bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and safety of abatacept in patients with rheumatoid arthritis with previous malignancy
Authors: Kunishita Yosuke , Ichikawa Kento , Uzawa Yuji , Mitsuhashi Masaki , Yoshioka Yuji , Okubo Tadanobu , Nagaoka Shouhei 
Published: August 2023

Background: Abatacept (ABT) is known to lower infection risk than other biologics and is effective and safe in elderly patients with rheumatoid arthritis (RA). However, there were inconsistent reports on the impact of ABT on malignancies which are more common in the elderly and strongly related to prognosis. Objectives: This study aimed to evaluate the efficacy and safety of ABT in patients with RA with previous malignancy in clinical practice. Design: A multicenter, retrospective study. Methods: Patients who received ABT for RA in two hospitals in Yokohama until May 2022 were included in this study. The patients were divided into two groups according to the presence or absence of a history of malignancy (no previous malignancy: NP group, previous malignancy: PM group). The collected parameters were compared between the groups using propensity score matching. Results: In this study, 312 patients were included, of whom 73 had previous malignancies when starting ABT. The age at ABT initiation was significantly higher in the PM group, the rate of methotrexate use was significantly lower in the PM group, and the Steinbrocker stage was significantly higher in the PM group. After matching these 3 factors, 68 patients were selected from each group. No significant differences in the ABT continuation rate, and malignancy incidence were observed between the two groups after ABT initiation. In addition to these factors, when matched for smoking history, interstitial lung disease, disease duration, sex, and inflammatory status, which are known risk factors for malignancy in RA, 40 patients were selected from each group. No significant differences in the ABT continuation rate, and malignancy incidence were observed between the two groups after ABT initiation. Conclusion: In our clinical practice, ABT was as effective and safe in patients with a history of malignancy as in those without.
Do baseline patient reported outcome measures predict changes in self-reported function, following a chronic pain rehabilitation programme?
Authors: Heelas L , Soni A , Barker Karen 
Published: August 2023

Background Interdisciplinary pain management programmes, based on cognitive-behavioural principles, aim to improve physical and psychological functioning and enhance self-management in people living with chronic pain. Currently there is insufficient evidence about whether psychological, biological or social factors are predictive of positive outcomes following pain rehabilitation. This study aims to evaluate predictors of change in Brief Pain Inventory – pain interference score (BPI) in a clinical data set to determine whether age, sex and baseline outcome measures are predictive of improvement in pain interference following pain rehabilitation. Methods A retrospective, pragmatic observational analysis of routinely collected clinical data in two pain rehabilitation programmes, Balanced Life Programme (BLP) and Get Back Active (GBA) was conducted. Standard regression and hierarchical regression analyses were used to identify predictors of change to assess temporal changes in BPI. Responder analysis was also conducted. Results Standard regression analyses of 208 (BLP) and 310 (GBA) patients showed that higher baseline BPI and better physical performance measures predicted better improvement in BPI across both programmes. Hierarchical regression showed that age and sex accounted for 2.7% (BLP) and 0.002% (GBA) of the variance in change in BPI. After controlling for age and sex, the other measures explained an additional 23% (BLP) and 19% (GBA) of the variance, p = < .001 where BPI and physical performance measures were consistently statistically significant predictors, p < .05. Responder analysis also showed that pain interference and physical performance were significantly associated with improvement ( p = < .0005). Conclusions The combination of high self-reported pain interference and better physical performance measures may be a useful indicator of who would benefit from interdisciplinary rehabilitation. Further validation of the results is required.
Clinical and Biomechanical Outcomes of Suture Button Fixation for Ligamentous Lisfranc Injury: A Systematic Review and Meta-analysis
Authors: Chona Deepak V. , Park Caroline N. , Kim Billy I. , Lau Brian C. 
Published: August 2023

Background: Flexible ligamentous fixation has increased in popularity for the treatment of ligamentous Lisfranc injury, but the optimal fixation strategy is unclear. Purpose: To review the biomechanical, clinical, and radiographic results of ligamentous Lisfranc injuries treated with flexible fixation. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed/Medline and Google Scholar literature databases were queried for clinical and biomechanical (cadaveric) studies relating to flexible fixation of ligamentous Lisfranc injury. Outcomes of interest included patient-reported outcome scores, clinical/biomechanical results, radiographic alignment, and return to activity. Where appropriate, meta-analysis of the postoperative outcomes was performed. Results: Of the 34 initial studies, 14 articles (243 feet) were included in the analysis. In the 11 clinical studies (216 patients), the mean postoperative American Orthopaedic Foot & Ankle Society score was 90.1 (n = 150; 6 studies) and the mean visual analog scale score was 1.5 (n = 137; 5 studies). The rate of return to activity was 100% (n = 35; 5 studies), and 100% of patients maintained radiographic alignment postoperatively (n = 62; 6 studies). No complications or subsequent hardware removals were reported. Of the 3 biomechanical studies (27 feet), 1 study found significantly greater change in diastasis under axial load between intact and postfixation ligaments with suture button versus screw fixation (+1.1 vs –0.1 mm; P < .05), another found no difference in the decrease in diastasis under axial load between the injured state and screw or suture button fixation (1.2 vs 1.0 mm; P = .5), and the third found no difference in displacement between intact and either screw or suture button fixation under either axial (intact vs screw: 1.0 vs 2.0 mm, P = .1; intact vs suture button: 0.6 vs 1.8 mm, P = .1) or abduction (intact vs screw: 1.5 vs 1.1 mm, P = .5; intact vs suture button: 1.3 vs 2.1 mm, P = .1) load. Conclusion: Flexible fixation use in the treatment of ligamentous Lisfranc injury was found to have significant potential as a fixation option, as demonstrated by excellent clinical results. Biomechanical evidence was inconclusive but suggested a trend toward decreased diastasis in specimens fixed with screws compared with suture buttons.
Paper 10: Characterization of Bone in Osteochondral Allografts Utilizing Inflammatory-Mediated Cellular Death Pathways
Authors: Langhans Mark , Rodeo Scott , Ying Lilly , Anand Krishna 
Published: August 2023

Objectives: Osteochondral allografts are used to treat chondral and osteochondral defects. While prior studies have correlated cell death within the chondral component of osteochondral allografts directly with clinical outcomes, cell death within the subchondral and trabecular bone has not been well characterized. While prior studies have demonstrated a role for apoptosis in chondral cell death in osteochondral allografts, none have examined the role of pyroptosis and necroptosis in osteochondral allografts. These pathways are of particular relevance because persistent inflammation associated with osteochondral allografts on imaging is correlated with poor patient-reported outcomes. We report here a study examining cell death and mechanism in osteochondral allografts. Methods: Fresh human talus allografts were cultured for 14, 28, or 42 days at 4oC in standard clinical media. Osteochondral plugs were taken at the specified time points and fixed in 10% formalin. Cell death was measured in the cartilage, subchondral bone, and trabecular bone with TUNEL staining. The mechanism of cell death was further examined with staining for apoptosis (activated caspase 3), necroptosis (MLKL), and pyroptosis (cleaved gasdermin D). Percentage of cells staining positive was calculated in each zone (cartilage, subchondral bone, trabecular bone). Each time point included 4-5 replicates. Appropriate statistical comparisons were made between groups. Results: Cell death was significantly greater in the trabecular bone and subchondral bone than the cartilage. There was an increase in cell death over time in cartilage as well as subchondral bone. Apoptosis was the most prevalent mechanism of cell death, but necrosis and pyroptosis were present in all areas of bone and cartilage. Conclusions: This study suggests that a component of osteochondral allograft clinical outcomes may be related to viability of the bony component of the allograft. There is significantly greater cell death in the bone versus the cartilage and a significantly greater percentage of the cell death is through pyroptosis, an inflammatory-mediated pathway. Culture media and surgical strategies that limit the effect of inflammatory cell death in the bone component of osteochondral allograft may help to improve postoperative incorporation and control persistent inflammation that can complicate surgical outcomes.
Paper 29: Untreated Type 4 Ramp Injuries at Index Anterior Cruciate Ligament Reconstruction Surgery Result in Higher Rates of Revision ACL-R within the First 2 Years
Authors: Green Joshua , Moran Jay , Medvecky Michael , Katz Lee , Gardner Elizabeth , Joo Peter , Wang Annie , Allen Christina , Jimenez Andrew , Santos Estevao , McLaughlin William 
Published: August 2023

Objectives: Ramp lesions are commonly associated with ACL tears and recent studies have identified these lesions in 17-42% of patients undergoing treatment with ACL reconstruction. In addition to its association with ACL tears, there is increasing recognition that ramp lesions lead to significant biomechanical changes in the knee. Our study seeks to investigate whether patients with type 4 ramp lesions at the time of initial ACL reconstruction have higher rates of reoperation, specifically revision ACL-R, compared to those that undergo ACL-R without a ramp lesion. Methods: Retrospective chart review was conducted on all patients surgically treated with ACL reconstruction at level I academic center from January 2015 to December 2019. Type 4 ramp lesions were diagnosed on preoperative MRIs by two MSK-trained radiologists blinded to clinical information. Demographic, associated injuries, intra-operative, clinical data, and re-operations were extracted from our ACL-R database. Statistical analysis using Students T-test and chi x2 for comparing cohorts. Cox Regression with covariates for re-operation surgery was used. Risk factors evaluated for revision surgery included patient age, sex, BMI, treatment of ramp, timing to surgery. Inter-reliability coefficient correlation was used for MRI reliability. Results: A total of 255 patients ACL-R were identified that met inclusion. There were 170 patients with ACL-R without a ramp present and 85 patients with ACL-R + type 4 ramp lesion. Revision ACL-R occurred in 10.5% in ramp group compared to 2.4% without ramp (P<0.005). Around 75% of the revision ACL-R for the ramp group occurred within the first 2 and half years after surgery. Risk factor associated with revision ACL-R included untreated ramp (HR 10.46 (CI: 2.13-109.70) p=0.01). Conclusions: Meniscal ramp lesions with ACL-R result in higher revision ACL-R when compared to no ramp ACL-R. Most significantly untreated type 4 ramp lesions with concomitant ACL-R were associated with increased risk of ACL-R revision surgery . Standard portals are not sufficient in diagnosing and assessing stability of ramp lesions intra-operatively. [Table: see text]
Paper 49: Bridging Reconstruction for Large-to-Massive Rotator Cuff Tears Has a Low Rate of Cuff Arthropathy Progression at A Minimum Five-Year Follow-Up
Authors: Kizaki Kazuha , Sparavalo Sara , Ma Jie , Wong Ivan , Med Dip Sports 
Published: August 2023

Objectives: Rotator cuff tears cause pain, muscle weakness, and difficulty with overhead activity. While smaller tears are easier to repair, large-to-massive cuff tears (>3 cm in size) are considered irreparable. For patients with large-to-massive cuff tears, surgical options include maximal repair, superior capsular reconstruction, bridging reconstruction, tendon transfers and reverse total shoulder arthroplasty (rTSA). Bridging reconstruction was developed to improve outcomes and to avoid the morbidity associated with other technique. Bridging reconstruction, also known as graft interposition, has been shown to have superior outcomes as compared to maximal repair with better patient-reported outcomes at two-years post-operatively as recently demonstrated in a randomized controlled trial. These positive results are maintained at five years, however the midterm changes in progression of rotator cuff arthropathy and conversion to rTSA have not been assessed. The purpose is to assess the progression of rotator cuff arthropathy in bridging reconstruction patients at a five-year follow-up. Methods: Forty-four patients who underwent bridging reconstruction between 2012 and 2017 for large-to-massive rotator cuff tears were included. All patients had a minimum five-year follow-up. Data collected included demographics, pre- and post-operative Western Ontario Rotator Cuff (WORC) Index, conversion to rTSA, and X-ray readings (including acromiohumeral distance (as measured on anterior-posterior pre/post-operative radiographs) and Hamada grades for rotator cuff arthropathy). Furthermore, a sub-group analysis was performed on post-operative MRIs for graft status. Results: The mean age at surgery was 59.9± 10.8 years with a mean follow-up of 7.3±1.4 years. The population was mostly male (70.5%). Pre-operatively, seven patients had mild rotator cuff arthropathy with Hamada grade 2-3, and one patient had Hamada grade 4B. The rest of the patients had Hamada grade one preoperatively. At a minimum five-year postoperative follow-up, only one patient had a rTSA, resulting in a survivorship rate of 98%. Two patients (4.6%) had post-operative Hamada grade 4. One patient had progression of cuff arthropathy from pre-operative Hamada 3 to post-operative Hamada 4A. The other patient maintained Hamada grade 4B from pre-operative to post-operative. Patients with progression of cuff arthropathy (i.e. higher post-operative Hamada grade) appear to have a higher possibility of complete post-operative graft tears. [SS1] [JM2] There were no correlations between progression of cuff arthropathy and WORC score at five years. Conclusions: At a minimum 5-year with a mean follow-up of 7.3 years, bridging reconstruction showed 98% survivorship rate with a low rate of conversion to rTSA and a low progression of cuff arthropathy with only 4.6% of patients having advanced RCA with Hamada grade 4.
Paper 68: Outcomes following Extracorporeal Shockwave Therapy for chronic Achilles tendinopathy at short to mid-term follow-up
Authors: Butler James , Zheng Danny , Walls Cian , Azam Mohammad , DeClouette Brittany , Kennedy John 
Published: August 2023

Objectives: The purpose of this retrospective clinical study was to evaluate outcomes following extracorporeal shockwave therapy (ESWT) for the treatment of Achilles tendinopathy. Subgroup analysis was conducted to identify predictors of poor outcomes. Methods: This retrospective cohort study included existing clinical data from 74 patients from a single academic institution. Patients greater than 16 years of old who underwent ESWT for Achilles tendinopathy in the office setting between 3/3/2017 to 8/2/2022 were included. Data collected included: patient demographics, co-morbidities, treatment characteristics, Victorian institute of sports assessment – Achilles (VISA-A) scoring tool, visual analog scale (VAS), magnetic resonance imaging data, return to play (RTP) data and failures were recorded. Failure was defined as no improvement in VISA-A nor VAS scores or surgical intervention. For these data, mean and standard deviation were calculated, and paired samples T-tests and Welch’s T-tests were performed on clinical outcome scores. Results: In total, 74 patients (91 heels) with a mean age of 54.1 ± 14.0 years and BMI of 27.3 ± 4.5 kg/m2 underwent ESWT for Achilles tendinopathy at a mean follow-up of 25.7 ± 15.0 months. Eighteen patients were in the non-insertional Achilles tendinopathy (NAT) cohort and 56 patients were in the insertional Achilles tendinopathy (IAT) cohort. Both NAT and IAT cohorts had a similar improvement in VISA-A score (p=0.365) and VAS scores (p=0.65). A shorter return to play time was found in the NAT cohort (1.1 ± 0.9 months) compared to the IAT cohort (2.6 ± 5.7 months) but this was not statistically significant (p=0.34). There was a higher failure rate in the the IAT cohort (50.0%) than the NAT cohort (38.9%). Patients who received platelet-rich plasma (PRP) had a higher failure rate (61.2%) than those who did not receive PRP (39.6%). In the NAT cohort, the failure rate in females was 0.0%. In the IAT cohort, the failure rate in females was 61.9%. Linear regression analysis found that elevated BMI and MRI severity were associated with worse post-ESWT outcomes. Conclusions: This retrospective study demonstrated a high failure rate at short-term follow-up in patients who underwent ESWT for Achilles tendinopathy. Higher failure rates were found in patients with IAT and those who received intratendinous PRP. Predictors of poor outcomes included elevated BMI and MRI severity. Further studies with larger patient cohorts and a longer follow-up are necessary to determine the role of ESWT in the treatment of Achilles tendinopathy.
Poster 122: RANTES/CCL5 and BFGF Concentration at the Time of Surgery Can Predict Postoperative Stiffness in Patients Undergoing ACLR
Authors: Petrera Massimo , Kingery Matthew , Duenes Matthew , Song Melissa , Jazrawi Laith , Strauss Eric , Avila Amanda 
Published: August 2023

Objectives: Patients undergoing anterior cruciate ligament reconstruction have been shown to be at risk for postoperative arthrofibrosis. Diagnostic biomarkers associated with development of stiffness are unknown. The objective of this study is to identify biomarkers found in the synovial fluid at the time of surgery that are associated with development of postoperative arthrofibrosis in a cohort of patients undergoing anterior cruciate ligament reconstruction Methods: Patients undergoing anterior cruciate ligament reconstruction were prospectively enrolled. Synovial fluid was collected in the OR prior to surgical incision. A cohort of patients with postoperative stiffness requiring manipulation under anesthesia or lysis of adhesions was identified. Matching of case to controls was performed using a 1:2 pair matching algorithm. Clinical factor-adjusted single biomarker and multivariable models were used to assess the association of biomarkers with postoperative stiffness requiring MUA/LOA. Results: A total of 11 (n = 3 male, n = 8 female) patients undergoing ACLR met inclusion criteria, matched with 21 (n = 6 male, n = 15 female) controls with no significant differences in age, sex, smoking history, or days from injury to surgery. Levels of RANTES were significantly higher in cases versus controls (694.20 [214.75 - 3428.79] vs. 113.04 [32.81 - 517.91]; p=0.034). IL-IRA, bFGF, and RANTES were found to have greatest predictive value by the final stepwise logistic regression model. Independent predictors of increased risk of postoperative stiffness after ACLR included RANTES (OR [95% CI]) (2.28 [1.29 – 5.37]; p=0.019) and bFGF (1.91 [1.07 – 3.99]; p=0.047) according to a multivariable logistic regression model. Only RANTES was a statistically significant predictor of developing postoperative stiffness (OR [95% CI]) (2.59 [1.26-9.07]; p=0.046). Conclusions: Higher concentrations of biomarkers bFGF and RANTES were found to be predictive of increased risk for stiffness after ACLR. IL-6, VEGF, TIMP1, IL-1RA, MMP3, MCP-1, and MIPB were not found to be associated with postoperative arthrofibrosis.
Poster 173: Comparison of Sensitivity of Diagnosis of Subscapularis Tear on 1.5 Tesla versus 3.0 Tesla Magnetic Resonance Imaging
Authors: Neel Robert , Bernholt David , Azar Frederick , Brolin Tyler , Throckmorton Thomas , Gutman Ilya 
Published: August 2023

Objectives: Diagnosis of subscapularis tears via Magnetic Resonance Imaging (MRI) has been reported to have variable accuracy, with prior studies indicating sensitivity of MRI ranging from 30.0-83.0%. In the current literature, studies utilizing 3.0T MRI scans have generally shown higher sensitivity compared to studies utilizing 1.5T MRI scans; however, there has not been direct comparison of differences in accuracy of 1.5 vs. 3.0T for diagnosis of subscapularis tear. The aim of this study is to investigate this difference. We hypothesize that 3.0T MRI scans will show higher sensitivity for the detection of subscapularis tears compared to 1.5T MRI scans. Methods: A single institution data set was queried to identify patients undergoing rotator cuff repair between January 2015 and January 2020. Patients were separated based on 1.5T and 3.0T MRI strength and these cohorts were analyzed based on intraoperative findings of subscapularis tears and interpretation of these MRI reports. Likewise, demographic information of the cohorts was analyzed including BMI, age, and sex. Univariate analysis, multivariate analysis, and Pearson’s χ2 test, Mann- Whitney U test were used when appropriate. Results: In a total 756 of patients, 151 were identified as having rotator cuff surgery with preoperative MRI that met our inclusion criteria. A total of 50 (33.1%) of patients were identified as having intraoperative findings of subscapularis tears that were not appreciable on MRI. A statistically significant difference was found when comparing the sensitivity of 3.0T MRI for identifying subscapularis tears when compared to 1.5T MRI. 3.0T MRI had a sensitivity of 72.9% compared to 56.4% respectively[TTW1] [GIM2] ( P < 0.05). Both groups had a PPV of 100% given no false positive results. 3.0T MRI had a NPV of 92.5% while 1.5T had a NPV of 92.2%. Conclusions: When a subscapularis tear is clinically suspected, surgeons should be critical over the choice of 1.5T vs 3.0T MRI imaging and understand their sensitivity to guide recommendations for intervention, preoperative planning, and overall patient satisfaction. [Table: see text][Table: see text]