bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paper 27: Preoperative Risk Factors of Subsequent Ipsilateral ACL Revision Surgery following an ACL Restoration Procedure
Authors: Sanborn Ryan , Badger Gary , Fleming Braden , Kiapour Ata , Murray Martha , Yen Yi-Meng , Kramer Dennis 
Published: August 2023

Objectives: To identify the preoperative risk factors for revision ACL surgery within the first two years after BEAR ACL repair procedure. Methods: Data from the prospective BEAR I, II, and III trials were used to determine preoperative risk factors for ACL revision surgery. All subjects with a complete ACL tear (ages between 13-47 years, depending on the trial), who passed all other inclusion/exclusion trial criteria, and underwent a primary BEAR procedure within 30-50 days from injury (dependent on trial) were included. Demographic data (age, sex, BMI), baseline patient-reported outcomes (IKDC Subjective Score, Marx Activity score), pre-operative imaging characteristics (ACL stump length, notch size, tibial slopes), and intraoperative findings (knee hyperextension, meniscal tear status) were evaluated to determine their contribution to ipsilateral revision ACL surgery risk. Results: 123 subjects, median age 17.6 years (IQR 16-23), including 67 (54%) females, met study criteria. 18 (15%) patients required revision ACL surgery in the first two years following the BEAR procedure. In bivariate analyses, younger age (p=.011), having a contact injury at the time of the initial tear (p=.048), and increased medial tibial slope (p=.029) were associated with a higher risk of ipsilateral revision surgery. Multivariable logistic regression analyses identified two independent predictors of revision: patient age and medial tibial slope. The odds of an ipsilateral revision surgery were decreased by 32% for each one-year increase in age (OR=0.684, 95% CI = 0.517 to 0.905, p=.008), and increased by 28% per each degree of increase in medial tibial slope (OR=1.280, 95% CI =1.024 to 1.601, p=.030). Sex, baseline IKDC or Marx score, knee hyperextension, or meniscus status were not significant predictors of revision. Conclusions: Younger age and higher medial tibial slope were predictors of increased odds of ipsilateral ACL revision surgery after the BEAR procedure. Younger patients with higher tibial slopes should be aware of the increased risk for revision surgery when deciding to undergo ACL restoration surgery.
Paper 30: Lower Socioeconomic Status Adversely Affects Timing of Care and Rate of Re-Injury Following Anterior Cruciate Ligament Reconstruction
Authors: Cherelstein Rachel , Kuenze Christopher , Curley Andrew , Bodendorfer Blake , Hopkins Mark , Conroy Christine , Fryar Caroline , Wang David , Chang Edward , Albelo Eduardo Natal 
Published: August 2023

Objectives: The primary aim of this study was to define the impact of socioeconomic factors, such as national area of deprivation index (ADI) and medical insurance type, on the access to orthopaedic care after an ACL rupture. The secondary aim was to determine if these variables, national ADI and medical insurance, were associated with second ACL injury after primary ACLR. We hypothesized that patients with a greater national deprivation index and Medicaid insurance will have less access to specialized care and an increased risk of re-injury. Methods: An IRB approved retrospective study was conducted evaluating 339 patients that underwent ACL reconstructions between November 2015 and August 2018 by 3 sports medicine fellowship-trained orthopaedic surgeons. Patients undergoing primary ACL reconstruction were included. Demographic and surgical characteristics data were obtained via chart review and telephone interviews. National ADI percentile was obtained utilizing the Neighborhood Atlas Website and the patients’ home addresses. The relationship between national ADI percentile and care characteristics (e.g., time to specialized care) were investigated using Spearman’s rank correlation coefficients (ρ) while the association between patient and care characteristics, and second ACL injury were investigated using multivariable logistic regression. Results: A total of 339 patients met inclusion criteria and had complete datasets for all variables of interest. Participants had an average age of 23 ± 7.4 yrs. 55.8% of the patients were males and identified themselves as: White 45.7%, African American 14.5%, Asian 11.8%, Hispanic 7.7% and Other 21.3%. Patients with a greater national ADI percentage took longer to seek specialized care from time of injury (ρ = 0.141, p = 0.009) as well as to undergo surgery from time of injury (ρ = 0.183, p < 0.001). Individuals who utilized Medicaid insurance had significantly greater odds of experiencing a second ACL injury (OR = 3.079, p = 0.023) when compared to individuals who utilized commercial insurance. National ADI percentile (p = 0.208), time from injury to specialized care (p = 0.342), and time from specialized care to surgery (p = 0.051) did not significantly contribute to the model. Conclusions: Lower socioeconomic status adversely affects timing of care and re-injury rates following an ACL injury. Patients with a greater national ADI percentage took significantly longer to seek specialized care and obtain surgery following ACL injury. Patients utilizing Medicaid insurance were more likely to sustain a re-injury following ACL Reconstruction. Future studies should look at factors that impede access to care and adversely affect post-operative outcomes. [Table: see text][Table: see text]
Paper 33: Superior Improvements in Knee Pain and Function with a Novel Synthetic Medial Meniscus Replacement Prosthesis Compared to Non-surgical Care in Subjects with Knee Pain Following Partial Meniscectomy: Three-year Results from US Randomized Controlled Trial
Authors: Hershman Elliott , Zaslav Kenneth , McKeon Brian , Lattermann Christian 
Published: August 2023

Objectives: This study tests the hypothesis that subjects receiving the meniscus replacement prosthesis show superior improvements at 3 years with regards to knee-related pain, function, and quality of life compared to control subjects, through 3 years of follow-up. Methods: 127 subjects (61 investigational, 66 control) were included in the multicenter RCT. Subjects had one or more partial meniscectomies at least 6 months before trial entry and continued to have pain. Patient-reported knee pain, function, and quality of life were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Treatment failure was defined as any investigational subject who discontinued the per-protocol treatment by permanent prosthesis removal, or control subjects undergoing any surgical procedure on the index knee. Standard statistical methodology was used, two tailed t-test was used to compare groups at each time point. Results: Both groups improved over 24 months, but the control group showed a significant drop at 3 years. Controls experienced a 35% decline in KOOS Overall improvement between the 2-year and 3-year timepoint (15.9 declined to 10.4). The treatment group continued to improve over 3 years. The treatment group had significantly better outcomes scores that were greater than MCD for all KOOS subscales at 3 years (Figure 1). KOOS Overall and KOOS Pain for the investigational and control cohorts at 3 years were 28.8 vs 10.4 points, and 29.7 vs 15.4 points, respectively. Treatment cessation through 3 years was 67% greater in the control cohort than the investigational cohort (11.5% vs. 19.2%). Conclusions: Patients receiving the meniscal replacement prosthesis had clinically meaningful improvement of their patient reported outcomes scores at 3 years. These improvements were superior to the control treatment. The improvements were maintained over three years, whereas the control group declined after 2 years. The magnitude of change from baseline to 3 years remained superior for the investigational cohort, even for subjects undergoing device exchange or repositioning, compared to non-surgical care subjects.
Paper 36: Levels of Synovial Fluid Cytokines Predict Midterm Patient Reported Outcomes Following Arthroscopic Partial Meniscectomy
Authors: Shankar Dhruv , Vasavada Kinjal , Kingery Matthew , Montgomery Samuel , Buzin Scott , Chan Calvin , Jazrawi Laith , Strauss Eric , Avila Amanda 
Published: August 2023

Objectives: To identify synovial fluid biomarkers associated with midterm postoperative outcomes in patients undergoing arthroscopic partial meniscectomy (APM). Methods: Subjects were prospectively enrolled in a cohort of patients who had synovial fluid aspirated from their knee on the day of surgery prior to undergoing APM. Biomarker analysis was performed. Preoperative patient-reported outcome (PRO) scores including VAS pain, Lysholm and Tegner activity score were collected preoperatively. At a minimum of 2 years of follow-up postoperative outcomes were collected. Using previously described values, patients who met the minimal clinically important difference (MCID) for Lysholm score were identified and groups were compared using parametric and non-parametric tests. Using preoperative and postoperative outcome scores, generalized linear models were used to explore the relationship between biomarkers and improvement in Lysholm Score, improvement in visual analog scale (VAS) pain score, and postoperative KOOS-PS. Results: Fifty patients were included in the study. 34 (68%) met the MCID for the Lysholm score and 16 (32%) did not. Mean age was 51 ± 9 years for the entire cohort, with no statically significant differences between the groups (p=0.35). Both groups were majority male (p=0.37) and there were no differences in BMI (0.74) or follow-up time (p=0.20). On logistic regression, increased concentration of RANTES (β = -6.30, p = 0.04) and MMP-3 (β = -15.16, p = 0.001) were predictive of less improvement in VAS pain. . For Lysholm score, higher SF levels of IL-1 RA were predictive of greater improvement (β = 12.57, p = 0.04) while higher levels of MMP-3 were predictive of reduced improvement (β = -10.34, p = 0.007). Conclusions: This study found that at the time of surgery, intraarticular levels of MMP-3 and RANTES are predictive of poorer midterm outcomes and higher pain levels following APM. Additionally, higher levels of IL-1RA at the time of surgery were associated with greater improvement in midterm Lysholm score.
Paper 38: Addition of a Lateral Extra-articular Tenodesis is Associated with Lower Quadriceps Tendon Autograft MRI Signal Intensity Two Years Following Anterior Cruciate Ligament Reconstruction in Skeletally Immature Adolescents
Authors: Chipman Danielle , Retzky Julia , Cordasco Frank , Green Daniel 
Published: August 2023

Objectives: In recent studies, quadriceps tendon autograft (QTA) has been shown to yield promising results in the treatment of anterior cruciate ligament (ACL) ruptures in pediatric and adolescent patients. Additionally, lateral extra-articular tenodesis (LET) has been found to reduce the risk of ACL re-tear in high-risk patients when performed concomitantly with ACL reconstruction (ACLR). The purpose of this study was to evaluate graft maturity two years after ACLR by comparing magnetic resonance imaging (MRI) signal intensity ratio (SIR) of QTA in patients that underwent a primary ACL reconstruction with a concomitant LET versus patients without a concomitant LET. Methods: After institutional review board approval, operative records of all pediatric patients ≤ 18 years old who underwent an ACLR from June 2015 to December 2021 were retrospectively reviewed. MRIs were ordered for this age cohort of patients for clinical growth plate surveillance. Patients were included if they underwent an ACLR using a QTA and had open distal femoral and proximal tibial physes. MRIs were excluded if they were external or were ordered due to a new injury. The final cohort included 28 patients: 13 without a LET (ACLR only) and 15 with a LET (ACLR+LET). Signal intensity ratio (SIR) was measured on sagittal MRI by averaging the signal at three regions of interest along the ACL graft and dividing by the signal of the insertion of the posterior cruciate ligament. Statistical analysis was performed to evaluate for differences in SIR values at 6 months, 1 year, and 2 years post-operatively in skeletally immature patients undergoing ACLR alone versus ACLR with LET. Results: A total of 43 patients had an MRI at a two-year follow-up, 28 of whom were included in the study. The mean age of the complete cohort was 12.63±3.62 years (ACLR+LET: 13.96±0.91 years vs. ACLR only: 13.51±1.19 years). There were no significant differences in SIR between groups on the 6-month MRI or the 12-month MRI. However, the average SIR of the ACLR+LET group was significantly lower than the average SIR of the ACLR-only group at the two-year post-operative time point (1.398 vs. 1.916, respectively, p=0.046). Conclusions: QTA MRI signal intensity is lower two years after surgery in patients that underwent ACLR with a LET versus ACLR alone. Lower MRI signal intensity correlates with increased graft maturity and structural integrity. These findings suggest improved graft maturation, remodeling, and structural integrity with the addition of a LET to an ACLR with QTA in skeletally immature patients. [Table: see text]
Paper 39: A Survival Analysis of ACL Graft and Contralateral ACL Ruptures in Patients Under 18 Years
Authors: Feller Julian , Webster Kate 
Published: August 2023

Objectives: Although high rates of graft and contralateral anterior cruciate ligament (ACL) ruptures have been reported in younger patients after ACL reconstruction, recent evidence suggests that previously reported crude event rates underestimate the actual event risk. Therefore, the aim of this study was to report rates of graft and contralateral ACL rupture after ACL reconstruction in a large series of younger patients using survival analysis. Methods: A consecutive series of 400 patients who were under 18 years at the time of primary ACL reconstruction were identified from a single surgeon database over a 12-year period ending January 2018. Patients with a prior contralateral ACL rupture (n=8) or bilateral ACL ruptures (n=2) were excluded as were two patients who died within 6 months of surgery, leaving 388 (203M, 185F) in the final dataset. Bespoke survey data and clinic follow-up data were used to record graft rupture and contralateral ACL rupture events. Rates of graft and contralateral ACL rupture were calculated with Kaplan-Meier survival analysis. Log rank tests were used to compare survival functions between males and females. Results: The cumulative rates of graft rupture via survival analysis were 11% at 2 years, 16% at 4 years and 28% at 8 years. For contralateral ACL injury the cumulative rates were 7% at 2 years, 17% at 4 years and 49% at 8 years. Males had significantly greater rates of graft rupture than females although this was more prominent at 4 years (22% vs 9%) than at 8 years (31% vs 23%) after surgery (figure 1). Contralateral ACL rupture survival functions were not significantly different between male and female patients, although rates were higher in females until 5 years after which males had a notable increase in contralateral ACL ruptures with a cumulate rate of 63% at 8 years compared to 35% for females (figure2). Conclusions: The current study is one of the largest consecutive series of younger patients with one of the longest follow-up periods that reports a high risk for a second ACL injury. Over time, the cumulative risk for contralateral ACL rupture was higher than for graft rupture. This contradicts previous work that had shorter follow-up times. In males, the risk for contralateral ACL rupture substantially increased after 5 years. Understanding the postoperative time course for second ACL injury in young patients is important so that factors which contribute to this increased risk can be better understood and such injuries prevented.
Paper 43: Defining and Predicting the “Optimal Observed Outcome” Following Surgical Treatment of Anterior Shoulder Instability: A Machine Learning Clustering Analysis of 200 patients with 11-year mean follow up.
Authors: Till Sara , Lu Yining , Reinholz Anna , Krych Aaron , Okoroha Kelechi , Camp Christopher 
Published: August 2023

Objectives: Desirable outcomes following surgery for anterior shoulder instability (ASI) include a multitude of functional and clinical functions, yet it remains uncertain if all of these outcomes are simultaneously achievable (i.e. can patients have full motion and no instability; does excellent stability coincide with stiffness?). The purpose of this study was to employ unsupervised machine learning techniques to define the actual "optimal observed outcome” for patients undergoing surgical treatment for ASI and to identify predictors of obtaining this outcome. Methods: Patients <40 years with an initial diagnosis of ASI from 1994 -2016 were included. Four unsupervised machine learning clustering algorithms were evaluated to partition subjects into “optimal observed outcome” or “suboptimal outcome” based on combinations of actually observed outcomes. Demographic, clinical, and treatment variables were compared between groups using descriptive statistics and Kaplan-Meier survival curves; multivariate stepwise logistic regression evaluated variable prognostic value. Results: 200 patients with a mean follow-up of 11 years were included. 146 (64%) obtained the “optimal observed outcome”, characterized by significantly (P <0.001) lower rates of: recurrent postoperative pain (23% vs 52%), recurrent instability (12% vs 41%), revision surgery (10% vs 24%), progression to osteoarthritis (OA) (5% vs. 19%), and mildly restricted motion (161° vs. 168°). Stepwise multivariate logistic regression identified time from initial instability to presentation (OR: 0.96, 95% CI: 0.92-0.98) and habitual instability (OR: 0.17, 95%CI: 0.04-0.77) as negative predictors of “observed optimal outcome”. Increased rate of subluxation over frank dislocation pre-operatively (OR: 1.30, 95% CI: 1.02-1.65) was a positive predictor. Type of surgery performed was not a significant predictor. Conclusions: Following surgical treatment for ASI, an appropriate “optimal observed outcome” can be defined as: minimal postoperative pain, absence of recurrent instability, low rates of revision surgery, absence of OA, and increased ROM. This “optimal observed outcome” was achieved in over 2/3rds of the cohort and this work demonstrated the synergistic relationship of these. The most significant predictors included shorter time to presentation and history of subluxations over frank dislocations pre-operatively. This definition of the “optimal observed outcome” may be more appropriate for surgical decision making and setting appropriate expectations. [Table: see text][Table: see text]
Paper 51: A Radiostereometric Analysis of Tendon Migration following Arthroscopic and Mini-Open Biceps Tenodesis: Interference Screw confers Greater Construct Stability than All-Suture Suture Anchor Fixation, with No Difference in Patient-Reported Outcomes
Authors: Patel Harsh , Berlinberg Elyse , Forlenza Enrico , Gamsarian Vahram , Mirle Vikranth , Okoroha Kelechi , Williams Brady , Yanke Adam , Cole Brian , Verma Nikhil ,   Forsythe Group
Published: August 2023

Objectives: To quantify the postoperative migration of the BT construct between arthroscopic suprapectoral (ASPBT) and open subpectoral (OSPBT) techniques via interference screw (IS) or all-suture anchor with a single suture (SSSA) fixation with radiostereometric analysis (RSA). Methods: Distal migration of the biceps tendon following OSPBT with a Polyetheretherketone (PEEK) IS, OSPBT with one SSSA, ASPBT with PEEK IS, and ASPBT with two SSSAs was measured prospectively. Patients with symptomatic biceps tendinopathy and preoperative Patient-Reported Outcome Measures (PROMs) including CMS, SANE, or PROMIS-UE scores were included. A tantalum bead was sutured on the proximal end of the long head biceps tendon before fixation. AP radiographs were performed immediately postoperatively, 1 week, and 3 months. Bead migration was measured, and PROMs were compared. Results: Of 115 patients, 94 were available for final follow-up (82%). Average age was 52.1±10.5 years, and BMI was 30.8±5.4 kg/m2. There was no difference in tendon migration between OSPBT and ASPBT performed with an IS (P=0.70). OSPBT performed with one SSSA (21.70 mm) demonstrated significantly greater migration than ASPBT with IS (4.31mm, P<0.001) and OSPBT with IS (5.04 mm, P<0.001). Three patients (9.4%) who had OSPBT with one SSSA and one who had ASPBT with two SSSAs (3.8%), developed a Popeye deformity; none occurred in the IS groups. Mean 12-week bead migration in patients with versus without Popeye deformity was 60.8 mm and 11.2 mm, respectively (P<0.0001). PROMs did not differ at final follow-up. Conclusions: ASPBT and OSPBT with IS fixation demonstrated the least tendon migration, while OSPBT with one SSSA yielded the most. Compared to IS, fixation with one, but not two, SSSAs resulted in significantly greater migration. Average bead migration following a Popeye deformity was 6.1cm. To minimize migration when using SSSAs, at least 2 sutures should be used with an interlocking pattern within the tendon. [Table: see text]