bluuebunny/crossref_metadata_2025 huggingface dataset:
Paper 30: Lower Socioeconomic Status Adversely Affects Timing of Care and Rate of Re-Injury Following Anterior Cruciate Ligament Reconstruction
Authors: Cherelstein Rachel , Kuenze Christopher , Curley Andrew , Bodendorfer Blake , Hopkins Mark , Conroy Christine , Fryar Caroline , Wang David , Chang Edward , Albelo Eduardo Natal
Published: August 2023

Objectives:

The primary aim of this study was to define the impact of socioeconomic factors, such as national area of deprivation index (ADI) and medical insurance type, on the access to orthopaedic care after an ACL rupture. The secondary aim was to determine if these variables, national ADI and medical insurance, were associated with second ACL injury after primary ACLR. We hypothesized that patients with a greater national deprivation index and Medicaid insurance will have less access to specialized care and an increased risk of re-injury.

Methods:

An IRB approved retrospective study was conducted evaluating 339 patients that underwent ACL reconstructions between November 2015 and August 2018 by 3 sports medicine fellowship-trained orthopaedic surgeons. Patients undergoing primary ACL reconstruction were included. Demographic and surgical characteristics data were obtained via chart review and telephone interviews. National ADI percentile was obtained utilizing the Neighborhood Atlas Website and the patients’ home addresses. The relationship between national ADI percentile and care characteristics (e.g., time to specialized care) were investigated using Spearman’s rank correlation coefficients (ρ) while the association between patient and care characteristics, and second ACL injury were investigated using multivariable logistic regression.

Results:

A total of 339 patients met inclusion criteria and had complete datasets for all variables of interest. Participants had an average age of 23 ± 7.4 yrs. 55.8% of the patients were males and identified themselves as: White 45.7%, African American 14.5%, Asian 11.8%, Hispanic 7.7% and Other 21.3%. Patients with a greater national ADI percentage took longer to seek specialized care from time of injury (ρ = 0.141, p = 0.009) as well as to undergo surgery from time of injury (ρ = 0.183, p < 0.001). Individuals who utilized Medicaid insurance had significantly greater odds of experiencing a second ACL injury (OR = 3.079, p = 0.023) when compared to individuals who utilized commercial insurance. National ADI percentile (p = 0.208), time from injury to specialized care (p = 0.342), and time from specialized care to surgery (p = 0.051) did not significantly contribute to the model.

Conclusions:

Lower socioeconomic status adversely affects timing of care and re-injury rates following an ACL injury. Patients with a greater national ADI percentage took significantly longer to seek specialized care and obtain surgery following ACL injury. Patients utilizing Medicaid insurance were more likely to sustain a re-injury following ACL Reconstruction. Future studies should look at factors that impede access to care and adversely affect post-operative outcomes. [Table: see text][Table: see text]
Paper 33: Superior Improvements in Knee Pain and Function with a Novel Synthetic Medial Meniscus Replacement Prosthesis Compared to Non-surgical Care in Subjects with Knee Pain Following Partial Meniscectomy: Three-year Results from US Randomized Controlled Trial
Authors: Hershman Elliott , Zaslav Kenneth , McKeon Brian , Lattermann Christian
Published: August 2023

Objectives:

This study tests the hypothesis that subjects receiving the meniscus replacement prosthesis show superior improvements at 3 years with regards to knee-related pain, function, and quality of life compared to control subjects, through 3 years of follow-up.

Methods:

127 subjects (61 investigational, 66 control) were included in the multicenter RCT. Subjects had one or more partial meniscectomies at least 6 months before trial entry and continued to have pain. Patient-reported knee pain, function, and quality of life were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Treatment failure was defined as any investigational subject who discontinued the per-protocol treatment by permanent prosthesis removal, or control subjects undergoing any surgical procedure on the index knee. Standard statistical methodology was used, two tailed t-test was used to compare groups at each time point.

Results:

Both groups improved over 24 months, but the control group showed a significant drop at 3 years. Controls experienced a 35% decline in KOOS Overall improvement between the 2-year and 3-year timepoint (15.9 declined to 10.4). The treatment group continued to improve over 3 years. The treatment group had significantly better outcomes scores that were greater than MCD for all KOOS subscales at 3 years (Figure 1). KOOS Overall and KOOS Pain for the investigational and control cohorts at 3 years were 28.8 vs 10.4 points, and 29.7 vs 15.4 points, respectively. Treatment cessation through 3 years was 67% greater in the control cohort than the investigational cohort (11.5% vs. 19.2%).

Conclusions:

Patients receiving the meniscal replacement prosthesis had clinically meaningful improvement of their patient reported outcomes scores at 3 years. These improvements were superior to the control treatment. The improvements were maintained over three years, whereas the control group declined after 2 years. The magnitude of change from baseline to 3 years remained superior for the investigational cohort, even for subjects undergoing device exchange or repositioning, compared to non-surgical care subjects.
Paper 36: Levels of Synovial Fluid Cytokines Predict Midterm Patient Reported Outcomes Following Arthroscopic Partial Meniscectomy
Authors: Shankar Dhruv , Vasavada Kinjal , Kingery Matthew , Montgomery Samuel , Buzin Scott , Chan Calvin , Jazrawi Laith , Strauss Eric , Avila Amanda
Published: August 2023

Objectives:

To identify synovial fluid biomarkers associated with midterm postoperative outcomes in patients undergoing arthroscopic partial meniscectomy (APM).

Methods:

Subjects were prospectively enrolled in a cohort of patients who had synovial fluid aspirated from their knee on the day of surgery prior to undergoing APM. Biomarker analysis was performed. Preoperative patient-reported outcome (PRO) scores including VAS pain, Lysholm and Tegner activity score were collected preoperatively. At a minimum of 2 years of follow-up postoperative outcomes were collected. Using previously described values, patients who met the minimal clinically important difference (MCID) for Lysholm score were identified and groups were compared using parametric and non-parametric tests. Using preoperative and postoperative outcome scores, generalized linear models were used to explore the relationship between biomarkers and improvement in Lysholm Score, improvement in visual analog scale (VAS) pain score, and postoperative KOOS-PS.

Results:

Fifty patients were included in the study. 34 (68%) met the MCID for the Lysholm score and 16 (32%) did not. Mean age was 51 ± 9 years for the entire cohort, with no statically significant differences between the groups (p=0.35). Both groups were majority male (p=0.37) and there were no differences in BMI (0.74) or follow-up time (p=0.20). On logistic regression, increased concentration of RANTES (β = -6.30, p = 0.04) and MMP-3 (β = -15.16, p = 0.001) were predictive of less improvement in VAS pain. . For Lysholm score, higher SF levels of IL-1 RA were predictive of greater improvement (β = 12.57, p = 0.04) while higher levels of MMP-3 were predictive of reduced improvement (β = -10.34, p = 0.007).

Conclusions:

This study found that at the time of surgery, intraarticular levels of MMP-3 and RANTES are predictive of poorer midterm outcomes and higher pain levels following APM. Additionally, higher levels of IL-1RA at the time of surgery were associated with greater improvement in midterm Lysholm score.
Paper 38: Addition of a Lateral Extra-articular Tenodesis is Associated with Lower Quadriceps Tendon Autograft MRI Signal Intensity Two Years Following Anterior Cruciate Ligament Reconstruction in Skeletally Immature Adolescents
Authors: Chipman Danielle , Retzky Julia , Cordasco Frank , Green Daniel
Published: August 2023

Objectives:

In recent studies, quadriceps tendon autograft (QTA) has been shown to yield promising results in the treatment of anterior cruciate ligament (ACL) ruptures in pediatric and adolescent patients. Additionally, lateral extra-articular tenodesis (LET) has been found to reduce the risk of ACL re-tear in high-risk patients when performed concomitantly with ACL reconstruction (ACLR). The purpose of this study was to evaluate graft maturity two years after ACLR by comparing magnetic resonance imaging (MRI) signal intensity ratio (SIR) of QTA in patients that underwent a primary ACL reconstruction with a concomitant LET versus patients without a concomitant LET.

Methods:

After institutional review board approval, operative records of all pediatric patients ≤ 18 years old who underwent an ACLR from June 2015 to December 2021 were retrospectively reviewed. MRIs were ordered for this age cohort of patients for clinical growth plate surveillance. Patients were included if they underwent an ACLR using a QTA and had open distal femoral and proximal tibial physes. MRIs were excluded if they were external or were ordered due to a new injury. The final cohort included 28 patients: 13 without a LET (ACLR only) and 15 with a LET (ACLR+LET). Signal intensity ratio (SIR) was measured on sagittal MRI by averaging the signal at three regions of interest along the ACL graft and dividing by the signal of the insertion of the posterior cruciate ligament. Statistical analysis was performed to evaluate for differences in SIR values at 6 months, 1 year, and 2 years post-operatively in skeletally immature patients undergoing ACLR alone versus ACLR with LET.

Results:

A total of 43 patients had an MRI at a two-year follow-up, 28 of whom were included in the study. The mean age of the complete cohort was 12.63±3.62 years (ACLR+LET: 13.96±0.91 years vs. ACLR only: 13.51±1.19 years). There were no significant differences in SIR between groups on the 6-month MRI or the 12-month MRI. However, the average SIR of the ACLR+LET group was significantly lower than the average SIR of the ACLR-only group at the two-year post-operative time point (1.398 vs. 1.916, respectively, p=0.046).

Conclusions:

QTA MRI signal intensity is lower two years after surgery in patients that underwent ACLR with a LET versus ACLR alone. Lower MRI signal intensity correlates with increased graft maturity and structural integrity. These findings suggest improved graft maturation, remodeling, and structural integrity with the addition of a LET to an ACLR with QTA in skeletally immature patients. [Table: see text]
Paper 39: A Survival Analysis of ACL Graft and Contralateral ACL Ruptures in Patients Under 18 Years
Authors: Feller Julian , Webster Kate
Published: August 2023

Objectives:

Although high rates of graft and contralateral anterior cruciate ligament (ACL) ruptures have been reported in younger patients after ACL reconstruction, recent evidence suggests that previously reported crude event rates underestimate the actual event risk. Therefore, the aim of this study was to report rates of graft and contralateral ACL rupture after ACL reconstruction in a large series of younger patients using survival analysis.

Methods:

A consecutive series of 400 patients who were under 18 years at the time of primary ACL reconstruction were identified from a single surgeon database over a 12-year period ending January 2018. Patients with a prior contralateral ACL rupture (n=8) or bilateral ACL ruptures (n=2) were excluded as were two patients who died within 6 months of surgery, leaving 388 (203M, 185F) in the final dataset. Bespoke survey data and clinic follow-up data were used to record graft rupture and contralateral ACL rupture events. Rates of graft and contralateral ACL rupture were calculated with Kaplan-Meier survival analysis. Log rank tests were used to compare survival functions between males and females.

Results:

The cumulative rates of graft rupture via survival analysis were 11% at 2 years, 16% at 4 years and 28% at 8 years. For contralateral ACL injury the cumulative rates were 7% at 2 years, 17% at 4 years and 49% at 8 years. Males had significantly greater rates of graft rupture than females although this was more prominent at 4 years (22% vs 9%) than at 8 years (31% vs 23%) after surgery (figure 1). Contralateral ACL rupture survival functions were not significantly different between male and female patients, although rates were higher in females until 5 years after which males had a notable increase in contralateral ACL ruptures with a cumulate rate of 63% at 8 years compared to 35% for females (figure2).

Conclusions:

The current study is one of the largest consecutive series of younger patients with one of the longest follow-up periods that reports a high risk for a second ACL injury. Over time, the cumulative risk for contralateral ACL rupture was higher than for graft rupture. This contradicts previous work that had shorter follow-up times. In males, the risk for contralateral ACL rupture substantially increased after 5 years. Understanding the postoperative time course for second ACL injury in young patients is important so that factors which contribute to this increased risk can be better understood and such injuries prevented.
Paper 43: Defining and Predicting the “Optimal Observed Outcome” Following Surgical Treatment of Anterior Shoulder Instability: A Machine Learning Clustering Analysis of 200 patients with 11-year mean follow up.
Authors: Till Sara , Lu Yining , Reinholz Anna , Krych Aaron , Okoroha Kelechi , Camp Christopher
Published: August 2023

Objectives:

Desirable outcomes following surgery for anterior shoulder instability (ASI) include a multitude of functional and clinical functions, yet it remains uncertain if all of these outcomes are simultaneously achievable (i.e. can patients have full motion and no instability; does excellent stability coincide with stiffness?). The purpose of this study was to employ unsupervised machine learning techniques to define the actual "optimal observed outcome” for patients undergoing surgical treatment for ASI and to identify predictors of obtaining this outcome.

Methods:

Patients <40 years with an initial diagnosis of ASI from 1994 -2016 were included. Four unsupervised machine learning clustering algorithms were evaluated to partition subjects into “optimal observed outcome” or “suboptimal outcome” based on combinations of actually observed outcomes. Demographic, clinical, and treatment variables were compared between groups using descriptive statistics and Kaplan-Meier survival curves; multivariate stepwise logistic regression evaluated variable prognostic value.

Results:

200 patients with a mean follow-up of 11 years were included. 146 (64%) obtained the “optimal observed outcome”, characterized by significantly (P <0.001) lower rates of: recurrent postoperative pain (23% vs 52%), recurrent instability (12% vs 41%), revision surgery (10% vs 24%), progression to osteoarthritis (OA) (5% vs. 19%), and mildly restricted motion (161° vs. 168°). Stepwise multivariate logistic regression identified time from initial instability to presentation (OR: 0.96, 95% CI: 0.92-0.98) and habitual instability (OR: 0.17, 95%CI: 0.04-0.77) as negative predictors of “observed optimal outcome”. Increased rate of subluxation over frank dislocation pre-operatively (OR: 1.30, 95% CI: 1.02-1.65) was a positive predictor. Type of surgery performed was not a significant predictor.

Conclusions:

Following surgical treatment for ASI, an appropriate “optimal observed outcome” can be defined as: minimal postoperative pain, absence of recurrent instability, low rates of revision surgery, absence of OA, and increased ROM. This “optimal observed outcome” was achieved in over 2/3rds of the cohort and this work demonstrated the synergistic relationship of these. The most significant predictors included shorter time to presentation and history of subluxations over frank dislocations pre-operatively. This definition of the “optimal observed outcome” may be more appropriate for surgical decision making and setting appropriate expectations. [Table: see text][Table: see text]
Paper 51: A Radiostereometric Analysis of Tendon Migration following Arthroscopic and Mini-Open Biceps Tenodesis: Interference Screw confers Greater Construct Stability than All-Suture Suture Anchor Fixation, with No Difference in Patient-Reported Outcomes
Authors: Patel Harsh , Berlinberg Elyse , Forlenza Enrico , Gamsarian Vahram , Mirle Vikranth , Okoroha Kelechi , Williams Brady , Yanke Adam , Cole Brian , Verma Nikhil ,   Forsythe Group
Published: August 2023

Objectives:

To quantify the postoperative migration of the BT construct between arthroscopic suprapectoral (ASPBT) and open subpectoral (OSPBT) techniques via interference screw (IS) or all-suture anchor with a single suture (SSSA) fixation with radiostereometric analysis (RSA).

Methods:

Distal migration of the biceps tendon following OSPBT with a Polyetheretherketone (PEEK) IS, OSPBT with one SSSA, ASPBT with PEEK IS, and ASPBT with two SSSAs was measured prospectively. Patients with symptomatic biceps tendinopathy and preoperative Patient-Reported Outcome Measures (PROMs) including CMS, SANE, or PROMIS-UE scores were included. A tantalum bead was sutured on the proximal end of the long head biceps tendon before fixation. AP radiographs were performed immediately postoperatively, 1 week, and 3 months. Bead migration was measured, and PROMs were compared.

Results:

Of 115 patients, 94 were available for final follow-up (82%). Average age was 52.1±10.5 years, and BMI was 30.8±5.4 kg/m2. There was no difference in tendon migration between OSPBT and ASPBT performed with an IS (P=0.70). OSPBT performed with one SSSA (21.70 mm) demonstrated significantly greater migration than ASPBT with IS (4.31mm, P<0.001) and OSPBT with IS (5.04 mm, P<0.001). Three patients (9.4%) who had OSPBT with one SSSA and one who had ASPBT with two SSSAs (3.8%), developed a Popeye deformity; none occurred in the IS groups. Mean 12-week bead migration in patients with versus without Popeye deformity was 60.8 mm and 11.2 mm, respectively (P<0.0001). PROMs did not differ at final follow-up.

Conclusions:

ASPBT and OSPBT with IS fixation demonstrated the least tendon migration, while OSPBT with one SSSA yielded the most. Compared to IS, fixation with one, but not two, SSSAs resulted in significantly greater migration. Average bead migration following a Popeye deformity was 6.1cm. To minimize migration when using SSSAs, at least 2 sutures should be used with an interlocking pattern within the tendon. [Table: see text]
Paper 58: Against Surgeons’ Advice: The Return to Sport in High Demand Weightlifters Following Anatomic Total Shoulder Arthroplasty at Average 3.6 Years Follow-up
Authors: Pettit Robert , Li Lambert , Chilton Matthew , Ives Katharine , Ross Glen , Shah Sarav , Ames Andrew
Published: August 2023

Objectives:

Return to sport in high-demand weightlifters following total shoulder arthroplasty has rarely been investigated, as most surgeons recommend against returning to heavy lifting postoperatively. The purpose of this study is to determine the incidence of return to sport, patient reported outcomes, patient satisfaction, performance, and failures in a specific population of high demand weightlifters that continue lifting after undergoing total shoulder arthroplasty.

Methods:

Retrospective review of a specific population of high demand weightlifters that underwent anatomic total shoulder arthroplasty with minimum one-year clinical follow up was conducted. Prospective surveys determining pre- and postoperative participation in weightlifting included maximum weight, frequency, and duration of workouts, Single Assessment Numeric Evaluation (SANE), patient satisfaction, and post-operative range of motion were collected. Secondary outcomes included failure, revision surgery, risk factors for not returning to weightlifting, and performance measured as percentage of prior maximum bench press. Bivariate and multivariate analysis was performed to compare cohorts and identify risk factors, respectively.

Results:

Forty-two shoulders in 36 patients who met inclusion criteria (avg age 57.9 years, 97% male). No patient underwent revision surgery at average 3.6 year follow up (1 to 7 years, SD 1.9 years). The majority of patients (23/42 shoulders) report returning to heavy weightlifting postoperatively against senior surgeon’s recommendations. Mean SANE score for current weightlifters and retired weightlifters were 86.9 and 91.6, respectively (P = 0.148). In the weightlifting cohort, only 78.3% of patients achieved patient-acceptable symptom state (PASS) threshold for SANE compared to 89.5% of patients (p = .332) in the retired cohort. Patient satisfaction and return to sport satisfaction in current weightlifting shoulders were good-to-excellent in 91.3% (P= 0.922) and 82.6% (P = 0.972) respectively. Patients who continued lifting reported substantially decreased maximum weight in all lifts compared to pre symptomatic maximum.

Conclusions:

This data provides insight for surgeons on the expected activity level of prior high demand weightlifters. Against their surgeon’s recommendations, most patients who participated in preoperative weightlifting returned to high demand weightlifting after surgery, but patients demonstrated lower lifting performance postoperatively. There were no early clinical catastrophic failures with high patient reported outcomes. While caution is still advised with returning to heavy weightlifting, the current data highlights the advances of modern fixation techniques, fourth generations implants, and diminished lifting capacity after surgery, which likely play a role in the high implant survivorship in this cohort.
Poster 108: The Deep Region of the Supraspinatus Is Architecturally Distinct
Authors: Hyman Sydnee , Norman Mackenzie , Sendek Gabriela , Powell Jenna , Kirchberg Tyler , Berry Dave , Lane John , Singh Anshuman , Ward Samuel , Wu Isabella
Published: August 2023

Objectives:

The supraspinatus (SSP) tendon is the most frequently involved in rotator cuff tears, a common orthopedic condition. Previous anatomical studies have described distinct anterior and posterior regions of the SSP muscle. The purpose of this study is to determine if the deep region of the supraspinatus muscle has significantly different architectural properties from the other regions. This could have implications on the mechanical and functional nature of the deep supraspinatus muscle.

Methods:

Architecture measurements were collected from 25 cadaver SSPs (Figure 1). There were 13 SSPs without a tear, 3 with partial tears, and 9 with full tears. The anterior to posterior dimension of the humeral head (APHH), musculotendinous junction length (MTJL), muscle mass and length were recorded. The muscle regions were demarcated as deep, [superficial] anterior, and [superficial] posterior. Raw and normalized fiber length, pennation angle, sarcomere length and number were analyzed for each region. Measurements were compared using repeated measures ANOVAs. The intact SSPs were analyzed first, and then a sub-analysis was performed based on presence of tear.

Results:

In 13 SSPs without tears (Figure 2), the deep region showed a lower mean pennation angle of 3.3±1.0° than the posterior region (11.0±3.9°, p<0.0001), which had a higher angle than the anterior region (7.6±2.6°, p=0.0005). Normalized fiber lengths in the deep region were 21.1% (p=0.0052) and 34.5% (p<0.0001) shorter than posterior and anterior, respectively. Deep region sarcomeres measured 3.4±0.2 µm compared to 3.1±0.2 µm (posterior, p=0.0012) and 3.2±0.2 µm (anterior, p=0.0390). Sarcomere number also decreased in the deep region by 21.2% (p=0.0056) and 34.2% (p<0.0001) compared to posterior and anterior regions, respectively. After including partial (n=3) and full (n=9) tears, all architecture measurements remained different in the deep region versus anterior or posterior. Finally, to help visualize the deep region of the SSP, diffusion tensor imaging with tractography was performed on a healthy volunteer’s MRI (Figure 3) to depict the tissue microstructure and muscle fiber orientation/length.

Conclusions:

The deep supraspinatus has lower pennation angles, shorter fiber lengths, and fewer but longer sarcomeres. These structural differences suggest a functionally unique ‘submuscle’ within the supraspinatus.
Poster 119: MRI evidence of labral tears in healthy young athletes without hip pain
Authors: Ellis Henry , Chen Diana , Kalia Vivek , Wilson Philip , Alizai Hamza , CHANG IYUAN JOSEPH
Published: August 2023

Objectives:

The prevalence of labral tears in asymptomatic active adults has been reported, but the prevalence of labral tears and other incidental hip lesions in the asymptomatic adolescent population has not yet been determined. The purpose of this study was to determine the prevalence of hip abnormalities detected on 3T MRI in an active adolescent population with no hip symptoms and, secondarily to compare with hip abnormalities found in adolescents who underwent an MRI for a hip related condition.

Methods:

Following IRB approval, adolescent patients presenting with isolated knee pain requiring knee MRI were prospectively recruited to have a 3T MRI of their asymptomatic contralateral hip (ASx). A comparison group of adolescent subjects who underwent an MRI for hip pain was enrolled retrospectively (Sx). All MRI scans were anonymized and randomized. Based on preliminary power analysis, 50 subjects were enrolled for each cohort. Blinded to the patient’s cohort status, clinical and demographic data, 2 fellowship-trained musculoskeletal radiologists evaluated these MRI’s independently for abnormal hip lesions, including labral tears. Inter-reader reliability was evaluated using Cohen’s Kappa. A chi-square or Fisher’s exact test was used to compare the prevalence of these hip lesions between the two cohorts.

Results:

Average patient age was 14.9 years for both cohorts (range 9-18 years); 52% were female. In the ASx group, incidental labral tears were found in 18%, labral/paralabral cysts 6%, cartilage lesion 0%, subchondral cyst 0%, ligamentum teres tear 0%, femoral fibrocystic change 0%, cam lesion 30%, acetabular bone edema 0%, acetabular rim fracture 0%. The prevalence of labral tears (30%, P-value 0.160) and cam lesion (36%, P-value 0.523) in the Sx group was not significantly different from that of the ASx cohort.

Conclusions:

Labral tears were present on 3T MRI’s of adolescents with and without hip pain. While MRI is essential to confirm the surgeon’s suspicion and to detect unexpected pathology, clinical exam and history are crucial in pinpointing clinically relevant abnormal imaging findings. [Table: see text]
Poster 124: Elevated Lipid Metabolites in Stored Clinical OCA Media are Associated with Chondrocyte Death
Authors: Tabbaa Suzanne , Guilak Farshid , Lemmerman Luke , Glembotski Nicholas , D’Lima Darryl , Wang Tong , Bugbee William
Published: August 2023

Objectives:

A major limitation of osteochondral allografts (OCA) is the deterioration of cartilage health associated with cell death during prolonged storage. It is well established that chondrocyte viability in OCA is a critical factor for repair and clinical outcomes, but little is known about the mechanisms that contribute to chondrocyte death during storage. Elevated bioactive lipid metabolites and free fatty acids (FFAs) have been associated with cell death and tissue damage for various pathologies through lipotoxicity. However, the levels and effect of FFA accumulation in OCA media during prolonged storage are unknown. The purpose of this study was to determine if bioactive lipid metabolites accumulate in the storage media of OCA and are associated with a loss of chondrocyte viability during prolonged storage. We hypothesized that FFAs will accumulate over time in the storage media of OCA and adversely impact cartilage health during storage.

Methods:

To elucidate potential mechanisms of cartilage health decline during storage, 21 fresh human hemi-condyle osteochondral allograft tissues and media provided by a US tissue bank were analyzed after 7, 28, and 68 days of prolonged cold storage. Targeted metabolomics analysis measured bioactive FFAs, and primary (lipid hydroperoxide, ROOH) and secondary (malondialdehyde, MDA) lipid oxidation products. Chondrocyte viability was measured using standard LIVE/DEAD assay and confocal microscopy.

Results:

All fatty acid metabolites in storage media significantly increased with increased storage time (Figure 1; p<0.05). ROOH was significantly higher at Day 28 of storage. No difference in secondary lipid hydroperoxide products in storage media were observed. Chondrocyte viability significantly declined in both the en face and vertical cross-section analysis with increased storage time (Figure 2) and inversely correlated with fatty acid metabolites (Figure 3; p<0.05).

Conclusions:

It is well established that elevated levels of certain free fatty acids and lipid oxidation products can alter cell function and cause cell death through lipotoxicity and other mechanisms. This work is the first to identify elevated levels of FFA metabolites and primary oxidation lipid product in the storage media from clinical OCA. The concentrations of FFA metabolites were measured at levels (>100µM) known to induce cell death and were directly correlated with chondrocyte viability. These findings provide important targets for understanding why cartilage health declines during storage to better optimize media formulations and improve graft health.
Poster 148: Preoperative Platelet Rich Plasma Injections Decreases Inflammatory and Chondrodegenerative Biomarkers in Patients with Acute Anterior Cruciate Ligament Tears and Reconstruction: A Pilot Study
Authors: Jordan Steve , Ostrander Roger , Kindle Brett , Hackel Josh , Cook Joshua , Maggi Emily , Plummer Hillary , Anz Adam , Branch Eric
Published: August 2023

Objectives:

Post-traumatic osteoarthritis occurs at an alarming rate after ACL injury and surgery. The purpose of this study was to compare the effect of two, pre-operative PRP injections upon the progression of inflammatory and chondrodegenerative biomarkers to the natural progression before ACL reconstruction surgery. Our hypothesis was that pre-operative PRP injections would decrease the chondrotoxicity of the presurgery knee fluid.

Methods:

Participants were randomized to either a control or intervention group. Both groups received joint aspirations within the first 10 days following ACL injury (Time 1). In addition to joint aspiration at Time 1, the PRP group received a PRP injection at Time 1 and an additional PRP injection at a second visit 5-12 days after the initial visit. Synovial fluid samples were harvested in both groups at the time of ACL reconstruction (Time 2). ELISA was performed on all samples to detect cytokine levels of IL-1B, IL-10, IL-6, GM-CSF, IL-5, IFN-γ, TNF-⍺, IL-2, IL-4, and IL-8

Results:

A total 24 participants were enrolled, final analysis was completed on 8 participants in the control group and 9 participants in the intervention group. The control group demonstrated a change in concentration (Δ1à2) between time 1 and time 2 that was not statistically significant for any cytokines p>0.05, except for a statistically significant decrease in IL-8 (p=0.005). The intervention group demonstrated a decrease in all cytokine concentrations that was statistically significant for all cytokines p<0.05, except for IL-8 (p=0.074). When comparing the control group to the intervention group at time 1, no significant difference was seen between cytokine concentrations (p>0.05). Likewise, comparing the control group to the intervention group at time 2, no significant difference was seen between cytokine concentrations (p>0.05). The magnitude of decrease was larger in the intervention group than the control group, but with comparison of means between groups there was not a statistically significant difference. The natural history for these biomarkers is a decrease but at a variable rate/amount. Preoperative intervention with PRP has the potential to consistently alter the concentration of chondrodestructive proteins.

Conclusions:

Intervention with aspiration and 2 injection series of PRP in the acute ACL injured knee resulted in greater reduction in effusion inflammatory markers than control. This may suggest a treatment modality to improve perioperative pain, function and possibly alter the course of post trauma arthritis in these patients, without the deleterious effect of steroid injection. Long term study and follow up is required to determine if intervention alters the natural history of post traumatic arthritis. [Table: see text][Table: see text]
Poster 155: The Prevalence of “Pipelining” at the Top Orthopaedic Sports Medicine Fellowship Programs
Authors: Kraeutler Matthew , Mulcahey Mary , Tanguilig Grace
Published: August 2023

Objectives:

The term “pipelining” refers to the phenomenon that applicants from certain residency programs frequently match at the same fellowship programs. However, it is unclear how prevalent pipelining is amongst the top orthopaedic sports medicine fellowship programs. The purpose of this study was to determine the prevalence of pipelining at the top orthopaedic sports medicine fellowships in the United States.

Methods:

The fellowship programs included in this study came from a recent survey study that determined the top 10 programs as perceived by fellowship applicants over the past 5 years. The residency programs of current and former fellows at each of these fellowship programs over the last 5- 10 years was determined by searching program websites and/or contacting program coordinators/directors. For each program, we determined the number of occurrences of more than 2, 3, and 4 fellows from the same residency program. We also calculated a “pipelining ratio”, defined as the ratio of the total number of fellows at the program over the duration of the study to the number of different residency programs represented within the fellowship program.

Results:

Data was obtained from 7 of the top 10 fellowship programs. Of the remaining 3 programs, 1 declined to provide the information and 2 did not respond. Pipelining was found to be highly prevalent at one program (Program 1), with a pipelining ratio of 1.9. Two different residency programs had at least 5 residents match at Program 1 over 10 years. Although not as prevalent, there was also found to be evidence of pipelining at Programs 2 and 3, with one residency program matching 5 residents over 5 years at Program 2, and 2 residency programs matching at least 2 residents at Programs 2 and 3 over 5 and 10 years, respectively. Programs 2 and 3 each had pipeline ratios of 1.5, and programs 4 and 5 were close behind with a ratio of 1.4. Programs 6 and 7 exhibited minimal pipelining with a pipelining ratio of 1.1.

Conclusions:

This study highlights the prevalence of pipelining at the top orthopaedic sports medicine fellowship programs. The practice of pipelining may present a disadvantage for residents from residency programs without previous connections to certain fellowship programs. Future studies may seek to determine methods of minimizing the practice of pipelining and to provide a fair assessment of all fellowship applicants.
Poster 165: Non-Rigid Fixation Results in Higher Failure Rates Following Arthroscopic Glenoid Reconstruction
Authors: Ivan Wong Heinrichs , Sports Dip
Published: August 2023

Objectives:

It has previously been established that screw fixation results in better outcomes than button fixation for arthroscopic anatomic glenoid reconstruction (AAGR) with frozen allograft. There has been considerable debate on the causes for the higher dislocation rates with non-rigid fixation. The purpose of this study was to evaluate which factors may affect failure rates for AAGR with non-rigid fixation.

Methods:

This was a retrospective review of patients who had AAGR using non-rigid fixation that were age-, gender-, and followup-matched with screw fixation patients. Arthroscopic videos were used to evaluate surgical factors including graft placement, fixation quality, tensioning, graft contact, soft tissue quality, quality of soft tissue repair, presence of Hill-Sachs, and addition of Remplissage. Patient demographic factors (age, gender, medical history etc) were also assessed. XRays and CTs were used to evaluate graft union, screw and button angle, graft remodeling, and button pull through.

Results:

A total of 36 patients were included in our study who had AAGR between 2014 and 2019 (18 non-rigid fixation matched to 18 screw fixation). Seven patients who had non-rigid fixation had a dislocation requiring reoperation. Of these, 4/7 had poor anterior soft tissue. All but one patient had excellent soft tissue repair and balance at end of surgery. All seven patients had complete graft resorption compared with those did not fail who had a normal post-operative glenoid A-P dimension.

Conclusions:

In our case series, AAGR with non-rigid fixation had high rate of recurrent dislocation. These failed patients had appropriate surgical factors that were equivalent between dislocated patients and successful patients. The failure rate was not correlated with surgical technique, patient or radiographic factors but rather only fixation type. Further study is needed to evaluate fixation methods and to assess whether type of graft impacts these clinical outcomes.
Poster 170: First-Time Anterior Shoulder Instability Events in Subluxators versus Dislocators: A Comparison of Clinical Presentation, Extent of Injury, and Revision
Authors: ENGLER IAN , Herman Zachary , Kaarre Janina , Gibbs Christopher , Greiner Justin , Drain Nicholas , Rai Ajinkya , Carlos Noel , Vodovotz Lena , Njoku-Austin Confidence , Lin Albert , Nazzal Ehab
Published: August 2023

Objectives:

The objective of this study was to characterize epidemiology and postoperative outcomes in subluxators and dislocators after a first-time anterior instability (FTAI) event. We hypothesized that subluxators would have a milder clinical presentation, lesser degree of pathology on imaging, and fewer anchors placed intraoperatively in comparison to dislocators.

Methods:

Surgically managed FTAI patients from a single institution between 2013-2020 were included. Exclusion criteria included multidirectional instability and recurrent instability. Demographics and surgical details were retrospectively collected. Instability was categorized into dislocation, in which another person reduced the shoulder, or subluxation, in which there was no documentation of another person reducing the shoulder. Labral tear location was determined using the clock method and labral tear size was determined by assigning 1 point to each hour around the clock for a maximum value of 12.

Results:

146 patients (97 subluxators, 79 dislocators) were available for analysis. There were no significant differences in baseline demographics. Rates of bony Bankarts were equivalent, but Hill-Sachs lesions were reported more in dislocators (88.1% vs. 52.6%, p<0.001). Table 1. Preoperative and postoperative ROM and strength was equivalent between cohorts. There was no difference in either labral total tear size or incidence of concomitant posterior or superior labrum tears. There was no difference in the number of anchors used, although remplissage was performed more in dislocators (18.9% for dislocators vs. 6.0%, p = 0.002). Revision rates were not significantly different between cohorts.

Conclusions:

Subluxators and dislocators had similar clinical presentations with no difference in the extent of injury except for greater frequency of Hill-Sachs lesions in dislocators with similar surgical outcomes. Given comparable injury characteristics, a tendency to bias subluxation events as “less severe” should be reconsidered. Further investigations may be necessary to determine demographic and anatomic predictive risk factors that influence outcomes between these two populations. [Table: see text]
Poster 175: ALPSA Lesions Associated with High Rate of Early Repair Failure
Authors: Yow Bobby , Riccio Cory , Dickens Jonathan , Kilcoyne Kelly , LeClere Lance , Hoyt Benjamin
Published: August 2023

Objectives:

Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions occur in patients with recurrent shoulder instability and are associated with higher rates of failure after capsulolabral repair surgery compared to typical Bankart lesions. Despite recognition that these lesions can portend poor outcomes, there is relatively limited data to understand the associated injuries and postoperative course in a young, active population. The purpose of this study is to evaluate ALPSA lesions for associated pathology and outcomes.

Methods:

Methods: We reviewed the records of 312 patients who underwent arthroscopic shoulder stabilization by one of two fellowship trained sports surgeons at a single facility between 1 January 2010 and 31 December 2015. Inclusion criteria were a minimum follow-up of five years after index surgical repair and presence of an ALPSA lesion as identified on arthroscopic exam, leaving 46 patients available for review. Our primary outcome measures were failure and operative revision surgery. We considered failure as any recurrent shoulder instability events including subjective subluxation and dislocation, recurrence of pain consistent with instability, or functionally limiting apprehension. We performed survival analysis and a multivariate logistic regression analysis to identify factors associated with failure.

Results:

Results: In total, 46 patients with average age 21.2 years met inclusion and underwent surgery a median of 7.1 months after initial recalled injury event. 11/46 had concomitant posterior pathology in addition to anterior labral lesion. Six patients were found to have SLAP lesions. All patients experienced subjective instability, and 44/46 endorsed pain prior to surgery. 38/46 reported having experienced complete dislocation. The median number of dislocations before surgery was 3. Repairs were performed with average 3.7 anchors. Eight patients failed surgery at median 15.1 months post-index procedure, with 75% of failures occurring before two years with the remaining 25% occurring later in follow-up. Three of these failed revision repair.

Conclusions:

Conclusions: ALPSA lesions frequently occur in the presence of other intra-articular shoulder lesions and portend a high rate of recurrent shoulder instability despite repair. Notably, while failure occurs at a high rate, most repair failure for these lesions tends to occur early.
Poster 200: Earlier Evaluation by an Orthopaedic Surgeon Is Associated with Higher Return to Work Among Workers’ Compensation Patients Undergoing Shoulder Arthroscopy
Authors: Massey Patrick , Sampognaro Gabriel , Fincher Phillip , Mody Milan , Barton R. Shane , Kushner Rachel
Published: August 2023

Objectives:

Workers’ compensation (WC) patients represent a large expenditure to the health care system and account for a large number of missed work days. Studies have shown that WC patients are less likely to return to work after injury or surgery. The purpose of our study was to determine if there was a higher return to full duty among WC patients who underwent arthroscopic shoulder surgery when they were seen by an orthopaedic surgeon within 100 days of injury.

Methods:

After obtaining Institutional Review Board approval, a retrospective chart review was conducted of WC patients treated with arthroscopic shoulder surgery by 2 senior authors at a community hospital between 2011 and 2018. WC patients that were treated with arthroscopic shoulder surgery were identified using Current Procedural Terminology (CPT) codes 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, and 29828. Patients were excluded if they were polytrauma patients who had undergone surgical procedures in other locations, patients who had a fracture, and patients being treated with revision shoulder surgery. A total of 59 WC patients were included in the study and were followed up to 2 years post-operatively. WC patients who identified as laborers were divided into 2 groups. The first group was evaluated by an orthopaedic surgeon within 100 days of injury (early orthopaedic evaluation) and the second group was evaluated by an orthopaedic surgeon more than 100 days after injury (late orthopaedic evaluation). The primary outcomes included the length of time from injury to evaluation by an orthopaedic surgeon and from surgery to return to work in some form.

Results:

Early orthopaedic evaluation was associated with a higher rate of return to full duty (p=0.02). The early orthopaedic evaluation group had a 69% (25 out of 36) return to full duty while the late orthopaedic evaluation group had a return to full duty of 39% (9 out of 23). There was no significant difference in the rate of return to work in some form with the early orthopaedic evaluation group returning at 94% (34 out of 36) and the late orthopaedic evaluation group returning at 83% (19 out of 23). There was a moderate association between time to evaluation by an orthopaedic surgeon following injury and time to return to work in some form (r=.22). There was no significant difference between the groups with respect to the type of laborer (p=.128).

Conclusions:

WC patients who were evaluated by an orthopaedic surgeon within 100 days of injury had a higher likelihood of return to full duty as well as return to work in some form compared to WC patients who were evaluated by an orthopaedic surgeon more than 100 days after injury. [Table: see text]