bluuebunny/crossref_metadata_2025 huggingface dataset:
Poster 205: Performance and Return to Sport Following Medial Ulnar Collateral Ligament Repair with Internal Brace Augmentation in Professional Baseball Players
Authors: Singh Akash , Fares Mohamad , Abboud Joseph , Ramsey Matthew , Erickson Brandon , Khan Adam
Published: August 2023

Objectives:

Medial ulnar collateral ligament (UCL) reconstruction (UCLR) has been the gold standard treatment for symptomatic UCL injuries in throwing athletes. Recently, a novel technique of UCL repair with suture augmentation has been described and shown promising biomechanical as well as clinical results in a few small series of nonprofessional athletes. An added advantage of this technique over UCLR is that it affords the potential ability to return to competitive throwing with an accelerated timeline of 6-7 months as opposed to 12-18 months. No prior work has described the outcomes of this technique in professional athletes. This study aimed to evaluate the frequency and rate of return to prior level of sport as well as athletic performance of professional baseball players following UCL repair with Internal Brace augmentation.

Methods:

This study included all professional Major League Baseball (MLB) and Minor League Baseball (MiLB) players who underwent primary UCL repair with Internal Brace from January 2016 to June 2021. Demographic and performance data were recorded for each player. Performance metrics were then compared from one year preinjury against one year postoperative metrics. The return to play date was recorded. Univariate statistical analysis was performed to compare preinjury to postoperative performance (p< 0.05 considered statistically significant).

Results:

Fifteen players met inclusion criteria (8 MLB and 7 MiLB). Mean age was 28.2 +/- 4.06 years at time of surgery. There were 10 pitchers and 5 position players. All injuries were to the dominant extremity. No players underwent revision surgery during the study period. 93.3% (14/15) of players returned to sport and eventually prior level of competition. Average time to return to sport was 11.5 +/- 4.27 months and average time to prior level of competition was 12.1 +/- 4.61 months. When comparing competitive performance of players that returned successfully, one year preinjury to one year postoperatively, there was no statistically significant difference observed in performance [Table 1].

Conclusions:

This study demonstrates promising early results of UCL repair with Internal Brace augmentation in professional baseball players. 93.3% of players were able to return to sport in under 12 months. All players, pitcher and position, that returned to sport were able to return to their prior level of play. No statistically significant drop in performance was observed in players that were able to return to play. Further clinical evaluation of UCL repair with Internal Brace augmentation and direct comparison of this procedure with UCL reconstruction is warranted. [Table: see text]
Poster 206: What are the Indications for Medial Ulnar Collateral Ligament Surgery in Baseball Players? An MRI Case-based Study
Authors: Smith Matthew , Freehill Michael , Camp Christopher , Erickson Brandon , Sciascia Aaron , Da Silva Adrik , Chalmers Peter , Bowman Eric
Published: August 2023

Objectives:

Ulnar Collateral Ligament (UCL) tears are common in baseball players. When non-operative management fails; reconstruction or repair may be necessary to restore physical function. There is no clear consensus regarding the indications for surgery based on magnetic resonance imaging (MRI) tear characteristics, or the indications for selecting repair over reconstruction. The purpose of this study was to define the indications for UCL surgery based on MRI and to elucidate indications for UCL repair vs reconstruction.

Methods:

Twenty-six orthopaedic surgeons who treat baseball players were surveyed. Forty-five MRIs were reviewed: 15 without UCL tears, 15 with intra-operatively confirmed partial-thickness tears, and 15 with full-thickness tears. Factors investigated included ligament characteristics (peri-ligamentous or osseous edema, ligament hypertrophy, calcification, partial or full-thickness tearing) and location (proximal, mid-substance, or distal). Surgeons were given a clinical scenario and asked whether 1) surgery was indicated and 2) whether repair or reconstruction was recommended. Odds ratios (OR) and 95% confidence intervals (95%CI) helped identify significant predictors for both queries.

Results:

The odds of recommending surgical treatment compared to non-operative treatment were 2.4x more likely for a proximal partial-thickness tear, 3.2x for distal partial-thickness tear, 5.1x for distal full- thickness tear, and 7.0x for proximal full-thickness tear (p<0.001). Significant indications for repair included distal partial (OR=1.6, 95%CI 1.0, 2.1, p<0.001) and full-thickness tears (OR=1.7, 95%CI 1.1, 2.3, p<0.001). Repair was 3x less likely recommended for mid-substance full-thickness tears (OR=3.0, 95%CI - 5.0, -1.0, p=0.004). Ultrasound stress testing was requested in 78% of partial tears.

Conclusions:

Among surgeons surveyed, the highest odds for recommending operative treatment were proximal full-thickness tears, then distal full-thickness, distal partial-thickness, and proximal partial- thickness tears. Repair was most appropriate for partial and full-thickness distal tears, but relatively contraindicated for complete mid-substance UCL tears. Ultrasound stress testing was frequently requested for partial tears. Given the lack of consensus among surgeons, future prospective registries are necessary to determine whether these factors associate with clinical outcomes. [Table: see text]
Poster 208: Clinical Outcomes Following Ulnar Collateral Ligament Reconstructions with Concomitant Ulnar Nerve Transposition in Overhead Athletes: A Matched Cohort Analysis
Authors: Ciccotti Michael , Johnson Emma , Erickson Brandon , Dodson Christopher , Cohen Steven , Ciccotti Michael , Ciccotti Michael , Lynch Jeffrey
Published: August 2023

Objectives:

Injury of the ulnar collateral ligament (UCL) has become increasingly common, particularly in overhead athletes. There is no consensus on management of the ulnar nerve in UCL reconstruction (UCLR) in patients with pre-operative ulnar nerve symptoms, as literature supports both not decompressing the nerve as well as ulnar nerve transposition (UNT). The purpose of this study is to compare subjective clinical outcomes and return to play metrics between patients who received UNT during UCLR and a matched cohort who underwent UCLR alone. We hypothesized that there would be no significant difference in patient outcomes or return to sport (RTS) metrics between the cohorts.

Methods:

Using an institutional database, patients who underwent UCLR with UNT between 2007 and 2017 were retrospectively identified. These patients were matched based on sex, age at surgery (± 3 years), and BMI (± 2) to a comparison group that underwent UCLR alone. Patients completed the Kerlan Jobe Orthopaedic Clinic Shoulder & Elbow score (KJOC), the Timmerman and Andrews elbow score, the Conway-Jobe scale, and custom patient satisfaction and return to play questionnaires.

Results:

Thirty patients who underwent UCLR with concomitant UNT and 30 matched patients who underwent UCLR without UNT were available for follow up at a mean of 6.9 and 8.1 years respectively. The UNT group reported similar KJOC (78.4 in UNT vs 76.8; P=0.780), Conway-Jobe (60% excellent in UNT vs 77% excellent; P=0.504), Timmerman and Andrews (86.2 in UNT vs. 88.8; P=0.496), and satisfaction scores (85.3% in UNT vs. 89.3%; P=0.512) compared to UCLR group. In terms of RTS rate (84% in UNT vs 93%; P=0.289) and duration required to RTS (11.1 months in UNT vs 12.5 months; P=0.176), the two groups did not significantly differ. Finally, despite significant differences in preoperative ulnar nerve symptoms (100% in UNT vs 7% in UCLR; P<0.001), the two groups did not statistically differ in the proportion of patients that experienced post-operative ulnar nerve symptoms (13% in UNT vs 0%; P=0.112)

Conclusions:

This matched cohort analysis showed no statistically significant differences in patient reported outcomes and return to sport between patients undergoing UCLR with and without UNT. [Table: see text]
Poster 209: Physical Examination vs Ultrasonography for Detection of Ulnar Nerve Subluxation in Professional Baseball Pitchers
Authors: Day Hannah , Reddy Manoj , Paul Ryan , Nazarian Levon , Cohen Steven , Looney Austin
Published: August 2023

Objectives:

Despite the importance of accurately detecting the presence of ulnar nerve subluxation in vulnerable athletes, minimal research has compared the performance of physical examination and ultrasound in professional baseball pitchers. Therefore, the purpose of this study was to characterize the diagnostic validity of physical examination in the detection of ulnar nerve subluxation at the cubital tunnel of the elbow compared with ultrasound.

Methods:

Physical and sonographic examinations for ulnar nerve subluxation were performed on 186 elbows of 95 consecutive male professional baseball pitchers (ages 17 to 30 years) as a routine part of Spring Training assessments. Provocative maneuvers consisting of Tinel’s test and the elbow flexion compression test were evaluated over the cubital tunnel. The validity of physical examination for detecting ulnar nerve subluxation at the elbow was determined using ultrasound as the gold standard for comparison.

Results:

Ulnar nerve subluxation was detected by physical examination in 58 (31.2%) elbows and by ultrasonography in 61 (32.8%) elbows. Of the 58 elbows with positive physical examination, 47 were positive on ultrasound. The accuracy of physical examination was 86.6%, with 77.0% sensitivity and 91.2% specificity. The positive and negative predictive value of physical examination were 81.0% and 89.1%, respectively. There was no relationship between nerve instability and positive provocative tests overall, in dominant vs nondominant arms, or in right vs left arms (all P > .05).

Conclusions:

Physical examination has moderate sensitivity and high specificity for detecting ulnar nerve subluxation at the cubital tunnel of the elbow when compared with ultrasound. These findings suggest that when detecting the presence of a subluxating ulnar nerve is most important, it may be advisable to obtain an ultrasound evaluation instead of relying on physical examination; however, physical examination alone may be appropriate for ruling out subluxation. [Table: see text]
Poster 234: Minimum 10-Year Clinical Outcomes and Survivorship of Meniscal Allograft Transplantation with Bone Fixation
Authors: Kaiser Joshua , Frazier Landon , Quigley Ryan , Cotter Eric , Hevesi Mario , Gilat Ron , Meeker Zachary , Yanke Adam , Cole Brian , Wagner Kyle
Published: August 2023

Objectives:

Meniscal allograft transplantation (MAT) can reliably reduce pain and improve function in symptomatic patients with meniscal insufficiency without diffuse chondral wear. Ten-year survival rates following MAT have been estimated to be as high as 74%, though previous studies have been limited to small sample sizes or pooled outcomes including patients who have less than 10-year minimum follow- up. The purpose of this study was to report on clinical outcomes and survivorship following primary meniscal allograft transplantation in a large cohort of patients with 10-year minimum follow-up.

Methods:

A retrospective review of prospectively collected data was performed to identify patients undergoing primary MAT from 1999-2012. Lysholm, International Knee Documentation Committee (IKDC), and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales were collected preoperatively and at 1-, 2-, 5-, and minimum 10-year follow-up. Cox proportional hazards modelling was utilized to identify variables associated with reoperation and failure. Failure was defined as revision MAT or conversion to unicompartmental or total knee arthroplasty (UKA and TKA, respectively). Reoperation was defined as a subsequent surgical intervention of the transplanted meniscus, including partial or total meniscectomy, meniscal repair, or failure as defined above.

Results:

A total of 143 patients undergoing primary MAT met inclusion criteria and were followed for a mean of 12.8 ± 2.7 years (range: 10.0 - 21.0). Concomitant procedures were performed in 96 (67%) patients, the most common being osteochondral allograft transplantation (n=50, 35%) (Table 1). Patients demonstrated statistically significant (p ≤ .037) postoperative improvements in all patient- reported outcome measures at all time points, compared to baseline (Figure 1). Fifty-four patients (38%) underwent a meniscal reoperation at a mean time of 6.5 ± 5.4 years (range: 0.3 – 16.7) postoperatively, with the most common reoperation procedure being partial meniscectomy (n=27, 19%). Thirty-five (24%) patients met criteria for failure at a mean time of 7.2 ± 4.9 years following MAT (range: 1.0 - 16.5). Twelve (8%) patients underwent revision MAT, and 23 (16%) underwent conversion to arthroplasty. MAT survival free of meniscal reoperation and failure was 73% and 83% at 10 years and 58% and 69% at 15-years, respectively (Figure 2). At the time of final follow-up, 88% of patients reported being satisfied with their overall postoperative condition.

Conclusions:

Primary MAT demonstrates efficacy and durability with high rates of patient satisfaction at minimum 10-year follow-up. Patients should be counseled that while reoperation rates may approach 42% at 15 years, overall revision rates (8%) and conversion to arthroplasty (16%) remain low at long- term follow-up. [Table: see text]
Poster 242: Predictors of the Ten-Year Patient-Reported Outcome Measures After Collagen Meniscus Implant (CMI) for Partial Meniscus Deficiency
Authors: Lucidi Gian Andrea , Zaffagnini Stefano , Agostinone Piero , Fabbro Giacomo Dal , Pizza Nicola , Di Paolo Stefano , Grassi Alberto
Published: August 2023

Objectives:

Collagen Meniscus Implant (CMI) is considered an effective procedure for reducing knee pain and improving knee function after previous meniscectomy. Nevertheless, the current knowledge regarding the clinical results of CMI are limited to small case series at short- to mid-term follow-up studies. The goal of the present study was to evaluate clinical outcomes, reoperations, and failures of CMI at a minimum 10 years of follow-up.

Methods:

Consecutive patients who underwernt CMI at a single institution were screened for elegibility. Inclusion criteria for the present study were (1) Medial or Lateral CMI, (2) Isolated or combined procedure with ACL reconstruction, knee osteotomy or cartilage treatment, (3) follow-up between 10 and 15 years. Demographics and surgical details were obtained via chart review. Patients were asked if they were satisfied with the procedure and were evaluated with the Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, and Tegner score at the final follow-up. Survival analysis was performed with Kaplan-Meier curve, and clinical scores were analyzed based on the Patient Acceptable Symptom State (PASS).

Results:

A total of 92 patients (mean age, 42.8 years) were included in the analysis. A significant improvement in all the clinical scores was reported between the preoperative evaluation and the last follow-up. A chondropaty with outerbridge grade ≥III was associated with significantly overall lower clinical score, while a timing from meniscectomy to CMI implant to ≥5 years determined more pain at rest and lower score in the KOOS quality of life. Overall, 25% of patients did not achieved the PASS for Lysholm score and a percentage variable from 19% (KOOS Pain) and 40% (KOOS Symptoms) did not achieved the PASS in the KOOS subscales. Chondropaty with outerbridge grade ≥III was associated with an higher Risk of not achieving the PASS in all the KOOS subscales, while an age at surgery ≥45 years was resulted in a lower risk of not achieving PASS in the pain subscale. At the last follow-up 63% of patients returned to sport practice after CMI implantation, with 41% at the same or higher level. Finally, 80% of the patients were satisfied with the procedure

Conclusions:

CMI provided satisfactory results in terms of function, symptoms, sports and quality of life in 60% to 80% of the patients after more than 10 years of follow-up with clinical scores still higher compared to the preoperative evaluation. The cartilage status and the time from meniscectomy have shown to impact negatively on the outcomes, while an age >45 years was associated with less pain. [Table: see text][Table: see text]
Poster 244: A Retrospective Analysis of Bucket Handle Meniscus Tear Repair Outcomes
Authors: Gupta Puneet , Reynolds Alan , Taber Caroline , Saltzman Bryan , Popkin Charles , Trofa David , Mehta Apoorva
Published: August 2023

Objectives:

Bucket handle meniscal tears are a challenging clinical entity with a failure rate as high as 34.5%, which is in stark contrast from the estimated 5% for more simple tear patterns. There are limited data on patient or surgical factors that affect failure. The purpose of this study is to characterize patient and surgical variables that impact two main outcomes: return to sport and revision surgery following surgical repair for bucket handle meniscus tears.

Methods:

A retrospective review of all meniscus repairs from 1/1/11 to 1/1/21 was performed for a single institution, and all bucket handle meniscus repairs were included in the study. Demographic information was collected along with injury characteristics and surgical techniques. Outcomes included return to sport and need for revision surgery. Patients with more than 50% of data missing for the variables of interest were removed from the study. Patients without follow-up notes were excluded from return to sport analysis. Failure rate was defined by either a documented re-tear of the former bucket handle meniscus or a revision surgery.

Results:

There were 205 patients included in the final analysis, with an average of age of 24.42 and 76.39% male, with an average follow-up time of 12.52 months. Demographic and clinical characteristics are summarized in Table 1. Operative characteristics are summarized in Table 2. Of the 117 patients that played sports with available follow-up data, 90 (76.9%) returned to sport and 27 did not (23.1%) with an average follow-up time of 15.01 months. Average return to sport time was 7.21 months +/- 3.77 months. Twelve (13.8%) patients that returned to sport and 12 (44.4%) of the patients who did not underwent future meniscectomy or revision repair surgery. Overall failure rate was 19.0%. The rate of failure of combined all-inside and outside-in technique (33.33%) was higher than rate of failure in all-inside technique alone (14.17%). In a bivariate analysis of risk factors for failure, the variables for age, sex, smoking, BMI, ASA classification, mechanism of injury, and symptom duration before surgery were not found to be statistically significantly different between patients who failed and did not fail repair.

Conclusions:

The overall return to sport rate after bucket handle meniscus tear repair in this study was found to be 76.9 with an average return to sport time of 7.21 months. The overall failure rate was found to be 19.0% with an average follow-up time of 12.52 months. Further studies are needed to better understand outcomes following bucket handle meniscus repairs. [Table: see text][Table: see text]
Poster 249: Low Failure Rate in a Young Cohort of Patients Undergoing Anterior Cruciate Ligament Reconstruction with Quadriceps Tendon is Independent of Graft Fixation Methods
Authors: Herman Zachary , Drain Nicholas , Nazzal Ehab , Ramraj Raghav , Steuer Fritz , Lesniak Bryson , Musahl Volker , Hughes Jonathan , Dadoo Sahil
Published: August 2023

Objectives:

To determine failure and clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon in a young cohort of patients, and, secondarily, determine if method of femoral and tibial fixation of the graft affects these outcomes.

Methods:

All patients aged 10-30 years old who underwent primary ACLR with quadriceps tendon autograft from 2010 to 2021 were retrospectively analyzed. Patients with double-bundle ACLR, posterolateral corner augmentation, and revision ACLR were excluded. Patient demographics, surgical details, ACLR failure, and pre- and post-operative International Knee Documentation Committee (IKDC) scores were recorded. The primary outcome was ACLR failure and secondary outcome was post- operative IKDC score. Patients were further categorized into three groups based on femoral and tibial fixation: suspensory/suspensory (Group 1), suspensory/aperture (Group 2), and aperture/aperture (Group 3). Suspensory fixation included fixed loop, adjustable loop, and screw and washer fixation, whereas aperture fixation included use of interference screw. Chi Squared analyses were used to analyze categorical outcomes, and ANOVA and Kruskal-Wallis tests were used to analyze continuous outcomes. Significance was set at p < 0.05.

Results:

A total of 350 patients were included for analysis. The average age of the cohort was 19.4 (+/- 4.3) years old, and the average follow-up length was 12.6 (+/- 7.0) months. BMI, sex, and laterality of procedure were statistically similar. ACLR failure rate in the cohort was 4.9% overall, and mean post- operative IKDC score was almost two times higher than mean pre-operative IKDC score (76.2 vs 38.8, respectively). When dividing the cohort based on fixation type, 122 patients had femoral and tibial suspensory fixation, 191 patients had femoral suspensory and tibial aperture fixation, and 37 patients had femoral and tibial aperture fixation. ACLR failure rate was statistically similar across groups (6.6% (1), 4.7% (2), 0% (3); p > 0.05). Further, post-operative IKDC scores did not differ significantly across groups (74.2 (1), 77.1 (2), 79.2 (3); p > 0.05).

Conclusions:

Results of this study suggest that quadriceps tendon autograft is a viable option for ACL reconstruction in young patients, as demonstrated by a low failure rate and marked increase in IKDC score post-operatively. The follow-up interval in this study was short, however, and slightly increased failure rates may be observed over time. Femoral and tibial fixation methods in this study did not influence failure rate or IKDC scores, suggesting they may not play a role in post-operative success following quadriceps tendon ACLR. Surgeons may utilize the information in this study during pre- operative planning and discussion of graft options with their patients.
Poster 255: Socioeconomic Predictors of Time to Initial Evaluation, Time to Surgery, and Postoperative Outcomes among Medial Patellofemoral Ligament Reconstruction Patients
Authors: Avila Amanda , DeClouette Brittany , Vasavada Kinjal , Jazrawi Isabella , Alaia Michael , Strauss Eric , Campbell Kirk , Shankar Dhruv
Published: August 2023

Objectives:

Operative management of patellar instability with medial patellofemoral ligament reconstruction (MPFLR) has been associated with good results, but socioeconomic disparities may be an obstacle to patients receiving timely care and achieving satisfactory outcomes. The purpose of this study was to identify socioeconomic predictors of time to initial evaluation, time to surgery, and postoperative outcomes among lateral instability patients undergoing MPFLR.

Methods:

We conducted a retrospective review of patients at our institution who underwent primary MPFLR with allograft from 2011 to 2019. Patients were administered an email survey to assess symptom history, socioeconomic variables (ex. language, race, ethnicity, marital status, household size), and postoperative outcomes including Visual Analog Scale (VAS) pain, Kujala score, MPFL-Return to Sport After Injury (MPFL-RSI) score, and return to work and sport. Predictors of time to initial evaluation, time to surgery, concomitant procedures, and postoperative outcomes were identified using multivariable linear and logistic regression with stepwise selection. P-values less than 0.05 were considered significant.

Results:

Seventy patients were included in the cohort (mean age 24.8 years, 72.9% female, mean follow- up time 45.7 months). Mean time to evaluation was 6.4 months (range 0-221) and mean time to surgery was 73.6 months (range 0-444). Home ownership was predictive of reduced time to surgery (β: -56.5 [- 104.7 to -8.3]; p = 0.02). Non-white race was predictive of increased odds of undergoing a concomitant procedure (OR: 12.4 [1.8 to 83.4]; p = 0.01). Full-time employment was predictive of higher satisfaction (β: 14.1 [4.3 to 23.9]; p = 0.006) and higher Kujala score (β: 8.7 [0.9 to 16.5]; p = 0.03).

Conclusions:

Certain markers of higher socioeconomic status, including home ownership and full-time employment, were predictive of higher satisfaction and knee function following MPFLR for patellar instability. Non-white race was associated with higher risk of concomitant procedures. Identifying modifiable socioeconomic risk factors for delayed presentation and poorer surgical outcomes may allow surgeons to prioritize earlier intervention among the most vulnerable segments of their patient population.
Poster 287: The 5-Factor Modified Frailty Index (mFI-5) Predicts Adverse Outcomes After Arthroscopic Meniscectomy
Authors: Elali Faisal , Patel Neil , Krasnyanskiy Benjamin , Mai David , Urban William , Wolfert Adam
Published: August 2023

Objectives:

This study sought to determine associations between mFI-5 score and 30-day adverse outcomes after arthroscopic meniscectomy.

Methods:

The National Surgical Quality Improvement Program (NSQIP) database was queried to identify all patients who underwent arthroscopic meniscectomy using Current Procedural Terminology (CPT) codes 29880 and 29881. Patients were included between 2005 and 2009. Patients were included if they were 50 years old or older. The mFI-5 score was calculated for each patient using variables present in NSQIP. Multivariate logistic regression models were utilized to identify the associations between mFI-5 scores and 30-day rates of overall complications, readmissions, reoperations, and mortality.

Results:

41,102 patients were included. This included 21,102 patients with an mFI-5 score of 0, 15,438 with a score of 1, 4,641 with a score of 2, and 265 with a score of 3 or higher (3+). 388 patients experienced a complication, 275 experienced readmission, 4,675 experienced reoperation, and 9 experienced mortality within 30-days of surgery. Regression revealed that an mFI-5 score of 3+ was associated with an increased risk of overall complications (OR: 3.9; CI: 2.0-7.8; p<0.001). An mFI-5 score of 1 and 2 was associated with an increased risk of reoperation (OR: 1.2; CI: 1.1-1.3; p<0.001) (OR: 1.2; CI 1.1-1.3; p<0.001). An mFI-5 score of 1 (OR: 2.1; CI: 1.6-2.8; p<0.001), 2 (OR: 2.3; CI: 1.6-3.4), and 3+ (OR: 14.7; CI: 8.2-26.1; p<0.001) were all predictive of readmission. No mFI-5 score was predictive of mortality.

Conclusions:

mFI-5 scores were predictive of adverse outcomes within 30-days of arthroscopic meniscectomy, especially overall complications and readmissions. Further research is warranted into the development of patient risk stratification tools as well as on the impact of patient comorbidities on the rates of subsequent reoperations and mortality. Patients should be counseled on the increased risk of adverse events presented by medical comorbidities and should be optimized in regards to chronic conditions.
Poster 289: Time to Achievement of Clinically Significant Outcomes Following Isolated Arthroscopic Meniscal Repair
Authors: Gamsarian Vahram , Krishnan Aditya , Mirle Vikranth , Levine Zachary , Berlinberg Elyse , Chahla Jorge , Yanke Adam , Cole Brian , Verma Nikhil , Group Forsythe
Published: August 2023

Objectives:

To comprehensively define the time required to achieve outcomes (CSOs) after arthroscopic meniscal repair (AMR). The primary outcome was to identify an evidence-based timepoint for functional recovery, including the time needed to attain minimally clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for isolated AMR.

Methods:

Patients who underwent isolated AMR between 2015 and 2021 were collected. Those with completed preoperative and at least 1 post-operative (6-month, 1 year, and 2 years) Patient-Reported Outcome Measures (PROMs), including International Knee Documentation Committee (IKDC), Patient- Reported Outcomes Measurement Information System Physical Function (PROMIS PF), or Knee Injury and Osteoarthritis Outcome Score (KOOS) were included. Exclusion criteria included patients with significant concomitant ligament procedures, concomitant meniscectomies, or prior ipsilateral knee surgery. MCID and PASS for each PROM were identified from prior literature and utilized as a threshold needed to attain functional recovery. The time needed to achieve CSO was then calculated and plotted using Kaplan-Meier survival analysis.

Results:

Of the 71 included patients (33.8% female, age: 30±14.9 years), 69 patients had completed IKDC forms, and 41 had completed PROMIS PF forms. Patients attained IDKC achievement rates of 84% for MCID and 68% for PASS, and PROMIS PF achievement rates of 80.5% for MCID and 78% for PASS. Median achievement time across all surveys (IKDC, PROMIS PF, and KOOS) ranged between 5.27 - 5.31 months for MCID, and between 5.21–5.40 months for PASS. Averages for achievement time for MCID ranged from 6.28–8.20 months, and for PASS from 6.42 – 9.51 months, in respective PRO surveys.

Conclusions:

The majority of patients (72%) undergoing AMR achieved benefit within 6 months of surgery (overall median: 5.3 months), with diminishing proportions at later timepoints. The timeline for achieving improvement that was established by this study may aid in setting patient expectations and designing future outcome studies involving AMR.
Poster 306: Examining Preoperative Magnetic Resonance Imaging for Medial Meniscal Ramp Lesions in Patients Surgically Treated for Acute Grade III Combined Posterolateral Corner Knee Injuries
Authors: Jimenez Andrew , Katz Lee , Wang Annie , McLaughlin William , Gillinov Stephen , Kunze Kyle , Hewett Timothy , Alaia Michael , LaPrade Robert , Medvecky Michael , Moran Jay
Published: August 2023

Objectives:

While medial meniscocapsular tears ( ramp lesions) are commonly associated with isolated anterior cruciate ligament (ACL) injuries, there are limited descriptions of these meniscal injuries in multi-ligament knee injuries (MLKIs). The purposes of this study were: (1) To retrospectively evaluate preoperative MRIs for the presence of ramp lesions in patients surgically treated for acute grade III combined posterolateral corner knee injuries and (2) To determine if a preoperative posteromedial tibia plateau (PMTP) bone bruise is associated with the presence of preoperative ramp lesions on MRI in these same patients.

Methods:

Data on consecutive patients at a Level I trauma center with MLKIs between 2001 and 2021 were retrospectively reviewed. Only patients with acute grade III combined PLC injuries who received a magnetic resonance imaging (MRI) scan within 30 days of injury were assessed. Two musculoskeletal radiologists retrospectively reviewed each patient’s preoperative MRI for evidence of ramp lesions and bone bruises (Figure 1). Intra-class correlation coefficients (ICCs) were used to calculate reliability among the reviewers. Multivariate analysis was used to evaluate the relationship between bone bruising patterns and the presence of a ramp lesion on MRI.

Results:

Sixty-eight patients (79.4% male; mean age, 36.2 ± 13.7 years) with an acute grade III combined PLC injury were included in the study (Table 1). On MRI, the ICC for detection of ramp lesions and PMTP bone bruising were 0.921 and 0.938, respectively. Medial meniscal ramp lesions were diagnosed in 18/68 (26.5%). 11/18 (61.1%) patients with ramp lesions also showed evidence of PMTP bruising, while 13/50 (26.0%) patients without ramp lesions had PMTP bruising (P=0.008) (Table 2). When controlling for age and sex, PTMP bruising was significantly associated with the presence of a ramp lesion in combined PLC injuries (OR, 4.62; P=0.012) (Table 3).

Conclusions:

Preoperative medial meniscal ramp lesions were diagnosed on MRI in 26.5% of patients with acute grade III combined PLC injuries. In addition, PMTP bone bruising was significantly associated with the presence of a ramp lesion in patients with a grade III combined PLC injury. These findings demonstrate the need to assess for potential ramp lesions at the time of multi-ligament reconstruction. [Table: see text][Table: see text][Table: see text]
Poster 315: Fifteen-Year Radiographic Follow-Up of a Prospectively Randomized Clinical Trial Comparing Early versus Delayed Anterior Cruciate Ligament Reconstruction.
Authors: Miles Rebecca , Bottoni Craig , Wake Jeffrey , Cruz Christian
Published: August 2023

Objectives:

Post-traumatic osteoarthritis (PTOA) after anterior cruciate ligament (ALC) injury remains a difficult problem. PTOA is considered to be the consequence of an initial mechanical disruption or injury to the cartilage. Recent literature has suggested that 50-60% of reconstructed knees demonstrate post- traumatic arthritis at long term follow up. Several studies evaluating synovial fluid have suggested that inflammatory cytokines present after injury may contribute to post-traumatic arthritis. Therefore, the purpose of this study was to compare the rate of post-traumatic osteoarthritis between acutely reconstructed ACLs (within 21 days) and delayed ACL reconstructions (greater than 6 weeks).

Methods:

This study is a retrospective review of a previous prospectively randomized controlled clinical trial where ACL reconstructions were randomized to either early (within 21 days) or delayed (beyond 6 weeks) reconstruction using hamstring autograft. Bilateral weight bearing radiographs were obtained at a minimum of 15-year follow-up. Radiographs were analyzed using the Kellgren-Lawrence classification system by a musculoskeletal radiologist. Seventy patients were enrolled in the study and 1 was excluded because of infection. Therefore, the original study cohort consisted of sixty-nine patients (34 acute, 35 delayed) with an average of 27.3 years at the time of surgery. Follow-up radiographs were obtained for 58 total patients (28 acute, 30 delayed).

Results:

The average time from injury to surgery in the acute group was 9 days (2-18) and 85 days (42- 192) in the delayed group. At an average follow up of 15.6 years, post-operative radiographs were obtained in a total of 58 patients (28 acute, 30 delayed). In the acute cohort, 53.5% of patients had greater than Grade 3 PTOA compared to 60.0% in the delayed cohort (p=0.1). In the acute cohort, 42.8% (12/28) had Grade 3 PTOA and 10.7% (3/28) had Grade 4 PTOA compared to 46.7% (14/30) Grade 3 PTOA and 13.3% (4/30) Grade 4 PTOA in the delayed cohort (p=0.1). Four patients in the delayed cohort had undergone a total knee arthroplasty compared to 2 patients in the early cohort. In the acute cohort, the average KOOS score was 61.7% in patients with > Grade 3 PTOA compared to 80.6% in those with < Grade 3. In the delayed cohort, in the average KOOS was 56.8% in patients with > Grade 3 PTOA compared to 77.9 in those with < Grade 3.

Conclusions:

In conclusion, we found that early ACL reconstruction resulted in no difference in the rate of post-reconstruction osteoarthritis of the knee compared to delayed reconstruction. At fifteen-year radiographic follow-up, both cohorts resulted in high rates of post-traumatic osteoarthritis. Furthermore, patients with greater than Grade 3 PTOA demonstrated worse KOOS scores in both cohorts.
Poster 316: Increased tibiofemoral rotation angle is associated with graft failure after anterior cruciate ligament reconstruction
Authors: Merkely Gergo , Farina Evan , Smith Richard , Gortz Simon , Hazzard Sean , Asnis Peter , Lattermann Christian , Leite Chilan
Published: August 2023

Objectives:

Coronal and sagittal malalignment of the knee are well-recognized risk factors for failure after anterior cruciate ligament reconstruction (ACLR). However, the effect of axial malalignment on ACLR graft survival is yet to be determined. This study aimed to evaluate whether increased tibiofemoral rotational malalignment, namely tibiofemoral rotation angle (TFA) and tibial tubercle-trochlear groove (TT-TG) distance, is associated with ACLR graft failure.

Methods:

In this matched-control study, 151 patients who underwent revision ACLR due to graft failure (failure ACLR group) were compared to a matched-control group of 151 patients who underwent primary ACLR with no evidence of failure after at least 2-years follow-up (intact ACLR group). Patients were matched by sex, age, and meniscal injury during primary ACLR. Axial malalignment was assessed on preoperative magnetic resonance imaging (MRI) through the TFA and the TT-TG distance. Sagittal alignment was measured through posterior tibial slope (PTS) on MRI. Optimal TFA cutoff associated with graft failure was identified by a receiver operating characteristic (ROC) curve. Kaplan-Meier curve with log-rank analysis was performed to evaluate the influence of TFA on ACLR longevity.

Results:

In the failure ACLR group, mean TFA was 5.8 ± 4.5 (range, -5 to 16) degrees while this mean was 3.0 ± 3.3 (range, -3 to 15) degrees in the intact ACLR group (p<0.001). Neither TT-TG distance nor PTS presented statistical differences between the groups. ROC curve suggested an optimal TFA cutoff of 4.5 degrees for ACLR graft failure. Considering this as a threshold, patients who presented TFA ≥ 4.5 degrees had 6.6-times higher likelihood of graft failure compared to patients with TFA < 4.5 degrees (p<0.001). Survival analysis demonstrated a 5-years survival of 81% in patients with TFA < 4.5 degrees, while it was 44% when TFA ≥ 4.5 degrees (p<0.001).

Conclusions:

Increased TFA was associated with increased odds of ACLR failure when the TFA was ≥ 4.5 degrees. Measuring the TFA in patients with ACL tears undergoing reconstruction may inform the surgeon about additional factors that may require consideration prior to ACL reconstruction for a successful outcome.
Poster 344: Reduced Incidence of Anterior Cruciate Ligament Reconstruction Revision with Internal Brace Augmentation: A Retrospective Matched Cohort Study with a minimum 2-year Follow-up
Authors: Wijdicks Coen , Smith Patrick , Daniel Adam
Published: August 2023

Objectives:

The primary purpose of this study was to investigate retear rates in patients who underwent ACLR with and without internal bracing in a matched cohort study. Additionally, we also sought to investigate if there were any differences in clinical and patient-reported outcomes between the groups. We hypothesized that ACLR with internal bracing would reduce the incidence of revisions in a safe and effective manner.

Methods:

A total of 200 patients were included in this study. Patients between the ages of 13-39 at the time of surgery who underwent primary autograft ACLR with internal bracing (IB group) between October 2010 and July 2020 and were enrolled in our institution’s registry with a minimum of 2-year follow-up were identified and matched 1:1 with a non-internal brace (no-IB) group based on patient demographics and concomitant procedures. Every patient completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale (MARS), Veterans RAND 12-Item Health Survey (VR- 12), and the Visual Analog Scale (VAS) pre- and postoperatively. KT-1000 arthrometer measurements were included in the pre- and postoperative objective, clinical assessments.

Results:

The IB group underwent significantly less revision ACLRs (1% vs. 8%, p = 0.017). Additionally, the average time elapsed from the original ACLR to the revision did not differ significantly and the average ages for the IB and the no-IB groups were comparable (19.0-years-old vs. 19.9-years-old). 5 patients in the no-IB group underwent a total of 9 meniscal procedures among them at the time of their revision ACLR compared to just one in the IB group (p = 0.009). There were also 4 patients in the no-IB group that underwent anterolateral ligament reconstruction at the time of their revisions (4 vs. 0, p = 0.043). All postoperative patient-reported outcome measures (PROMs) significantly increased in both groups with the exception of the MARS score which significantly decreased in both groups postoperatively. KT-1000 measurements significantly improved in both groups following surgery with the IB and no-IB cohorts yielding comparable results at the manual maximum pull (0.97mm vs. 0.65mm).

Conclusions:

ACLR with internal bracing resulted in an 88% decrease in revision ACLRs while maintaining comparable patient reported outcomes. Incorporating an Internal brace into ACLR is therefore safe and effective within these study parameters. [Table: see text][Table: see text][Table: see text]
Poster 352: Adverse Events and Complications following Primary ACL Reconstruction with Quadriceps Tendon Autograft: A Systematic Review
Authors: Mameri Enzo , McCormick Johnathon , Khan Zeeshan , Verma Nikhil , Chahla Jorge , Jackson Garrett
Published: August 2023

Objectives:

To systematically review the incidence of postoperative complications and adverse events following primary ACLR with quadriceps tendon autograft, while secondarily comparing the reported rates in an all-soft tissue quadriceps tendon (QT) graft relative to quadriceps tendon grafts with a patellar bone plug (QTPB).

Methods:

Two independent authors conducted a literature search using PubMed, Embase, and Scopus databases using the Preferred Reporting Items for Systematic Meta-Analyses (PRISMA) guidelines. The search strategy included the following keywords combined with Boolean operators: ‘Anterior Cruciate Ligament’, ‘ACL’ ‘Reconstruction’, and ‘Quadriceps Tendon’. Inclusion criteria consisted of level I to IV human clinical studies in English or English-language translation reporting complications and adverse events after primary ACLR using quadriceps tendon autograft. The overall incidence of complications throughout the included studies, as well as the incidence of specific complications were extracted. A 2- proportion z-test was performed to evaluate for potential differences in the incidence of postoperative complications between ACLR with quadriceps tendon with and without a patellar bone plug.

Results:

A total of twenty studies, consisting of 2,381 patients (2,389 knees) with a mean age of 27 (mean range, 12 - 58) years, consisting of 68.3% males (n=1626/2381), were identified. The mean follow-up was 28.5 (mean range, 6 – 47) months. The total incidence of complications was 10.3% (n = 246/2389 patients), with persistent post-operative knee pain being the most common, as seen in 10.8% (n = 91/843) of knees. Patients who underwent ACL reconstruction with QT graft had increased incidence of persistent knee pain (23.3%) and reoperations (5.9%) when compared to QTPB grafts (8.6% and 3.2%, respectively) (p < .01). Nontraumatic graft ruptures were greater with the QTPB (2.1%) relative to QT (0.5%) (p = 0.01). There was no appreciable difference in total complications, total graft failures, traumatic rupture, ACLR revisions, cyclops lesions, or arthrofibrosis (all, p > 0.05). Patellar fractures occurred exclusively with the QTPB (2.2%).

Conclusions:

Complications following primary ACLR using quadriceps tendon autograft were recorded in 10.5% of knees, the most common of which is persistent knee pain. No difference was reported in the overall incidence of complications with the use of the QT versus QTPB grafts, however persistent knee pain was 2.7x greater with QT. [Table: see text][Table: see text]
Poster 356: Injury patterns of Achilles tendon ruptures: a systematic video analysis of 80 cases in professional male football
Authors: Gronwald Thomas , Klein Christian , Hollander Karsten , Ueblacker Peter , Rolvien Tim , Hoenig Tim
Published: August 2023

Objectives:

Achilles tendon ruptures are injuries with a high severity. Analyses of underlying biomechanical and situational patterns may promote a better understanding of Achilles tendon ruptures and aid in their management and prevention. However, a systematic biomechanical and situational video analysis of real-life Achilles tendon ruptures has not been performed to date.

Methods:

Professional male football players with an acute Achilles tendon rupture were identified by using an online database (Transfermarkt.com, Hamburg, Germany). For every in-competition injury, the coinciding football match leading to injury was detected. Video files of the injuries were accessed using Wyscout.com (Wyscout.com, Genova, Italy). Situational patterns and injury biomechanics of the injury frame were independently analyzed by two reviewers using a standardized checklist and a motion analysis software (Kinovea v.0.8.15, www.kinovea.org). Finally, consensus was reached to describe the main injury patterns of Achilles tendon ruptures in professional male football.

Results:

Overall, 80 injuries were included for video analysis. Most injuries (94%) were indirect or non- contact injuries. The kinematic analysis revealed a knee extension movement and an ankle dorsiflexion movement in most cases. Typical joint positions at the assumed injury frame were hip extension, knee extension and ankle dorsiflexion. Player actions identified as main injury patterns were stepping back, landing, running/sprinting, starting, and jumping. All main patterns were closed-chain movements (that is, fixation of the affected leg to the ground).

Conclusions:

Most Achilles tendon ruptures share characteristic injury features, that is, Achilles tendon elongation, closed-chain movements, and sudden loading. The findings of this study allow insight into injury mechanisms of Achilles tendon ruptures in professional male football and may support translation towards future development of prevention programs.