bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster 182: Acromial Morphology Influences Instability Risk and Direction: An MRI Study
Authors: Nolte Philip , Ruzbarsky Joseph , Provencher Matthew , Bradley James , Millett Peter , Arner Justin 
Published: August 2023

Objectives: To determine if acromial morphology is associated with posterior or anterior shoulder instability as measured on MRI. Methods: MRI measurements of posterior acromial coverage (PAC), posterior acromial height (PAH), posterior acromial tilt (PAT), and anterior acromial coverage (AAC) were completed for three separate matched groups who underwent surgical intervention: posterior instability, anterior instability, and a comparison group of patients with who underwent arthroscopic surgery for snapping scapula. Inclusion criteria were patients with recurrent instability younger than 40 years of age without multidirectional instability, glenoid bone loss greater than 13.5% or glenoid retroversion greater than 10%. Results: Thirty-seven patients were included in each group. PAC was significantly less in the posterior instability group when compared to anterior and the comparison groups (68.3° vs. 88.7° vs. 81.7°, p<.001). PAH was significantly greater in the posterior group than compared to the anterior instability patients (11.0 mm vs -0.1 mm, p<.001) as well as the comparison patients (0.7 mm, p<.001). There was no difference between the posterior and anterior groups in terms of PAT or AAC (p=0.45, p=0.05). PAT was significantly smaller in the posterior instability group than the comparison group (55.2 degrees vs 62.2 degrees, p=0.026). The anterior and comparison groups were not significantly different in PAH or PAT (p=8.74, p=0.067) but were significantly different with AAC (p=0.26). Conclusions: The posterior acromion is significantly higher and flatter in patients with posterior shoulder instability who require arthroscopic capsulolabral repair when measured on pre-operative MRI. This information may help clinicians to both diagnose and predict the need for operative intervention for patients with posterior labral tears.
Poster 201: Trends and Projections in Surgical Stabilization of Glenohumeral Instability in the United States from 2009 to 2030: Rise of the Latarjet and Fall of the Open Bankart
Authors: Gabig Andrew , Karzon Anthony , Cooke Hayden , Graf Alexander , Gottschalk Michael , Wagner Eric 
Published: August 2023

Objectives: Advances in surgical techniques have improved the ability to addressrecurrent glenohumeral instability via arthroscopic capsulolabral repair and bonerestoring procedures such as Latarjet. Given the paucity of studies analyzing temporaltrends in surgical management of glenohumeral instability, the purpose of this studywas to assess trends in treatment of anterior, posterior, and multidirectional instabilityover a 10-year period and model projections to 2030. Methods: Using IBM Watson Marketscan national database, all patients thatunderwent glenohumeral instability procedures from 2009 to 2018 were identified.Procedures were identified using common procedural terminology (CPT) codes foropen Bankart Repair, Latarjet, anterior bone block, posterior bone block,multidirectional capsular shift, and arthroscopic Bankart procedures. Sample weightsprovided by the database were utilized to calculate national estimates. The UnitedStates (U.S.) Census Bureau annual population data were utilized for calculatingincidence. Future projections to 2030 were modeled using Poisson and linearregression. Results: There were an estimated 446,072 glenohumeral instability cases from 2009-2018. Per capita (per 100,000) incidence remained constant, from 14.8 in 2009 to 14.5in 2018. Arthroscopic Bankart comprised the highest number of procedures throughoutthe study period, accounting for 89% of all procedures in 2009 and 93% in 2018. OpenBankart procedures decreased by 65% from 2009 to 2018, while there was a 250%increase in Latarjet procedures over the same period. Patient demographics did notchange over the study period, and males aged 18-25 comprised the largestdemographic group undergoing anterior instability procedures. Multidirectionalinstability procedures exhibited the least pronounced gender differences. Futuremodeling from 2018-2030 projected continued steady rise in arthroscopic Bankart(40,000-49,000 case/yr), rapid growth in Latarjet (1370-4300 cases/yr), and continueddecline in open Bankart (1000-250 cases/yr) procedures. Conclusions: Arthroscopic Bankart continues to be the most common glenohumeralinstability procedure in the U.S. From 2009 to 2018, incidence of open Bankartprocedures declined while Latarjet procedures markedly increased. Future projectionsto 2030 mirrored these findings. These data may provide an enhanced understandingof the evolution of surgical treatment of glenohumeral instability within the U.S. layingthe foundation for continued prospective studies into the appropriate indications andadvancements in surgical techniques. [Table: see text][Table: see text]
Poster 229: Expectations for Return to Sport Before and After Hip Arthroscopy with Minimum 1-year Follow-Up
Authors: Li Zachary , Triana Jairo , Mojica Edward , Blaeser Anna , Shankar Dhruv , Akpinar Berkcan , Lin Lawrence , Youm Thomas , buldo-licciardi michael 
Published: August 2023

Objectives: Setting appropriate expectations for orthopedic surgery functional outcomes can contribute to postoperative motivation and satisfaction. For hip arthroscopy, the literature is limited regarding patients’ expectations for returning to sport. This study aims to compare preoperative expectations with postoperative return-to-sport status in patients who underwent primary hip arthroscopy. Methods: We conducted a prospective cohort study of patients who underwent primary hip arthroscopy. Return to sport expectations were recorded preoperatively. Return to preinjury sport status was assessed along with updated sport expectations at a minimum of 1 year follow-up after surgery (range 1.1 to 2.6 years; mean 2.0 years). The proportion of patients who expected to return was compared to actual return rates. Results: Thirty-five patients who underwent hip arthroscopy were prospectively recruited. Preoperatively, 31 patients (88.6%) expected to return to their preinjury sport level, while only 16 (45.7%) actually returned to that level. 34 (97.1%) expected to return to their main sport and 22 (62.9%) actually returned. 9/35 returned to their preinjury primary sport at a lower level. 10/35 patients had completely given up their original sport by time of follow-up. All 11 patients who reported a change in their primary sport chose a lower impact sport, transitioning from tennis, running, kickboxing, frisbee, volleyball to cycling, pilates, walking, and yoga. Logistical regression found no significant difference between expectations and return to sport level when controlling for age, BMI, gender. Conclusions: This study found a significant difference between preinjury return-to-sport expectations and actual return rates following hip surgery. Although patients had high expectations for recovery, a majority did not return to their preinjury sport level and a high portion did not return at all. All patients that took up a different sport went from one of high impact to low impact. These data can provide more realistic return-to-sport expectations for patients undergoing hip arthroscopy.
Poster 243: TT-TG Measurements Obtained in Weight Bearing and Non-Weight Bearing States are Different- Positioning in CT Scan Affects Treatment Selection
Authors: Cirrincione Peter , Price Payton 
Published: August 2023

Objectives: There are multiple aspects of lower extremity alignment that can contribute to patellar instability. Physicians regularly consider TT-TG distance when planning treatment for patients with patellar instability. TT-TG has been classically measured on non-weight bearing magnetic resonance imaging (MRI) or computed topography (CT) scans, but more recently clinicians have been obtaining these measurements on weight bearing CT scans. Literature has not previously compared TT-TG measurements obtained in weight bearing and non-weight bearing positions. This study compares TT- TG measurements performed in weight-bearing vs. non-weight bearing positions of the same knees. Methods: The images of patients with patellar instability who obtained weight bearing and non-weight bearing CT scans between the dates of January 1st, 2014 and December 31st, 2021 were measured for TT-TG distance. A paired two sample t test for means was utilized to compare the measurements. Results: Thirty knees had both a weight bearing and non-weight bearing TT-TG length CT scan performed that could be used to measure TT-TG distance. The weight bearing group, with an average of 15.2 mm, was significantly greater than the non-weight bearing group, averaging 10.2 mm (p=<.0001). Additionally, the variance in measurements for knees under the weight bearing positions (37.6 mm) was more than twice as large as the variance for measurements obtained in the non-weight bearing position (16.5 mm). Conclusions: TT-TG distance is routinely used while diagnosing and planning treatment of patients with patellar instability. In this study, TT-TG distance was found to be significantly greater in the weight bearing position compared with the non-weight bearing position of the same knee. This fact is both critical to understand and useful in planning the appropriate instability procedure. Dynamic motion, rotation and axial loading play a role in patellar instability and need to be evaluated to arrive at the appropriate treatment algorithm.
Poster 263: MRI Evaluation of Pediatric Knee Morphology
Authors: Sun Yuhang , Campbell Abigail , Haselman William , Uquillas Carlos 
Published: August 2023

Objectives: Abnormal patellar femoral morphology is a central risk factor for patellar instability. While this relationship has been well studied in the adult population, less is known about the relationship during skeletal development. Prior studies have demonstrated that the morphology of the knee changes as a child develops. We predict that a significant difference in the morphological development of children with instability compared to children without instability. Our objective is to compare the progression of morphological parameters in patients with patellar instability to patients without patellar instability. Methods: An IRB approved retrospective chart review was performed measuring TT-TG, trochlear depth, and patellar height (Caton Deschamps Index) in skeletally immature patients between the ages of 5 and 16 who underwent an MRI of their knee. Patients with patellar instability were MRI age matched in a 1 to 2 ratio to patients without patellar instability. Exclusion criteria included osteoarthritis, prior knee surgery, and unreadable MRIs. Morphological measurements were then compared between the two group. Statistical analysis was performed using paired sample t-tests with p≤ 0.05 considered significant. Morphological measurements were then plotted overtime at each age group to determine changes in morphology as a patient develops. Results: A total of 180 patients were included in our analysis. Sixty patients with patellar instability were compared to 120 patients without patellar instability. There was a significant difference in all measurements between the patients with patellar instability and patients without (TT-TG 10.50mm versus 15.72mm, p<0.01; trochlear depth 5.55 mm versus 3.77mm, p<0.01; Caton Deschamps Index 1.07 versus 1.19, p<0.01). TT-TG for patients with prior instability was greater at all ages when compared patients without patellar instability. As patients aged, trochlear depth increased in patients without patellar instability, while it remained relatively stable in patients with patellar instability. Caton Deschamps Index was greater in patients with patellar instability compared to patients without patellar instability at most ages, however they were mostly within normal limit (0.6-1.3). Conclusions: Our data demonstrates that trochlear depth continues to increase in skeletally immature patients without patellar instability as they aged, while patients with patellar instability remained relatively stable. Future studies can be aimed at determining if intervening at a younger age and reducing the patella in these unstable patients can result in increased trochlear depth as they develop.
Poster 278: Spin in the Abstracts of Meta-analyses and Systematic Reviews: Quadriceps Tendon Graft for Anterior Cruciate Ligament Reconstruction
Authors: Taka Taka , Peterson Joshua , Chung Jun Ho , Syed Hasan , Liu Joseph , Gulbrandsen Matthew 
Published: August 2023

Objectives: Spin is a reporting bias that misrepresents research. Ultimately it can impact surgeon decision making and patient care. Anterior Cruciate Ligament (ACL) reconstruction is common; however debate continues over the optimal graft choice. The quadriceps tendon has become an increasingly popular graft. The purpose of this study was to identify the prevalence of spin in meta-analysis and systematic review abstracts regarding the treatment of ACL injuries with quadriceps tendon graft. Methods: Electronic libraries (MEDLINE, Embase, Web of Science, Google Scholar) were searched for meta-analyses and systematic reviews regarding the treatment of ACL tears with quadriceps tendon graft. The key words used for searches included (ACL or Anterior Cruciate Ligament) and (Quad or Quadricep or Quadriceps). All meta-analyses and systematic reviews that contained analysis for quadriceps tendon graft for ACL reconstruction were included. The nine most severe types of spin commonly found in abstracts were used as an evaluation tool to assess the articles. Further evaluation included year of publication, number of citations, journal impact factor, and AMSTAR-2 score. Results: The electronic database search resulted in 986 articles, of which 13 met our inclusion criteria. After review of these papers, it was found that 53.8% (7/13) of the included articles contained one of the nine most severe forms of spin. Of the types of spin evaluated, type 3 spin (selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention) was found to be the most prevalent (4/13, 30.8%). The other common types of spin found included type 5: conclusion claims the beneficial effect of the experimental treatment despite high risk of bias in primary studies (2/13, 15.4%); and type 9: conclusion claims the beneficial effect of the experimental treatment despite reporting bias (2/13, 15.4%). A detailed accounting of the prevalence of each type of spin can be found in Table 1. There was no relationship between the presence or total types of spin when comparing the publication year, journal impact factor, number of citations per year for the article, or the A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) rating. Conclusions: This study demonstrated the presence of spin in a significant portion (53.8%) of meta- analysis and systematic review abstracts pertaining to quadriceps tendon graft for ACL reconstruction. Orthopedic surgeons should learn to recognize spin as they review articles when deciding the treatment course for ACL injuries. Additionally, strict criteria should be considered to reduce the prevalence of spin in orthopedic literature. [Table: see text]
Poster 307: A Standardized Method that Improves Readability of Patient Education Materials in Sports Medicine Knee Injuries
Authors: Cherian Nathan , Baumann John , Gieg Samuel , DeFroda Steven , Hanish Stefan 
Published: August 2023

Objectives: Sports-related knee injuries such as anterior cruciate ligament (ACL) or meniscus tears are very common, and there are ample resources for knee injury-related patient education materials (PEMs). However, the anatomy, pathology, and treatment plans of knee injuries are often described in terms that are obscure to patients. While the internet has become a vast resource for medical information, online PEMs in orthopaedics have consistently been shown to be written above the NIH- recommended sixth-grade reading level to the detriment of patient health literacy. The purpose of this study is to develop a standardized method to improve readability of orthopaedic PEMs without diluting their critical content by reducing the use of complex words (>3 syllables) and shortening sentence length to <15 words. Methods: OrthoInfo, a patient education website developed by the Academy of American Orthopedic Surgeons, was queried for PEMs relevant to the care of athletic injuries of the knee. Inclusion criteria were PEMs that were unique, pertained to topics of knee pathology in sports medicine, and written in a prose-format. Exclusion criteria were information presented in video or slideshow format, or topics not pertaining to knee pathology in sports medicine. Readability of PEMs was evaluated using seven unique readability formulas before and after applying a standardized method to improve readability while preserving critical content (reducing the use of >3 syllable words and ensuring sentence length is <15 words). Paired samples t-tests were conducted to assess the relationship between reading levels of the original PEMs and reading level of edited PEMs. Results: Reading levels differed significantly between the 23 original PEMs and edited PEMs across all seven readability formulas (p<0.01). Mean Flesch Kincaid Grade Level of original PEMs (9.8±1.4) was significantly increased compared to that of edited PEMs (6.4±1.1) (p=1.9x10-13). 4.0% of original PEMs met NIH recommendations of a sixth-grade reading level compared to 48.0% of modified PEMs. Conclusions: A standardized method that reduces the use of >3 syllable words and ensures sentence length is <15 words significantly reduces the reading-grade level of PEMs for sports-related knee injuries. Orthopaedic organizations and institutions should apply this simple standardized method when creating PEMs to enhance health literacy. [Table: see text][Table: see text]
Poster 318: CHANGE IN POSTERIOR TIBIAL SLOPE FOLLOWING DISPLACED PEDIATRIC TIBIAL TUBERCLE FRACTURES: A POTENTIAL MODEL FOR GROWTH MODULATION IN THE ACL DEFICIENT KNEE
Authors: Zogby Andrew , Wilps Tyler , Paras Tyler , Pennock Andrew , Vasudevan Rajiv 
Published: August 2023

Objectives: Increased posterior tibial slope angle (PTSA) increases the risk for anterior cruciate ligament (ACL) tear and ACL graft failure. Proximal tibial slope changing osteotomies are employed in the adult population; growth modulation procedures may present a treatment opportunity in the skeletally immature. This procedure has not been described in the context of ACL injuries, and the rate at which posterior tibial slope could be corrected is unknown. Our purpose was to quantify the rate of change in PTSA following operatively treated displaced tibial tubercle fractures in skeletally immature patients, and to determine how this rate is affected by skeletal age. We hypothesized that there would be a progressive loss of posterior tibial slope after injury, and that rate of change in PTSA would be highest during peak growth velocity Methods: We retrospectively reviewed skeletally immature patients with tibial tubercle fractures treated with ORIF. We measured posterior tibial slope angle (PTSA) at ˜3-, 6-, 12-months, and further postoperative time points if available. All subjects had a minimum of 6-months follow up. Bone age at the time of injury was determined. Negative PTSA was indicative of posteriorly directed slope, positive PTSA indicated anterior slope. Linear regression analysis was used to evaluate rate of change in PTSA (ΔPTSA) for individual patients and total cohort trend. Patient regression coefficients were averaged into bone age cohorts. The unit of analysis was the knee. Results: Twenty-two patients with 23 knees were included. 86% of patients were male. Average chronologic and bone age was 14 years at time of injury. Average follow-up was 17 months (range 6 to 52 months). Patients had a mean PTSA of -12˚ ± 2.4˚ at the time of injury. The overall mean ΔPTSA for the cohort was 0.30˚ ± 0.31˚ per month (range -0.27˚ to 0.97˚ per month). Linear regression revealed a significant relationship between months post-fixation and PTSA, demonstrating a ΔPTSA of +0.31˚ per month (CI 95% (0.24, 0.38); p<.001) (Figure 1). The highest average ΔPTSA was seen at 14-years (0.58˚ ± 0.44˚ per month). The average overall absolute change in PTSA from injury to final follow-up was +4.1˚ (range -3.4˚ to 21˚) (Figure 2). Conclusions: Our data suggest progressively more anterior slope following ORIF. The greatest rate of change in PTSA corresponded with peak growth velocity. These findings may serve as a model for predicting the effect of anterior proximal tibia epiphysiodesis on tibial slope in ACL surgery.
Poster 328: Pre-Operative Low-Intensity Blood Flow Restriction Training Does Not Improve Quadriceps Strength or Hypertrophy After Anterior Cruciate Ligament Reconstruction
Authors: McGurren Daniel , Lee Jedediah , De Luigi Arthur , Klanderman Molly , Chhabra Anikar , Glattke Kaycee 
Published: August 2023

Objectives: The purpose of this study is to evaluate the effect of low-intensity blood flow restriction (LI- BFR) training utilized in a pre-rehabilitative setting for patients undergoing anterior cruciate ligament reconstruction (ACLR) on postoperative outcomes by minimizing postoperative atrophy and impairment of the quadriceps. We hypothesize that postoperative strength and hypertrophy of the quadriceps will be greater in a population that undergoes preoperative LI-BFR training than that of a population that undergoes low-intensity sham control (LI-SHAM) training. Methods: Twenty-eight subjects undergoing primary ACLR underwent 2 weeks of either a BFR intervention or a SHAM intervention at a rate of 2 sessions per week before surgery. Quadriceps strength and cross-sectional area were measured as well as other exploratory outcomes were measured before and after the intervention before surgery and at 5 different time points after surgery, through 6 months postoperative. Quadriceps strength was assessed through handheld dynamometry and a leg press test and quadriceps cross-sectional area was assessed using musculoskeletal ultrasound imaging. Results: Adjusting for sex, time, and strength/hypertrophy at baseline, there were no significant differences found between treatment groups for the primary endpoints. Compared to 24-48 hours pre- op, this suggests that the post-op average hypertrophy remains significantly lower through 24 weeks post-op, while leg strength is similar at 24 weeks post-op as measured by handheld dynamometer and even significantly larger at 24 weeks as measured by the leg press test. Conclusions: A 2-week preoperative program of LI-BFR training may not be effective to improve postoperative quadriceps strength and hypertrophy after ACLR.