bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster 249: Low Failure Rate in a Young Cohort of Patients Undergoing Anterior Cruciate Ligament Reconstruction with Quadriceps Tendon is Independent of Graft Fixation Methods
Authors: Herman Zachary , Drain Nicholas , Nazzal Ehab , Ramraj Raghav , Steuer Fritz , Lesniak Bryson , Musahl Volker , Hughes Jonathan , Dadoo Sahil 
Published: August 2023

Objectives: To determine failure and clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon in a young cohort of patients, and, secondarily, determine if method of femoral and tibial fixation of the graft affects these outcomes. Methods: All patients aged 10-30 years old who underwent primary ACLR with quadriceps tendon autograft from 2010 to 2021 were retrospectively analyzed. Patients with double-bundle ACLR, posterolateral corner augmentation, and revision ACLR were excluded. Patient demographics, surgical details, ACLR failure, and pre- and post-operative International Knee Documentation Committee (IKDC) scores were recorded. The primary outcome was ACLR failure and secondary outcome was post- operative IKDC score. Patients were further categorized into three groups based on femoral and tibial fixation: suspensory/suspensory (Group 1), suspensory/aperture (Group 2), and aperture/aperture (Group 3). Suspensory fixation included fixed loop, adjustable loop, and screw and washer fixation, whereas aperture fixation included use of interference screw. Chi Squared analyses were used to analyze categorical outcomes, and ANOVA and Kruskal-Wallis tests were used to analyze continuous outcomes. Significance was set at p < 0.05. Results: A total of 350 patients were included for analysis. The average age of the cohort was 19.4 (+/- 4.3) years old, and the average follow-up length was 12.6 (+/- 7.0) months. BMI, sex, and laterality of procedure were statistically similar. ACLR failure rate in the cohort was 4.9% overall, and mean post- operative IKDC score was almost two times higher than mean pre-operative IKDC score (76.2 vs 38.8, respectively). When dividing the cohort based on fixation type, 122 patients had femoral and tibial suspensory fixation, 191 patients had femoral suspensory and tibial aperture fixation, and 37 patients had femoral and tibial aperture fixation. ACLR failure rate was statistically similar across groups (6.6% (1), 4.7% (2), 0% (3); p > 0.05). Further, post-operative IKDC scores did not differ significantly across groups (74.2 (1), 77.1 (2), 79.2 (3); p > 0.05). Conclusions: Results of this study suggest that quadriceps tendon autograft is a viable option for ACL reconstruction in young patients, as demonstrated by a low failure rate and marked increase in IKDC score post-operatively. The follow-up interval in this study was short, however, and slightly increased failure rates may be observed over time. Femoral and tibial fixation methods in this study did not influence failure rate or IKDC scores, suggesting they may not play a role in post-operative success following quadriceps tendon ACLR. Surgeons may utilize the information in this study during pre- operative planning and discussion of graft options with their patients.
Poster 255: Socioeconomic Predictors of Time to Initial Evaluation, Time to Surgery, and Postoperative Outcomes among Medial Patellofemoral Ligament Reconstruction Patients
Authors: Avila Amanda , DeClouette Brittany , Vasavada Kinjal , Jazrawi Isabella , Alaia Michael , Strauss Eric , Campbell Kirk , Shankar Dhruv 
Published: August 2023

Objectives: Operative management of patellar instability with medial patellofemoral ligament reconstruction (MPFLR) has been associated with good results, but socioeconomic disparities may be an obstacle to patients receiving timely care and achieving satisfactory outcomes. The purpose of this study was to identify socioeconomic predictors of time to initial evaluation, time to surgery, and postoperative outcomes among lateral instability patients undergoing MPFLR. Methods: We conducted a retrospective review of patients at our institution who underwent primary MPFLR with allograft from 2011 to 2019. Patients were administered an email survey to assess symptom history, socioeconomic variables (ex. language, race, ethnicity, marital status, household size), and postoperative outcomes including Visual Analog Scale (VAS) pain, Kujala score, MPFL-Return to Sport After Injury (MPFL-RSI) score, and return to work and sport. Predictors of time to initial evaluation, time to surgery, concomitant procedures, and postoperative outcomes were identified using multivariable linear and logistic regression with stepwise selection. P-values less than 0.05 were considered significant. Results: Seventy patients were included in the cohort (mean age 24.8 years, 72.9% female, mean follow- up time 45.7 months). Mean time to evaluation was 6.4 months (range 0-221) and mean time to surgery was 73.6 months (range 0-444). Home ownership was predictive of reduced time to surgery (β: -56.5 [- 104.7 to -8.3]; p = 0.02). Non-white race was predictive of increased odds of undergoing a concomitant procedure (OR: 12.4 [1.8 to 83.4]; p = 0.01). Full-time employment was predictive of higher satisfaction (β: 14.1 [4.3 to 23.9]; p = 0.006) and higher Kujala score (β: 8.7 [0.9 to 16.5]; p = 0.03). Conclusions: Certain markers of higher socioeconomic status, including home ownership and full-time employment, were predictive of higher satisfaction and knee function following MPFLR for patellar instability. Non-white race was associated with higher risk of concomitant procedures. Identifying modifiable socioeconomic risk factors for delayed presentation and poorer surgical outcomes may allow surgeons to prioritize earlier intervention among the most vulnerable segments of their patient population.
Poster 287: The 5-Factor Modified Frailty Index (mFI-5) Predicts Adverse Outcomes After Arthroscopic Meniscectomy
Authors: Elali Faisal , Patel Neil , Krasnyanskiy Benjamin , Mai David , Urban William , Wolfert Adam 
Published: August 2023

Objectives: This study sought to determine associations between mFI-5 score and 30-day adverse outcomes after arthroscopic meniscectomy. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried to identify all patients who underwent arthroscopic meniscectomy using Current Procedural Terminology (CPT) codes 29880 and 29881. Patients were included between 2005 and 2009. Patients were included if they were 50 years old or older. The mFI-5 score was calculated for each patient using variables present in NSQIP. Multivariate logistic regression models were utilized to identify the associations between mFI-5 scores and 30-day rates of overall complications, readmissions, reoperations, and mortality. Results: 41,102 patients were included. This included 21,102 patients with an mFI-5 score of 0, 15,438 with a score of 1, 4,641 with a score of 2, and 265 with a score of 3 or higher (3+). 388 patients experienced a complication, 275 experienced readmission, 4,675 experienced reoperation, and 9 experienced mortality within 30-days of surgery. Regression revealed that an mFI-5 score of 3+ was associated with an increased risk of overall complications (OR: 3.9; CI: 2.0-7.8; p<0.001). An mFI-5 score of 1 and 2 was associated with an increased risk of reoperation (OR: 1.2; CI: 1.1-1.3; p<0.001) (OR: 1.2; CI 1.1-1.3; p<0.001). An mFI-5 score of 1 (OR: 2.1; CI: 1.6-2.8; p<0.001), 2 (OR: 2.3; CI: 1.6-3.4), and 3+ (OR: 14.7; CI: 8.2-26.1; p<0.001) were all predictive of readmission. No mFI-5 score was predictive of mortality. Conclusions: mFI-5 scores were predictive of adverse outcomes within 30-days of arthroscopic meniscectomy, especially overall complications and readmissions. Further research is warranted into the development of patient risk stratification tools as well as on the impact of patient comorbidities on the rates of subsequent reoperations and mortality. Patients should be counseled on the increased risk of adverse events presented by medical comorbidities and should be optimized in regards to chronic conditions.
Poster 289: Time to Achievement of Clinically Significant Outcomes Following Isolated Arthroscopic Meniscal Repair
Authors: Gamsarian Vahram , Krishnan Aditya , Mirle Vikranth , Levine Zachary , Berlinberg Elyse , Chahla Jorge , Yanke Adam , Cole Brian , Verma Nikhil , Group Forsythe 
Published: August 2023

Objectives: To comprehensively define the time required to achieve outcomes (CSOs) after arthroscopic meniscal repair (AMR). The primary outcome was to identify an evidence-based timepoint for functional recovery, including the time needed to attain minimally clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for isolated AMR. Methods: Patients who underwent isolated AMR between 2015 and 2021 were collected. Those with completed preoperative and at least 1 post-operative (6-month, 1 year, and 2 years) Patient-Reported Outcome Measures (PROMs), including International Knee Documentation Committee (IKDC), Patient- Reported Outcomes Measurement Information System Physical Function (PROMIS PF), or Knee Injury and Osteoarthritis Outcome Score (KOOS) were included. Exclusion criteria included patients with significant concomitant ligament procedures, concomitant meniscectomies, or prior ipsilateral knee surgery. MCID and PASS for each PROM were identified from prior literature and utilized as a threshold needed to attain functional recovery. The time needed to achieve CSO was then calculated and plotted using Kaplan-Meier survival analysis. Results: Of the 71 included patients (33.8% female, age: 30±14.9 years), 69 patients had completed IKDC forms, and 41 had completed PROMIS PF forms. Patients attained IDKC achievement rates of 84% for MCID and 68% for PASS, and PROMIS PF achievement rates of 80.5% for MCID and 78% for PASS. Median achievement time across all surveys (IKDC, PROMIS PF, and KOOS) ranged between 5.27 - 5.31 months for MCID, and between 5.21–5.40 months for PASS. Averages for achievement time for MCID ranged from 6.28–8.20 months, and for PASS from 6.42 – 9.51 months, in respective PRO surveys. Conclusions: The majority of patients (72%) undergoing AMR achieved benefit within 6 months of surgery (overall median: 5.3 months), with diminishing proportions at later timepoints. The timeline for achieving improvement that was established by this study may aid in setting patient expectations and designing future outcome studies involving AMR.
Poster 306: Examining Preoperative Magnetic Resonance Imaging for Medial Meniscal Ramp Lesions in Patients Surgically Treated for Acute Grade III Combined Posterolateral Corner Knee Injuries
Authors: Jimenez Andrew , Katz Lee , Wang Annie , McLaughlin William , Gillinov Stephen , Kunze Kyle , Hewett Timothy , Alaia Michael , LaPrade Robert , Medvecky Michael , Moran Jay 
Published: August 2023

Objectives: While medial meniscocapsular tears ( ramp lesions) are commonly associated with isolated anterior cruciate ligament (ACL) injuries, there are limited descriptions of these meniscal injuries in multi-ligament knee injuries (MLKIs). The purposes of this study were: (1) To retrospectively evaluate preoperative MRIs for the presence of ramp lesions in patients surgically treated for acute grade III combined posterolateral corner knee injuries and (2) To determine if a preoperative posteromedial tibia plateau (PMTP) bone bruise is associated with the presence of preoperative ramp lesions on MRI in these same patients. Methods: Data on consecutive patients at a Level I trauma center with MLKIs between 2001 and 2021 were retrospectively reviewed. Only patients with acute grade III combined PLC injuries who received a magnetic resonance imaging (MRI) scan within 30 days of injury were assessed. Two musculoskeletal radiologists retrospectively reviewed each patient’s preoperative MRI for evidence of ramp lesions and bone bruises (Figure 1). Intra-class correlation coefficients (ICCs) were used to calculate reliability among the reviewers. Multivariate analysis was used to evaluate the relationship between bone bruising patterns and the presence of a ramp lesion on MRI. Results: Sixty-eight patients (79.4% male; mean age, 36.2 ± 13.7 years) with an acute grade III combined PLC injury were included in the study (Table 1). On MRI, the ICC for detection of ramp lesions and PMTP bone bruising were 0.921 and 0.938, respectively. Medial meniscal ramp lesions were diagnosed in 18/68 (26.5%). 11/18 (61.1%) patients with ramp lesions also showed evidence of PMTP bruising, while 13/50 (26.0%) patients without ramp lesions had PMTP bruising (P=0.008) (Table 2). When controlling for age and sex, PTMP bruising was significantly associated with the presence of a ramp lesion in combined PLC injuries (OR, 4.62; P=0.012) (Table 3). Conclusions: Preoperative medial meniscal ramp lesions were diagnosed on MRI in 26.5% of patients with acute grade III combined PLC injuries. In addition, PMTP bone bruising was significantly associated with the presence of a ramp lesion in patients with a grade III combined PLC injury. These findings demonstrate the need to assess for potential ramp lesions at the time of multi-ligament reconstruction. [Table: see text][Table: see text][Table: see text]
Poster 315: Fifteen-Year Radiographic Follow-Up of a Prospectively Randomized Clinical Trial Comparing Early versus Delayed Anterior Cruciate Ligament Reconstruction.
Authors: Miles Rebecca , Bottoni Craig , Wake Jeffrey , Cruz Christian 
Published: August 2023

Objectives: Post-traumatic osteoarthritis (PTOA) after anterior cruciate ligament (ALC) injury remains a difficult problem. PTOA is considered to be the consequence of an initial mechanical disruption or injury to the cartilage. Recent literature has suggested that 50-60% of reconstructed knees demonstrate post- traumatic arthritis at long term follow up. Several studies evaluating synovial fluid have suggested that inflammatory cytokines present after injury may contribute to post-traumatic arthritis. Therefore, the purpose of this study was to compare the rate of post-traumatic osteoarthritis between acutely reconstructed ACLs (within 21 days) and delayed ACL reconstructions (greater than 6 weeks). Methods: This study is a retrospective review of a previous prospectively randomized controlled clinical trial where ACL reconstructions were randomized to either early (within 21 days) or delayed (beyond 6 weeks) reconstruction using hamstring autograft. Bilateral weight bearing radiographs were obtained at a minimum of 15-year follow-up. Radiographs were analyzed using the Kellgren-Lawrence classification system by a musculoskeletal radiologist. Seventy patients were enrolled in the study and 1 was excluded because of infection. Therefore, the original study cohort consisted of sixty-nine patients (34 acute, 35 delayed) with an average of 27.3 years at the time of surgery. Follow-up radiographs were obtained for 58 total patients (28 acute, 30 delayed). Results: The average time from injury to surgery in the acute group was 9 days (2-18) and 85 days (42- 192) in the delayed group. At an average follow up of 15.6 years, post-operative radiographs were obtained in a total of 58 patients (28 acute, 30 delayed). In the acute cohort, 53.5% of patients had greater than Grade 3 PTOA compared to 60.0% in the delayed cohort (p=0.1). In the acute cohort, 42.8% (12/28) had Grade 3 PTOA and 10.7% (3/28) had Grade 4 PTOA compared to 46.7% (14/30) Grade 3 PTOA and 13.3% (4/30) Grade 4 PTOA in the delayed cohort (p=0.1). Four patients in the delayed cohort had undergone a total knee arthroplasty compared to 2 patients in the early cohort. In the acute cohort, the average KOOS score was 61.7% in patients with > Grade 3 PTOA compared to 80.6% in those with < Grade 3. In the delayed cohort, in the average KOOS was 56.8% in patients with > Grade 3 PTOA compared to 77.9 in those with < Grade 3. Conclusions: In conclusion, we found that early ACL reconstruction resulted in no difference in the rate of post-reconstruction osteoarthritis of the knee compared to delayed reconstruction. At fifteen-year radiographic follow-up, both cohorts resulted in high rates of post-traumatic osteoarthritis. Furthermore, patients with greater than Grade 3 PTOA demonstrated worse KOOS scores in both cohorts.
Poster 316: Increased tibiofemoral rotation angle is associated with graft failure after anterior cruciate ligament reconstruction
Authors: Merkely Gergo , Farina Evan , Smith Richard , Gortz Simon , Hazzard Sean , Asnis Peter , Lattermann Christian , Leite Chilan 
Published: August 2023

Objectives: Coronal and sagittal malalignment of the knee are well-recognized risk factors for failure after anterior cruciate ligament reconstruction (ACLR). However, the effect of axial malalignment on ACLR graft survival is yet to be determined. This study aimed to evaluate whether increased tibiofemoral rotational malalignment, namely tibiofemoral rotation angle (TFA) and tibial tubercle-trochlear groove (TT-TG) distance, is associated with ACLR graft failure. Methods: In this matched-control study, 151 patients who underwent revision ACLR due to graft failure (failure ACLR group) were compared to a matched-control group of 151 patients who underwent primary ACLR with no evidence of failure after at least 2-years follow-up (intact ACLR group). Patients were matched by sex, age, and meniscal injury during primary ACLR. Axial malalignment was assessed on preoperative magnetic resonance imaging (MRI) through the TFA and the TT-TG distance. Sagittal alignment was measured through posterior tibial slope (PTS) on MRI. Optimal TFA cutoff associated with graft failure was identified by a receiver operating characteristic (ROC) curve. Kaplan-Meier curve with log-rank analysis was performed to evaluate the influence of TFA on ACLR longevity. Results: In the failure ACLR group, mean TFA was 5.8 ± 4.5 (range, -5 to 16) degrees while this mean was 3.0 ± 3.3 (range, -3 to 15) degrees in the intact ACLR group (p<0.001). Neither TT-TG distance nor PTS presented statistical differences between the groups. ROC curve suggested an optimal TFA cutoff of 4.5 degrees for ACLR graft failure. Considering this as a threshold, patients who presented TFA ≥ 4.5 degrees had 6.6-times higher likelihood of graft failure compared to patients with TFA < 4.5 degrees (p<0.001). Survival analysis demonstrated a 5-years survival of 81% in patients with TFA < 4.5 degrees, while it was 44% when TFA ≥ 4.5 degrees (p<0.001). Conclusions: Increased TFA was associated with increased odds of ACLR failure when the TFA was ≥ 4.5 degrees. Measuring the TFA in patients with ACL tears undergoing reconstruction may inform the surgeon about additional factors that may require consideration prior to ACL reconstruction for a successful outcome.
Poster 344: Reduced Incidence of Anterior Cruciate Ligament Reconstruction Revision with Internal Brace Augmentation: A Retrospective Matched Cohort Study with a minimum 2-year Follow-up
Authors: Wijdicks Coen , Smith Patrick , Daniel Adam 
Published: August 2023

Objectives: The primary purpose of this study was to investigate retear rates in patients who underwent ACLR with and without internal bracing in a matched cohort study. Additionally, we also sought to investigate if there were any differences in clinical and patient-reported outcomes between the groups. We hypothesized that ACLR with internal bracing would reduce the incidence of revisions in a safe and effective manner. Methods: A total of 200 patients were included in this study. Patients between the ages of 13-39 at the time of surgery who underwent primary autograft ACLR with internal bracing (IB group) between October 2010 and July 2020 and were enrolled in our institution’s registry with a minimum of 2-year follow-up were identified and matched 1:1 with a non-internal brace (no-IB) group based on patient demographics and concomitant procedures. Every patient completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale (MARS), Veterans RAND 12-Item Health Survey (VR- 12), and the Visual Analog Scale (VAS) pre- and postoperatively. KT-1000 arthrometer measurements were included in the pre- and postoperative objective, clinical assessments. Results: The IB group underwent significantly less revision ACLRs (1% vs. 8%, p = 0.017). Additionally, the average time elapsed from the original ACLR to the revision did not differ significantly and the average ages for the IB and the no-IB groups were comparable (19.0-years-old vs. 19.9-years-old). 5 patients in the no-IB group underwent a total of 9 meniscal procedures among them at the time of their revision ACLR compared to just one in the IB group (p = 0.009). There were also 4 patients in the no-IB group that underwent anterolateral ligament reconstruction at the time of their revisions (4 vs. 0, p = 0.043). All postoperative patient-reported outcome measures (PROMs) significantly increased in both groups with the exception of the MARS score which significantly decreased in both groups postoperatively. KT-1000 measurements significantly improved in both groups following surgery with the IB and no-IB cohorts yielding comparable results at the manual maximum pull (0.97mm vs. 0.65mm). Conclusions: ACLR with internal bracing resulted in an 88% decrease in revision ACLRs while maintaining comparable patient reported outcomes. Incorporating an Internal brace into ACLR is therefore safe and effective within these study parameters. [Table: see text][Table: see text][Table: see text]