bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sling Versus Abduction Brace Shoulder Immobilization After Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis
Authors: Gao Jing-Hui , Zhou Jing-Yi , Li Hong , Li Hong-Yun 
Published: August 2023

Background: The optimal immobilization position of the shoulder after rotator cuff repair is controversial. Purpose: To compare the clinical outcomes and incidence of retears after arthroscopic rotator cuff repair between patients who used an abduction brace versus a sling for postoperative shoulder immobilization. Study Design: Systematic review; Level of evidence, 1. Methods: This systematic review and meta-analysis was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched the PubMed, MEDLINE, and Embase electronic databases for randomized controlled trials (RCTs) that compared abduction brace and sling immobilization after arthroscopic rotator cuff repair using single-row, double-row, or suture-bridge fixation. Clinical scores, pain severity, and retear rates were compared between patients with abduction brace versus sling immobilization. Results: Of 1572 retrieved studies, 4 RCTs with a total of 224 patients (112 patients with abduction brace and 112 patients with sling) were included in the qualitative analysis, and 3 of the RCTs were included in the quantitative analysis (meta-analysis). There were no significant differences between the abduction brace and sling immobilization groups in the Constant-Murley score at 3 months (weighted mean difference [WMD], 0.26 [95% CI, –1.30 to 1.83]; P = .74; I 2 = 84%), 6 months (WMD, 1.91 [95% CI, –0.17 to 4.00]; P = .07; I 2 = 85%), and 12 months (WMD, 0.55 [95% CI, –1.37 to 2.47]; P = .57; I 2 = 0%); the visual analog scale score for pain at 1 week (WMD, 0.10 [95% CI, –0.20 to 0.41]; P = .51; I 2 = 0%), 3 weeks (WMD, –0.12 [95% CI, –0.34 to 1.00]; P = .29; I 2 = 0%), 6 weeks (WMD, –0.12 [95% CI, –0.30 to 0.06]; P = .20; I 2 = 0%), and 12 weeks (WMD, –0.13 [95% CI, –0.27 to 0.02]; P = .09; I 2 = 18%); or the retear rate at 3 months (risk ratio, 0.63 [95% CI, 0.09 to 4.23]; P = .64; Z = 0.47%) postoperatively. Conclusion: Our systematic review demonstrated a lack of significant differences between the abduction brace and sling immobilization groups regarding postoperative clinical scores, pain severity, and tendon healing.
Outcomes After Revision Posterior Shoulder Capsulolabral Repair in Adolescent Athletes
Authors: Whicker Emily A. , Arner Justin W. , Edwards Callee , Bradley James P. 
Published: August 2023

Background: Few studies have evaluated the outcomes of posterior arthroscopic capsulolabral repair in adolescents, especially with regard to outcomes after revision repair. Hypothesis: Adolescent athletes who undergo revision arthroscopic posterior unidirectional capsulolabral repair will have similar outcomes and return to play when compared with adolescent athletes who underwent primary arthroscopic posterior unidirectional capsulolabral repair. Study Design: Cohort study; Level of evidence, 3. Methods: Data were reviewed from patients who underwent posterior shoulder stabilization between 2000 and 2019 and had a minimum follow-up of 2 years. Patients <11 and >19 years of age and those with multidirectional instability were excluded. Revision surgery was defined as repeat arthroscopic posterior capsular repair. The ability to return to sport (and level of sport), clinical outcomes scores (American Shoulder and Elbow Surgeons [ASES] and visual analog scale for pain), and patient-reported perception of range of motion, strength, and satisfaction were recorded. Comparisons between the primary and revision cohorts were made using the chi-square or the Mann-Whitney U test. Results: Included were 180 adolescent patients (182 shoulders) who underwent a primary unidirectional posterior stabilization, with an average follow-up of 6.1 years. Of these patients, 17 patients required revision surgery (9.3% revision rate). At the final follow-up, patients who underwent revision surgery returned to sport at similar rates to those who did not (70.6% vs 85.9%; P = .095) and were similarly likely to return to their presurgery level of play (41.1% vs 23.7%; P = .10). The no-revision patients had higher ASES scores (76.1 vs 87.1; P = .007) as well as less pain and improved subjective range of motion scores. However, both groups had similar subjective strength scores, and both reported that surgical repair was satisfactory (no revision, 93.2% vs revision, 88.2%; P = .45). Conclusion: Adolescent athletes had a low risk of revision surgery and frequently returned to play after arthroscopic posterior capsulolabral repair, often at a lower level of play. Those who required revision surgery had poorer outcome scores but still reported a high rate of satisfaction.
Paper 04: Acromial Morphology Differences in Primary versus Revision Posterior Shoulder Instability Patients
Authors: Freedman Benjamin , Mescher Patrick , Bedrin Michael , Dekker Travis , Kilcoyne Kelly , Dickens Jonathan , McCarthy Conor 
Published: August 2023

Objectives: Predisposing factors for failure of shoulder posterior stabilization surgery are not well defined. Characterization of revision posterior instability patients allows for insight into potentially identifiable risk factors for failure. Methods: A series of patients who underwent stabilization surgery for posterior shoulder instability as well as revision posterior instability cases performed between 2005-2019 were identified. Patient demographics were collected and glenoid morphology was quantified by measuring posterior bone loss, acromial tilt, and posterior acromial height on shoulder MRIs. Continuous variables were compared with Student’s t-test. Results: 42 active duty servicemembers who underwent successful primary posterior stabilization (primaries, P) and 41 who underwent revision posterior stabilization (revisions, R) and were identified. Mean ages of the primaries and revisions at time of primary surgery were 28.7 (±6.0; 18-39) and 23.0 (±5.2; 18-41) years respectively (p < 0.005). Males made up 92.9% (P) and 92.7% (R) of each group. Mean posterior glenoid bone loss at index MRI was 4.5% (±7.2; P) and 6.3% (±7.8; R) (p = 0.316). Mean index acromial tilt (from horizontal) was 40.9 degrees (±10.2; P) and 28.8 degrees (±10.6; R) (p < 0.005). Index posterior acromial height was 14.2 mm (±7.4; P) and 19.8 mm (±7.6; R) (p = 0.001). In the revision group, the progression of bone loss from index MRI to pre-revision MRI was 6.3% (±7.8) to 6.6% (±6.2) (p = 0.456). Index bone loss greater than 15% was present in 5/41 revision patients; when excluding these, mean index bone loss was 3.4% (±3.3), significantly less than that at pre-revision MRI (p = 0.038). Additional surgery occurred in 9.8% (4/41) of the revision group, and 2/4 separated from the military. In the revision group, 17.1% (7/41) separated, while an additional 7.3% (3/41) remained on active duty with upper extremity activity limitations. Conclusions: Index acromial tilt and posterior acromial height were respectively lower and higher in a population of revision posterior stabilization than in a cohort of patients who underwent successful posterior stabilization. A “high and flat” acromial morphology may predispose patients to failure of standard posterior stabilization procedures, potentially justifying further study into supplemental techniques to decrease failure risk.
Paper 14: Is the Use of a Postoperative Hip Orthosis Beneficial Following Routine Arthroscopy of the Hip? A Retrospective Cohort Study
Authors: Enos Jake , Mullen Scott , Schroeppel John , Mar Damon , Smoak Jason , Goodman Ian , Wentzel Dylan 
Published: August 2023

Objectives: Treatment of intra- and extra-articular pathologies of the hip via arthroscopy continues to gain popularity. To date, the impact of routinely bracing patients postoperatively on patient reported outcome measures (PROMs) and re-operation rate has not been elucidated. The purpose of this study is to determine if there is a difference in PROMs and re-operation rate for patients who were braced versus those who were not braced following routine hip arthroscopy. Methods: This was a retrospective review of 193 patients who underwent hip arthroscopy from 2018 to 2021 by two orthopedic surgeons at a single institution. 101 patients prior to July 1, 2019 were immobilized in a hip orthosis following hip arthroscopy whereas 92 patients after July 1, 2019 were not. Baseline patient reported outcomes in the form of visual analog pain scale (VAS), modified Harris Hip Score (M-HHS), single assessment numeric evaluation (SANE) hip scores, VR-12 physical score, VR-12 mental score were obtained for all patients in both cohorts and postoperatively repeated at two weeks, four weeks, three months, six months, one year, and two years. Additionally, results were stratified by gender to assess gender-based difference. The groups were then compared to evaluate for a difference in PROMs over time. T-tests or Wilcoxon ranked-sum were utilized to compare these groups depending on normality of the data. Comparisons of categorical demographics such as age and gender between bracing groups were assessed using chi-squared tests. Re-operation rate was compared between the two groups using the Fischer Exact Test. Statistical significance was set at p<0.05 for all analyses. Results: After analyzing a cohort of patients who were braced and a cohort who were not braced postoperatively, no significant difference (p>.05) in PROMs at two weeks, four weeks, three months, one year or two years was detected for VAS, mHHS, SANE, VR-12 Physical and VR-12 Mental. No significant difference in reoperation rate was detected for the braced vs the non-braced cohort (p=.105). Demographics were not significantly different regarding gender distribution (p=0.418) and age (p=0.087) between groups. Conclusions: The findings above suggest the use of an orthosis after routine hip arthroscopy does not improve patient reported outcomes or alter the reoperation rate. Postoperative bracing increases perioperative cost and by foregoing routine bracing, patients may avoid associated morbidity that can come with wearing a brace for a prolonged period of time. The results of this project will help to guide clinical decision making as it pertains to whether to use a postoperative hip orthosis following routine hip arthroscopy.
Paper 16: What Happens to Youth Baseball Players Diagnosed with Little League Shoulder and Little League Elbow?
Authors: Bastrom Tracey , Paranjape Chinmay , Tadlock Josh , Pennock Andrew , Jensen Evan 
Published: August 2023

Objectives: Little League elbow (LLE) and Little League shoulder (LLS) are frequent diagnoses encountered in youth baseball players. To date, limited data exists as to how these athletes fare as they progress in their baseball careers. The purpose of the current study was to evaluate the career progression and patient reported outcomes in a series of youth baseball players 5 years after being diagnosed with LLE and LLS. Methods: The electronic medical record from a single pediatric hospital was searched for all patients receiving a diagnosis of LLE or LLS sustained from playing baseball between 2014 and 2018. Baseline data at the time of diagnosis was documented including age, primary position, months played per year, duration of symptoms, and treatment. Patients were then interviewed with a standardized questionnaire including several validated outcomes tools and baseball specific questions at a minimum of 3 years post-diagnosis. Suboptimal outcome was defined as symptom recurrence or a SANE score less than previously published patient acceptable symptom state (PASS) of 75.5. Statistical analysis was then performed to compare outcome groups. Results: In total, 61 athletes were contacted (17 LLS, 44 LLE). All patients were male and the mean age at diagnosis was 13±2 years. While 95% returned to baseball post-diagnosis, at 4.8±1.5 years follow-up, 48% of the cohort was still playing with 18% attributing persistent arm pain as a reason for quitting. Symptom recurrence was present in 25% occurring at an average of 9 months post-diagnosis. Players changing position was not uncommon (26%). In the elbow group, no patient went on to require a UCL reconstruction, whereas one patient in the shoulder group ultimately underwent surgery. The mean QuickDASH, ASES, and Kerlan Jobe scores were 2±5, 96±10, and 90±11, respectively. There were no differences between LLE and LLS groups with respect to these scores (p>0.05). No differences were observed between groups in terms of demographics or play characteristics, however those with recurrence were less likely to be still playing ball and had lower outcome scores (<0.05). Conclusions: While arm pain is frequently encountered in youth baseball players, receiving a diagnosis of LLE or LLS appears to have a good prognosis for these athletes with many patients continuing to remain active in competitive baseball even up to 5 years post-diagnosis. Rates of future arm pain requiring surgical intervention were negligible. This data is important for counseling patients about the long-term prognosis of their arm injuries.
Paper 34: Midterm Outcomes of Meniscal Allograft Transplantation in the Adolescent Population
Authors: Kaiser Joshua , Wagner Kyle , Hevesi Mario , Damodar Dhanur , Swindell Hasani , Yanke Adam , Cole Brian , Quigley Ryan 
Published: August 2023

Objectives: To report midterm outcomes following primary meniscal allograft transplantation (MAT) from a single surgeon in an adolescent population. Methods: A retrospective review was performed to identify adolescent patients <18 years old at the time of primary MAT from 1999-2016. International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, and Lysholm scores were collected preoperatively and at 1-year, 2-years, and a minimum of 5-years follow-up. Results: Forty-four (female n=33; male n=11) of 62 identified patients (71%) met inclusion criteria with a mean follow-up of 9.5 ± 3.8 years (range: 5.0-17.7). Isolated MAT was performed in 27 (61.3%) patients. Common concomitant procedures included osteochondral allograft transplantation (OCA) (n=14, 31.8%), autologous chondrocyte implantation (ACI) (n=8, 18.1%), and anterior cruciate ligament reconstruction (ACLR) (n=6, 13.6%) (Table 1). Eleven patients (25%) required a reoperation an average 5.9 ± 4.5 years (range: 0.8 – 14.0) post-transplant. Three (6.8%) patients met criteria for failure, requiring revision MAT an average of 3.8 ± 1.1 years (range: 2.8-4.9) post-transplant. Graft survivability at 1, 2, 5, and 10 years was 100.0%, 100.0%, 93.2%, and 93.2%, respectively (Figure 1). When compared to preoperative scores, significant increases in Lysholm, IKDC, and KOOS subscales were observed at 1-year, 2-year, and most recent follow-up (Figure 2 and Supplemental Table 1). 90% of patients reported satisfaction with their current physical status. Conclusions: At midterm follow-up, primary MAT in the adolescent population resulted in predictable improvements in functional outcomes. These improvements were maintained at an average follow-up of 9.5 years. The meniscal reoperation rate was 25% with a 71.3% probability of being reoperation free at 5 years while graft survivability was 93.2% at 5 years. When compared to extant literature profiling MAT in the adult population, adolescents who undergo MAT demonstrate similar functional outcomes and graft survivability. [Table: see text] [Table: see text]
Paper 69: Do Patients Participate in Sports or Recreational Activity After Osteochondral Allograft Transplantation of the Talus?
Authors: Fiske Joseph , DALAL ALIASGAR , McCauley Julie , Bugbee William 
Published: August 2023

Objectives: Fresh osteochondral allograft (OCA) transplantation has been reported as a viable treatment option for chondral lesions of the talus, but there is insufficient data regarding patients’ participation in sports or recreational activity following the procedure. The purpose of this study was to assess the frequency of patients who participated in sports or recreational activity following OCA of the talus. Methods: We identified 36 ankles in 34 patients (70% well trained or highly competitive athletes) who underwent OCA transplantation of the talus. Mean age was 36 years and 50% were male. Postoperatively, participation in sport or recreational activity, foot and ankle ability measure (FAAM) scores, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, and patient satisfaction with the results of surgery were assessed. Further surgery on the ankle was captured, and OCA failure was defined as any operation that involved removal of the allograft. Results: At a mean follow up of 8.6 years, 67% of patients reported that they had participated in sports or recreational activity after the OCA transplantation. Among those who participated in sport or recreation, 68% returned to their pre-injury sport, 21% played in competitive sports, and 95% participated in regular exercise. Following the OCA transplantation, 17% of ankles required further surgery and 11% were classified as OCA failures (underwent revision OCA transplantation or fusion). There was significant improvement in FAAM and AOFAS ankle-hindfoot scores, and 79% of patients were either satisfied or extremely satisfied with the results of surgery. Survivorship of the OCA transplantation was 94% at five years and 85% at ten years. Conclusions: Fresh OCA transplantation is a reasonable surgical option for osteochondral defects of the talus for young, active patients who have failed non-operative management. Most patients participate in sports or recreational activity following OCA transplantation of the talus.
Poster 115: Patients who Underwent Primary Hip Arthroscopy for Femoroacetabular Impingement with Acetabular Microfracture Show 77% Survivorship at 10-Year Follow-Up
Authors: Maldonado David , Lee Michael , Annin Shawn , Owens Jade , Jimenez Andrew , Sabetian Payam , Domb Benjamin 
Published: August 2023

Objectives: The purpose is to report minimum 10-year follow-up survivorship, defined as non- conversion to total hip arthroplasty (THA), and patient-reported outcome scores (PROS) following primary hip arthroscopy with acetabular microfracture in the setting of femoroacetabular impingement syndrome (FAIS) and acetabular chondral lesions, respectively. Methods: Data was prospectively collected and retrospectively analyzed on all patients who underwent a primary hip arthroscopy and received an acetabular microfracture between June 2009 and January 2011 and included in this study. Patients with a minimum 10-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the visual analog scale (VAS) for pain were included. If available, the minimum 10-year follow-up for the Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) was reported. The demographics, intraoperative findings, surgical procedures, PROS, rate of achieving the minimal clinical important difference (MCID), and secondary surgeries were analyzed and reported. Results: Twenty-two hips (20 patients) were included in the study, and the mean follow-up time was 124.5 ± 2.2 months. There were 17 hips (77.3%) from males and 5 hips (22.7%) from females. The average patient age at the time of surgery was 42.3 years ± 9.6. All patients on average experienced statistically significant improvement (P < 0.05) between preoperative and minimum 10-year follow-up scores for all PROs. In total, 77.3% of the patients did not require conversion to THA. Additionally, 83.3% of the patients achieved the MCID for the mHHS, NAHS, and VAS for pain. Conclusions: At a minimum 10-year follow-up, survivorship of 77.3% was reported for patients that underwent primary hip arthroscopy with acetabular microfracture for the treatment of FAIS and focal/full-thickness acetabular cartilage lesions. Further, in the patients that did not require THA conversion, significant improvement in all PROS was demonstrated.
Poster 159: At-home physical therapy with a remote monitoring digital health platform leads to similar patient reported outcomes compared to traditional in-office physical therapy following shoulder surgery
Authors: Denard Patrick , Higgins Laurence , Gobezie Reuben , Shishani Yousef 
Published: August 2023

Objectives: Physical therapy (PT) following shoulder surgery has traditionally occurred via in-office supervised visits. Recently digital health tools with remote patient monitoring (RPM) have emerged as an option to enhance the ability to both monitor and encourage engagement of home PT. The appeal of such tools has been accelerated by the impact of COVID-19 on the healthcare system. The primary purpose of this study was to compare patient-reported outcomes (PROs) following shoulder surgery of patients who completed at-home PT with a digital rehab application to patients who completed in-office supervised PT. The secondary purpose was to assess engagement among patients who used digital PT. Methods: A retrospective matched comparative evaluation was performed of patients who underwent arthroscopic shoulder surgery or shoulder arthroplasty at a single institution between April 2020 and May 2021. Patients who underwent home-based physical therapy with a digital remote monitoring platform (PT Genie; Orland, FL) were identified and age and procedure matched (arthroscopy or arthroplasty) to a cohort of patients that underwent in-office physical therapy. The digital platform provided remote monitoring capabilities with measurement of range of motion. PROs measured preoperatively and at 1 year postoperative included visual analog scale pain score (VAS), American Shoulder Elbow Surgeons Score (ASES), and Single Assessment Numeric Evaluation (SANE). Engagement measured as the number of sessions recorded was analyzed in the digital PT based on 6 age groups (≤40, 41-50, 51-60, 61-70, 71-80, and 81+). Statistical analysis using the student t-test to compare means was performed using SPSS version 17 (SPSS Inc., Chicago). Results: A total of 862 patients were identified, including 396 arthroscopic surgeries (198 in each PT group) and 466 in the arthroplasty group (233 patients in each PT group). The groups were similar at baseline other than a higher preoperative ASES score in the digital PT arthroplasty group (Table 1). There was no significant difference in any PROs between the two groups at 1-year follow-up. The highest engagement in the digital PT group was observed in the arthroplasty group and over the age of 50 (Figure 1). Conclusions: There appears to be no difference in PROs following shoulder surgery whether physical therapy is performed in-office or at home via a digital platform. Interestingly, engagement with digital PT was highest in older patients, suggesting that the technology is not a large barrier. Although further study is needed to confirm these findings, benefits of digital PT with remote monitoring may include: 1) Decreased cost for the healthcare system, 2) Decreased travel time for the patient, and 3) Scheduling efficiency and improved access to the PT for the patient.