3, Table 1). The most common concomitant procedure was meniscal allograft transplantation (Table 2). A mismatch in donor and recipient sex was present for significantly more female patients (65%) than male patients (10%, p < 0.001). The mean days from donor death until implantation was 24.1 days (range: 15 – 28). Thirty-nine patients (18%) met criteria for graft failure at a mean of 4.3 ± 3.2 years (Table 3). Log-rank testing did not determine a difference in survivability between those with a donor-recipient sex mismatch for female or male patients (P = .130 and .831, respectively). Upon multivariate cox regression, no association existed between donor-recipient sex mismatch or time from donor death to implantation with graft survival. Of note, increased donor age was associated with failure for female patients (P = .020) and trended towards significance in males (P = .166).

Conclusions:

OCA graft survival appears to be most strongly influenced by donor age. In contrast to previous historic data, no substantial survival difference was noted for sex mismatched donors and recipients. These data can help inform graft selection and outcome optimization following OCA. [Table: see text][Table: see text][Table: see text]
Poster 279: A NOVEL MAGNETIC RESONANCE IMAGING MARKER FOR ANTERIOR INSTABILITY OF THE LATERAL MENISCUS
Authors: Kinnard Matthew , Hoyt Benjamin , Murphy Timothy , Niu Emily
Published: August 2023

Objectives:

Anterior instability (AI) of the lateral meniscus is potentially debilitating in young patients. The lack of reliable and accurate Magnetic Resonance Imaging (MRI) findings limits the ability to preoperatively recognize AI. The goal of this study is to present a novel MRI finding (phantom sign) for AI of the lateral meniscus.

Methods:

Two independent blinded reviewers performed retrospective review of preoperative MRI for all patients who underwent lateral meniscus repair between 7/1/2019 and 3/31/2022 by a single fellowship trained surgeon. Positive phantom sign was defined as attenuated or decreased signal intensity along the anterior horn of the lateral meniscus on a single coronal cut at the anterior tibial insertion of the ACL. The lateral meniscus was also evaluated on coronal MRI for lateral extrusion, posterior displacement and posterior “megahorn” on sagittal cuts, and increased fluid signal adjacent to the anterior horn or a radial tear at the anterior root on axial cuts. Intraclass Pearson correlations were calculated for inter and intra-rater reliability in assessment for presence of pathology on MRI. Predictive ability of each imaging finding with at least good (ICC 0.6 or above) reliability was also evaluated by comparing MRI and documented intraoperative findings.

Results:

55 patients with preoperative MRIs of arthroscopically repaired lateral meniscus tears were included. 21 patients (38.2%) were female with median age 15.0 years (range 10.5-16.0). 26 patients (47.3%) had a discoid lateral meniscus (DLM). Lateral meniscus AI was present on arthroscopy for 25 knees (45.5%) and among these 18 had concurrent DLM. Intraclass correlation was good for phantom sign (ICC 0.75, 95% CI 0.60-0.84), lateral extrusion (ICC 0.60 95% CI 0.41-0.75), posterior displacement (ICC 0.71, 95% CI 0.55-0.82), and posterior “megahorn” (ICC 0.76, 95% CI 0.62-0.85). On predictive analysis, phantom sign was 95.0% sensitive and 74.2% specific for lateral meniscal anterior instability. Posterior displacement and posterior megahorn were specific for anterior instability (both 93.3%) though with limited sensitivity (32.0% and 28.6%, respectively).

Conclusions:

Phantom sign is a reliable and sensitive MRI finding for AI, even in the absence of frank displacement of the meniscus, and should prompt thorough arthroscopic evaluation for this pathology. It may help guide treatment decision-making and preoperative planning, which may in turn improve patient outcomes and reduce complications of untreated anterior instability. [Table: see text][Table: see text][Table: see text]
Poster 291: Ultrasound-based patellar glide test: A new dynamic assessment of patellar instability
Authors: Hammerle Maria Virginia Velasquez , Rangaswamy Dharsini , Berkson Eric , Babu Ashwin , Tanaka Miho
Published: August 2023

Objectives:

Patellar instability can be difficult to assess due to the dynamic nature of this condition. While MRI and CT can demonstrate the morphology of the patellofemoral joint, the assessment of instability relies on dynamic testing. The patellar glide test is commonly utilized as a method of dynamic assessment on physical examination, yet precise quantification with this method remains difficult. Recently, cadaveric studies have demonstrated the utility of ultrasound in quantifying patellar translation. Therefore, our study aimed to apply the ultrasound-based patellar glide test to determine its utility in differentiating between knees with and without patellar instability in a clinical population.

Methods:

Patients with recurrent patellar instability were included in this study. Using a portable device, the ultrasound-based patellar glide test was performed with the knee in extension, and patellar position was visualized with and without a manual lateralizing force. The ultrasound probe was placed at the medial patellofemoral joint to visualize the relation of the medial patellar facet to the medial trochlea. Descriptive statistics were used to describe patellar position in the unloaded and loaded states, and patellar translation was calculated as the difference between the loaded and unloaded positions. Values were compared between symptomatic and asymptomatic knees. For each measurement of translation, receiver operating characteristic (ROC) curve analysis was performed. Youden’s J statistic was calculated to determine the optimal cutoff values to distinguish between asymptomatic vs symptomatic knees.

Results:

50 knees from 25 patients (17F, 8M, mean age 26.9+/-9.4) were included in this study, of which 29 knees were unstable and 21 were stable and asymptomatic. When comparing symptomatic and asymptomatic knees, patellar position in the unloaded (4.6+/-2.8mm vs 3.8+/-2.3mm, p=0.277) and loaded states (1.1+/-3.24mm, 2.1+/-2.5mm, p=0.252) were not significantly different. Patellar translation was found to be significantly different between the symptomatic and asymptomatic states (3.5+/-2.2mm vs 1.7+/-1.5mm, p=0.002). ROC curve analysis demonstrated that patellar translation >3mm detected the presence of patellar instability with AUC 0.88 (95% CI 0.77, 0.98). 3mm translation was found to identify patellar instability with sensitivity 43.4%, specificity 95.2%, PPV 90.9%, and NPV 60.6%.

Conclusions:

The ultrasound-based patellar glide test was found to differentiate between symptomatic and asymptomatic knees in patients with patellar instability with high accuracy. Given the increasing availability of portable ultrasound devices and the need for quantification of patellar laxity, further studies are recommended to evaluate the role of this method of assessment in the diagnosis and management of patellar instability.