bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paper 57: Labral Tear Management in Patients Aged 40 Years and Older Undergoing Primary Hip Arthroscopy: A Propensity-Matched Case-Control Study Comparing Labral Reconstruction to Labral Repair with Minimum Two-Year Follow-Up. *ACCEPTED TO AJSM*
Authors: Maldonado David , Ouyang Vivian , Owens Jade , Jimenez Andrew , Saks Benjamin , Sabetian Payam , Lall Ajay , Domb Benjamin 
Published: July 2022

Objectives: To report minimum two-year patient-reported outcome (PRO) scores, survivorship, and secondary surgeries, in patients aged ≥ 40 years who underwent primary hip arthroscopy with labral reconstruction compared to a propensity-matched primary labral repair group. Methods: Data were prospectively collected and retrospectively reviewed for patients who underwent a primary hip arthroscopy for femoroacetabular impingement syndrome from January 2014 to June 2018. Patients aged ≥ 40 years who underwent a labral reconstruction or a labral repair and had preoperative and minimum two-year PROs for the modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale (VAS) for pain were included. Patients with prior ipsilateral hip conditions and surgery, Tonnis grade > 1, hip dysplasia, or worker’s compensation status were excluded. Patients in the reconstruction group were propensity-matched 1:2 to patients in the repair group based on age, sex, and body mass index. Secondary surgeries and the achievement of the minimal clinically importance difference (MCID), patient acceptable symptomatic state (PASS), and maximum outcome improvement (MOI) were recorded. Results: Fifty-three and 106 hips were included in the labral reconstruction and repair groups, respectively. The average follow-up time was 37.6 months. The average age for the reconstruction and repair groups were 48.01 ± 5.4 years and 48.61 ± 6.0 years, respectively. Both groups achieved significant improvements in all PROs at minimum two-years with similar achievements of MCID, PASS, and MOI. Both groups showed comparable secondary surgeries rates. Conclusions: Patients aged 40 years and older who received primary labral repair and primary labral reconstruction, achieved similar significant improvements in all PROs, VAS pain, and patient satisfaction at minimum two-year follow-up, with comparable rates of secondary surgeries and achieving MCID, PASS, and MOI. Based on these findings, labral repair remains the gold standard treatment for viable labrum in this population group, while reconstruction is a useful alternative for irreparable labrum.
Paper 68: Cannabidiol is Effective in Improving Immediate Post-operative Pain and Patient Satisfaction Following Arthroscopic Rotator Cuff Repair: A Placebo-Controlled, Randomized, Double-Blinded Study
Authors: Hurley Eoghan , Markus Danielle , Britton Briana , Vasavada Kinjal , Rokito Andrew , Jazrawi Laith , Gonzalez-Lomas Guillem , Kaplan Kevin , Alaia Michael 
Published: July 2022

Objectives: The purpose of this study is to evaluate the potential analgesic effects of buccal-absorbed cannabidiol (CBD) in patients that have undergone arthroscopic rotator cuff repair (ARCR). Methods: This is an FDA sanctioned, multi-center, placebo-controlled, randomized, double-blinded trial conducted in patients undergoing ARCR. Patients from 18 to 75 years of age undergoing an ARCR were prospectively enrolled. Patients were equally randomized to the control and experimental groups. The experimental group post-operatively received 25mg of CBD (Oravexx, Orcosa Pharmaceuticals, USA) TID if < 80kg and 50mg of CBD TID if > 80kg for 14 days, with control groups receiving an identical placebo. Patients were followed-up on Day 1, 2, 7, and 14, and Visual Analog Scale (VAS) for pain, opioid consumption, and satisfaction with pain control were recorded. Additionally, liver function tests (LFT) were done on Days 7 and 14 to assess safety, and nausea was monitored. A priori power analysis was performed based on the VAS score as primary endpoint, which revealed that a minimum of 39 patients would be required in each group to detect a clinically important difference in the VAS score (1.4) with a power of 0.8. A value of p < 0.05 was considered to be statistically significant. Results: Overall, 80 patients were recruited. There were no significant differences in age, sex, or BMI between the two groups. On Day 1, VAS pain score was significantly lower in those receiving CBD (4.1 ± 3.0 vs 6.0 ± 3.1, p = 0.01), which also meets VAS MCID for shoulder arthroscopy (1.2-1.4). Patient satisfaction with pain control trended towards significance favoring the CBD group (72% vs 60%, p = 0.072). However, there were no statistically significant differences in opioid consumption (16.4mme ± 12.7 vs 20.6mme ± 14.4, p = 0.186), which was relatively small in both groups. Notably, patients receiving 50 mg of CBD reported lower VAS scores at day 1 (3.9 ± 3.3 vs 4.6 ±2.5 ± 6.0 ± 3.1, p = 0.0394) and higher satisfaction with pain control at day 1 and 2 (8.1 ± 2.3, 5.8 ± 3.3, 5.9 vs 3.6, p = 0.0175 | 7.8 ± 1.8 vs 6.3 ± 3.0 6.0 ± 3.2, p = 0.05) compared to those receiving 25 mg of CBD and control group respectively. On Day 7 and Day 14, there were no statistically significant differences in VAS score, opioid consumption, or patient satisfaction with pain control (p>0.05 for all). There were no significant differences in nausea or LFTs post-operatively (p > 0.05). Conclusions: CBD is safe and effective in reducing pain in the immediate peri-operative period following ARCR and should be considered in post-operative multimodal pain control. [Table: see text]
Paper 78: Integrating PROM Collection for Shoulder Surgical Patients through the Electronic Medical Record: A Low Cost and Effective Strategy for High Fidelity PROM Collection
Authors: Fife Johnathan , McGee Anna , Swantek Alexander , Makhni Eric 
Published: July 2022

Objectives: Patient Reported Outcome Measures (PROMs) are critical measures of quality of care and treatment outcomes; however, they are challenging to collect without significant financial and administrative investment. The purpose of this study was to evaluate the efficacy and cost of an automated PROM collection through the electronic medical record for shoulder surgery patients in a large, integrated healthcare system. Methods: An existing, electronic medical record (EMR) based, automated, PROM scheduling system was integrated into the surgical check-in workflow for all elective primary total hip, total knee, and partial knee arthroplasty patients from November 2020 through August 2021 at 3 high volume surgical sites in a large, integrated health system. Rates of completion for Patient Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE), Patient Reported Outcomes Measurement Information System Pain Interference (PROMIS-PI) and American Shoulder and Elbow Surgeons Shoulder (ASES) surveys were determined. No additional staff were hired to assist in PROM collection. In our institution, if the patient had an ambulatory appointment within 25 days prior to surgery, their PROM scores were marked complete and were not reassigned on the day of surgery (DOS). For all other patients, PROMs were assigned by the automated system on DOS. Results: A total of 325 patients with a mean age of 42 + 28 years were included in this study. The vast majority, 94% (306), were assigned surveys on their day of surgery as a result of the automated system. The other 6% (19) had PROM scores completed in the ambulatory setting as they had a pre-operative visit less than 25 days prior to surgery. For patients completing PROMS on their day of surgery, 87% (266/306) completed at least 1 of PROMIS-UE or ASES, while 82% (251/306) completed both. In total 88% (285/325) of patients completed at least 1 PROM on or within 25 days prior to surgery and 85% (277/325) completed both. This entire system cost $5180 to deploy. Conclusions: A native PROM scheduling and collection system was successfully implemented with a survey completion rate of 82% to 95% of patients. This system serves as an efficient, low-cost model for other surgical departments to leverage existing systems to collect day of surgery PROMs.
Paper 86: Symptoms of post-traumatic osteoarthritis remain stable up to 10 years after ACL reconstruction
Authors: Spindler Kurt , Jin Yuxuan , Jones Morgan 
Published: July 2022

Objectives: ACL reconstruction (ACLR) can restore knee stability and return athletes to the field of play, but these athletes are still at risk of knee pain from post-traumatic osteoarthritis. The purpose of this study was to determine the incidence of clinically significant knee pain at 2, 6 and 10 years after ACLR in patients who had surgery using modern surgical techniques and rehabilitation protocols including early motion. Methods: The Multicenter Orthopaedic Outcomes Network (MOON) enrolled 3273 patients at 7 centers between 2002 and 2008. Patients completed a baseline questionnaire including demographics, injury characteristics, sports participation, and validated outcome instruments including KOOS, IKDC, and Marx Activity. Surgeons completed a questionnaire documenting physical examination, arthroscopic findings, and details of the procedure. Patients repeated the questionnaire at 2, 6 and 10 years. Patients were categorized into symptomatic versus asymptomatic at each timepoint by multiple criteria: KOOS pain <=70, KOOS pain <= 80, or answering “moderate, severe, or extreme” to any KOOS pain question (a common entry criteria for OA clinical trials). We hypothesized that incidence of knee pain would increase with increasing time since surgery. We applied McNemar’s test with a significance level of p<.05. Results: The median age of the cohort was 23 years (IQR 17-27) and 44 percent were female. 2798 completed the questionnaire at 2 years (85%), 2759 at 6 years (84%), and 2526 at 10 years (77%). For the 70-point cutoff, the incidence of clinically significant knee pain was 9.3% at 2 years, 8.9% at 6 years, and 9.1% at 10 years. For the 80-point cutoff, the incidence was 16.6% at 2 years, 16.3% at 6 years, and 15.7% at 10 years. For the “moderate, severe or extreme” criteria, the incidence was 26.3% at 2 years, 22.9% at 6 years, and 22.6% at 10 years. There were no statistically significant differences between the three timepoints for any of the criteria. Conclusions: A substantial proportion of patients develop clinically significant knee pain as early as 2 years after ACLR (as high as 26.3% by one criteria); however, this proportion remains constant at 6 and 10 years after surgery. We expected an increased proportion of patients with symptoms of PTOA by 10 years post-op; however, these findings suggest that the development of knee pain occurs early after ACLR, and that treatments should be focused on improving recovery and minimizing knee pain early to prevent symptoms of PTOA in the first 10 years after surgery.
Paper 88: The Natural History of Anterior Shoulder Instability in Patients Over the Age of 50: A Population Based Study
Authors: Wilbur Ryan , Song Bryant , Reinholz Anna , Till Sara , Okoroha Kelechi , Krych Aaron , Camp Christopher , Smartt Anne 
Published: July 2022

Objectives: Anterior shoulder instability (ASI) is a well-studied topic in young patients, however there is a dearth of knowledge about older patients with this pathology. The goals of this study were to describe patient demographics, injury characteristics and outcomes in patients >50 years old with anterior shoulder instability along with historical trends in diagnosis and treatment. Methods: An established geographic database was used to identify 179 patients who experienced new onset anterior shoulder instability after the age 50 between 1994-2016. Mean age was 59.7 years, mean BMI was 31.3 and 54.2% were female. The dominant arm was involved in 62.2% of instability events. 26.8% of our study population were laborers and 50% reported current or former smoking habits. The primary etiology for ASI involved trauma in 96.6% of cases. Comparative analysis was performed to identify differences between age groups. Mean follow up time was 11 years. Results: The overall incidence of ASI in our study population was 28.8/100,000 person years with the highest incidence in the age cohort 60-64 at 38.9/100,000 person years. At initial presentation, 73% of all patients were found to have a lesion apparent on either XR or MRI. Rotator cuff tears were found in 92.4% of all patients undergoing MRIs. 26.2% ultimately progressed to surgery at a mean time of 1.57 years after injury. 53% of all surgical procedures involved a rotator cuff repair whereas only 25% were performed for instability. In terms of historical trends, the one-year rate of obtaining an MRI after an ASI event has increased from 10% in the late 1990s to 46% in 2015-16. Similarly, the one-year rate of performing surgery has increased from 5.1% to 47% from 1994-1999 to 2015-2016. Conclusions: In our cohort, patients over the age of 50 with ASI were found to often have concomitant pathology on imaging, however only ¼ of all patients required surgery. Although the rate of ASI has stayed relatively stable over the last 20 years, the rate of obtaining an MRI and of surgical management has increased. [Figure: see text]
Poster 121: Inter- and Intra-Observer Agreement are Unsatisfactory when Determining Study Design and Level of Evidence
Authors: Schmitz Matthew , McKay Scott , Patel Neeraj 
Published: July 2022

Objectives: Understanding differences between types of study design (SD) and level of evidence (LOE) are important when selecting research for presentation or publication and determining its potential clinical impact. The purpose of this study was to evaluate inter- and intra-observer reliability when assigning LOE and SD as well as quantify the impact of a commonly used reference aid on these assessments. Methods: Thirty-six accepted abstracts from the Pediatric Orthopaedic Society of North America (POSNA) 2021 annual meeting were selected for this study. Thirteen reviewers from the POSNA Evidence Based Practice Committee were asked to determine LOE and SD for each abstract, first without any assistance or resources. Four weeks later, abstracts were reviewed again with the guidance of the Journal of Bone and Joint Surgery (JBJS) LOE chart, which is adapted from the Oxford Centre for Evidence-Based Medicine. Inter- and intra-observer reliability were calculated using Fleiss’ kappa statistic (k). Chi-square analysis was used to compare the rate of SD-LOE mismatch between the first and second round of reviews. Results: Inter-observer reliability for LOE improved slightly from fair (k=0.28) to moderate (k=0.43) with use of the JBJS chart. There was better agreement with increasing LOE, with the most frequent disagreement between levels 3 and 4. Inter-observer reliability for SD was fair for both rounds 1 (k=0.29) and 2 (k=0.37). Similar to LOE, there was better agreement with stronger study design. The most common disagreements were between retrospective cohort, retrospective case-control, and case series. Intra-observer reliability was widely variable for both LOE and SD (k=0.10 to 0.92 for both). When matching a selected SD to its associated LOE, the overall rate of correct concordance was 82% in round 1 and 92% in round 2 (p<0.001). Six of the 13 respondents improved in round 2, and 3 were 100% correct both times. Conclusions: Inter-observer reliability for LOE and SD was fair to moderate at best, even among experienced reviewers. Use of the JBJS/Oxford chart mildly improved agreement on LOE and resulted in less SD-LOE mismatch, but did not affect agreement on SD. Professional societies and journals may consider requiring more specific information on SD from authors, while authors and reviewers may benefit from improved instruments to guide SD and LOE designation.
Poster 127: Vitamin D levels and Musculoskeletal Injuries in Collegiate Athletes
Authors: Frank Alexandra , Stiffler-Joachim Mikel , Sanfilippo Jennifer , Call Cory , Dooley Matthew , Hetzel Scott , Brooks Margaret , Spiker Andrea 
Published: July 2022

Objectives: Vitamin D (Vit D) deficiency has been identified as a global epidemic, sparking numerous studies into its more detailed effects on the body. In orthopedics, Vit D deficiency has been found to correlate with an increase in a variety of musculoskeletal injuries. Although current evidence suggests a connection between the number of musculoskeletal injuries sustained and an athlete’s vitamin D level, this correlation has not yet been thoroughly investigated in the collegiate athlete population. We hypothesized that lower levels of serum vitamin D would be associated with an increased number of musculoskeletal injuries and increased recovery time. Methods: A retrospective study was performed on 285 student athletes at the authors’ institution, a Division I university (Table 1). Serum 25-hydroxyvitamin D (25(OH)D) levels obtained on each athlete via chart review in conjunction with the athletic department and categorized into normal (≥32 ng/mL), insufficient (20 to 31 ng/mL) and deficient (≤19 ng/mL). Additional data collected included demographics, athletic performance, injury history and bone density. Results: 139/285 (48.8%) of athletes were Vit D insufficient, with an additional 50/285 (17.5%) being deficient (Table 2). For football players specifically (our largest cohort of athletes), 71/91 (78%) had a Vit D level below normal, with the average value falling at 24.5 ng/mL. For injury susceptibility, there was a 7% increase in injuries for those with a below normal Vit D. (40% vs 33%). For recovery length, athletes with a below normal Vit D took twice as long to recover (23.7 days vs 10.2 days). Conclusions: A large percentage collegiate athletes have insufficient or deficient levels of Vit D. Our results also suggest that a lower Vit. D level correlates to an increase in the number of musculoskeletal injuries sustained and an increase in recovery length. [Table: see text][Table: see text]
Poster 133: Validation of 3D MRI in Glenohumeral Instability Evaluation of Glenoid and Humeral Bone Loss including Glenoid Track Compared to CT Scan
Authors: Liles Jordan , Taylor Dean , Lau Brian , Lander Sarah 
Published: July 2022

Objectives: The objective of our study is to determine whether the addition of 3-dimensional (3D) MRI to standard MRI sequences is comparable to 3D CT scan evaluation of glenoid and humeral bone loss in glenohumeral instability. There is increasing understanding of the importance of the glenoid, as well as humeral bone loss in outcomes and surgical decision making in patients with shoulder instability. Although magnetic resonance imaging (MRI) is performed as standard of care for soft tissue evaluation of shoulder instability, CT scan remains the gold standard in bony measurements. Standard MRI evaluation has been shown to inaccurately measure bone loss. However, additional CT scans result in increased financial, time, and ionizing radiation cost to the patient. Methods: Eighteen patients who presented with glenohumeral instability were prospectively enrolled and received both MRI and CT within 1 week of each other. The MRI included an additional sequence (VIBE) which underwent post-processing for reformations (Figure 1a). The addition of a VIBE protocol, on average is an addition 4 to 4.5minutes in the scanner. CT data also underwent 3D post-processing (Figure 1b) and therefore each patient had four imaging modalities (2D CT, 2D MRI, 3D CT reformats, and 3D MRI reformats). Each sequence underwent the following measurements from two separate reviewers: glenoid defect, glenoid defect percent, humeral defect, humeral defect percentage (Figure 2a and 2b), and evaluation of glenoid track and version. Paired t-tests were used to assess differences between imaging modalities and chi squared for glenoid track. Intra-observer and inter-observer reliability were evaluated. Bland-Altman tests were also performed to assess the agreement between CT and MRI. In addition, we determined cost of each imaging modality at our single institution. Results: 3D MRI measurements for glenoid and humeral bone loss measurements were comparable to 3D CT (Table 1). There were no significant differences for glenoid defect size and percentage, or humeral defect size and percentage (P>0.05) (Table 2). Bland-Altman analysis demonstrated strong agreement with small measurement errors for 3D CT and 3D MRI percentage glenoid bone loss. There was also no difference in evaluation for determining on vs off track between any of the imaging modalities. Inter- and intra-rater reliability was good to excellent for all CT and MRI measurements (r >= 0.7). Conclusions: 3D MRI measurements for bone loss in glenohumeral instability through utilization of VIBE sequence were equivalent to 3D CT. At our institution, the costs of MRI with 3D reconstruction was 1.67x cheaper than MRI and CT with 3D reconstructions. 3D MRI may be a useful adjuvant to standard MRI sequences to allow concurrent soft tissue and accurate assessment of glenoid and humeral bone loss in glenohumeral instability. [Figure: see text][Figure: see text][Table: see text][Table: see text]
Poster 165: Psychosocial Factors Play a Greater Role in Preoperative Symptoms for Patients with Atraumatic Shoulder Instability: Data from the Moon-Shoulder Instability Group
Authors: Jacobs Cale , Lemaster Nicole , Ortiz Shannon , Magnuson Justin , Hettrich Carolyn , Nichols Michael 
Published: July 2022

Objectives: Previous studies have demonstrated altered brain activation patterns on functional MRI for those with shoulder instability suggesting a potential link between recurrent instability, depression, and emotional wellbeing. It is unknown whether this potential link would differ between those with traumatic vs. atraumatic instability. The purpose of this study was to determine whether psychosocial factors and/or comorbid depression play a greater role in preoperative symptoms for patients with atraumatic or traumatic mechanisms of shoulder instability. We hypothesized that when controlling age, sex, and direction of instability, psychosocial factors and comorbid depression would be more predictive of shoulder-related pain and symptoms for patients with atraumatic instability than patients with traumatic instability. Methods: As part of the IRB-approved Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, 1553 patients provided informed consent and completed pre- and intraoperative data collection. Patients were categorized based on self-reports of whether the mechanism of shoulder instability was traumatic (n=1267) or atraumatic (n=286). Multivariable linear regressions were performed to determine whether psychological factors (VR12, Mental Component Score (MCS), Depression Diagnosis, PAS-22) were predictive of preop ASES and WOSI score in the atraumatic group, controlling for age, sex, and the direction of instability. The same model was repeated for the traumatic instability group, and the model fit was compared between groups using the methods described by Cohen, Cohen, and West with p < 0.05 considered statistically significant. Results: Sex and Mental Component Scores (MCS) were significantly predictive of preop ASES and WOSI scores for the group with atraumatic instability (ASES r2=0.15, p<0.001; WOSI r2=0.17 p<0.001). The same model performed significantly worse for both ASES and WOSI scores in the group with traumatic instability (ASES r2=0.06, WOSI r2=0.07, p<0.05 for both ASES and WOSI). Conclusions: Preoperative psychosocial factors were found to be more predictive of shoulder-related pain and symptoms for patients with atraumatic instability. Across multiple orthopedic conditions, depression and emotional wellbeing have been associated with worse preoperative symptoms and inferior postoperative patient-reported outcomes. As opposed to medically optimizing patients prior to surgery, the current findings identify a subset of shoulder instability patients that may need to be psychologically optimized either prior to surgery or early in the postoperative period to potentially improve postoperative outcomes.