bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk analysis of visceral pleural invasion in malignant solitary pulmonary nodules that appear touching the pleural surface
Authors: Zhu Ziwen , Jiang Weizhen , Zhou Danhong , Zhu Weidong , Chen Cheng 
Published: October 2024

Background: The preoperative determination of visceral pleural invasion (VPI) in patients with malignant solitary pulmonary nodules (SPNs) is essential for determining the surgical range and selecting adjuvant chemotherapy. Objectives: This study aimed to systematically investigate risk factors of VPI in patients with SPN and construct a preoperative predictive model for such patients. Design: This is a retrospective study. The clinical, radiological, and pathological characteristics of study subjects were reviewed, and the groups with and without VPI were compared. Methods: Multivariate logistic analysis was utilized to identify independent risk factors for VPI. Moreover, a predictive nomogram was constructed to assess the likelihood of VPI occurrence. Results: Of the 364 enrolled cases, SPNs adjacent to the pleura with VPI were found in 110 (30.2%) patients. By incorporating four preoperative variables, including tumor diameter (>2 cm), maximum computed tomography value (>200 Hu), air bronchogram sign, and age, a preoperative predictive nomogram was constructed. The nomogram demonstrated good discriminative ability, with a C-index of 0.736 (95% CI (0.662–0.790)). Furthermore, our data indicated that the air bronchogram sign (odd ratio (OR) 1.81, 95% CI (0.99–3.89), p = 0.048), a maximum diameter >2 cm (OR 24.48, 95% CI (8.43–71.07), p < 0.001), pathological type (OR 5.01, 95% CI (2.61–9.64), p < 0.001), and Ki-67 >30% (OR 2.95, 95% CI (1.40–6.21), p = 0.004) were overall independent risk factors for VPI. Conclusion: This study investigated the risk factors for VPI in malignant SPNs touching the pleural surface. Additionally, a nomogram was developed to predict the likelihood of VPI in such patients, facilitating informed decision-making regarding surgical approaches and treatment protocols.
Poster 135: Tranexamic Acid for Rotator Cuff Repair: A Systematic Review & Meta-Analysis of Randomized Controlled Trials
Authors: Hurley Eoghan , Levin Jay , Rodriguez Kaitlyn , Karavan Mark , Helmkamp Joshua , Alaia Michael , Klifto Christopher , Anakwenze Oke 
Published: October 2024

Objectives: The purpose of this study was to perform a systematic review of the randomized controlled trials in the literature to evaluate the use of tranexamic on arthroscopic rotator cuff repair. Methods: Two independent reviewers performed the literature search based on the PRISMA guidelines with a third author resolving any discrepancies. RCTs comparing TXA to a control in ARCR were included. Visualization, postoperative pain, operative time, pump pressures and shoulder swelling. A p value < 0.05 was deemed statistically significant. Results: Six RCTs with 450 patients were included in this review. Overall, 6 studies evaluated intra-operative visualization with 4 studies finding a significant difference in favor of TXA. With TXA patients had a lower average postoperative VAS score of 3.3, and with the control, patients had an average VAS score of 4.1, which was statistically significant (p = 0.001). With TXA the average weighted operation time was 79.3 minutes and with the control the average operation time was 88.8 minutes, which was statistically significant (p = 0.001). No study found any difference in post-operative pump pressures or swelling. Conclusions: TXA improved visualization, operative time and subsequent postoperative pain levels in patients undergoing ARCR.
Poster 141: In Vitro Inflammatory Response to Surgical Scaffolds for Rotator Cuff Repair
Authors: Smith Richard , Dakin Stephanie , Carr Andrew , Snelling Sarah 
Published: October 2024

Objectives: Surgical scaffolds are used to augment rotator cuff tendon repairs. Interactions between recruited immune cells and tendon-resident stromal cells influence whether the scaffold is integrated or rejected by the body. The primary aim of this in vitro study was to compare the inflammatory response of human monocytes to different surgical scaffolds. The secondary aim was to determine how this monocyte response affects the behavior of human rotator cuff tendon-derived stromal cells in vitro. Methods: Primary human monocytes were cultured on four commercially available scaffolds: LARS ligament (synthetic); GraftJacket (allograft), Permacol (xenograft, cross-linked), and Conexa (xenograft, noncross-linked). Secreted inflammatory proteins were measured after 1 and 10 days. Foreign body giant cell formation was assessed after 10 days. Proliferation and gene expression of tendon stromal cells were assessed after being grown in a conditioned medium from monocyte-scaffold cultures. Results: After 10 days, monocytes cultured on the Conexa scaffold secreted the highest levels of the pro-inflammatory markers GM-CSF, IL-8, and IL-10 (fig. 1). After 1 day, tendon stromal cells incubated in conditioned media from Conexa-monocyte cultures expressed lower Collagen Type VI and increased MMP3 and MMP6 mRNA (fig. 2). Foreign Body Giant Cell formation was most prominent in monocytes cultured on the Permacol scaffold (Figure 3). Conclusions: In vitro experiments demonstrated that xenograft scaffolds elicited a more pronounced pro-inflammatory response in human monocytes compared to synthetic and allograft scaffolds. Inflammatory cytokines secreted by monocytes in response to xenografts may modulate scaffold integration through paracrine signaling to tendon stromal cells. These findings may help explain the clinical performance of xenograft scaffolds for tendon repair and inform future scaffold design.
Poster 150: Subscapularis CT Evaluation in Patients following Treatment for Proximal Humerus Fractures: Reverse versus Anatomical Total Shoulder Arthroplasty
Authors: Gaj Eduardo , Pagnotta Susanna , Criseo Natale , Maggiori Alessandro , Forsythe Brian , Gamsarian Vahram , Mirle Vikranth , Khazi-Syed Daanish , Chang Joshua , Giallorenzi Maria Agostina , De Carli Angelo 
Published: October 2024

Objectives: Hemiarthroplasty (HA) and reverse total shoulder arthroplasty (RTSA) are both reliable treatment options for complex proximal humerus fractures. While the role of the subscapularis tendon is well defined in HA, its role in RTSA has not been clearly demonstrated. The purpose of our study is to evaluate the role of the subscapularis tendon in patients treated with HA and RTSA and investigate its association with clinical outcomes. Methods: Sixty-eight consecutive patients with proximal humeral fractures were prospectively enrolled in the study between June 2015 and May 2020 (RTSA = 36; HA = 32). Shoulder CT scans were performed pre- and postoperatively, and subscapularis muscle cross-sectional area (SMCSA) and supraspinatus fossa cross-sectional area (SFCSA) were measured. SMCSA/SFCSA ratio was employed to standardize values. Patient-reported outcomes (PROs) and range of motion (ROM) were evaluated at the final follow-up. Results: RTSA group demonstrated higher PROs compared to HA patients: Constant Score (p = .0001), Quick Dash (p = .0006), Simple Shoulder Test (p = .01). ROM was better in RTSA than HA: internal rotation (p = .0047 adduction and p = .026 abduction), external rotation (p = .001 adduction and p = .026 abduction) and forward flexion (p < .0001). Reduction of subscapularis size of >35% occurred in 20 RTSA and 8 HA (p = 0.01). The loss of subscapularis surface was greater in the RTSA patients (p = 0.018). Conclusions: RTSA demonstrated better results compared to HA, providing better PROs and ROM. Postoperative reduction in subscapularis size was significantly higher in RTSA compared to HA. Subscapularis condition demonstrated no correlation with functional outcomes in RTSA.
Poster 174: Is Articular Width or Epicondylar Width Superior to Age to Optimize Radius of Curvature Matching in Capitellar Osteochondral Allografts?
Authors: Chan Charles , Sueyoshi Tetsuro , Maruyama Masahiro , Nissen Carl , Shea Kevin 
Published: October 2024

Objectives: There is growing interest to use matched distal humeral osteochondral allograft (OCA) for treatment of osteochondritis dissecans (OCD) of the capitellum due to concerns of donor site morbidity in osteochondral autograft transplantation surgery. Current graft match processes utilize the epicondylar width (EW) of the distal humerus, though little information is available regarding the correlation of this measurement to the radius of curvature (ROC) of the capitellum. The purpose of this study was to characterize the correlation between the EW and ROC as well as to evaluate two additional candidate parameters including patient age and the distal humeral articular width (AW). Methods: Forty patients (age ≤18) were identified for analysis. The capitellar cartilage ROC was measured on the sagittal plane of each magnetic resonance imaging (MRI) study at the level where the corresponding radial head was greatest in diameter (fig. 1). The EW (fig. 2) and the AW (fig. 3), which is bordered by the medial articular border of the trochlea and the lateral articular border of the capitellum, were also measured on the axial plane of each MRI study at maximal width. R2 correlation coefficients were calculated for ROC to EW, AW, and patient age (fig. 4). Intra-observer and inter-observer reliability measurements were performed to assess precision and validity of method. Results: The mean sagittal cartilage ROC, EW, and AW were 11.05 mm, 60.79 mm, and 44.31 mm. When measured against ROC, patient age had poor correlation with a R2 value of 0.46 whereas EW and AW demonstrated strong correlation with R2 values of 0.68 and 0.76 respectively. Intra-observer correlation coefficients were 0.93, 0.96, and 0.95 for ROC, EW, and AW respectively. Inter-observer correlation coefficients were 0.79, 0.94, and 0.94 for ROC, EW, and AW, respectively. Conclusions: Our results suggest that both AW and EW demonstrate superior correlation to capitellar ROC in comparison to age, and AW may be superior to EW. AW may be considered for utilization as a distal humeral allograft matching parameter particularly in patients that may have altered epicondylar morphology such as in the throwing athlete. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]
Poster 181: Hip Arthroscopy with Concomitant Periacetabular Osteotomy Demonstrates Excellent Outcomes and Survivorship at Minimum 10-Year Follow-Up
Authors: Domb Benjamin , Kahana-Rojkind Ady , Parsa Ali , Bruning Rachel , Padmanabhan Saiswarnesh , LaReau Justin 
Published: October 2024

Objectives: Multiple studies have shown that hip arthroscopy with concomitant periacetabular osteotomy (PAO) is a safe and effective treatment option for patients presenting with Symptomatic acetabular dysplasia and intra-articular pathology. While excellent short- and mid-term outcomes have been previously reported, there exists a paucity of literature investigating long-term outcomes of hip arthroscopy with concomitant PAO. The purpose of this study was to report minimum 10-year follow-up results and survivorship of hip arthroscopy with concomitant PAO to treat acetabular dysplasia and intraarticular pathologies such as femoroacetabular impingement (FAI) and labral tears. Methods: Data from October 2010 to December 2012 was prospectively collected and retrospectively reviewed to identify patients undergoing hip arthroscopy with concomitant PAO. Patients were included in the present analysis if they had preoperative and minimum 10-year patient reported outcomes (PROs) documented for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Scored Sports-Specific Subscale (HOS-SSS), and pain on a visual analog scale (VAS), as well as the International Hip Outcome Tool (iHOT-12) and patient satisfaction score on a 0-10 scale. Results: Fifteen patients were eligible for analysis and 12 had complete minimum 10-year follow-up (80.0%) at mean 10.2 years postoperation. There were 10 females (83.3%) and 2 males (16.7%) included in the study with a mean age and BMI of 24.4 years and 24.5 kg/m2, respectively. The mean lateral center-edge angle (LCEA) of all included hips in the analysis increased from 13.8° to 29.8° postoperatively ( P<0.05) and the anterior center-edge angle (ACEA) increased from 14° to 28.8° postoperatively ( P<0.05). Additionally, the Tönnis angle of acetabular inclination decreased from 17.9° to 7.3° postoperatively ( P<0.05) and the alpha angle decreased from 56.5° to 52.1° postoperatively ( P<0.05). There was significant improvement in all PROs from baseline to minimum 10-year follow-up (mHHS; NAHS; HOS-SSS, P< 0.05). All patients achieved high rates of MCID for mHHS, NAHS, and HOS-SSS, as well as high rates of PASS for mHHS and VAS. The 10-year survivorship for all patients included in the analysis was 83.3% with 2 patients (16.7%) progressing to total hip arthroplasty (THA) at mean 58.0 months postoperatively. Additionally, 2 patients (16.7%) underwent subsequent ipsilateral revision hip arthroscopy at mean 79.5 months postoperatively. Conclusions: Patients with dysplasia and intra-articular pathology such as labral tears and FAI can be safely treated using hip arthroscopy with concomitant PAO. These patients can achieve excellent long-term outcomes and high rates of survivorship at minimum 10 years postoperation.
Poster 296: Comparing Outcomes of Osteochondral Allograft Transplantation of the Knee Preserved by the Missouri Osteochondral Preservation System to Standard Preservation Methods
Authors: Perez Andres , Hanna Adeeb J. , Destine Henson , Campbell Michael P. , Kern Nathaniel , Tucker Bradford S. , Freedman Kevin B. 
Published: October 2024

Objectives: Osteochondral allograft (OCA) transplantation is an established surgical intervention for full-thickness chondral defects. Standard Preservation (SP) protocols currently allow for osteochondral allografts to be stored for a maximum of 28 days after procurement. The Missouri Osteochondral Allograft Preservation System allows for grafts to be stored for at least 60 days after procurement. The purpose of this study is to compare clinical and radiographic outcomes in patients that have undergone OCA transplantation utilizing Missouri Osteochondral Allograft Preservation System (MOPS) to standard preservation protocols. Methods: Retrospective review identified all patients who underwent OCA transplantation between 2012 and 2018. Patients without appropriate follow-up, postoperative outcomes, or necessary imaging were excluded. All patients had at least 2-year follow-up data. Patient demographics, outcomes, and graft information were compared between patients who received grafts preserved by MOPS and standard preservation as previously defined. Results: Sixty-four patients were included. Twenty-five were in the MOPS group and 39 in the SP group. Members of the MOPS group were younger at the time of surgery than those in the SP group (28.6 ± 10.7 years in MOPS vs. 36.7 ± 10.9 in SP group, P = 0.005). Seventy-six grafts were analyzed with 39 grafts in the MOPS group and 37 in the SP group. Grafts in the MOPS group were stored longer (average 50.03 days) than grafts in the SP group (average 23.18 days) (P < 0.001). No difference between groups was found in complications or reoperation rates. Outcomes between the 2 groups showed no statistical differences for complications or revisions as well as similar Knee Injury and Osteoarthritis Outcome Scores for Joint Replacement, International Knee Documentation Committee scores, 12-item psychosocial safety climate scores, and 12-item mental health component summary scores. Conclusions: Grafts preserved using the MOPS were stored for more than double the length of time than grafts preserved with standard preservation techniques. There was no difference in postoperative outcomes following OCA transplantation regardless of preservation method used.
Poster 328: Effect of Knee Aspiration prior to ACL Reconstruction Surgery on Subsequent Surgery: A Randomized Clinical Trial
Authors: Inclan Paul , Rai Muhammad , Chen Ling , Brophy Robert 
Published: October 2024

Objectives: The traumatic effusion associated with an acute anterior cruciate ligament (ACL) rupture contains pro-inflammatory cytokines, chemokines and matrix degrading enzymes. Aspiration of the effusion may help reduce the burden of joint inflammation. However, the short and mid-term implications of routine aspiration have not been well documented. The primary objective of this prospective, randomized control trial is to determine whether routine pre-operative aspiration upon presentation to the orthopaedic clinic impacts (a) all-cause re-operation rate in patients undergoing ACL reconstruction (ACLr) and, more specifically, (b) rate of surgical debridement for postoperative arthrofibrosis, a common clinical sequela of ACLr. Methods: Eligible patients presented to a single, academic sports surgeon with an acute ACL rupture and were clinically indicated for ACLr. Both sexes were included in this study. Exclusion criteria included pre-existing osteoarthritis (Kellgren-Lawrence grade 3 or greater), focal chondral injury (International Cartilage Repair Society grade 3 or higher), concurrent ipsilateral extra-articular injury, history of contralateral knee injury, or age greater than 62 years. Patients were randomized to either routine preoperative care or in-office aspiration of their traumatic effusion upon initial presentation. Patients underwent routine diagnostic arthroscopy at the time of ACLr to evaluate for concurrent chondral or meniscal pathology. Patients underwent standard postoperative rehabilitation and follow-up care. Results: Eighty-seven patients were enrolled in this study, with 46 (53%) patients randomized to and undergoing preoperative aspiration (Table 1). At a mean follow-up of 2.56 years, 14 patients (16%) underwent re-operation for any reason  and 10 (11.5%) patients underwent debridement of arthrofibrosis (Table 2). Preoperative aspiration was not significantly associated with a decreased rate of arthrofibrosis (Figure 1) or re-operation (Figure 2). However, it was significantly associated with a longer time to debridement for arthrofibrosis (125 days vs 457 days, p = 0.0029). Conclusions: Preoperative aspiration does not modify rates of subsequent surgery following ACLr. In patients who develop arthrofibrosis after ACLr, preoperative aspiration is associated with a delay in the development of arthrofibrosis. This could be due to a decrease in burden of intraarticular inflammation after aspiration. Further study is needed to assess why aspiration delays the onset of arthrofibrosis and whether aspiration impacts long-term outcomes such as the development of post-traumatic OA.
Poster 339: Outcomes of Anterior Cruciate Ligament Reconstruction in Competitive Ice Hockey Players: Outcomes, Reoperations, and Return to Play at 7 Years Mean Follow-Up
Authors: Feroe Aliya , Lamba Abhinav , Regan Christina , Marigi Erick , Stuart Michael 
Published: October 2024

Objectives: Ice hockey is a physically demanding sport, with young athletes prone to anterior cruciate ligament (ACL) injuries. Currently, there is a paucity of data examining the results of ACL reconstruction (ACLR) in competitive hockey players. The purpose of this study was to assess return to hockey (RTH) and reoperation rates following ACLR for ACL injuries in a cohort of competitive hockey players. Methods: All competitive ice hockey players (including, youth, high school, juniors, collegiate, or professional) with a history of ACL injury and subsequent ACLR at a single academic institution between 2000 and 2022 were identified. Exclusion criteria included ACL injuries that did not occur during hockey, history of ACLR prior to hockey injury, and recreational hockey players. Graft failure was defined as a retear (as determined via clinical or advanced imaging evaluation) and/or revision ACLR. Results: Ultimately, 50 knees in 44 hockey players were included at a mean (± standard deviation) follow-up time of 7.0 years ± 5.4 years (Table 1). The mean age at the time of index surgery was 18.9 years ± 3.0 years, with 38 males (76%), and the distribution of bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts was 40 (80%) and 10 (20%), respectively. RTH occurred in 66% of hockey players at a mean of 10.2 months ± 6.2 months. Graft failure occurred in 9 knees (18%) at a mean of 5.9 years ± 5.8 years after the index ACLR. All patients who sustained a retear underwent reoperation. Kaplan-Meier survivorship free from surgical failure of the entire cohort was 94% at 1 year, 88% at 5 years, 74% at 10 years, and 67% at 15 years (Figure 1A). BPTB autograft demonstrated a lower failure rate compared with HT autograft (13% vs 40%; P = 0.041) and was associated with better survival compared with HT autograft up to 15 years after the index ACLR (80% vs 39%; P = 0.047; Figure 1B). Conclusions: ACL injury remains a concern for competitive hockey players after ACLR. Return to competitive ice hockey was observed in 66% of athletes after ACLR, with 18% of hockey players experiencing graft failure and undergoing subsequent reoperation. BPTB autograft was associated with better survival than HT autograft.
Poster 371: ChatGPT: An Effective Tool for Patients to Understand Platelet-Rich Plasma in Orthopedic Surgery
Authors: Samsonov Alan , Butler James , Roof Mackenzie , Kennedy John 
Published: October 2024

Objectives: Web-based technology has augmented healthcare delivery for both patients and providers. ChatGPT, a free and easily accessible artificial intelligence (AI) chatbot, has the potential to further optimize current practice. The chatbot has cemented itself as an informative resource for orthopaedic patients, but its use in ortho-biologics, particularly platelet-rich plasma (PRP), has not been described. The purpose of this study was to assess the quality of information provided by ChatGPT in response to frequently asked questions about the use of PRP in orthopedic surgery. Methods: ChatGPT was posed 10 frequently asked questions about the use of PRP in orthopedic surgery in a conversational thread. Responses were recorded and no follow-up queries or clarification was obtained. The responses were subsequently graded “A,” “B,” “C,” or “F,” corresponding with “excellent response,” “adequate response needing mild clarification,” “inadequate response needing moderate clarification,” and “poor response needing severe clarification.” Results: Of the 10 responses, 1 was grade “A,” 7 were grade “B,” 2 were grade “C,” and 0 were grade “F.” Overall, ChatGPT provided good quality responses to the prompts. Conclusions: ChatGPT provided sufficient responses to questions regarding PRP in orthopedic surgery, utilizing appropriate language to provide responses representative of the current literature surrounding PRP. The biggest limitation to superior chatbot performance is the lack of robust consensus on the use and preparation of PRP. This study accentuated the possibility for ChatGPT to serve as an additional informative resource for orthopedic surgery patients who want to learn about PRP.