bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster 188: Is Hormone Replacing Therapy Associated with Reduced Risk of Adhesive Capsulitis in Menopausal Women? A Single Center Analysis
Authors: Saltzman Eliana , Kennedy June , Ford Anne , Reinke Emily , Green Cindy , Poehlein Emily , Wittstein Jocelyn 
Published: August 2023

Objectives: The purpose of this study was to determine if hormone replacing therapy (HRT) is protective against adhesive capsulitis in menopausal women. We hypothesized that patients undergoing HRT will have a lower incidence of AC as compared to those without HRT. Methods: A single institution electronic medical record system was queried to retrospectively review menopausal women between the ages of 45 and 60. Subjects included were those enrolled in a single healthcare system coverage model to minimize inaccessibility to external episodes of care. Only data in existence as of November 1st 2018 was reviewed. Patients were identified using ICD-9 and 10 codes for shoulder pain, shoulder stiffness and AC. A REDCap database was then built, allowing the authors to review medical records and verify the variables and diagnoses. The diagnosis of AC on chart review was confirmed by a sports medicine fellowship-trained orthopaedic surgeon and shoulder-specialized physical therapist. Patients identified with AC were further reviewed for rotator cuff tears, if corticosteroid injections were received, and lastly if surgery was required. Both groups were assessed for associated endocrine disorders. Odds ratio for diagnosis of AC was determined for subjects with and without HRT using a logistic regression analysis. All statistical analysis were conducted in SAS 9.4 (Cary, NC). Statistical significance was assessed at p< 0.05. Results: A total of 1,952 patients were included in the study, with 152 patients receiving HRT. The distribution of thyroid disorder and diabetes were similar between the two groups with no statistically significant difference. In the HRT cohort 11.2% were identified with thyroid disorder and 9.2% with diabetes; in the no HRT 12.4% were identified with a thyroid disorder and 14.3% with diabetes. Additionally, 4.0% of patients with HRT and 7.7% of those without HRT had AC. Those not receiving HRT had 99% greater odds of adhesive capsulitis compared to those receiving HRT; however, this association did not reach statistical significance (OR: 1.99; 95% CI 0.86, 4.58; p = 0.11). Conclusions: This is the first known study to evaluate the role of HRT in the development of AC amongst menopausal women in a single center. We concluded from our preliminary study that women not receiving HRT had greater odds of AC, however the study is limited by the available sample size. While the analysis is underpowered, the 95% confidence interval for the odds ratio contains values that support the hypothesis that HRT may be protective against AC. This preliminary data will serve as a basis for larger multi-center and prospective studies to further evaluation this association.
Poster 256: Pediatric Meniscus Repair: Safety Profile based on > 2000 Arthroscopic Meniscus Repairs
Authors: Registry SCORE Quality Improvement , Ellis Henry 
Published: August 2023

Objectives: Pediatric meniscus tear prevalence is increasing, and meniscus preservation methods are essential for long term knee function in this at risk group. In this patient population meniscus anatomy and vascularity may support higher rates of healing after repair, but safety of meniscus repair has not been studied in a large prospective cohort group. The purpose of this study is to establish the incidence of complications associated with pediatric meniscus repairs in a multi-center prospective quality improvement registry, and to identify the characteristics of meniscus repair that are associated with complications. Methods: A prospective multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of meniscus repairs was reviewed. Audit processes using CPT codes were designed to ensure that all consecutive cases were prospectively entered on patients <19 years old into a HIPAA- compliant electronic platform. Each meniscus repair case with a complication form was secondarily reviewed to ensure consistency of identification and grading according to the modified Clavien Dindo classification. Demographics, tear type, repair technique, and implant type, when applicable, were included, and a common cause analysis was performed to evaluate risk factors for early repair failures. Results: 2375 meniscus repair cases were identified, with a mean age of 15.1 years (2-19) and 44.1% females. These consisted of (25%) isolated repair, (5.4%) discoid meniscus repair, and (66.9%) concomitant ACL and meniscus repair. Overall complication rate was 12.64%, with 5.67% grade III complications. The most common complications were motion loss/stiffness (3.96%), failed repair (2.3%) and continued pain/mechanical symptoms (2.09%). Failed repair was identified in all repair groups but had the highest prevalence in isolated meniscus repair (6.38%), in which grade III complications were more common overall. Stiffness was more common when a meniscus repair was performed during an ACL reconstruction (2.1% Grade II and 1.27% Grade III). There was no statistical difference in complications associated with age, gender, or technique, medial or lateral meniscus, displacement, or zone of repair. However, posterior horn and posterior horn + body repairs of the medial meniscus sustained more complications (p=0.003) as did longitudinal/complex tears of the lateral meniscus (p=0.02). Conclusions: Pediatric meniscus repairs performed arthroscopically have a complication rate of 12.64%, with 1 and 20 meniscus repairs leading to a grade III complication. Although there is no difference in complications based on technique, posterior horn medial meniscus and longitudinal tears of lateral meniscus may be at higher risk of complications.
Poster 275: The Impact of Socioeconomic Status on Meniscus Repair Outcomes
Authors: Sackey Nathalie , Cavendish Parker , Milliron Eric , Duerr Robert , Flanigan David , Kaeding Christopher , Magnussen Robert , Barnes Ryan 
Published: August 2023

Objectives: Meniscus tears are among the most common knee injuries. Successful meniscus repair is vital to avoid articular cartilage damage and osteoarthritis. There are many factors that contribute to the outcome and prognosis of meniscus repair including patient and injury factors. The goal of this study was to identify demographic and socioeconomic factors that may influence patient outcomes after meniscus repair. It was hypothesized that income can impact meniscus repair outcomes. Methods: Retrospective review identified patients who underwent meniscus repair surgery between 2009 and 2018 at a single academic institution. Patients were included if they lived in the local metropolitan area. Chart review was undertaken to collect demographic and surgical data. Patients were split into two groups: the 16 wealthiest zip codes and 16 poorest zip codes based on adjusted gross income from the internal revenue service (IRS) in 2018. Patients were included in the analysis if KOOS and IKDC scores were available. An independent t-test was used to determine the difference in scores between the two groups. Results: 67 patients were included in the analysis. 23 were from low-income zip codes and 44 were from high income zip codes. The patients from the poorer zip codes had significantly lower KOOS and IKDC scores compared to patients from the wealthier zip codes. Chart review identified socioeconomic factors that limited access to care in the postoperative period in 5 patients from the poorer zip codes (21.74%). Among these patients 40% of them reported lack of access to physical therapy due inadequate insurance coverage, and 60% due to lack of transportation, inability to take time off work and personal or family problems. Conclusions: Socioeconomic status may significantly impact outcomes, like KOOS and IKDC scores, following meniscus repair. Further work with larger dataset would provide more insight into this important question and allow for controlling of potential confounding variables. [Table: see text]
Poster 285: MRI Measurement of TT-TG Can Change Without Intervention: An Analysis of Sequential Pre-Operative MRIs in PFI patients
Authors: Pascual-Leone Nicolas , Chipman Danielle , Davie Ryann , Bram Joshua , Mintz Douglas , Fabricant Peter , Green Daniel 
Published: August 2023

Objectives: Following a patella dislocation event, the patella can remain unstable, leading to patellofemoral instability (PI). There are various anatomic risk factors for PI that help guide surgical treatment including the tibial tubercle to trochlear groove (TT-TG) distance. However, to the authors knowledge, no study has analyzed the temporal changes in TT-TG prior to any surgical intervention. This study, therefore, sought to understand the variations in TT-TG for pediatric patients suffering from patellar instability prior to any surgical intervention. The authors hypothesized that the TT-TG would not substantially change between timepoints. Methods: Patients undergoing medial patellofemoral ligament (MPFL) reconstruction using CPT code 27427 between January 1, 2014 and December 31, 2019 by one of two orthopedic surgeons were identified. Patients were included if they 1) had two pre-operative MRIs performed of the same knee within 8 months of each other prior to any surgical intervention and 2) had an initial TT-TG between 10 mm and 20 mm. Exclusion criteria were previous ipsilateral knee surgery or planned MPFL reconstruction with tibial tubercle osteotomy. Initial and subsequent TT-TG measurements were compared using paired-samples t-tests with two-tailed statistical significance set at p ≤0.05. IBM SPSS Statistics version 22 (Armonk, NY) was used for all statistical analysis. Results: After considering 251 patients for inclusion, 26 patients met inclusion criteria and were analyzed. Mean age of the cohort was 14.5±2.4 years and 42.3% were male. TT-TG was initially noted to be 15.3±1.8 mm. At mean time between sequential MRI’s of 4.8±1.9 months, TT-TG was noted to be 17.1±3.5 mm. The differences between initial and subsequent TT-TG ranged from a 21% decrease to a 61% increase, with a mean difference of a 12.1% increase. Comparison between initial and subsequent TT-TG values demonstrated a significant difference (p=0.006). Conclusions: At a mean time between MRIs of 4.8 months, variations in TT-TG ranged from a decrease of 21% to an increase of 61%. These findings suggest that TT-TG measurements may vary in patients on sequential MRIs and could be due to variations in tibiofemoral rotation during imaging. Surgeons should be aware of these variations when planning surgical correction for patellar instability. [Table: see text]
Poster 321: MENISCAL RAMP LESIONS IN ADOLESCENT PATIENTS UNDERGOING PRIMARY ACL RECONSTRUCTION
Authors: Pennock Andrew , Bomar James , Chambers Henry , Edmonds Eric , Hollnagel Katharine 
Published: August 2023

Objectives: Meniscal ramp lesions describe a specific injury to the meniscocapsular junction at the posterior horn of the medial meniscus. The lesions are strongly associated with anterior cruciate ligament (ACL) injuries and may affect the biomechanical stability of the knee if left untreated. Despite the increasing rates of ACL reconstructions performed in adolescents each year, the prevalence and risk factors for ramp lesions in this patient population is poorly understood. The purpose of this study was to determine the prevalence and risk factors for ramp lesions in children and adolescent patients undergoing primary ACL reconstruction. Methods: All patients ≤19 who underwent primary ACL reconstruction at a single institutional between 2019 and 2021 were included. All surgeries were performed by three fellowship trained orthopedic surgeons. Patients were considered to have a ramp lesion if one was identified arthroscopically at the time of ACL reconstruction. Basic demographic data, preoperative imaging, and other arthroscopic findings at the time of ACL reconstruction were reviewed. Results: 247 consecutive patients who underwent ACL reconstruction were reviewed. Patients were excluded if they had had prior ACL injury, prior knee surgery, fibular hemimelia, or incomplete documentation. A total of 230 patients met inclusion criteria. Average age at time of injury was 15.7 years (range 4.0-18.2 years). A ramp lesion was identified in 12% of patients. Posteromedial tibial bone bruise on preoperative MRI and medial femoral chondromalacia at time of ACL reconstruction were associated with the presence of a ramp lesion, Figure 1A (OR = 2.6, 95% CI [1.15, 5.93]). A striation pattern of medial femoral chondromalacia was highly specific for the presence of a ramp lesion, Figure 1B (OR = 424.3, 95% CI [50.99, 3531.3]). Sensitivity and specificity for detecting a ramp lesion was 68% and 76% with preoperative MRI and 68% and 99.5% with medial condyle striations, respectively. Conclusions: The prevalence of a ramp lesion in our cohort was 12%, mirroring historical reports in adult patients. Posteromedial bone bruising and medial femoral chondromalacia, especially in a striation pattern, should increase suspicion for the presence of a ramp lesion in patients undergoing ACL reconstruction.
Poster 334: Failure Rates and Complications with Multiple-Revision ACL Reconstruction: Don’t Forget the Over-The-Top Technique
Authors: Winkler Philipp , Nazzal Ehab , Zsidai Bálint , Drain Nicholas , Kaarre Janina , Sprague Andrew , Lesniak Bryson , Musahl Volker , Ozbek Emre Anil 
Published: August 2023

Objectives: Multiple-revision anterior cruciate ligament reconstruction (ACL-R) presents several technical challenges, often due to residual hardware, tunnel widening, or malposition. The aim of this study was to compare complication rates between over-the-top (OTT) and anteromedial portal drilling (AMD) techniques in patients undergoing multiple-revision ACL-R. Methods: A retrospective cohort study comprised of patients undergoing multiple-revision ACL-R was performed by four sports medicine fellowship trained surgeons in a single institute. Patients with two or more revision ACL-Rs performed with the OTT or AMD techniques were included. Data on patient demographics, graft characteristics, number of revisions, concomitant procedures, complications (arthrofibrosis, septic arthritis, cyclops lesion), and failures were collected. Between- group comparisons of continuous and categorical variables were conducted with independent samples t- tests and Fisher’s exact or the chi-squared test, respectively. Level of significance was set at p < 0.05. Results: A total of 101 patients undergoing multiple revision ACL-R with OTT (n=37, 37%) and AMD (n=64, 63%) techniques were identified. The mean follow-up period was 60 months (range: 12-196). No statistically significant differences were found in age, gender, body mass index, laterality, or follow-up length ( p > 0.05, Table 1) between the groups. Allograft was the most frequently used graft (n=64, 67.3%) with no significant differences between groups in terms of graft diameter. There were no statistically significant differences between groups regarding rate of concurrent medial meniscus, lateral meniscus, cartilage, or lateral extra-articular tenodesis procedures ( p > 0.05; Table 2). As displayed in Table 3, there was also no statistically significant difference in complication rate (OTT: n=2 (5.4%); AMD: n=8 (13%); p > 0.05) or graft failure rate (OTT: n=4 (11%); AMD: n=14 (22%); p > 0.05) between groups. Conclusions: The results of this study showed notably elevated failure and complication rates in challenging multiple-revision ACL-R. Complication and failure rates were lower in the OTT compared to the AMD technique, however, there were no significant between group differences in these outcomes. In the setting of multiple-revision ACL-R, surgeons may consider the use of the OTT technique. [Table: see text][Table: see text][Table: see text]
Poster 341: Clinical Outcomes of Concomitant Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction and Meniscal Allograft Transplantation
Authors: Vasavada Kinjal , Avila Amanda , DeClouette Brittany , Aziz Hadi , Strauss Eric , Alaia Michael , Jazrawi Laith , Gonzalez-Lomas Guillem , Campbell Kirk , Shankar Dhruv 
Published: August 2023

Objectives: Single-stage meniscus allograft transplantation (MAT) with concomitant anterior cruciate ligament reconstruction (ACLR) is a technically challenging procedure for management of knee pain and instability in younger patients. However, there is limited data on specific outcomes of this procedure, such as return to work and functional status relative to the U.S. population at large. The purpose of this study was to assess surgical and patient-reported outcomes following concomitant ACLR and MAT. Methods: We conducted a retrospective review of patients who underwent concomitant ACLR and MAT at our institution from 2010 to 2021. We included patients who underwent either concomitant primary or revision ACLR and medial or lateral MAT with a minimum follow-up of 8 months. Complications, graft failures, and reoperations were abstracted from patient records and Visual Analog Scale (VAS) pain, satisfaction, Lysholm Knee Scale, return to sport, and return to work outcomes were assessed using an email survey. Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, Pain Intensity, and Physical Function Scores were used to measure patients’ functional status relative to the U.S. population. All p-values less than 0.05 were considered significant. Results: The cohort consisted of 18 knees of 17 individual patients (16 unilateral, 1 bilateral). The cohort were majority male (15 patients; 83%) with mean age of 31.6 years (range 19-49) and mean BMI of 27.6 (range 22.2-53.3). Mean follow-up time was 47.3 months (range 8-101). A majority underwent revision ACLR (12 patients; 67%) with medial MAT (18 patients; 92%). Reoperation rate was high (5 patients; 28%) but only one patient experienced recurrence of painrequiring TKA. Patient-reported outcomes (n = 14) were generally positive with low VAS pain (mean 2.2), high satisfaction (mean 77.9%), and fair Lysholm score (mean 81.1) though satisfaction was lower among revision ACLR patients versus primary ACLR patients (mean 67% vs 100%; p = 0.04). Return to work rate was high (13 patients; 93%) while return to sport rate was low (6 patients; 43%). Postoperative PROMIS scores were comparable or superior to the national average and correlated significantly with patient satisfaction (p < 0.05). Conclusions: The concomitant ACLR and MAT procedure is associated with excellent knee pain and functional outcomes, low rates of complications and meniscus graft failure, and high rate of return to work after surgery. However, rate of return to sport is low and satisfaction is worse among revision ACLR patients. Overall, the single-stage ACLR and MAT procedure appears to be a safe and efficacious treatment option for patients with concomitant ACL and meniscus deficiency.
Poster 377: Patient Perception of Social Media Use by Orthopedic Surgeons
Authors: Wharton Benjamin , Geraghty Elisabeth , Bradsell Hannah , Ishikawa Andrew , McCarty Eric , Bravman Jonathan , Frank Rachel , Johnson Alexander 
Published: August 2023

Objectives: The purpose of this study was to characterize content posted by orthopedic surgeons on social media while investigating patient perceptions of this content and how it may influence their healthcare decisions. Methods: Social media posts by orthopedic surgeons from around the country were reviewed and categorized. A patient survey was written to assess perception of these categories and level of patient social media utilization. The survey was administered in the clinic of three separate orthopedic surgeons via QR code. Results: There were 250 completed patient surveys. In terms of social media utilization, the 18-24 (87.1%) and 25-34 (86.4%) age groups more likely to report daily use (p=0.002). However, social media utilization was high among all age groups with 78% of all patients and at least 62.5% of patients in each age group reporting weekly or daily usage. 17% of patients reported using social media to see information about their healthcare at least once per month, 21% of patients reported reviewing the social media account of a physician at least once per month, and 19% of patients reported that they were likely or very likely to view the social media account of their own physician. 23% of patients reported that social media content is likely or very likely to influence which physician they see, while only 6% of patients considered a large social media following important or very important. Patients held the most consistently positive view of posts educating patients, discussing sports team coverage, and providing patient testimonials. Patients held consistently neutral views of posts educating colleagues, discussing presentations at national meetings, displaying aspects of surgeons’ personal lives, and supporting marginalized groups. Several post categories elicited negative or highly polarized responses including those discussing research publications, showing surgical technique pictures/videos, showing pictures or videos taken of the surgeon in the operating room, political statements, or showing pictures from a patient’s own surgery. Conclusions: Social media is a useful tool to help physicians interact with patients and grow a practice. Physicians should consider posting content that is viewed most positively by patients including post educating patients, discussing sports team coverage, and providing patient testimonials. Content that is viewed less favorably should be posted sparingly or with a sensitive tag so that patients can avoid seeing posts that they may not enjoy. Further study is required to understand the differences between physician social media content focused on interacting with patients compared to content focused on interacting with other physicians.