bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster 219: Posterior Sagittal Position of the Tibial Tubercle as Measured by the Sagittal Tibial Tubercle – Trochlear Groove Distance Correlates with an Increased Risk for Surgery in Patients with Patellofemoral Chondral Lesions
Authors: Mojica Edward , Ortega Paola , Triana Jairo , Strauss Eric , Jazrawi Laith , Gonzalez-Lomas Guillem , Kaplan Daniel 
Published: July 2022

Objectives: The etiology of isolated patellofemoral (PF) cartilage defects without patellar instability is currently incompletely understood. The purpose of the present study was to evaluate the variation in knee sagittal alignment in patients with and without PF cartilage wear. Methods: This was a single-center, retrospective review of patients that underwent a cartilage restoration procedure for isolated PF cartilage wear from 2014-2020. Patients were matched in a 1:2:2 ratio for age, sex, and BMI to anterior knee pain diagnosis and meniscectomy procedure cohorts as controls. Exclusion criteria included knee flexion angle >10°, elevated Caton-Deschamps index (CDI>1.3), increased sulcus angle (>145°), increased patellar tilt (>5°), elevated coronal TT-TG (>15mm), varus/valgus malalignment (>5°), or ICRS patellofemoral cartilage defects of ≥3 in either control group. The sagittal TT-TG (sTT-TG) distance was measured on preoperative axial T2 magnetic resonance imaging (MRI) and was defined as the distance between a point at the nadir of the trochlear cartilage and the most anterior point of the tibial tubercle. Comparisons between the 3 groups were made using ANOVA testing with Bonferroni corrections. Reliability was assessed with the interclass correlation coefficient (ICC). Odds ratios were calculated based on a sTT-TG measurement threshold obtained from a receiver operative characteristic curve graph. Results: Two hundred and thirty-five patients (47 cartilage restoration, 94 anterior knee pain, 94 meniscectomy) were included. Mean age, BMI, and height were 33.8 +/- 8.7 and 26.7 +/- 5.7, 170.6 +/- 24.3 respectively, with 130 males (55%) and 105 females (45%). There were no significant differences between groups for age, BMI or sex(p>0.05). Mean sTT-TG was significantly more posterior in the cartilage restoration group compared to the meniscectomy group (-2.5 mm +/-5.9 vs 1.72 mm +/- 5.3, p<0.001). The anterior knee pain group sTT-TG was between the meniscectomy and cartilage restoration groups, but was not significantly different from either (p=0.067, p=0.13). Interrater reliability was excellent (ICC=0.927, p<0.001). Patients with a posterior translation of -2.15 or greater were 2.12 times more likely to undergo a cartilage restoration procedure (OR 2.12, 95% CI 1.1 to 4.1). Conclusions: Cartilage restoration procedure patients had a significantly more posterior tibial tubercle than partial meniscectomy controls. Anterior knee pain patient sagittal TT-TG was between both groups, but was not significantly different from either. Patients with sTT-TG of <-2.15 mm were 2.12 x more likely to have a cartilage restoration procedure.
Poster 220: The Effect of Bone-Void Filler on Anterior Knee Pain Following BPTB Autograft ACL Reconstruction
Authors: Vasavada Kinjal , Hurley Eoghan , Strauss Eric , Campbell Kirk , Gonzalez-Lomas Guillem , Jazrawi Laith , Alaia Michael , Strauss Eric , Markus Danielle 
Published: July 2022

Objectives: The purpose of the current study is to evaluate and compare the effect of three different bone void fillers; autogenous bone (auto), calcium phosphate cement (cement), and demineralized bone matrix (DBM), on anterior knee pain following anterior cruciate (ACL) reconstruction with bone-patellar tendon-bone (BPTB) autograft. Methods: This is a single-center randomized, controlled trial conducted in 150 patients. Patients undergoing ACL reconstruction with BTPB autograft were equally randomized into the three bone void filler cohorts; 1) auto, 2) cement, or 3) DBM. Baseline day of surgery, postoperative 1 week, and postoperative 1.5, 3, and 6 months VAS scores and KOOS and KUJALA scores at 1.5, 3, 6, and 12 months were evaluated. To compare primary and secondary outcomes between the three groups with auto group as control, an analysis of variance (ANOVA) was performed. A p-value of 0.05 was set to determine statistical significance. Results: An interim analysis was conducted on 70 patients with 6 month follow-up outcomes. There were no significant differences in VAS scores between groups at baseline (p =0.919), 1 week postoperatively (p = 0.75), 1.5 months postoperatively (p = 0.708), 3 months postoperatively (p = 0.529), and 6 months postoperatively (p = 0.115). In addition, no significant differences in KOOS scores were seen between the groups at 1.5 months (p = 0.365), 3 months (p = 0.964), or 6 months (p = 0.917). Similarly, no significant differences in KOOS scores were seen between the groups at 1.5 months (p =0.514), 3 months (p =0.763), or 6 months (p =0.815). Conclusions: There is no difference in the level of anterior knee pain or patient-reported functional outcome scores between the auto, cement and DBM for patellar bone void filling following ACLR with BPTB.
Poster 226: Autograft versus Allograft for Medial Patellofemoral Ligament Reconstruction: A Systematic Review
Authors: Aliberti Gianna , Kraeutler Matthew , Miskimin Cadence , Scillia Anthony , Mulcahey Mary 
Published: July 2022

Objectives: Patients with recurrent lateral patellar dislocations are often treated with reconstruction of the medial patellofemoral ligament (MPFL). The purpose of this study was to perform a systematic review to evaluate clinical outcomes and the risk of recurrent patellar dislocation following medial patellofemoral ligament reconstruction (MPFLR) with autograft versus allograft. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies comparing outcomes of MPFLR with autograft versus allograft. The search phrase used was: medial patellofemoral ligament reconstruction autograft allograft. The inclusion criteria were full-text studies that directly compared clinical outcomes and/or risk of recurrent patellar instability events between patients undergoing MPFLR with autograft versus allograft. A quality assessment was performed using the Modified Coleman Methodology Score (MCMS). Risk of bias was performed using the ROBINS-I and the Cochrane Collaboration’s risk of bias tools. Results: Seven studies (one level II, three level III, three level IV) were identified that met inclusion criteria, including a total of 150 patients who underwent MPFLR with autograft and 193 with allograft (Figure 1, Table 1). All studies showed a moderate risk of bias due to confounding, and five studies showed a moderate risk of bias for using non-blinded but identical postoperative protocols. All six studies showed serious risk of bias for using physicians not blinded to the treatment group (Figure 2). One study found a significantly higher failure rate among autograft patients, and another study found a trend toward a significantly higher failure rate among autograft patients (Table 2). One study demonstrated no significant difference between tibial tubercle-trochlear groove distance (measured on magnetic resonance imaging) in failed versus successful grafts. One study found that patellar tilt angle improved significantly from preoperatively to postoperatively (p<0.001), but there was no difference between the groups. Kujala scores significantly improved for both autograft and allograft patients across studies. Two studies found significant differences in postoperative Kujala scores between the two groups, one of which found better scores in allograft patients (p=0.0032) and another in which scores were better in autograft patients (p=0.02). Conclusions: This is the first systematic review limited to comparative studies comparing autograft versus allograft for MPFL reconstruction. Patients undergoing MPFLR with either autograft or allograft can expect to experience improvement in clinical outcomes. Graft failure was more frequently observed in autograft patients. Subjective outcomes improved to a similar degree in both groups. Allograft may be a better option for MPFLR due to lower failure rate. [Figure: see text][Figure: see text][Table: see text][Table: see text]
Poster 230: A Modified Lemaire Lateral Extra-Articular Tenodesis in High-Risk Adolescents Undergoing Anterior Cruciate Ligament Reconstruction: Two-Year Clinical Outcomes
Authors: Cordasco Frank , Perea Sofia Hidalgo , Brusalis Christopher , Green Daniel 
Published: July 2022

Objectives: This study aimed to evaluate the safety and efficacy of performing a lateral extra-articular tenodesis (LET) with a modified Lemaire technique (MLT) in conjunction with anterior cruciate ligament reconstruction (ACLR) in children and adolescents at increased risk for failed ACLR. Methods: A consecutive series of patients ≤19 years who underwent simultaneous ACLR and LET with minimum two-year follow-up data were reviewed. Patients were indicated for LET when one or more of the following risk factors were present: participant in high-risk competitive sport such as football, lacrosse, soccer or basketball, grade 3 pivot shift, hyperlaxity (Beighton score > 6), recurvatum, revision ACLR, contralateral ACLR, or chronic ACL insufficiency. ACLR was performed using either full-thickness quadriceps tendon (QUAD) for skeletally immature patients or bone-patellar tendon-bone (BTB) autograft for skeletally mature patients. All-epiphyseal (AE) or complete transphyseal (CT) techniques were used depending on patients’ skeletal maturity. At a minimum two-year follow-up, patient-reported outcome measures included Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC), and the HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores. Return-to-sport (RTS) data and second surgeries were also obtained. Results: Sixty-one consecutive patients (mean age 15.17 ±1.73 years, range 11-19 years, 62% female) were analyzed (Table 1). 59 patients (97%) participated in organized sports including soccer, basketball, football and lacrosse, with soccer being the most popular one. The average grade at the time of surgery was 9th grade. Ten patients (16%) were revision ACLR procedures. Seven (11%) patients underwent AE and 54 (89%) underwent CT ACLR. Forty-two (69%) cases employed a QUAD autograft, while 19 (31%) utilized a BTB autograft. All patients underwent a LET with a MLT and 2 patients underwent simultaneous implant mediated guided growth with a plate for structural genu valgum. At two-year follow-up, mean SANE score was 95, median Pedi-IKDC score was 91, and median HSS-Pedi Fabs score was 27. RTS rate was 91.8%. Ten patients had subsequent surgical procedures, including two hardware removal procedures for hemiepiphysiodesis, three contralateral ACLR, three meniscus surgeries, one lysis of adhesions, and one revision ACLR for BTB graft re-rupture. Two patients were lost to follow-up and excluded from the study. Conclusions: The findings suggest that concomitant LET and ACLR in adolescent patients with risk factors for failed ACLR is associated with favorable patient-reported outcomes, high return to sports participation, and low ACL re-rupture rate at two years follow-up. [Table: see text]
Poster 237: Distance Between the Tibial Physis and Meniscotibial Ligament: Implications for Meniscus Repair
Authors: Tompkins Marc , Yen Yi-Meng , Karius Alex , Cinque Mark , Vuong Brian , Ganley Theodore , Wilson Philip , Ellis Henry , Green Daniel , Fabricant Peter , Boucher Laura , Shea Kevin , Dingel Aleksei 
Published: July 2022

Objectives: Anatomic meniscus repair is frequently performed in young patients to maximize joint preservation and long-term joint health. Increasingly, surgeons are considering the role and function of the meniscotibial ligament structures during meniscus repair and transplant. The purpose of this study was to determine the distance between the tibial insertion of the meniscotibial ligament capsular attachment and the proximal tibial physis in skeletally immature subjects. Methods: 14 pediatric knee cadaver knee specimens (ages 3 months to 11 years) were dissected to clarify the relationship physis and meniscus/meniscotibial ligament complex. Metallic markers were placed marking the meniscotibial ligament capsular attachment in specific domains (Figure 1). The specimens underwent CT scanning to evaluate pin placement and relationship to the physis. OsiriX was used to measure the distances between the proximal tibial physis and the pins (placed at 5 points on both the lateral and medial meniscus- anterior root, 12 o’clock, 3/9 o’clock, 6 o’clock and posterior root). Specimens were divided into two groups for analysis- Group 1: ages 3 months- 2 years (10 pediatric knee specimens: 8 male, 2 female), and Group 2: ages 10-11 years (4 pediatric knee specimens: 2 male, 2 female). Results: There was an increase in the distance between the proximal tibial physis and the insertion points of the meniscotibial ligament with increasing specimen age. For both the medial and lateral menisci, Group 1’s meniscotibial ligament insertion points were less than 10mm away from the physis. Group 2’s meniscotibial ligament insertion points tended to be further away from the physis, but less than 20mm away, and sometimes even as close as <5mm (lateral posterior root). (Figure 2). Conclusions: This anatomic study defines the relationship between the physis and meniscotibial ligament capsular attachments that increases with age. These anatomic parameters can be considered as future meniscus repair and reconstruction techniques seek to restore the meniscus anatomy, stability, and mobility provided by the meniscotibial ligament structures. This anatomic information and may be used by surgeons to develop techniques to perform meniscal repair/reconstruction in patients that utilize the meniscotibial ligament structures. Avoiding direct physeal injury during menisco-tibial ligament repair is possible. [Figure: see text][Figure: see text]
Poster 243: Synovial Fluid MMP-1 and VEGF Concentration Correlates with Chondral Defects Severity and Symptoms in the Knee
Authors: DeFroda Steven , Trasolini Nicholas , Zavras Athan , Darwish Reem , Cole Brian , Yanke Adam , Dandu Navya 
Published: July 2022

Objectives: The clinical significance of the concentration of inflammatory biomarkers in the synovial fluid of the knee has been studied in the context of several pathologies. However, there is a paucity of literature examining concentrations of synovial fluid inflammatory biomarkers in patients with focal chondral defects and their correlation with imaging findings. This study sought to explore the correlations between preoperative synovial fluid biomarkers, cartilage structural characteristics on MRI, and pre- and postoperative PROs in patients undergoing chondroplasty for focal chondral defects. We hypothesized that certain biomarkers within the synovial fluid would correlate with more severe grading of cartilage defects on MRI and have a negative relationship with patient reported outcomes. Methods: This study prospectively enrolled patients undergoing chondroplasty for symptomatic focal chondral defects of the knee. Prior to the initiation of arthroscopy, synovial fluid was aspirated from the operative knee. Multiplex ELISA was then performed on the supernatant for several analytes. The relationships between biomarker concentrations, demographic factors, MRI findings as measured by AMADEUS score, and pre- and postoperative PROs were explored via independent t-test or Pearson correlation analysis. Variables significant on univariate analysis were included for multivariate linear regression. Results: Cartilage defects of greater severity on MRI were significantly associated with increased concentration of MMP-1 and VEGF in synovial fluid (p<.05). Decreased preoperative KOOS Symptoms scores were correlated with increased concentrations of MMP-1 (r = -0.786, p<.001) and VEGF (r= -0.810, p<.001). These variables were non-significant on multivariate regression for KOOS Symptoms, although dominance analysis demonstrated that MMP-1 and VEGF were the greatest contributors to overall model fit, contributing 27.5% and 29.7%, respectively. Increased preoperative VEGF (r= -0.835, p=.019) and MMP-1 (r= -0.788, p=.036) were correlated with decreased improvement, or worsening of WOMAC stiffness score at 6 weeks after chondroplasty, while increased FGF2 (r=0.758, p=.049) and CCL2 (r= 0.777, p=.040) were positively correlated with improvement. Conclusions: This study demonstrated that the concentration of MMP-1 and VEGF in synovial fluid correlate with cartilage lesion severity and may correlate with patient function and symptoms. These inflammatory biomarkers may be an important target in clinical practice towards improving outcomes when managing chondral defects of the knee.
Poster 255: Lateral Extra-Articular Tenodesis Staple Risks Penetration of ACL Reconstruction Tunnel
Authors: Anderson Gregory , Barras Laurel , Graf Ryan , Moran Thomas , Gwathmey F. Winston , Diduch David , Miller Mark , MacLean Ian 
Published: July 2022

Objectives: The purpose of this study was to identify the risk of ACL femoral tunnel penetration by a small Richards staple used for Lateral Extra-Articular Tenodesis (LET) fixation and to determine whether or not the risk varies between two techniques for ACL femoral tunnel creation. Methods: 20 paired fresh frozen cadaver knees underwent ACL reconstruction with a LET using the modified Lemaire technique (Getgood et al. AJSM, Jan 2020). Left and right knees were randomized to ACL reconstruction with femoral tunnel creation by either the accessory anteromedial portal (AMP) technique or the flexible guide pin and reamer method. The femoral tunnels in the accessory AMP technique arm were created using a 7mm offset guide. Both arms used a 10mm reamer and were reamed to a depth of 25mm. After tunnel creation and prior to passing the ACL graft, the LET was performed. This was completed by harvesting an 8cm long and 10mm wide central portion of the IT band which was left attached to its distal insertion on Gerdy’s tubercle. This was routed underneath the LCL and fixed with a small Richards staple on the lateral metaphyseal flare proximal and posterior to the LCL insertion. The staple was angled anteriorly and distally. Fluoroscopy was used to obtain a lateral view of the knee to ensure appropriate position of the staple (Figure 1). Finally, tunneloscopy was performed from the anteromedial portal to investigate penetration of the staple into the femoral tunnel (Figure 2). A Fisher’s exact test was conducted to determine if there was any difference in tunnel penetration between tunnel creation techniques. Results: The staple was noted to penetrate the ACL femoral tunnel in 8/20 (40%) extremities. When stratified by tunnel creation technique, the Richards staple violated 5/10 (50%) of the tunnels made via the accessory AMP technique compared to 3/10 (30%) of those created with a flexible guide pin and reamer (p = 0.65). Conclusions: Staple fixation of a LET carries significant risk of penetrating the ACL tunnel that does not vary by the technique of femoral tunnel creation. This raises concerns over the potential effect of the staple on ACL graft fixation and the ACL graft itself.
Can Patients Read, Understand, and Act on Online Resources for Anterior Cruciate Ligament Surgery?
Authors: Gao Burke , Shamrock Alan G. , Gulbrandsen Trevor R. , O’Reilly Olivia C. , Duchman Kyle R. , Westermann Robert W. , Wolf Brian R. 
Published: July 2022

Background: Patients undergoing elective procedures often utilize online educational materials to familiarize themselves with the surgical procedure and expected postoperative recovery. While the Internet is easily accessible and ubiquitous today, the ability of patients to read, understand, and act on these materials is unknown. Purpose: To evaluate online resources about anterior cruciate ligament (ACL) surgery utilizing measures of readability, understandability, and actionability. Study Design: Cross-sectional study; Level of evidence, 4. Methods: Using the term “ACL surgery,” 2 independent searches were performed utilizing a public search engine ( Google.com ). Patient education materials were identified from the top 50 results. Audiovisual materials, news articles, materials intended for advertising or medical professionals, and materials unrelated to ACL surgery were excluded. Readability was quantified using the Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Coleman-Liau Index, Automated Readability Index, and Gunning Fog Index. The Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) was utilized to assess the actionability and understandability of materials. For each online source, the relationship between its Google search rank (from first to last) and its readability, understandability, and actionability was calculated utilizing the Spearman rank correlation coefficient (ρS). Results: Overall, we identified 68 unique websites, of which 39 met inclusion criteria. The mean Flesch-Kincaid Grade Level was 10.08 ± 2.34, with no website scoring at or below the 6th-grade level. Mean understandability and actionability scores were 59.18 ± 10.86 (range, 33.64-79.17) and 34.41 ± 22.31 (range, 0.00-81.67), respectively. Only 5 (12.82%) and 1 (2.56%) resource scored above the 70% adequate PEMAT-P threshold mark for understandability and actionability, respectively. Readability (lowest P value = .103), understandability (ρS = –0.13; P = .441), and actionability (ρS = 0.28; P = .096) scores were not associated with Google rank. Conclusion: Patient education materials on ACL surgery scored poorly with respect to readability, understandability, and actionability. No online resource scored at the recommended reading level of the American Medical Association or National Institutes of Health. Only 5 resources scored above the proven threshold for understandability, and only 1 resource scored above it for actionability.