bluuebunny/crossref_metadata_2025 huggingface dataset:
Do baseline patient reported outcome measures predict changes in self-reported function, following a chronic pain rehabilitation programme?
Authors: Heelas L , Soni A , Barker Karen
Published: August 2023

Background

Interdisciplinary pain management programmes, based on cognitive-behavioural principles, aim to improve physical and psychological functioning and enhance self-management in people living with chronic pain. Currently there is insufficient evidence about whether psychological, biological or social factors are predictive of positive outcomes following pain rehabilitation. This study aims to evaluate predictors of change in Brief Pain Inventory – pain interference score (BPI) in a clinical data set to determine whether age, sex and baseline outcome measures are predictive of improvement in pain interference following pain rehabilitation.

Methods

A retrospective, pragmatic observational analysis of routinely collected clinical data in two pain rehabilitation programmes, Balanced Life Programme (BLP) and Get Back Active (GBA) was conducted. Standard regression and hierarchical regression analyses were used to identify predictors of change to assess temporal changes in BPI. Responder analysis was also conducted.

Results

Standard regression analyses of 208 (BLP) and 310 (GBA) patients showed that higher baseline BPI and better physical performance measures predicted better improvement in BPI across both programmes. Hierarchical regression showed that age and sex accounted for 2.7% (BLP) and 0.002% (GBA) of the variance in change in BPI. After controlling for age and sex, the other measures explained an additional 23% (BLP) and 19% (GBA) of the variance, p = < .001 where BPI and physical performance measures were consistently statistically significant predictors, p < .05. Responder analysis also showed that pain interference and physical performance were significantly associated with improvement ( p = < .0005).

Conclusions

The combination of high self-reported pain interference and better physical performance measures may be a useful indicator of who would benefit from interdisciplinary rehabilitation. Further validation of the results is required.
Rare combination of chronic primary adrenal insufficiency, subclinical hypothyroidism, and bicytopenia as features of systemic lupus erythematosus in a young man: A case report
Authors: Mulya Deshinta Putri , Leo Benedreky , Ikhsan Mohammad Robikhul , Hutajulu Susanna Hilda
Published: August 2023

Adrenal insufficiency in systemic lupus erythematosus is rarely detected, especially in male patients. Nevertheless, such coexistence can occur, and screening for systemic lupus erythematosus should be considered in primary adrenal insufficiency with symptoms of systemic multiorgan involvement. We report a 22-year-old Asian man, initially diagnosed with bicytopenia, developed severe unintentional weight loss, skin and mucosal hyperpigmentation, along with persistent fatigue. Laboratory examination showed positive antinuclear antibody—indirect immunofluorescence, elevated anti-double-stranded DNA, extremely low morning serum cortisol, and mildly elevated thyroid stimulating hormone with normal free T4. He was diagnosed with systemic lupus erythematosus, manifesting as chronic primary adrenal insufficiency, subclinical hypothyroidism, and bicytopenia. He was treated with mycophenolic acid of 180 mg b.i.d, methylprednisolone of 4 mg q.d, and vitamin D3 1000 IU q.d. Methylprednisolone was given for its anti-inflammatory property and as a simple once-daily regimen to supplement glucocorticoid deficiency. Levothyroxine was not prescribed for our patient since his thyroid stimulating hormone was only mildly elevated, and supplementation of levothyroxine in the setting of adrenal insufficiency might precipitate an adrenal crisis. At the 6-month follow-up, he was no longer fatigued, he regained his body weight, his skin and mucosal hyperpigmentation improved significantly, his thyroid stimulating hormone level normalized (without levothyroxine supplementation), and his complete blood count stabilized, remitting him from the need for transfusion.
Takayasu arteritis presenting with fever of unknown origin and bilateral carotid artery tenderness: A case report
Authors: Maita Hiroki , Kobayashi Tadashi , Akimoto Takashi , Ota Shinji , Sakuraba Hirotake , Kato Hiroyuki
Published: August 2023

A 51-year-old otherwise healthy woman was referred to our hospital with a fever of unknown origin, liver dysfunction, and anemia. One month prior, she had persistent and spontaneous anterior neck pain, with no exacerbation during swallowing or neck movements. Physical examination revealed no pharyngeal or tonsillar abnormalities, heart murmur, arthritis, skin rash, or lymphadenopathy, except for mild bilateral common carotid artery tenderness at the level of the thyroid cartilage. Blood tests showed nonspecific chronic inflammatory findings, anemia, and liver damage, whereas blood cultures, viral antibodies, interferon-γ release assay, and antibodies specific for any collagen disease showed negative results. Echocardiography and computed tomography without contrast of the neck, chest, abdomen, and pelvis showed no apparent abnormalities. She was subsequently diagnosed with Takayasu arteritis using positron emission tomography. Identifying a characteristic history of bilateral carotid artery tenderness and subsequent positron emission tomography can be useful for diagnosing Takayasu arteritis.
By any memes necessary: Belief- and chaos-driven motives for sharing conspiracy theories on social media
Authors: Farhart Christina E. , Fitz Erin B. , Miller Joanne M. , Saunders Kyle L.
Published: August 2023

Although a growing body of scholarship examines who believes conspiracy theories (CTs) and why, less is known about why people share CTs. We test the impact of three independent motives on people’s willingness to share CTs on social media: bolstering their or their group’s beliefs (motivated sharing), generating collective action against their political outgroup because of losing (sounding the alarm), and mobilizing others against the political system (need for chaos). Using an original survey of US adults ( N = 3336), we test these three motives together and find strong evidence for motivated sharing and need for chaos, but no evidence for sounding the alarm. Our findings suggest that motivated sharing—when measured directly as belief in the CTs—is the strongest predictor of willingness to share CTs on social media. Need for chaos has less of an effect on sharing than belief but a consistently stronger effect on sharing than partisanship and ideology. Altogether, we demonstrate that sharing CTs on social media can serve both motivated and mobilizing functions, particularly for those who believe the CTs or seek to challenge the political system, rather than impugn their political rivals.
The safe use of lasers in biomedicine: Principles of laser-matter interaction
Authors: Insero Giacomo , Fusi Franco , Romano Giovanni
Published: August 2023

Optical radiation sources, and in particular lasers, find an ever-increasing number of applications in the medical field. It is essential that personnel who are in the presence of an optical radiation source, whether operator, patient or researcher, know precisely the risks inherent in the exposure of the human body to radiation. In order to reduce the risk of biological damage, beyond the provisions of the law on safety regulations, the precise information and accurate preparation of personnel are the main guarantee for the correct use of these sources. In all the application fields, the possibility of a biological damage cannot be completely eliminated, assuming the connotation of occupational risks. In order to understand the risks and operate their effective mitigation, the basic knowledge of the fundamental concepts at the basis of laser-matter interaction will be presented and discussed, with a focus on the physical parameters needed to efficiently estimate and mitigate the related occupational risks, in both a laboratory and clinical context.
Validity and Reliability of the Human Immunodeficiency Virus-Related Stigma Questionnaire in Persian
Authors: Moradzadeh Rahmatollah , Navidi Iman , Zamanian Maryam
Published: August 2023

Background: It was aimed to adapt a 12-item questionnaire into Persian among people living with human immunodeficiency virus (PLHIV) in Markazi province. Material and Methods: Content validity was evaluated based on the opinions of the relevant experts, and by calculating the scale-level content validity index (S-CVI) and the item-level content validity index (I-CVI). Reliability was assessed via test–retest, intraclass correlation coefficient (ICC), and Cronbach's alpha. Results: The obtained scores on clarity and relevancy (I-CVI) ranged from 0.9 to 1. The S-CVI also had an acceptable validity of 0.99. The Cronbach's alpha index of the whole questionnaire was 0.84 and ranged from 0.69 to 0.82 for subscales. The ICC in test–retest for all questionnaires was 0.88 and for subscales ranged from 0.77 to 0.88. Conclusion: The Persian version of the 12-item human immunodeficiency virus-related stigma questionnaire was found to be, in addition to being short and comprehensive, acceptable reliability and high validity to use in order to determine the stigma related to Persian-speaker PLHIV.
Clinical and Biomechanical Outcomes of Suture Button Fixation for Ligamentous Lisfranc Injury: A Systematic Review and Meta-analysis
Authors: Chona Deepak V. , Park Caroline N. , Kim Billy I. , Lau Brian C.
Published: August 2023

Background:

Flexible ligamentous fixation has increased in popularity for the treatment of ligamentous Lisfranc injury, but the optimal fixation strategy is unclear.

Purpose:

To review the biomechanical, clinical, and radiographic results of ligamentous Lisfranc injuries treated with flexible fixation.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed/Medline and Google Scholar literature databases were queried for clinical and biomechanical (cadaveric) studies relating to flexible fixation of ligamentous Lisfranc injury. Outcomes of interest included patient-reported outcome scores, clinical/biomechanical results, radiographic alignment, and return to activity. Where appropriate, meta-analysis of the postoperative outcomes was performed.

Results:

Of the 34 initial studies, 14 articles (243 feet) were included in the analysis. In the 11 clinical studies (216 patients), the mean postoperative American Orthopaedic Foot & Ankle Society score was 90.1 (n = 150; 6 studies) and the mean visual analog scale score was 1.5 (n = 137; 5 studies). The rate of return to activity was 100% (n = 35; 5 studies), and 100% of patients maintained radiographic alignment postoperatively (n = 62; 6 studies). No complications or subsequent hardware removals were reported. Of the 3 biomechanical studies (27 feet), 1 study found significantly greater change in diastasis under axial load between intact and postfixation ligaments with suture button versus screw fixation (+1.1 vs –0.1 mm; P < .05), another found no difference in the decrease in diastasis under axial load between the injured state and screw or suture button fixation (1.2 vs 1.0 mm; P = .5), and the third found no difference in displacement between intact and either screw or suture button fixation under either axial (intact vs screw: 1.0 vs 2.0 mm, P = .1; intact vs suture button: 0.6 vs 1.8 mm, P = .1) or abduction (intact vs screw: 1.5 vs 1.1 mm, P = .5; intact vs suture button: 1.3 vs 2.1 mm, P = .1) load.

Conclusion:

Flexible fixation use in the treatment of ligamentous Lisfranc injury was found to have significant potential as a fixation option, as demonstrated by excellent clinical results. Biomechanical evidence was inconclusive but suggested a trend toward decreased diastasis in specimens fixed with screws compared with suture buttons.
Paper 10: Characterization of Bone in Osteochondral Allografts Utilizing Inflammatory-Mediated Cellular Death Pathways
Authors: Langhans Mark , Rodeo Scott , Ying Lilly , Anand Krishna
Published: August 2023

Objectives:

Osteochondral allografts are used to treat chondral and osteochondral defects. While prior studies have correlated cell death within the chondral component of osteochondral allografts directly with clinical outcomes, cell death within the subchondral and trabecular bone has not been well characterized. While prior studies have demonstrated a role for apoptosis in chondral cell death in osteochondral allografts, none have examined the role of pyroptosis and necroptosis in osteochondral allografts. These pathways are of particular relevance because persistent inflammation associated with osteochondral allografts on imaging is correlated with poor patient-reported outcomes. We report here a study examining cell death and mechanism in osteochondral allografts.

Methods:

Fresh human talus allografts were cultured for 14, 28, or 42 days at 4oC in standard clinical media. Osteochondral plugs were taken at the specified time points and fixed in 10% formalin. Cell death was measured in the cartilage, subchondral bone, and trabecular bone with TUNEL staining. The mechanism of cell death was further examined with staining for apoptosis (activated caspase 3), necroptosis (MLKL), and pyroptosis (cleaved gasdermin D). Percentage of cells staining positive was calculated in each zone (cartilage, subchondral bone, trabecular bone). Each time point included 4-5 replicates. Appropriate statistical comparisons were made between groups.

Results:

Cell death was significantly greater in the trabecular bone and subchondral bone than the cartilage. There was an increase in cell death over time in cartilage as well as subchondral bone. Apoptosis was the most prevalent mechanism of cell death, but necrosis and pyroptosis were present in all areas of bone and cartilage.

Conclusions:

This study suggests that a component of osteochondral allograft clinical outcomes may be related to viability of the bony component of the allograft. There is significantly greater cell death in the bone versus the cartilage and a significantly greater percentage of the cell death is through pyroptosis, an inflammatory-mediated pathway. Culture media and surgical strategies that limit the effect of inflammatory cell death in the bone component of osteochondral allograft may help to improve postoperative incorporation and control persistent inflammation that can complicate surgical outcomes.
Paper 29: Untreated Type 4 Ramp Injuries at Index Anterior Cruciate Ligament Reconstruction Surgery Result in Higher Rates of Revision ACL-R within the First 2 Years
Authors: Green Joshua , Moran Jay , Medvecky Michael , Katz Lee , Gardner Elizabeth , Joo Peter , Wang Annie , Allen Christina , Jimenez Andrew , Santos Estevao , McLaughlin William
Published: August 2023

Objectives:

Ramp lesions are commonly associated with ACL tears and recent studies have identified these lesions in 17-42% of patients undergoing treatment with ACL reconstruction. In addition to its association with ACL tears, there is increasing recognition that ramp lesions lead to significant biomechanical changes in the knee. Our study seeks to investigate whether patients with type 4 ramp lesions at the time of initial ACL reconstruction have higher rates of reoperation, specifically revision ACL-R, compared to those that undergo ACL-R without a ramp lesion.

Methods:

Retrospective chart review was conducted on all patients surgically treated with ACL reconstruction at level I academic center from January 2015 to December 2019. Type 4 ramp lesions were diagnosed on preoperative MRIs by two MSK-trained radiologists blinded to clinical information. Demographic, associated injuries, intra-operative, clinical data, and re-operations were extracted from our ACL-R database. Statistical analysis using Students T-test and chi x2 for comparing cohorts. Cox Regression with covariates for re-operation surgery was used. Risk factors evaluated for revision surgery included patient age, sex, BMI, treatment of ramp, timing to surgery. Inter-reliability coefficient correlation was used for MRI reliability.

Results:

A total of 255 patients ACL-R were identified that met inclusion. There were 170 patients with ACL-R without a ramp present and 85 patients with ACL-R + type 4 ramp lesion. Revision ACL-R occurred in 10.5% in ramp group compared to 2.4% without ramp (P<0.005). Around 75% of the revision ACL-R for the ramp group occurred within the first 2 and half years after surgery. Risk factor associated with revision ACL-R included untreated ramp (HR 10.46 (CI: 2.13-109.70) p=0.01).

Conclusions:

Meniscal ramp lesions with ACL-R result in higher revision ACL-R when compared to no ramp ACL-R. Most significantly untreated type 4 ramp lesions with concomitant ACL-R were associated with increased risk of ACL-R revision surgery . Standard portals are not sufficient in diagnosing and assessing stability of ramp lesions intra-operatively. [Table: see text]
Paper 49: Bridging Reconstruction for Large-to-Massive Rotator Cuff Tears Has a Low Rate of Cuff Arthropathy Progression at A Minimum Five-Year Follow-Up
Authors: Kizaki Kazuha , Sparavalo Sara , Ma Jie , Wong Ivan , Med Dip Sports
Published: August 2023

Objectives:

Rotator cuff tears cause pain, muscle weakness, and difficulty with overhead activity. While smaller tears are easier to repair, large-to-massive cuff tears (>3 cm in size) are considered irreparable. For patients with large-to-massive cuff tears, surgical options include maximal repair, superior capsular reconstruction, bridging reconstruction, tendon transfers and reverse total shoulder arthroplasty (rTSA). Bridging reconstruction was developed to improve outcomes and to avoid the morbidity associated with other technique. Bridging reconstruction, also known as graft interposition, has been shown to have superior outcomes as compared to maximal repair with better patient-reported outcomes at two-years post-operatively as recently demonstrated in a randomized controlled trial. These positive results are maintained at five years, however the midterm changes in progression of rotator cuff arthropathy and conversion to rTSA have not been assessed. The purpose is to assess the progression of rotator cuff arthropathy in bridging reconstruction patients at a five-year follow-up.

Methods:

Forty-four patients who underwent bridging reconstruction between 2012 and 2017 for large-to-massive rotator cuff tears were included. All patients had a minimum five-year follow-up. Data collected included demographics, pre- and post-operative Western Ontario Rotator Cuff (WORC) Index, conversion to rTSA, and X-ray readings (including acromiohumeral distance (as measured on anterior-posterior pre/post-operative radiographs) and Hamada grades for rotator cuff arthropathy). Furthermore, a sub-group analysis was performed on post-operative MRIs for graft status.

Results:

The mean age at surgery was 59.9± 10.8 years with a mean follow-up of 7.3±1.4 years. The population was mostly male (70.5%). Pre-operatively, seven patients had mild rotator cuff arthropathy with Hamada grade 2-3, and one patient had Hamada grade 4B. The rest of the patients had Hamada grade one preoperatively. At a minimum five-year postoperative follow-up, only one patient had a rTSA, resulting in a survivorship rate of 98%. Two patients (4.6%) had post-operative Hamada grade 4. One patient had progression of cuff arthropathy from pre-operative Hamada 3 to post-operative Hamada 4A. The other patient maintained Hamada grade 4B from pre-operative to post-operative. Patients with progression of cuff arthropathy (i.e. higher post-operative Hamada grade) appear to have a higher possibility of complete post-operative graft tears. [SS1] [JM2] There were no correlations between progression of cuff arthropathy and WORC score at five years.

Conclusions:

At a minimum 5-year with a mean follow-up of 7.3 years, bridging reconstruction showed 98% survivorship rate with a low rate of conversion to rTSA and a low progression of cuff arthropathy with only 4.6% of patients having advanced RCA with Hamada grade 4.
Paper 68: Outcomes following Extracorporeal Shockwave Therapy for chronic Achilles tendinopathy at short to mid-term follow-up
Authors: Butler James , Zheng Danny , Walls Cian , Azam Mohammad , DeClouette Brittany , Kennedy John
Published: August 2023

Objectives:

The purpose of this retrospective clinical study was to evaluate outcomes following extracorporeal shockwave therapy (ESWT) for the treatment of Achilles tendinopathy. Subgroup analysis was conducted to identify predictors of poor outcomes.

Methods:

This retrospective cohort study included existing clinical data from 74 patients from a single academic institution. Patients greater than 16 years of old who underwent ESWT for Achilles tendinopathy in the office setting between 3/3/2017 to 8/2/2022 were included. Data collected included: patient demographics, co-morbidities, treatment characteristics, Victorian institute of sports assessment – Achilles (VISA-A) scoring tool, visual analog scale (VAS), magnetic resonance imaging data, return to play (RTP) data and failures were recorded. Failure was defined as no improvement in VISA-A nor VAS scores or surgical intervention. For these data, mean and standard deviation were calculated, and paired samples T-tests and Welch’s T-tests were performed on clinical outcome scores.

Results:

In total, 74 patients (91 heels) with a mean age of 54.1 ± 14.0 years and BMI of 27.3 ± 4.5 kg/m2 underwent ESWT for Achilles tendinopathy at a mean follow-up of 25.7 ± 15.0 months. Eighteen patients were in the non-insertional Achilles tendinopathy (NAT) cohort and 56 patients were in the insertional Achilles tendinopathy (IAT) cohort. Both NAT and IAT cohorts had a similar improvement in VISA-A score (p=0.365) and VAS scores (p=0.65). A shorter return to play time was found in the NAT cohort (1.1 ± 0.9 months) compared to the IAT cohort (2.6 ± 5.7 months) but this was not statistically significant (p=0.34). There was a higher failure rate in the the IAT cohort (50.0%) than the NAT cohort (38.9%). Patients who received platelet-rich plasma (PRP) had a higher failure rate (61.2%) than those who did not receive PRP (39.6%). In the NAT cohort, the failure rate in females was 0.0%. In the IAT cohort, the failure rate in females was 61.9%. Linear regression analysis found that elevated BMI and MRI severity were associated with worse post-ESWT outcomes.

Conclusions:

This retrospective study demonstrated a high failure rate at short-term follow-up in patients who underwent ESWT for Achilles tendinopathy. Higher failure rates were found in patients with IAT and those who received intratendinous PRP. Predictors of poor outcomes included elevated BMI and MRI severity. Further studies with larger patient cohorts and a longer follow-up are necessary to determine the role of ESWT in the treatment of Achilles tendinopathy.
Poster 122: RANTES/CCL5 and BFGF Concentration at the Time of Surgery Can Predict Postoperative Stiffness in Patients Undergoing ACLR
Authors: Petrera Massimo , Kingery Matthew , Duenes Matthew , Song Melissa , Jazrawi Laith , Strauss Eric , Avila Amanda
Published: August 2023

Objectives:

Patients undergoing anterior cruciate ligament reconstruction have been shown to be at risk for postoperative arthrofibrosis. Diagnostic biomarkers associated with development of stiffness are unknown. The objective of this study is to identify biomarkers found in the synovial fluid at the time of surgery that are associated with development of postoperative arthrofibrosis in a cohort of patients undergoing anterior cruciate ligament reconstruction

Methods:

Patients undergoing anterior cruciate ligament reconstruction were prospectively enrolled. Synovial fluid was collected in the OR prior to surgical incision. A cohort of patients with postoperative stiffness requiring manipulation under anesthesia or lysis of adhesions was identified. Matching of case to controls was performed using a 1:2 pair matching algorithm. Clinical factor-adjusted single biomarker and multivariable models were used to assess the association of biomarkers with postoperative stiffness requiring MUA/LOA.

Results:

A total of 11 (n = 3 male, n = 8 female) patients undergoing ACLR met inclusion criteria, matched with 21 (n = 6 male, n = 15 female) controls with no significant differences in age, sex, smoking history, or days from injury to surgery. Levels of RANTES were significantly higher in cases versus controls (694.20 [214.75 - 3428.79] vs. 113.04 [32.81 - 517.91]; p=0.034). IL-IRA, bFGF, and RANTES were found to have greatest predictive value by the final stepwise logistic regression model. Independent predictors of increased risk of postoperative stiffness after ACLR included RANTES (OR [95% CI]) (2.28 [1.29 – 5.37]; p=0.019) and bFGF (1.91 [1.07 – 3.99]; p=0.047) according to a multivariable logistic regression model. Only RANTES was a statistically significant predictor of developing postoperative stiffness (OR [95% CI]) (2.59 [1.26-9.07]; p=0.046).

Conclusions:

Higher concentrations of biomarkers bFGF and RANTES were found to be predictive of increased risk for stiffness after ACLR. IL-6, VEGF, TIMP1, IL-1RA, MMP3, MCP-1, and MIPB were not found to be associated with postoperative arthrofibrosis.
Poster 173: Comparison of Sensitivity of Diagnosis of Subscapularis Tear on 1.5 Tesla versus 3.0 Tesla Magnetic Resonance Imaging
Authors: Neel Robert , Bernholt David , Azar Frederick , Brolin Tyler , Throckmorton Thomas , Gutman Ilya
Published: August 2023

Objectives:

Diagnosis of subscapularis tears via Magnetic Resonance Imaging (MRI) has been reported to have variable accuracy, with prior studies indicating sensitivity of MRI ranging from 30.0-83.0%. In the current literature, studies utilizing 3.0T MRI scans have generally shown higher sensitivity compared to studies utilizing 1.5T MRI scans; however, there has not been direct comparison of differences in accuracy of 1.5 vs. 3.0T for diagnosis of subscapularis tear. The aim of this study is to investigate this difference. We hypothesize that 3.0T MRI scans will show higher sensitivity for the detection of subscapularis tears compared to 1.5T MRI scans.

Methods:

A single institution data set was queried to identify patients undergoing rotator cuff repair between January 2015 and January 2020. Patients were separated based on 1.5T and 3.0T MRI strength and these cohorts were analyzed based on intraoperative findings of subscapularis tears and interpretation of these MRI reports. Likewise, demographic information of the cohorts was analyzed including BMI, age, and sex. Univariate analysis, multivariate analysis, and Pearson’s χ2 test, Mann- Whitney U test were used when appropriate.

Results:

In a total 756 of patients, 151 were identified as having rotator cuff surgery with preoperative MRI that met our inclusion criteria. A total of 50 (33.1%) of patients were identified as having intraoperative findings of subscapularis tears that were not appreciable on MRI. A statistically significant difference was found when comparing the sensitivity of 3.0T MRI for identifying subscapularis tears when compared to 1.5T MRI. 3.0T MRI had a sensitivity of 72.9% compared to 56.4% respectively[TTW1] [GIM2] ( P < 0.05). Both groups had a PPV of 100% given no false positive results. 3.0T MRI had a NPV of 92.5% while 1.5T had a NPV of 92.2%.

Conclusions:

When a subscapularis tear is clinically suspected, surgeons should be critical over the choice of 1.5T vs 3.0T MRI imaging and understand their sensitivity to guide recommendations for intervention, preoperative planning, and overall patient satisfaction. [Table: see text][Table: see text]
Poster 188: Is Hormone Replacing Therapy Associated with Reduced Risk of Adhesive Capsulitis in Menopausal Women? A Single Center Analysis
Authors: Saltzman Eliana , Kennedy June , Ford Anne , Reinke Emily , Green Cindy , Poehlein Emily , Wittstein Jocelyn
Published: August 2023

Objectives:

The purpose of this study was to determine if hormone replacing therapy (HRT) is protective against adhesive capsulitis in menopausal women. We hypothesized that patients undergoing HRT will have a lower incidence of AC as compared to those without HRT.

Methods:

A single institution electronic medical record system was queried to retrospectively review menopausal women between the ages of 45 and 60. Subjects included were those enrolled in a single healthcare system coverage model to minimize inaccessibility to external episodes of care. Only data in existence as of November 1st 2018 was reviewed. Patients were identified using ICD-9 and 10 codes for shoulder pain, shoulder stiffness and AC. A REDCap database was then built, allowing the authors to review medical records and verify the variables and diagnoses. The diagnosis of AC on chart review was confirmed by a sports medicine fellowship-trained orthopaedic surgeon and shoulder-specialized physical therapist. Patients identified with AC were further reviewed for rotator cuff tears, if corticosteroid injections were received, and lastly if surgery was required. Both groups were assessed for associated endocrine disorders. Odds ratio for diagnosis of AC was determined for subjects with and without HRT using a logistic regression analysis. All statistical analysis were conducted in SAS 9.4 (Cary, NC). Statistical significance was assessed at p< 0.05.

Results:

A total of 1,952 patients were included in the study, with 152 patients receiving HRT. The distribution of thyroid disorder and diabetes were similar between the two groups with no statistically significant difference. In the HRT cohort 11.2% were identified with thyroid disorder and 9.2% with diabetes; in the no HRT 12.4% were identified with a thyroid disorder and 14.3% with diabetes. Additionally, 4.0% of patients with HRT and 7.7% of those without HRT had AC. Those not receiving HRT had 99% greater odds of adhesive capsulitis compared to those receiving HRT; however, this association did not reach statistical significance (OR: 1.99; 95% CI 0.86, 4.58; p = 0.11).

Conclusions:

This is the first known study to evaluate the role of HRT in the development of AC amongst menopausal women in a single center. We concluded from our preliminary study that women not receiving HRT had greater odds of AC, however the study is limited by the available sample size. While the analysis is underpowered, the 95% confidence interval for the odds ratio contains values that support the hypothesis that HRT may be protective against AC. This preliminary data will serve as a basis for larger multi-center and prospective studies to further evaluation this association.
Poster 256: Pediatric Meniscus Repair: Safety Profile based on > 2000 Arthroscopic Meniscus Repairs
Authors: Registry SCORE Quality Improvement , Ellis Henry
Published: August 2023

Objectives:

Pediatric meniscus tear prevalence is increasing, and meniscus preservation methods are essential for long term knee function in this at risk group. In this patient population meniscus anatomy and vascularity may support higher rates of healing after repair, but safety of meniscus repair has not been studied in a large prospective cohort group. The purpose of this study is to establish the incidence of complications associated with pediatric meniscus repairs in a multi-center prospective quality improvement registry, and to identify the characteristics of meniscus repair that are associated with complications.

Methods:

A prospective multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of meniscus repairs was reviewed. Audit processes using CPT codes were designed to ensure that all consecutive cases were prospectively entered on patients <19 years old into a HIPAA- compliant electronic platform. Each meniscus repair case with a complication form was secondarily reviewed to ensure consistency of identification and grading according to the modified Clavien Dindo classification. Demographics, tear type, repair technique, and implant type, when applicable, were included, and a common cause analysis was performed to evaluate risk factors for early repair failures.

Results:

2375 meniscus repair cases were identified, with a mean age of 15.1 years (2-19) and 44.1% females. These consisted of (25%) isolated repair, (5.4%) discoid meniscus repair, and (66.9%) concomitant ACL and meniscus repair. Overall complication rate was 12.64%, with 5.67% grade III complications. The most common complications were motion loss/stiffness (3.96%), failed repair (2.3%) and continued pain/mechanical symptoms (2.09%). Failed repair was identified in all repair groups but had the highest prevalence in isolated meniscus repair (6.38%), in which grade III complications were more common overall. Stiffness was more common when a meniscus repair was performed during an ACL reconstruction (2.1% Grade II and 1.27% Grade III). There was no statistical difference in complications associated with age, gender, or technique, medial or lateral meniscus, displacement, or zone of repair. However, posterior horn and posterior horn + body repairs of the medial meniscus sustained more complications (p=0.003) as did longitudinal/complex tears of the lateral meniscus (p=0.02).

Conclusions:

Pediatric meniscus repairs performed arthroscopically have a complication rate of 12.64%, with 1 and 20 meniscus repairs leading to a grade III complication. Although there is no difference in complications based on technique, posterior horn medial meniscus and longitudinal tears of lateral meniscus may be at higher risk of complications.
Poster 275: The Impact of Socioeconomic Status on Meniscus Repair Outcomes
Authors: Sackey Nathalie , Cavendish Parker , Milliron Eric , Duerr Robert , Flanigan David , Kaeding Christopher , Magnussen Robert , Barnes Ryan
Published: August 2023

Objectives:

Meniscus tears are among the most common knee injuries. Successful meniscus repair is vital to avoid articular cartilage damage and osteoarthritis. There are many factors that contribute to the outcome and prognosis of meniscus repair including patient and injury factors. The goal of this study was to identify demographic and socioeconomic factors that may influence patient outcomes after meniscus repair. It was hypothesized that income can impact meniscus repair outcomes.

Methods:

Retrospective review identified patients who underwent meniscus repair surgery between 2009 and 2018 at a single academic institution. Patients were included if they lived in the local metropolitan area. Chart review was undertaken to collect demographic and surgical data. Patients were split into two groups: the 16 wealthiest zip codes and 16 poorest zip codes based on adjusted gross income from the internal revenue service (IRS) in 2018. Patients were included in the analysis if KOOS and IKDC scores were available. An independent t-test was used to determine the difference in scores between the two groups.

Results:

67 patients were included in the analysis. 23 were from low-income zip codes and 44 were from high income zip codes. The patients from the poorer zip codes had significantly lower KOOS and IKDC scores compared to patients from the wealthier zip codes. Chart review identified socioeconomic factors that limited access to care in the postoperative period in 5 patients from the poorer zip codes (21.74%). Among these patients 40% of them reported lack of access to physical therapy due inadequate insurance coverage, and 60% due to lack of transportation, inability to take time off work and personal or family problems.

Conclusions:

Socioeconomic status may significantly impact outcomes, like KOOS and IKDC scores, following meniscus repair. Further work with larger dataset would provide more insight into this important question and allow for controlling of potential confounding variables. [Table: see text]
Poster 285: MRI Measurement of TT-TG Can Change Without Intervention: An Analysis of Sequential Pre-Operative MRIs in PFI patients
Authors: Pascual-Leone Nicolas , Chipman Danielle , Davie Ryann , Bram Joshua , Mintz Douglas , Fabricant Peter , Green Daniel
Published: August 2023

Objectives:

Following a patella dislocation event, the patella can remain unstable, leading to patellofemoral instability (PI). There are various anatomic risk factors for PI that help guide surgical treatment including the tibial tubercle to trochlear groove (TT-TG) distance. However, to the authors knowledge, no study has analyzed the temporal changes in TT-TG prior to any surgical intervention. This study, therefore, sought to understand the variations in TT-TG for pediatric patients suffering from patellar instability prior to any surgical intervention. The authors hypothesized that the TT-TG would not substantially change between timepoints.

Methods:

Patients undergoing medial patellofemoral ligament (MPFL) reconstruction using CPT code 27427 between January 1, 2014 and December 31, 2019 by one of two orthopedic surgeons were identified. Patients were included if they 1) had two pre-operative MRIs performed of the same knee within 8 months of each other prior to any surgical intervention and 2) had an initial TT-TG between 10 mm and 20 mm. Exclusion criteria were previous ipsilateral knee surgery or planned MPFL reconstruction with tibial tubercle osteotomy. Initial and subsequent TT-TG measurements were compared using paired-samples t-tests with two-tailed statistical significance set at p ≤0.05. IBM SPSS Statistics version 22 (Armonk, NY) was used for all statistical analysis.

Results:

After considering 251 patients for inclusion, 26 patients met inclusion criteria and were analyzed. Mean age of the cohort was 14.5±2.4 years and 42.3% were male. TT-TG was initially noted to be 15.3±1.8 mm. At mean time between sequential MRI’s of 4.8±1.9 months, TT-TG was noted to be 17.1±3.5 mm. The differences between initial and subsequent TT-TG ranged from a 21% decrease to a 61% increase, with a mean difference of a 12.1% increase. Comparison between initial and subsequent TT-TG values demonstrated a significant difference (p=0.006).

Conclusions:

At a mean time between MRIs of 4.8 months, variations in TT-TG ranged from a decrease of 21% to an increase of 61%. These findings suggest that TT-TG measurements may vary in patients on sequential MRIs and could be due to variations in tibiofemoral rotation during imaging. Surgeons should be aware of these variations when planning surgical correction for patellar instability. [Table: see text]
Poster 321: MENISCAL RAMP LESIONS IN ADOLESCENT PATIENTS UNDERGOING PRIMARY ACL RECONSTRUCTION
Authors: Pennock Andrew , Bomar James , Chambers Henry , Edmonds Eric , Hollnagel Katharine
Published: August 2023

Objectives:

Meniscal ramp lesions describe a specific injury to the meniscocapsular junction at the posterior horn of the medial meniscus. The lesions are strongly associated with anterior cruciate ligament (ACL) injuries and may affect the biomechanical stability of the knee if left untreated. Despite the increasing rates of ACL reconstructions performed in adolescents each year, the prevalence and risk factors for ramp lesions in this patient population is poorly understood. The purpose of this study was to determine the prevalence and risk factors for ramp lesions in children and adolescent patients undergoing primary ACL reconstruction.

Methods:

All patients ≤19 who underwent primary ACL reconstruction at a single institutional between 2019 and 2021 were included. All surgeries were performed by three fellowship trained orthopedic surgeons. Patients were considered to have a ramp lesion if one was identified arthroscopically at the time of ACL reconstruction. Basic demographic data, preoperative imaging, and other arthroscopic findings at the time of ACL reconstruction were reviewed.

Results:

247 consecutive patients who underwent ACL reconstruction were reviewed. Patients were excluded if they had had prior ACL injury, prior knee surgery, fibular hemimelia, or incomplete documentation. A total of 230 patients met inclusion criteria. Average age at time of injury was 15.7 years (range 4.0-18.2 years). A ramp lesion was identified in 12% of patients. Posteromedial tibial bone bruise on preoperative MRI and medial femoral chondromalacia at time of ACL reconstruction were associated with the presence of a ramp lesion, Figure 1A (OR = 2.6, 95% CI [1.15, 5.93]). A striation pattern of medial femoral chondromalacia was highly specific for the presence of a ramp lesion, Figure 1B (OR = 424.3, 95% CI [50.99, 3531.3]). Sensitivity and specificity for detecting a ramp lesion was 68% and 76% with preoperative MRI and 68% and 99.5% with medial condyle striations, respectively.

Conclusions:

The prevalence of a ramp lesion in our cohort was 12%, mirroring historical reports in adult patients. Posteromedial bone bruising and medial femoral chondromalacia, especially in a striation pattern, should increase suspicion for the presence of a ramp lesion in patients undergoing ACL reconstruction.
Poster 334: Failure Rates and Complications with Multiple-Revision ACL Reconstruction: Don’t Forget the Over-The-Top Technique
Authors: Winkler Philipp , Nazzal Ehab , Zsidai Bálint , Drain Nicholas , Kaarre Janina , Sprague Andrew , Lesniak Bryson , Musahl Volker , Ozbek Emre Anil
Published: August 2023

Objectives:

Multiple-revision anterior cruciate ligament reconstruction (ACL-R) presents several technical challenges, often due to residual hardware, tunnel widening, or malposition. The aim of this study was to compare complication rates between over-the-top (OTT) and anteromedial portal drilling (AMD) techniques in patients undergoing multiple-revision ACL-R.

Methods:

A retrospective cohort study comprised of patients undergoing multiple-revision ACL-R was performed by four sports medicine fellowship trained surgeons in a single institute. Patients with two or more revision ACL-Rs performed with the OTT or AMD techniques were included. Data on patient demographics, graft characteristics, number of revisions, concomitant procedures, complications (arthrofibrosis, septic arthritis, cyclops lesion), and failures were collected. Between- group comparisons of continuous and categorical variables were conducted with independent samples t- tests and Fisher’s exact or the chi-squared test, respectively. Level of significance was set at p < 0.05.

Results:

A total of 101 patients undergoing multiple revision ACL-R with OTT (n=37, 37%) and AMD (n=64, 63%) techniques were identified. The mean follow-up period was 60 months (range: 12-196). No statistically significant differences were found in age, gender, body mass index, laterality, or follow-up length ( p > 0.05, Table 1) between the groups. Allograft was the most frequently used graft (n=64, 67.3%) with no significant differences between groups in terms of graft diameter. There were no statistically significant differences between groups regarding rate of concurrent medial meniscus, lateral meniscus, cartilage, or lateral extra-articular tenodesis procedures ( p > 0.05; Table 2). As displayed in Table 3, there was also no statistically significant difference in complication rate (OTT: n=2 (5.4%); AMD: n=8 (13%); p > 0.05) or graft failure rate (OTT: n=4 (11%); AMD: n=14 (22%); p > 0.05) between groups.

Conclusions:

The results of this study showed notably elevated failure and complication rates in challenging multiple-revision ACL-R. Complication and failure rates were lower in the OTT compared to the AMD technique, however, there were no significant between group differences in these outcomes. In the setting of multiple-revision ACL-R, surgeons may consider the use of the OTT technique. [Table: see text][Table: see text][Table: see text]
Poster 341: Clinical Outcomes of Concomitant Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction and Meniscal Allograft Transplantation
Authors: Vasavada Kinjal , Avila Amanda , DeClouette Brittany , Aziz Hadi , Strauss Eric , Alaia Michael , Jazrawi Laith , Gonzalez-Lomas Guillem , Campbell Kirk , Shankar Dhruv
Published: August 2023

Objectives:

Single-stage meniscus allograft transplantation (MAT) with concomitant anterior cruciate ligament reconstruction (ACLR) is a technically challenging procedure for management of knee pain and instability in younger patients. However, there is limited data on specific outcomes of this procedure, such as return to work and functional status relative to the U.S. population at large. The purpose of this study was to assess surgical and patient-reported outcomes following concomitant ACLR and MAT.

Methods:

We conducted a retrospective review of patients who underwent concomitant ACLR and MAT at our institution from 2010 to 2021. We included patients who underwent either concomitant primary or revision ACLR and medial or lateral MAT with a minimum follow-up of 8 months. Complications, graft failures, and reoperations were abstracted from patient records and Visual Analog Scale (VAS) pain, satisfaction, Lysholm Knee Scale, return to sport, and return to work outcomes were assessed using an email survey. Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, Pain Intensity, and Physical Function Scores were used to measure patients’ functional status relative to the U.S. population. All p-values less than 0.05 were considered significant.

Results:

The cohort consisted of 18 knees of 17 individual patients (16 unilateral, 1 bilateral). The cohort were majority male (15 patients; 83%) with mean age of 31.6 years (range 19-49) and mean BMI of 27.6 (range 22.2-53.3). Mean follow-up time was 47.3 months (range 8-101). A majority underwent revision ACLR (12 patients; 67%) with medial MAT (18 patients; 92%). Reoperation rate was high (5 patients; 28%) but only one patient experienced recurrence of painrequiring TKA. Patient-reported outcomes (n = 14) were generally positive with low VAS pain (mean 2.2), high satisfaction (mean 77.9%), and fair Lysholm score (mean 81.1) though satisfaction was lower among revision ACLR patients versus primary ACLR patients (mean 67% vs 100%; p = 0.04). Return to work rate was high (13 patients; 93%) while return to sport rate was low (6 patients; 43%). Postoperative PROMIS scores were comparable or superior to the national average and correlated significantly with patient satisfaction (p < 0.05).

Conclusions:

The concomitant ACLR and MAT procedure is associated with excellent knee pain and functional outcomes, low rates of complications and meniscus graft failure, and high rate of return to work after surgery. However, rate of return to sport is low and satisfaction is worse among revision ACLR patients. Overall, the single-stage ACLR and MAT procedure appears to be a safe and efficacious treatment option for patients with concomitant ACL and meniscus deficiency.