bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.