bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster 200: Earlier Evaluation by an Orthopaedic Surgeon Is Associated with Higher Return to Work Among Workers’ Compensation Patients Undergoing Shoulder Arthroscopy
Authors: Massey Patrick , Sampognaro Gabriel , Fincher Phillip , Mody Milan , Barton R. Shane , Kushner Rachel 
Published: August 2023

Objectives: Workers’ compensation (WC) patients represent a large expenditure to the health care system and account for a large number of missed work days. Studies have shown that WC patients are less likely to return to work after injury or surgery. The purpose of our study was to determine if there was a higher return to full duty among WC patients who underwent arthroscopic shoulder surgery when they were seen by an orthopaedic surgeon within 100 days of injury. Methods: After obtaining Institutional Review Board approval, a retrospective chart review was conducted of WC patients treated with arthroscopic shoulder surgery by 2 senior authors at a community hospital between 2011 and 2018. WC patients that were treated with arthroscopic shoulder surgery were identified using Current Procedural Terminology (CPT) codes 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, and 29828. Patients were excluded if they were polytrauma patients who had undergone surgical procedures in other locations, patients who had a fracture, and patients being treated with revision shoulder surgery. A total of 59 WC patients were included in the study and were followed up to 2 years post-operatively. WC patients who identified as laborers were divided into 2 groups. The first group was evaluated by an orthopaedic surgeon within 100 days of injury (early orthopaedic evaluation) and the second group was evaluated by an orthopaedic surgeon more than 100 days after injury (late orthopaedic evaluation). The primary outcomes included the length of time from injury to evaluation by an orthopaedic surgeon and from surgery to return to work in some form. Results: Early orthopaedic evaluation was associated with a higher rate of return to full duty (p=0.02). The early orthopaedic evaluation group had a 69% (25 out of 36) return to full duty while the late orthopaedic evaluation group had a return to full duty of 39% (9 out of 23). There was no significant difference in the rate of return to work in some form with the early orthopaedic evaluation group returning at 94% (34 out of 36) and the late orthopaedic evaluation group returning at 83% (19 out of 23). There was a moderate association between time to evaluation by an orthopaedic surgeon following injury and time to return to work in some form (r=.22). There was no significant difference between the groups with respect to the type of laborer (p=.128). Conclusions: WC patients who were evaluated by an orthopaedic surgeon within 100 days of injury had a higher likelihood of return to full duty as well as return to work in some form compared to WC patients who were evaluated by an orthopaedic surgeon more than 100 days after injury. [Table: see text]
Poster 205: Performance and Return to Sport Following Medial Ulnar Collateral Ligament Repair with Internal Brace Augmentation in Professional Baseball Players
Authors: Singh Akash , Fares Mohamad , Abboud Joseph , Ramsey Matthew , Erickson Brandon , Khan Adam 
Published: August 2023

Objectives: Medial ulnar collateral ligament (UCL) reconstruction (UCLR) has been the gold standard treatment for symptomatic UCL injuries in throwing athletes. Recently, a novel technique of UCL repair with suture augmentation has been described and shown promising biomechanical as well as clinical results in a few small series of nonprofessional athletes. An added advantage of this technique over UCLR is that it affords the potential ability to return to competitive throwing with an accelerated timeline of 6-7 months as opposed to 12-18 months. No prior work has described the outcomes of this technique in professional athletes. This study aimed to evaluate the frequency and rate of return to prior level of sport as well as athletic performance of professional baseball players following UCL repair with Internal Brace augmentation. Methods: This study included all professional Major League Baseball (MLB) and Minor League Baseball (MiLB) players who underwent primary UCL repair with Internal Brace from January 2016 to June 2021. Demographic and performance data were recorded for each player. Performance metrics were then compared from one year preinjury against one year postoperative metrics. The return to play date was recorded. Univariate statistical analysis was performed to compare preinjury to postoperative performance (p< 0.05 considered statistically significant). Results: Fifteen players met inclusion criteria (8 MLB and 7 MiLB). Mean age was 28.2 +/- 4.06 years at time of surgery. There were 10 pitchers and 5 position players. All injuries were to the dominant extremity. No players underwent revision surgery during the study period. 93.3% (14/15) of players returned to sport and eventually prior level of competition. Average time to return to sport was 11.5 +/- 4.27 months and average time to prior level of competition was 12.1 +/- 4.61 months. When comparing competitive performance of players that returned successfully, one year preinjury to one year postoperatively, there was no statistically significant difference observed in performance [Table 1]. Conclusions: This study demonstrates promising early results of UCL repair with Internal Brace augmentation in professional baseball players. 93.3% of players were able to return to sport in under 12 months. All players, pitcher and position, that returned to sport were able to return to their prior level of play. No statistically significant drop in performance was observed in players that were able to return to play. Further clinical evaluation of UCL repair with Internal Brace augmentation and direct comparison of this procedure with UCL reconstruction is warranted. [Table: see text]
Poster 206: What are the Indications for Medial Ulnar Collateral Ligament Surgery in Baseball Players? An MRI Case-based Study
Authors: Smith Matthew , Freehill Michael , Camp Christopher , Erickson Brandon , Sciascia Aaron , Da Silva Adrik , Chalmers Peter , Bowman Eric 
Published: August 2023

Objectives: Ulnar Collateral Ligament (UCL) tears are common in baseball players. When non-operative management fails; reconstruction or repair may be necessary to restore physical function. There is no clear consensus regarding the indications for surgery based on magnetic resonance imaging (MRI) tear characteristics, or the indications for selecting repair over reconstruction. The purpose of this study was to define the indications for UCL surgery based on MRI and to elucidate indications for UCL repair vs reconstruction. Methods: Twenty-six orthopaedic surgeons who treat baseball players were surveyed. Forty-five MRIs were reviewed: 15 without UCL tears, 15 with intra-operatively confirmed partial-thickness tears, and 15 with full-thickness tears. Factors investigated included ligament characteristics (peri-ligamentous or osseous edema, ligament hypertrophy, calcification, partial or full-thickness tearing) and location (proximal, mid-substance, or distal). Surgeons were given a clinical scenario and asked whether 1) surgery was indicated and 2) whether repair or reconstruction was recommended. Odds ratios (OR) and 95% confidence intervals (95%CI) helped identify significant predictors for both queries. Results: The odds of recommending surgical treatment compared to non-operative treatment were 2.4x more likely for a proximal partial-thickness tear, 3.2x for distal partial-thickness tear, 5.1x for distal full- thickness tear, and 7.0x for proximal full-thickness tear (p<0.001). Significant indications for repair included distal partial (OR=1.6, 95%CI 1.0, 2.1, p<0.001) and full-thickness tears (OR=1.7, 95%CI 1.1, 2.3, p<0.001). Repair was 3x less likely recommended for mid-substance full-thickness tears (OR=3.0, 95%CI - 5.0, -1.0, p=0.004). Ultrasound stress testing was requested in 78% of partial tears. Conclusions: Among surgeons surveyed, the highest odds for recommending operative treatment were proximal full-thickness tears, then distal full-thickness, distal partial-thickness, and proximal partial- thickness tears. Repair was most appropriate for partial and full-thickness distal tears, but relatively contraindicated for complete mid-substance UCL tears. Ultrasound stress testing was frequently requested for partial tears. Given the lack of consensus among surgeons, future prospective registries are necessary to determine whether these factors associate with clinical outcomes. [Table: see text]
Poster 208: Clinical Outcomes Following Ulnar Collateral Ligament Reconstructions with Concomitant Ulnar Nerve Transposition in Overhead Athletes: A Matched Cohort Analysis
Authors: Ciccotti Michael , Johnson Emma , Erickson Brandon , Dodson Christopher , Cohen Steven , Ciccotti Michael , Ciccotti Michael , Lynch Jeffrey 
Published: August 2023

Objectives: Injury of the ulnar collateral ligament (UCL) has become increasingly common, particularly in overhead athletes. There is no consensus on management of the ulnar nerve in UCL reconstruction (UCLR) in patients with pre-operative ulnar nerve symptoms, as literature supports both not decompressing the nerve as well as ulnar nerve transposition (UNT). The purpose of this study is to compare subjective clinical outcomes and return to play metrics between patients who received UNT during UCLR and a matched cohort who underwent UCLR alone. We hypothesized that there would be no significant difference in patient outcomes or return to sport (RTS) metrics between the cohorts. Methods: Using an institutional database, patients who underwent UCLR with UNT between 2007 and 2017 were retrospectively identified. These patients were matched based on sex, age at surgery (± 3 years), and BMI (± 2) to a comparison group that underwent UCLR alone. Patients completed the Kerlan Jobe Orthopaedic Clinic Shoulder & Elbow score (KJOC), the Timmerman and Andrews elbow score, the Conway-Jobe scale, and custom patient satisfaction and return to play questionnaires. Results: Thirty patients who underwent UCLR with concomitant UNT and 30 matched patients who underwent UCLR without UNT were available for follow up at a mean of 6.9 and 8.1 years respectively. The UNT group reported similar KJOC (78.4 in UNT vs 76.8; P=0.780), Conway-Jobe (60% excellent in UNT vs 77% excellent; P=0.504), Timmerman and Andrews (86.2 in UNT vs. 88.8; P=0.496), and satisfaction scores (85.3% in UNT vs. 89.3%; P=0.512) compared to UCLR group. In terms of RTS rate (84% in UNT vs 93%; P=0.289) and duration required to RTS (11.1 months in UNT vs 12.5 months; P=0.176), the two groups did not significantly differ. Finally, despite significant differences in preoperative ulnar nerve symptoms (100% in UNT vs 7% in UCLR; P<0.001), the two groups did not statistically differ in the proportion of patients that experienced post-operative ulnar nerve symptoms (13% in UNT vs 0%; P=0.112) Conclusions: This matched cohort analysis showed no statistically significant differences in patient reported outcomes and return to sport between patients undergoing UCLR with and without UNT. [Table: see text]
Poster 209: Physical Examination vs Ultrasonography for Detection of Ulnar Nerve Subluxation in Professional Baseball Pitchers
Authors: Day Hannah , Reddy Manoj , Paul Ryan , Nazarian Levon , Cohen Steven , Looney Austin 
Published: August 2023

Objectives: Despite the importance of accurately detecting the presence of ulnar nerve subluxation in vulnerable athletes, minimal research has compared the performance of physical examination and ultrasound in professional baseball pitchers. Therefore, the purpose of this study was to characterize the diagnostic validity of physical examination in the detection of ulnar nerve subluxation at the cubital tunnel of the elbow compared with ultrasound. Methods: Physical and sonographic examinations for ulnar nerve subluxation were performed on 186 elbows of 95 consecutive male professional baseball pitchers (ages 17 to 30 years) as a routine part of Spring Training assessments. Provocative maneuvers consisting of Tinel’s test and the elbow flexion compression test were evaluated over the cubital tunnel. The validity of physical examination for detecting ulnar nerve subluxation at the elbow was determined using ultrasound as the gold standard for comparison. Results: Ulnar nerve subluxation was detected by physical examination in 58 (31.2%) elbows and by ultrasonography in 61 (32.8%) elbows. Of the 58 elbows with positive physical examination, 47 were positive on ultrasound. The accuracy of physical examination was 86.6%, with 77.0% sensitivity and 91.2% specificity. The positive and negative predictive value of physical examination were 81.0% and 89.1%, respectively. There was no relationship between nerve instability and positive provocative tests overall, in dominant vs nondominant arms, or in right vs left arms (all P > .05). Conclusions: Physical examination has moderate sensitivity and high specificity for detecting ulnar nerve subluxation at the cubital tunnel of the elbow when compared with ultrasound. These findings suggest that when detecting the presence of a subluxating ulnar nerve is most important, it may be advisable to obtain an ultrasound evaluation instead of relying on physical examination; however, physical examination alone may be appropriate for ruling out subluxation. [Table: see text]
Poster 234: Minimum 10-Year Clinical Outcomes and Survivorship of Meniscal Allograft Transplantation with Bone Fixation
Authors: Kaiser Joshua , Frazier Landon , Quigley Ryan , Cotter Eric , Hevesi Mario , Gilat Ron , Meeker Zachary , Yanke Adam , Cole Brian , Wagner Kyle 
Published: August 2023

Objectives: Meniscal allograft transplantation (MAT) can reliably reduce pain and improve function in symptomatic patients with meniscal insufficiency without diffuse chondral wear. Ten-year survival rates following MAT have been estimated to be as high as 74%, though previous studies have been limited to small sample sizes or pooled outcomes including patients who have less than 10-year minimum follow- up. The purpose of this study was to report on clinical outcomes and survivorship following primary meniscal allograft transplantation in a large cohort of patients with 10-year minimum follow-up. Methods: A retrospective review of prospectively collected data was performed to identify patients undergoing primary MAT from 1999-2012. Lysholm, International Knee Documentation Committee (IKDC), and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales were collected preoperatively and at 1-, 2-, 5-, and minimum 10-year follow-up. Cox proportional hazards modelling was utilized to identify variables associated with reoperation and failure. Failure was defined as revision MAT or conversion to unicompartmental or total knee arthroplasty (UKA and TKA, respectively). Reoperation was defined as a subsequent surgical intervention of the transplanted meniscus, including partial or total meniscectomy, meniscal repair, or failure as defined above. Results: A total of 143 patients undergoing primary MAT met inclusion criteria and were followed for a mean of 12.8 ± 2.7 years (range: 10.0 - 21.0). Concomitant procedures were performed in 96 (67%) patients, the most common being osteochondral allograft transplantation (n=50, 35%) (Table 1). Patients demonstrated statistically significant (p ≤ .037) postoperative improvements in all patient- reported outcome measures at all time points, compared to baseline (Figure 1). Fifty-four patients (38%) underwent a meniscal reoperation at a mean time of 6.5 ± 5.4 years (range: 0.3 – 16.7) postoperatively, with the most common reoperation procedure being partial meniscectomy (n=27, 19%). Thirty-five (24%) patients met criteria for failure at a mean time of 7.2 ± 4.9 years following MAT (range: 1.0 - 16.5). Twelve (8%) patients underwent revision MAT, and 23 (16%) underwent conversion to arthroplasty. MAT survival free of meniscal reoperation and failure was 73% and 83% at 10 years and 58% and 69% at 15-years, respectively (Figure 2). At the time of final follow-up, 88% of patients reported being satisfied with their overall postoperative condition. Conclusions: Primary MAT demonstrates efficacy and durability with high rates of patient satisfaction at minimum 10-year follow-up. Patients should be counseled that while reoperation rates may approach 42% at 15 years, overall revision rates (8%) and conversion to arthroplasty (16%) remain low at long- term follow-up. [Table: see text]
Poster 242: Predictors of the Ten-Year Patient-Reported Outcome Measures After Collagen Meniscus Implant (CMI) for Partial Meniscus Deficiency
Authors: Lucidi Gian Andrea , Zaffagnini Stefano , Agostinone Piero , Fabbro Giacomo Dal , Pizza Nicola , Di Paolo Stefano , Grassi Alberto 
Published: August 2023

Objectives: Collagen Meniscus Implant (CMI) is considered an effective procedure for reducing knee pain and improving knee function after previous meniscectomy. Nevertheless, the current knowledge regarding the clinical results of CMI are limited to small case series at short- to mid-term follow-up studies. The goal of the present study was to evaluate clinical outcomes, reoperations, and failures of CMI at a minimum 10 years of follow-up. Methods: Consecutive patients who underwernt CMI at a single institution were screened for elegibility. Inclusion criteria for the present study were (1) Medial or Lateral CMI, (2) Isolated or combined procedure with ACL reconstruction, knee osteotomy or cartilage treatment, (3) follow-up between 10 and 15 years. Demographics and surgical details were obtained via chart review. Patients were asked if they were satisfied with the procedure and were evaluated with the Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, and Tegner score at the final follow-up. Survival analysis was performed with Kaplan-Meier curve, and clinical scores were analyzed based on the Patient Acceptable Symptom State (PASS). Results: A total of 92 patients (mean age, 42.8 years) were included in the analysis. A significant improvement in all the clinical scores was reported between the preoperative evaluation and the last follow-up. A chondropaty with outerbridge grade ≥III was associated with significantly overall lower clinical score, while a timing from meniscectomy to CMI implant to ≥5 years determined more pain at rest and lower score in the KOOS quality of life. Overall, 25% of patients did not achieved the PASS for Lysholm score and a percentage variable from 19% (KOOS Pain) and 40% (KOOS Symptoms) did not achieved the PASS in the KOOS subscales. Chondropaty with outerbridge grade ≥III was associated with an higher Risk of not achieving the PASS in all the KOOS subscales, while an age at surgery ≥45 years was resulted in a lower risk of not achieving PASS in the pain subscale. At the last follow-up 63% of patients returned to sport practice after CMI implantation, with 41% at the same or higher level. Finally, 80% of the patients were satisfied with the procedure Conclusions: CMI provided satisfactory results in terms of function, symptoms, sports and quality of life in 60% to 80% of the patients after more than 10 years of follow-up with clinical scores still higher compared to the preoperative evaluation. The cartilage status and the time from meniscectomy have shown to impact negatively on the outcomes, while an age >45 years was associated with less pain. [Table: see text][Table: see text]
Poster 244: A Retrospective Analysis of Bucket Handle Meniscus Tear Repair Outcomes
Authors: Gupta Puneet , Reynolds Alan , Taber Caroline , Saltzman Bryan , Popkin Charles , Trofa David , Mehta Apoorva 
Published: August 2023

Objectives: Bucket handle meniscal tears are a challenging clinical entity with a failure rate as high as 34.5%, which is in stark contrast from the estimated 5% for more simple tear patterns. There are limited data on patient or surgical factors that affect failure. The purpose of this study is to characterize patient and surgical variables that impact two main outcomes: return to sport and revision surgery following surgical repair for bucket handle meniscus tears. Methods: A retrospective review of all meniscus repairs from 1/1/11 to 1/1/21 was performed for a single institution, and all bucket handle meniscus repairs were included in the study. Demographic information was collected along with injury characteristics and surgical techniques. Outcomes included return to sport and need for revision surgery. Patients with more than 50% of data missing for the variables of interest were removed from the study. Patients without follow-up notes were excluded from return to sport analysis. Failure rate was defined by either a documented re-tear of the former bucket handle meniscus or a revision surgery. Results: There were 205 patients included in the final analysis, with an average of age of 24.42 and 76.39% male, with an average follow-up time of 12.52 months. Demographic and clinical characteristics are summarized in Table 1. Operative characteristics are summarized in Table 2. Of the 117 patients that played sports with available follow-up data, 90 (76.9%) returned to sport and 27 did not (23.1%) with an average follow-up time of 15.01 months. Average return to sport time was 7.21 months +/- 3.77 months. Twelve (13.8%) patients that returned to sport and 12 (44.4%) of the patients who did not underwent future meniscectomy or revision repair surgery. Overall failure rate was 19.0%. The rate of failure of combined all-inside and outside-in technique (33.33%) was higher than rate of failure in all-inside technique alone (14.17%). In a bivariate analysis of risk factors for failure, the variables for age, sex, smoking, BMI, ASA classification, mechanism of injury, and symptom duration before surgery were not found to be statistically significantly different between patients who failed and did not fail repair. Conclusions: The overall return to sport rate after bucket handle meniscus tear repair in this study was found to be 76.9 with an average return to sport time of 7.21 months. The overall failure rate was found to be 19.0% with an average follow-up time of 12.52 months. Further studies are needed to better understand outcomes following bucket handle meniscus repairs. [Table: see text][Table: see text]