bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paper 05: Inferior Hill-Sachs Position Predicts Failure Following Primary Bankart Repair for On-Track Lesions
Authors: Fox Michael , Fatora Gabrielle , Reddy Rajiv , Barrow Aaron , Charles Shaquille , Lesniak Bryson , Rodosky Mark , Hughes Jonathan , Popchak Adam , Lin Albert , Cong Ting 
Published: August 2023

Objectives: The on-track/off-track concept for shoulder instability primarily describes the medial-lateral rotational relationship between an engaging Hill-Sachs lesion and a Bankart defect. Though clinically more protective, on-track lesions retain some risk for failure following primary arthroscopic Bankart repair. While some of this risk can be explained by the “near-track” concept, the role of the superior-inferior position of the Hill-Sachs lesion has never been studied in the context of failure of primary Bankart repair. This study aims to identify the relationship between the superior-inferior position of a Hill-Sachs lesion and risk for failure following primary arthroscopic bankart repair. Our hypothesis is that inferiorly-based Hill-Sachs lesions may engage with the arm in neutral and thus be higher risk for failure following primary Bankart repair. Methods: We performed a retrospective analysis of 201 individuals with on track lesions who underwent primary arthroscopic Bankart repair (without remplissage) between 2007 and 2019 who have minimum 2 year follow-up. Patients with failure were defined as those who sustained a dislocation or subluxation after the index procedure. A pre-operative sagittal MRI cut showing the maximum Hill-Sachs diameter was used for position analysis. Sagittal position of the Hill-Sachs was defined the angle formed by the Hill-Sachs bisecting line through the humeral head center, against the mid-humeral axis on a sagittal MRI cut (Figure 1); for example, an angle of 0 is twelve o’clock on the humeral head, while an angle of 90 is equatorial. We defined a priori four Hill-Sachs quadrants for semi-quantitative analysis, based on physiologic arm positions: Superior (angle < 40), Mid-Superior (40-60), Mid (61-90), and Inferior (>90). Hill-Sachs quadrants were then correlated against failure following primary arthroscopic Bankart repair. Results: Failure rates following arthroscopic bankart repair as it relates to superior-inferior position of the Hill-Sachs lesion is as follows (Table 1): No Hill-Sachs (10 of 73, 13.7%), Superior (0 of 7, 0%), mid-superior (6 of 36, 16.7%), Mid (19 of 71, 26.8%), and Inferior (1 of 6, 16.7%). We grouped Hill-Sachs lesions into low grade (No Hill-Sachs, Superior, and Mid-Superior quadrants) and high grade (Mid and Inferior quadrants). Low grade represented a 13.8% risk of failure, while High grade represented a 26% risk for failure (p=0.034). Conclusions: The superior-inferior sagittal position of a Hill-Sachs lesion may contribute to risk for failure of primary arthroscopic Bankart repair for on-track lesions. Inferiorly-based Hill-Sachs lesions may risk engagement at lower degrees of arm abduction, and in our study represent nearly double the risk of failure of arthroscopic Bankart repair as compared to superior Hill-Sachs positions. [Table: see text]
Paper 15: 5 Year Radiographic and Functional Outcomes of Non-Operative Treatment of Completely Displaced Clavicle Fractures in Teenagers, A Prospective Study
Authors: Edmonds Eric , Bastrom Tracey , Heyworth Benton , Pennock Andrew , Polinsky Samuel 
Published: August 2023

Objectives: Optimal treatment for displaced clavicle fractures in adolescents remains controversial, with many surgeons favoring operative reduction and fixation. To prospectively assess patient reported outcomes (PROs) in teenagers undergoing non-operative treatment of a completely displaced clavicle fracture ≥ 5 years post-injury. Furthermore, bilateral clavicle imaging was used to determine the association between these outcomes and the presence or absence of bony remodeling. Methods: This study used a subset of patients previously enrolled in a multicenter study looking at adolescent clavicle fractures. Patients from a single institution and ≥ 13 years at the time of injury, with non-operatively treated completely displaced clavicle fractures who were ≥5 years out from their initial injury were able to participate in the study. Patients were clinically evaluated for evidence of scapular dyskinesia, strength deficits, and cosmetic concerns. Bilateral clavicle imaging was used to assess residual shortening, displacement, and angulation. PROs included: ASES, QuickDASH, Marx Shoulder Activity Scale, and return to sport data. Results: Twenty-four patients were available for follow-up, of whom 17 (71%) consented to the additional imaging. The mean age at the time of injury was 14.5±1.1 years with 89% being male. At a mean follow-up of 6.1 years, all fractures healed and no interventions were necessary (Figure 1). Significant remodeling was observed across all measurements with improvements of 70% in mean shortening (22.8 mm to 6.8 mm, p<0.001), 73% in superior displacement (13.4 mm to 3.6 mm, p<0.001), and 83% in angulation (10.4˚ to 1.8˚, p<0.001) (Figure 2). Thirteen patients (72%) had initial shortening > 2 cm and all remodeled to < 2 cm. PROs were almost universally excellent with no patients reporting shoulder pain and mean ASES, quickDASH, and Marx activity scores of99±3, 1±3, and 20±1, respectively, with 79% of patients reporting perfect scores in all 3 domains. Majority (58%) were completely satisfied with the appearance of their shoulder, 38% were more satisfied than not, one patient (4%) was neither satisfied nor dissatisfied, and no patients were dissatisfied. All patients except 1 returned to sporting activities if interested. No PROs were associated with bony remodeling (p>0.05). Conclusions: Teenage patients with completely displaced clavicle fractures can expect excellent radiographic and clinical outcomes 5 years post-injury if treated non-operatively. This study further supports the role of non-operative treatment for teenagers, with nearly perfect outcomes reported bringing into question the role of acute operative management of these fractures given its associated risks and costs.
Paper 44: Deep Learning Artificial Intelligence Tool for Automated Radiographic Determination of Posterior Tibial Slope in Patients with Anterior Cruciate Ligament Injuries
Authors: Lu Yining , Camp Christopher 
Published: August 2023

Objectives: An increased posterior tibial slope (PTS) corresponds with an increased risk of graft failure following anterior cruciate ligament reconstruction (ACLR). Validated methods of human PTS measurements are subject to interobserver variability and can be inefficient on large-scale sets of images. The purpose of this study is to develop a deep learning artificial intelligence technique for the automated measurement of PTS from standard lateral knee radiographs. Methods: A deep learning U-Net model was developed on a cohort of 300 postoperative short leg lateral radiographs from ACLR patients to segment the tibial shaft, tibial joint surface, and tibial tuberosity. The model was trained via a random split following an 80:20 train-validation scheme. Masks for training images were manually segmented and the model was trained for 400 epochs. An image processing pipeline was then deployed to annotate and measure the PTS using the predicted segmentation masks. Finally, the performance of this combined pipeline was compared to human measurements performed by two study personnel using a previously validated manual technique for measuring PTS on short leg lateral radiographs on an independent test-set consisting of both preoperative and postoperative images. Results: The U-Net semantic segmentation model achieved a mean Dice similarity coefficient of 0.885 on the validation cohort. The mean difference between human-made and computer-vision measurements was 1.92⁰ (σ = 2.81⁰, P=0.24). Extreme disagreements between human and machine measurements as defined by differences ≥5⁰ occurred less than 5% of the time. The model was incorporated into a web based digital application for demonstration purposes which can provide measurement of an uploaded image in portable network graphics format in less than 5 seconds. Conclusions: We developed an accurate and reliable deep learning computer vision algorithm to automate the measurement of PTS on lateral knee radiographs. This tool will be deployed for clinical use on an institution-wide basis and, pending external validation, be made available to outside orthopaedic surgeons. This will provide an efficient and accurate tool to measure PTS during the preoperative assessment of ACL-injured patients.
Paper 63: Return to Long Distance Running After Hip Arthroscopy for Femoroacetabular Impingement
Authors: Olsen Reena , Burger Joost , Dooley Matthew , Coleman Struan , Ranawat Anil , Kelly Bryan , Nawabi Danyal , Marom Niv 
Published: August 2023

Objectives: Arthroscopic hip surgery for femoroacetabular impingement (FAI) has shown high rates of return to different sports in athletes. No studies to date have focused on patients’ return to long- distance running, a running sport with unique characteristics and demands. The purpose of this study was to determine return to long-distance running rates and changes in running performance in long distance runners undergoing hip arthroscopic surgery for the treatment of FAI and to identify possible risk factors associated with not returning to long distance running. Methods: An institutional hip preservation registry was retrospectively reviewed for patients identified as long distance runners (half marathons and marathons) who underwent primary hip arthroscopies for FAI performed between March 2010 and January 2017. Patient demographics and injury characteristics as well as clinical and radiographic findings were recorded. All patients were contacted for return to running information using a running specific return to sport questionnaire. Multivariable logistic regression analysis was used to identify potential risk factors for not returning to long-distance running. Results: Sixty-eight long distance runners (78 hips) were included. Mean patient age and body mass index (BMI) were 37.8±8.9 years and 23.8±3.3 kg/m2, respectively. Thirty-eight (56%) were female runners. Mean weekly running milage prior to injury was 34.5±16.9 miles. Mean duration of hip symptoms prior to seeking medical evaluation was 77.3±16.9 weeks. Fifty-nine runners (87%) had to stop or modify their running for a mean duration of 44.3±45 weeks prior to surgery due to hip symptoms. Overall, 50 runners (74%) returned to any running, of which 25 runners (50%) returned to long distance running completing half/full marathons races after surgery. Most common reasons for not returning to running were pain or discomfort (50%) followed by fear of re-injury (22%) and additional different injuries (22%). Among runners who did not return to any running, 12 (67%) reported satisfaction from surgery. Multivariable logistic regression analysis revealed female runners (odds ratio [OR]=0.2; confidence interval [CI]=0.0 to 0.9; p=0.034) and hips with radiologic findings of higher alpha angles (OR=0.9; 95% CI=0.9 to 1.0; p=0.045) were less likely to return to long distance running. Conclusions: Hip arthroscopic treatment for FAI in symptomatic long-distance runners, a distinctive subgroup of runners, allowed most of them (74%) to return to running, however only 40% returned to long distance running races. Female runners and runners with radiologic findings of higher alpha angles were less likely to return to long-distance running. These data can better guide clinicians and long- distance runners with realistic expectations related to the arthroscopic management of symptomatic FAI.
Poster 129: Biomechanical Evaluation of the Isometry of Medial Patellofemoral Ligament Reconstruction Grafts Fixed at Non-Anatomic Femoral Insertion Points
Authors: Gupta Andrew , Mortensen Alex , Illing Damian , Guss Andrew , Herrick Jennifer , Presson Angela , Burks Robert , Aoki Stephen , Rosenthal Reece 
Published: August 2023

Objectives: In MPFL reconstruction surgery, achieving perfect placement of the femoral tunnel intraoperatively is difficult. An understanding of the effects femoral tunnel malpositioning has on graft isometry is crucial to minimizing instability or overconstraint which leads to anterior knee pain, increased patellofemoral contact pressures, or graft failure. The purpose of this study was to identify differences in MPFL reconstruction graft isometry with femoral tunnel malpositioning, specifically evaluating isometry differences as the femoral position is moved anterior, posterior, proximal, and distal relative to the femoral radiographic landmark of the MPFL, Schottle’s point. Methods: A biomechanical study evaluating 11 fresh frozen cadaveric knees was conducted. Non-elastic suture, used as an MPFL graft analogue, was anchored at Schottle’s point with the knee at 30° of flexion, and at 5 mm and 10 mm anterior, posterior, superior, and distal to Schottle’s point. A draw wire displacement sensor was used to evaluate length changes of the MPFL graft analogue through 0-120° of knee flexion. Knee flexion position was continuously measured using a motion tracking system. Pairwise t-tests with Bonferroni corrections were used to compare isometry between Schottle’s point and non- anatomic femoral insertion points. Results: Grafts placed at Schottle’s point demonstrated mild anisometry with tightening in extension and loosening in flexion. Similarly, grafts placed distally and posteriorly also demonstrated tightening in extension and loosening in flexion. Grafts placed anteriorly and proximally demonstrated tightening in flexion. Mean and range of total draw wire excursion over full ROM across specimens is shown in Figure 1. The mean draw wire length was found to be greater with further displacement from Schottle’s point in all directions but posterior. Pairwise comparisons relative to Schottle’s point found grafts placed in the proximal or distal direction demonstrated significant differences in MPFL excursion, while grafts placed in the anterior or posterior direction did not (10 mm proximal: 0.36 (p=0.028), 5 mm distal: 0.14 (p=0.012), 10 mm distal: 0.22 (p<0.001)) (Table 1). Conclusions: In order to minimize the risk of graft tightening during knee flexion, if deviating from Schottle’s point, it is safest to err posterior or distal in femoral tunnel position. Travel away from Schottle’s point in the proximal or distal direction has the greatest effects on graft isometry. The greatest risk of overconstraint and graft tightening in flexion is seen with proximal placement of the femoral insertion point.
Poster 135: Posterior Capsular Release for Knee Extension Deficits After Anterior Cruciate Ligament Reconstruction in Athletes
Authors: Iturregui Jose , Vij Neeraj , Tummala Sai , McQuivey Kade , Economopoulos Kostas , Brinkman Joseph 
Published: August 2023

Objectives: To describe outcomes of posterior capsular release to treat knee extension deficits after anterior cruciate ligament (ACL) reconstruction in athletes. Methods: A retrospective review was performed between January 2014 and December 2019 for patients undergoing arthroscopic posterior capsular release for knee extension loss following ACL reconstruction. Patients were indicated for the procedure if they had greater than 10° of extension loss at least three months after ACL reconstruction that was refractory to physical therapy. Patients were included in the study if they were involved in either high school or college athletics, had complete outcomes of interest, and had at least two years of follow up. Collected outcomes included preoperative and postoperative measurement of knee extension, international knee documentation committee (IKDC) score, Lysholm score, return to sport data, and complications. Results: Over the study period a total of 38 arthroscopic posterior capsular releases were performed. Of these, 20 were high school or college athletes. Two of these patients did not have 2-year follow up, leaving a total of 18 patients included in the analysis. Patients underwent surgery at an average of 16 weeks after ACL reconstruction. Knee extension improved an average of 13.8° at 2-years follow up (pre- release extension deficit 15.1°, post-release extension deficit 1.3°, p < 0.005). Improvements in the IKDC score averaged 21.7 at 6 months and 35.0 at 24 months, both of which were statistically significant (p < 0.001). Similarly, differences in Lysholm included a significant improvement of 23.0 and 34.2 at 6 months and 2 years, respectively (p < 0.001). In total, 77.8% returned to sport at an average of 9.8 months from their primary surgery and 6.5 months following posterior capsular release surgery. Complications included one patient that required revision capsular release for persistent extension loss, one ACL tear of the ipsilateral knee, and two ACL tears of the contralateral knee. No infections or neurovascular injuries occurred. Conclusions: Knee extension loss after ligamentous repair surgery can have significant consequences including diminished patient satisfaction, reduced return to sport, and an increased risk of osteoarthritis development. Although arthroscopic posterior capsular release is a recognized treatment for knee extension loss, outcomes have not been reported in athletes. In our series, arthroscopic posterior capsular release resulted in significant improvement of knee extension and patient reported outcome scores at 6 month and 2 years postoperatively. Additionally, the procedure appears to be safe with few complications and only 5.6% of patients requiring repeat arthroscopy for knee extension loss. Posterior capsular release appears to be a reliable and safe treatment for athletes with persistent knee extension loss after ACL reconstruction.
Poster 138: Intra-articular Femorotibial Rotation is Associated with Tibial Tubercle-Trochlear Groove Distance
Authors: Pascual-Leone Nicolas , Jahandar Amir , Davie Ryann , Bram Joshua , Chipman Danielle , Imhauser Carl , Green Daniel 
Published: August 2023

Objectives: A tibial tubercle-trochlear groove (TT-TG) distance of 20 mm is typically used when determining whether tibial tubercle anteromedialization (AMZ) is needed for patellar instability. TT-TG distance, however, may depend on the internal/external (IE) rotation of the tibia in relation to the femur, which is typically not controlled for. Without knowledge of the variability in an individual’s TT-TG influenced by femorotibial rotation, the use of a specific TT-TG distance during pre-operative planning for patellar instability may lead to incorrect decisions on the use of tibial tubercle AMZ. We hypothesized that knee joint IE rotation is related to the TT-TG distance. Methods: A total of 8 independent human cadaveric knee specimens (age: 32±6; 4 males, 4 females) were utilized. A robotic manipulator (ZX165U, Kawasaki Robotics, Wixom, MI, USA) instrumented with a universal force/moment sensor was used to determine knee joint internal/external (IE) rotation under applied moments of ±5Nm at full extension. Two independent reviewers selected the trochlear groove and tibial tuberosity points on CT images of each specimen to define TT-TG (ICC=0.969). To determine the influence of knee joint IE rotation on TT-TG, 3D models generated from CT scans were registered to tibiofemoral kinematics. Subsequently, linear regression was performed to determine the relationship between knee joint IE rotation and TT-TG. Regression coefficient and standard error of measurement (α=0.05), and coefficient of determination (r2) were reported. Results: Knee joint IE rotation averaged 23.0 ± 4.2°. TT-TG changed by 12.1 ± 2.8 mm over this range. For every degree of knee joint IE rotation, TT-TG changed by 0.52 ± 0.07 mm (p<0.001 and r2>0.987). At neutral rotation, the TT-TG averaged 14.21 ± 5.0 mm. Conclusions: TT-TG was highly dependent on knee joint IE rotation changing by 0.52 mm for every degree of knee joint IE rotation. Thus, an offset in IE rotation of 10° would lead to a change in TT-TG of 5.2 mm, enough to alter surgical decision making for or against tibial tubercle AMZ. Physicians should pay close attention to knee joint IE rotation when measuring TT-TG in their patients, specifically in patients found to have a TT-TG near 20 mm, a key indication for surgical treatment of patellar instability. [Table: see text][Table: see text]
Poster 141: Does the Traditional TT-TG Distance Accurately Reflect the Relative Position of the Tibial Tubercle to the Trochlear Groove? A Three-Dimensional Analysis
Authors: Dandu Navya , Elias Tristan , Hevesi Mario , Credille Kevin , Wang Zachary , Haneberg Erik , Inoue Nozomu , Yanke Adam 
Published: August 2023

Objectives: The tibial tubercle to trochlear groove (TT-TG) distance often guides surgical decision- making for patellar instability. Traditional TT-TG measurements are limited by interrater reliability and lack of consideration for variable anatomy throughout flexion. The purpose of this study was to compare the traditional TT-TG measurement to three-dimensional measures generated from automated trochlear groove detection with sequential radial slices on magnetic resonance imaging (MRI). Methods: Twenty-four knees (4 healthy controls, 20 patellar instability patients) were segmented into three-dimensional distal femur and tibia models. A custom-designed program was employed to detect the trochlear groove through its course based on the shortest distance to the origin in a polar (radial) axis defined by the distal femoral condyles. The program also identified the surface projection of the tibial tubercle center of mass. The medial-lateral distance between the trochlear groove and tibial tubercle was calculated for the first 45 degrees of the detected groove to generate radial TT-TG (rTT-TG) values. The mean and maximum rTT-TG values were compared to the traditional TT-TG MRI measurement performed by one grader. Results: Mean rTT-TG values were significantly greater than traditional measurements (21.8 mm versus 17.9 mm, p=.003) with moderate correlation between measurements (Pearson r = 0.59, p=.002). In Dejour C and D dysplasia, the mean rTT-TG measurements trended towards being greater than traditional measurements (C: 24.3 mm versus 16.6 mm; D: 28.5 mm versus 21.8 mm; p=0.057 for both comparisons). Dejour C dysplasia demonstrated a significantly greater maximum rTT-TG than the traditional measurement (27.9 mm versus 16.6 mm, p=0.029), and Dejour D dysplasia demonstrated a similar trend (30.2 mm versus 21.8 mm; p=0.057). Conclusions: Traditional TT-TG distances may underestimate the true medial-lateral offset between trochlear groove and tibial tubercle, particularly in patients with high- grade dysplasia. This represents a potential alternative to the current standard measurement techniques which may improve measurement reliability by automation. Our study suggests that utilizing 3D radial TT-TG values via automated measurement may more accurately portray the variable anatomy of the trochlear entrance and offer a standardized alternative to a frequently used measurement to overcome reader reliability.