bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster 166: Distal Clavicle versus Traditional and Congruent Arc Latarjet: Comparison of Surface Area and Glenoid Apposition with 3-Dimensional CT and MRI
Authors: Hudson Caroline , Taylor Dean , Anakwenze Oke , Dickens Jonathan , Lau Brian , Kim Billy 
Published: August 2023

Objectives: Limited studies have compared graft-glenoid apposition and glenoid augmentation area between the latarjet and distal clavicle grafts in glenohumeral stabilization. Additionally, pre-operative planning is typically performed using computerized tomography (CT), and few studies have used 3- dimensional magnetic resonance imaging (3D-MRI) reformations to assess graft dimensions. The purpose of the study was two-fold: 1) compare bony apposition, glenoid augmentation, and graft width among coracoid and distal clavicle bone augmentation techniques and 2) to determine the viability of 3D-MRI to assess bone graft dimensions. Methods: Twenty-four patients with recurrent glenohumeral instability and bone loss were included in this study. 3D-CT and 3D-MRI reformations were utilized to measure pertinent dimensions for five orientations of coracoid and distal clavicle autografts: (1) standard Latarjet (SLJ), (2) congruent arc Latarjet (CLJ), and (3) distal clavicle attached by its posterior surface, (DCP) and (4) inferior surface (DCI), and (5) resected end (DCR). Glenoid augment area was defined as the graft surface area contributing to the glenoid. Bone-on-bone apposition was defined as the graft-glenoid contact area for bone healing potential, and graft width was pertinent for fixation technique. Paired t-tests were performed to compare graft sizes between patients and compare 3D-CT vs 3D-MRI measurements. Results: CLJ had the largest glenoid augmentation area (mean: 318mm2, sd: 74) while SLJ displayed the most apposition (mean: 318mm2, sd: 74). DCI had the largest graft width (mean: 21mm, sd: 4). Paired t- tests revealed no significant differences between Latarjet methods, whereas distal clavicle grafts varied significantly with orientation. All 3D-CT and 3D-MRI measurements were within 1mm of each other, and only two demonstrated statistically significant difference (coracoid width: 13.03 vs 13.98mm, p=0.010; distal clavicle thickness: 9.69 vs 10.77, p=0.002). 3D-CT and 3D-MRI measurements demonstrated strong positive correlation (r>0.6 and p<0.001 for all dimensions). Conclusions: Glenoid augmentation, bony apposition, and graft width can vary with coracoid or distal clavicle graft type and orientation. Differences between 3D-CT and 3D-MRI were small and likely not clinically significant.
Poster 168: Notching of the Greater Tuberosity Revisited: A Radiographic Indicator of Degenerative Rotator Cuff Tears
Authors: Gruenberger Eric , Kersy Cameron , Stay Rourke , Jardaly Achraf , Williams Marshall , Ponce Brent , Baker Champ , Synovec John 
Published: August 2023

Objectives: The greater tuberosity notch (GTN) is an uncommonly reported radiographic finding which has been associated with articular sided partial rotator cuff tears (RCTs) in throwing athletes. This finding has yet to be evaluated in patients with degenerative tears. The purpose of this study is to assess the GTN measurement along with five other previously described radiographic indicators for degenerative RTCs. Methods: After obtaining IRB approval, we prospectively collected and compared 80 standard shoulder radiograph series with an additional “notch view”, a lateral oblique radiograph showing the greater tuberosity in profile. Thirty-four patients had confirmed rotator cuff tears confirmed via arthroscopy and 46 control patients did not have suspected rotator cuff pathology. Two musculoskeletal radiologists independently reviewed radiographs for GTN size and five previously described radiographic indicators of RCTs including: greater tuberosity cyst (GTC), acromiohumeral interval (AHI), critical shoulder angle (CSA), inferior acromial sclerosis (IAS), and lateral acromial spurring (LAS). A receiver operator characteristic (ROC) curve was performed to compare the individual performance of each of the six radiographic markers. Nearest neighbor analysis based on Euclidean distances followed by clustering described the pattern of radiographic variables occurring together in the setting of a RCT. Results: A total of 320 radiographs were reviewed and 1920 measurements were made. RCTs were independently associated with IAS, LAS, GTCs, decreased AHI and large GTNs (P < 0.01), but not the CSA or smaller notch sizes. Overall, the GTN size predicted a RCT with moderate accuracy (AUC=0.676). Cluster analysis suggested the AHI has the strongest correlation with RCTs and is the most closely related to the GTN size (P < 0.003) compared to other indicators based on Euclidean distances. Conclusions: The presence of a medium-sized greater tuberosity notch alone is moderately sensitive for detecting a degenerative RCT. Additionally, the presence of at least one other indicator on radiographs dramatically increases the likelihood of finding a RCT during surgery. The size and presence of these radiographic markers in combination may represent a continuum of increasing severity of cuff pathology.
Poster 169: Severe Attrition and Poor Satisfaction in Patients Undergoing Tele-Rehabilitation Versus Standard In-Office Rehabilitation After Arthroscopic Rotator Cuff Repair and Anterior Cruciate Ligament Reconstructions: Randomized Controlled Trials That Required Cessation
Authors: Shankar Dhruv , Avila Amanda , Mojica Edward , Hurley Eoghan , Lehane Kevin , Buzin Scott , Oeding Jacob , Stein Spencer , Gonzalez-Lomas Guillem , Alaia Michael , Strauss Eric , Jazrawi Laith , Campbell Kirk , Vasavada Kinjal 
Published: August 2023

Objectives: The use of telerehabilitation after sports medicine procedures such as arthroscopic rotator cuff repair (ARCR) and anterior cruciate ligament reconstruction (ACLR) has rapidly increased in recent years; however, functional outcomes and patient satisfaction after telerehabilitation compared to in- person rehabilitation remain unclear. We hypothesized that functional outcomes and patient satisfaction would not differ significantly between the rehabilitation modalities. Methods: Two separate randomized-controlled trials were conducted involving patients scheduled to undergo ARCR or ACLR by one of six fellowship-trained sports medicine surgeons between October 2020 and November 2021. Initially 60 patients were included in each arm of the trial. Patients were randomized to receive telerehabilitation or in-person rehabilitation for their post-operative course. International Knee Documentation Committee Subjective Knee Form (IKDC) scores (for ACLR), the American Shoulder & Elbow Surgeons (ASES) score (for ARCR), and satisfaction metrics were collected at timepoints of baseline and at each post-operative visit. Baseline characteristics and outcomes between the in-person and telerehabilitation arms of each cohort were compared using Mann-Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. P-values less than 0.05 were considered significant. Results: In total, 16 ACLR patients were enrolled, of whom 10 (62.5%) were assigned to in-person rehabilitation and 6 (37.5%) to telerehabilitation. Additionally, 32 ARCR patients were enrolled of whom 20 (62.5%) were assigned to in-person rehabilitation and 12 (37.5%) were assigned to telerehabilitation. In both trials combined, of the 30 patients initially assigned to in-person rehabilitation, 24 (80%) completed the final follow-up survey and none reported crossover to telerehabilitation. Of the 18 patients initially assigned to telerehabilitation, 12 (67%) completed the final follow-up survey. Of these 12 patients, 11 (92%) reported crossover; 9 patients completed in-person rehabilitation and 2 patients completed hybrid in-person and tele-rehabilitation. Conclusions: Though overall satisfaction with both modalities was high, patients preferred in-person rehabilitation to telerehabilitation after undergoing ACLR and ARCR as evidenced by nearly ubiquitous crossover from telerehabilitation to in-person rehabilitation in both studies. However, a hybrid model combining in-person and tele-visits may be acceptable to most patients.
Poster 181: Dual plating as a Cost-Effective Treatment Option for Operatively Indicated Midshaft Clavicle Fractures
Authors: Kumar Praveen , Reddy Rajiv , Chen Stephen , Mittwede Peter , Moloney Gele , Sabzevari Soheil , Siska Peter , Lin Albert , Charles Shaquille 
Published: August 2023

Objectives: Many studies have highlighted lower rates of secondary operations with dual-plating compared to single-plating. Despite higher upfront costs associated with the dual-plating construct, the observed reduction in secondary operations compared to single-plating may make it a more cost- effective treatment option. The objective of this study was to assess the cost-effectiveness of dual-plate fixation compared to single-plate fixation in patients with operatively indicated displaced midshaft clavicle fractures. We hypothesized dual-plating would be a more cost-effective surgical option than single-plating, given its lower rates of postoperative complications. Methods: We developed a decision tree to model the occurrence of postoperative complications (hardware issues, wound healing issues, deep infection, non-union, and symptomatic hardware) associated with secondary surgeries. Complication-specific risk estimates were summarized for both plating techniques. The time horizon was two years, and the analysis was conducted from the healthcare payer’s perspective. The costs included direct medical costs, while the benefits were measured in quality-adjusted life-years (QALYs). We assumed that dual-plating would be $300 more expensive than single-plating upfront. We conducted probabilistic and one-way sensitivity analyses. Results: The model predicted reoperation in 6% of patients in the dual-plating arm compared to 14% of patients in the single-plating arm. In the base case analysis, the dual-plating increased QALYs by 0.007 and costs by $70 per patient yielding an incremental cost-effectiveness ratio (ICER) of $10,600 per QALY gained. The sensitivity analysis demonstrated that the cost-effectiveness of dual plating is driven by the cost of index surgery, risk of non-union, and symptomatic hardware complications in single- and dual- plating. At a willingness to pay threshold of $100,000 per QALY gained, 92% of simulations suggested dual-plating is cost-effective compared to single-plating (Figure 1). Conclusions: When indicated, operative management of displaced midshaft clavicle fractures with dual- plating is cost-effective compared to single-plating. Despite its higher initial upfront hardware costs, dual plating appears to offset added costs via lower rates of reoperations and improved patient quality of life.
Poster 187: Similar Clinical and Patient Recorded Outcomes Amongst Older Patients over 65 Years of Age Compared to Younger Patients undergoing Arthroscopic Rotator Cuff Repair
Authors: Castle Joshua , Jiang Eric , Wager Susan , Brown Spencer , Kasto Johnny , Gasparro Matthew , Muh Stephanie , Makhni Eric , Moutzouros Vasilios , Gaudiani Michael 
Published: August 2023

Objectives: The purpose of our study was to determine if patients 65 years and over meet the minimally clinical important difference (MCID) for Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE), Depression (PROMIS-D), and Pain Interference (PROMIS-PI) at similar rates compared to a cohort of younger patients. Methods: A retrospective review of a prospectively collected database of patients undergoing RCR was performed. Patients with completed preoperative and 6-month follow up postoperative PROMIS scores were included. A cohort of 65 years and older (65<) was compared to a cohort of 64 years and younger (64>=) in terms of their clinical outcomes and PROMIS scores. A propensity matched analysis was then performed, which matched patients 65+ years old 1:1 to a cohort of 50 years or younger via tear size and body mass index (BMI). Results: A total of 318 patients were included with 79 patients ≥ 65 years (69.2 ± 3.4 years, mean ± SD) and 239 patients <65 years (55.1 ± 3.4 years). No significant differences were found in terms of gender, tear thickness, tear size, reoperation rate, retear rate, preoperative PROMIS-UE, PROMIS-PI, and PROMIS D scores, or change in postoperative PROMIS-UE, PROMIS-PI, and PROMIS D after 6 months. In the sub-analysis, 44 patients over 65 years of age were propensity matched to 44 under 50 years of age. No differences were found in PROMIS-UE change, PROMIS-D change, proportion meeting MCID PROMIS UE, and proportion meeting MCID of PROMIS PI after 6 months. Patients in the 65+ years group experienced larger changes in PROMIS PI scores (12.5 ± 9.6 vs 7.2 ± 7.5, p=0.005) while fewer patients experienced significant declines in PROMIS D scores (26% vs 47%, p=0.03). Conclusions: Patients ≥ 65 years experience no differences in reoperation or retear rate when compared to younger patients. Older patients undergoing RCR were more likely to have a larger improvement in pain scores but were less likely to have significant clinical change in their depression scores. With proper patient selection, patients ≥ 65 years can achieve clinically significant improvements 6 months after RCR that is similar to their younger counterparts. [Table: see text][Table: see text][Table: see text]
Poster 192: Depressive and Anxiety Disorders Increase Risk for Continued Biceps Pain Following Arthroscopic Biceps Tenodesis
Authors: Greiner Justin , Carlos Noel Bien , Simonian Lauren , Hughes Jonathan , Lin Albert , Lesniak Bryson , Drain Nicholas 
Published: August 2023

Objectives: Arthroscopic suprapectoral biceps tenodesis (ASPBT) may result in postoperative biceps pain. Previous studies have revealed associations between demographic or intraoperative factors and shoulder pain, but with conflicting results. No study has exclusively investigated predictors of biceps pain following ASPBT. The purpose of this study was to evaluate factors associated with postoperative biceps pain following ASPBT while also determining the clinical impact of postoperative biceps pain. We hypothesized that younger age and pre-existing diagnoses of chronic pain syndromes would be associated with increased postoperative biceps pain. Methods: A retrospective study comprised of patients that underwent ASPBT was completed. Groups were categorized by the presence (BP+) or absence (BP-) of postoperative biceps pain. Differences between continuous variables were tested with two-sample t-tests and differences between categorical variables were tested with the chi-squared or Fisher’s exact test. Variables collected at different postoperative timepoints were first analyzed using a linear mixed model or generalized linear mixed model with fixed effects for group, timepoint, the group*timepoint interaction, and a random subject effect. Post-hoc comparisons were analyzed and p-values were adjusted for multiple testing with the Benjamini-Hochberg procedure. Results: A total of 461 (47 BP+, 414 BP-) patients met criteria for analysis. A lower mean age was observed in the BP+ group (p<0.01). Diagnoses of major depressive disorder (MDD) (p=0.03) and any anxiety disorder (p<0.01) were more prevalent in the BP+ group. Prescription medication with selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors (p<0.01) and atypical antidepressants (p=0.01) was more prevalent in the BP+ group. Subacromial decompression (SAD) was performed less frequently in the BP+ group (p<0.01). Conclusions: Younger age, diagnosis of MDD or any anxiety disorder, as well as the use of psychotropic medications were predictive of postoperative biceps pain following ASPBT. The study also observed lower odds of developing postoperative biceps pain in patients undergoing concomitant SAD. Postoperative biceps pain after ASPBT resulted in prolonged recovery, inferior PROs, and a higher incidence of repeat surgical procedures. The decision to perform ASPBT in younger patients, patients diagnosed with MDD or anxiety, and patients taking psychotropic medications should be carefully considered given the correlation to postoperative biceps pain and inferior outcomes. [Table: see text][Table: see text]
Poster 194: Arthroscopic Reconstruction of Comminuted Glenoid Fractures Using Distal Tibia Allograft Results in Excellent Post-Operative Outcomes
Authors: DE LA PEÑA JOSE CASTILLO , Wong Ivan 
Published: August 2023

Objectives: Boney Bankart injuries with a fragment from the anterior rim of the glenoid are not the most frequent ones after an anterior shoulder dislocation but can cause severe impairment of the joint and residual instability directly related with the amount of bone avulsed. Different treatment options have been described including fixation or reconstruction of the glenoid bone using distal tibia allograft. The primary objective of this study is to analyze and compare clinical outcomes, Western Ontario Shoulder Instability (WOSI) scores, complication, and re-dislocation rates. Methods: This study included patients who underwent arthroscopic surgery for glenoid fracture between 2012-2020. Patients were included if they sustained a type Ia glenoid fracture according to Ideberg-Goss classification and if they were treated arthroscopically within three months of injury with one of two surgical techniques; Fixation (including fracture fragment reduction and fixation with screws, buttons, or sutures and anchors), and glenoid reconstruction. Patients were excluded if they had concomitant fractures to ipsilateral humerus or clavicle during injury and history of ipsilateral shoulder instability. Demographic information, WOSI scores, and complications related to the surgery, or new dislocation events were recorded. Results: Thirty-eight patients were included with both the fixation and reconstruction groups had similar demographics and baseline characteristics, except for the percentage of patients with comminution which was higher in the reconstruction group (p=0.04) (Table 1). Both the fixation and reconstruction groups has similar pre- and post-operative glenoid AP measurements (Table 1). Patient-reported outcomes were similar post-operatively between the two groups (p=0.546) (Figure 1). Conclusions: Arthroscopic glenoid fracture fixation has good outcomes but concerns exist regarding cartilage damage. Complex comminuted fracture patterns are suitable for reconstruction with patients achieving comparable outcomes to those who undergo fracture fixation. [Table: see text]
Poster 203: Worse Postoperative Outcomes and Higher Reoperation in Smokers Compared to Nonsmokers for Arthroscopic Rotator Cuff Repair
Authors: Castle Joshua , Jiang Eric , Wager Susan , Brown Spencer , Kasto Johnny , Gasparro Matthew , Muh Stephanie , Makhni Eric , Moutzouros Vasilios , Gaudiani Michael 
Published: August 2023

Objectives: Smoking significantly impairs healing potential and is a significant risk factor for complications after various orthopaedic surgeries. The purpose of this study was to determine if a cohort of former or current smokers at time of surgery met the minimally clinical important difference (MCID) for Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS- UE), Depression (PROMIS-D), and Pain Interference (PROMIS-PI) scores in comparison to nonsmoking patients. Methods: A retrospective review of a prospectively collected database of patients undergoing arthroscopic rotator cuff was performed. Patients who completed preoperative and 6-month postoperative PROMIS scores were included. The MCID was calculated using a distribution technique with a threshold of 0.5 standard deviations above the mean. A cohort of nonsmokers was compared to a cohort of patients currently or former smokers at time of surgery in terms of their clinical outcomes and PROMIS scores. A sub-analysis was also performed where a cohort of nonsmokers were propensity matched 1:1 to a cohort of current/former smokers via age, body mass index (BMI), and tear size. Results: A total of 182 patients, 80 current or former smokers and 102 nonsmokers, who underwent rotator cuff repair were included in the study. Smokers had statistically different sized tears with more rated massive and more reoperations (16.3% vs 5.9%, P=0.02). No differences were found in preoperative PROMIS scores, change in PROMIS scores, proportion meeting MCID for PROMIS scores, and retear rate. In the sub-analysis, 74 current or former smokers were matched to 74 nonsmokers. Smokers had a lower change in PROMIS-UE (8.6 ± 9.8 vs 12.3 ± 10.0, P=0.007) and PROMIS-PI (-9.1 ± 8.5 vs -12.8 ± 10.1, P=0.03) postoperatively. Fewer met MCID for PROMIS UE postoperatively (60.3% vs 82.4%, P=0.003) and more had reoperations (16.2% vs 4.1%, P=0.02). Conclusions: Patients who smoke currently or had a history of smoking preoperatively demonstrated smaller improvements in function, pain scores, and were less likely to meet MCID for PROMIS-UE when compared to nonsmokers after arthroscopic rotator cuff repair. Smokers were more likely to undergo reoperations within 6 months. [Table: see text][Table: see text][Table: see text][Table: see text]
Poster 221: Revision Hip Arthroscopy Outcomes at an Average 5 year Follow-Up: FAI and Capsular Complications
Authors: Selley Ryan , Olsen Reena , Kelly Bryan , Ranawat Anil , Nawabi Danyal 
Published: August 2023

Objectives: Femoroacetabular impingement (FAI) has become an increasingly recognized diagnosis contributing to morbidity in the adolescent and young adult population over the past decade. Our ability to treat such pathology with hip arthroscopy has grown in parallel. As the number of hip arthroscopy cases performed annually continues to rise, so will the number of patients requiring revision surgery. Trending outcomes and indications for revision hip arthroscopy is essential to improve surgical techniques, facilitate accurate diagnoses and address pathology appropriately. The purpose of this study was to report outcomes for revision hip arthroscopy and assess if outcomes vary by indication. Methods: A single-center hip preservation registry was reviewed to identify patients who underwent revision hip arthroscopy for the treatment of FAI between 2012 and 2019. Patient demographics and primary indications for revision hip arthroscopy were determined, patient reported outcomes were collected preoperatively and at an average follow-up of 5.2 years post-operatively. Results: A total of 239 patients met inclusion criteria for this study. The top 4 primary indications for revision were: Residual FAI 67.8%, instability 14.6%, heterotopic ossification (HO) 4.6% and adhesions 4.2%, trends in indication did not vary over time. On average patients improved significantly from pre- to post-operatively in mHHS 20.4(95% CI: 16.6 - 24.1), HOS ADL 15.0 (95%CI: 11.9 -18.2), HOS SS 23.8 (95% CI: 18.8 – 28.9), iHOT-33 30.2 (95% CI: 26.0 – 34.3), p<0.001. Rates of achieving MCID varied from 62.9%-78.3%, SCB 44.9-56.6% and SCB by absolute value at final follow-up of 32.1-65.9%. In a subgroup analysis, significantly lower pre-operative function was noted in the instability cohort compared to the impingement cohort as measured by HOS SS only, p=0.004. Post-operatively this instability cohort demonstrated significantly worse outcomes as measured by mHHS, HOS ADL and iHOT33. Rate of re- revision arthroscopy was 6.4% and 8.7% of patients required THA or were planning soon. Conclusions: The most common indication for revision hip arthroscopy in the treatment of femoroacetabular impingement remains residual impingement. Capsular complications have significant consequence for function and may represent a subset of patients who demonstrate more dysfunction both before and after revision arthroscopy. Lastly, heterotopic ossification is third most common reason for revision hip arthroscopy underlining the importance of postoperative prophylaxis.