bluuebunny/crossref_metadata_2025_split huggingface dataset:
The unique contribution of gendered racial stress to depressive symptoms among pregnant Black women
Authors: Clarke Lasha S , Riley Halley EM , Corwin Elizabeth J , Dunlop Anne L , Hogue Carol J Rowland 
Published: July 2022

Introduction: Pregnant Black women are at disproportionate risk for adverse birth outcomes, in part associated with higher prevalence of stress. Stress increases risk of depression, a known risk factor for preterm birth. In addition, multiple dimensions of stress, including perceived stress and stressful life events, are associated with adverse birth outcomes, independent of their association with prenatal depression. We use an intersectional and contextualized measure of gendered racial stress to assess whether gendered racial stress constitutes an additional dimension to prenatal depression, independent of stressful life events and perceived stress. Methods: In this cross-sectional study of 428 Black women, we assessed gendered racial stress (using the 39-item Jackson Hogue Phillips Reduced Common Contextualized Stress Measure), perceived stress (using the Perceived Stress Scale), and stressful life events (using a Stressful Life Event Index) as psychosocial predictors of depressive symptoms (measured by the Edinburgh Depression Scale). We used bivariate analyses and multivariable regression to assess the association between the measures of stress and prenatal depression. Results: Results revealed significant bivariate associations between participant scores on the full Jackson Hogue Phillips Reduced Common Contextualized Stress Measure and its 5 subscales, and the Edinburgh Depression Scale. In multivariable models that included participant Perceived Stress Scale and/or Stressful Life Event Index scores, the Jackson Hogue Phillips Reduced Common Contextualized Stress Measure contributed uniquely and significantly to Edinburgh Depression Scale score, with the burden subscale being the strongest contributor among all variables. No sociodemographic characteristics were found to be significant in multivariable models. Conclusion: For Black women in early pregnancy, gendered racial stress is a distinct dimension of stress associated with increased depressive symptoms. Intersectional stress measures may best uncover nuances within Black women’s complex social environment.
Paper 17: Follow-Up of Heterotopic Ossification (HO) After Platelet-Rich Plasma (PRP) for Groin Injuries
Authors: Roedl Johannes , Coleman Struan , Zoga Adam , Meyers William , Poor Alexander 
Published: July 2022

Objectives: A 2015 study of PRP for groin injuries in NFL players* alerted us to the possibility of PRP causing heterotopic ossification. This study of athletes seen from 2014 to 2019 provides a more comprehensive analysis of that observation. Methods: All athletes seen at one institution and identified at their first visit as having received PRP for a core muscle injury were followed and compared to core muscle injury patients who had not previously received PRP. HO was observed on MRI and intraoperatively and confirmed pathologically. All PRP patients were followed for at least two years. Results: PRP patients had a 40.7% occurrence of HO, compared to 0.7% in the non-PRP cohort (See Table). Three athletes who had PRP retired early from their sports due to the HO and scar issues. The occurrence of HO did not correlate with any technique of PRP administration. Twenty-two of 28 (78.6%) NFL players who received PRP developed HO, compared to 0 (0%) in 28 NFL randomly selected, age-, position- and injury matched controls. Three-month “success” rates were 67.9% and 96.4% respectively in the two groups (p<0.006) in terms of return to play at previously high-level levels of performance or greater, according to their own subjective assessments. Differences were mostly due to scar issues. Most “failure” patients in the PRP group had returned to play but not at their previously high levels. Conclusions: This longer-term, more comprehensive study confirms the previous preliminary analysis that caregivers should take a cautious approach to treatment with PRP for groin injuries. None None None [Table: see text]
Paper 47: Clinical Outcomes in Patients with Femoral Acetabular Impingement Syndrome and Acetabular Retroversion: A 3D Analysis
Authors: Knapik Derrick , Lambers Floor , Malloy Phil , Chahla Jorge , Nho Shane , Alter Thomas 
Published: July 2022

Objectives: To use computed tomography (CT)-based three-dimensional (3D) bone models to (1) quantify acetabular version in patients with femoroacetabular impingement syndrome (FAIS) and (2) explore the relationship between the magnitude of acetabular version and clinical outcomes following hip arthroscopy. Methods: Preoperative CT scans were acquired in 105 consecutive patients prior to hip arthroscopy for FAIS, of which 84 (80.0%) completed minimum two-year patient reported outcomes. 3D models of the pelvis and femur were generated by semi-automated segmentation, and aligned to a standard coordinate system. Acetabular version was quantified at the 12, 2, and 3 o’clock position. (Figure I) Acetabular version classifications were based on the version at the 3 o’clock position, and were defined as follows: acetabular retroversion (AR [<15°]), normal acetabular version (NV [15°-25°]), and acetabular anteversion (AA [>25°]). Patient demographic characteristics and clinical outcomes including the Hip Outcome Score – Activities of Daily Living (HOS-ADL), Hip Outcome Score – Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), and Visual Analog Scale (VAS) for pain and satisfaction were analyzed. Results: Mean age and body mass index (BMI) of patients was 33.9±12.6 years and 26.0±5.4 kg/m2, respectively, while 70.2% were female. The average acetabular version at 12, 2, and 3 o’clock for the study cohort was 9.3° ± 9.3°, 12.3° ± 7.4°, and 20.9° ± 5.7°, respectively (Figure II). After stratification based on the magnitude of acetabular anteversion at the 3 o’clock position, the number of patients and the average torsion within each group were as follows: AR (n=12; 11.3°±2.7°), NT (n=56; 20.7°±2.9°), AA (n=16; 28.5°±2.7°) (Figure III). At minimum two-year follow-up, significant between group differences in mHHS, iHOT-12, VAS for pain and satisfaction (P < 0.05) were appreciated (Table I). Post hoc analysis with Bonferroni correction ( P < 0.0167) found lower scores on mHHS, iHOT-12, VAS for pain and satisfaction in patients with AR compared to NV (Table I). Lower VAS for satisfaction scores were reported in patients with AR when compared to AA ( P = 0.006), but not mHHS (0.023), iHOT-12 (0.032), or VAS for pain (0.072) (Table I). Conclusions: Patients with AR reported inferior outcomes when compared to patients with NV and AA following hip arthroscopy for FAIS.
Paper 56: Defining Clinically Significant Outcomes After Gluteus Medius Repair at 5-Years
Authors: Sivasundaram Lakshmanan , Browning Robert , Holland Tai , Paul Katlynn , Nho Shane , Rice Morgan 
Published: July 2022

Objectives: To define minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) at a minimum of 5-years for patients undergoing endoscopic and open gluteus medius repair. Methods: A retrospective review was performed of prospectively collected data from all patients undergoing primary open or endoscopic repair of gluteus medius tears between January 2012 and December 2015 with a minimum 5-years follow-up. Patient data collected included patient demographics, preoperative clinical function scores, and pre and postoperative patient-reported outcomes (PROs). Patient reported outcome measures included the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports Subscale (HOS-SS), Modified Harris Hip Score (mHHS) and Internation Hip Outcome Tool 12 questions (iHOT-12). The minimal clinically important difference (MCID) values were calculated for each PRO using the distribution method while PASS was determined via the anchor-based method utilizing ROC curves and Youden’s index using SPSS Statistics (Version 27, IBM, Armonk, NY). Results: A total of 46 patients were included in the study. A majority of patients were female (91.3%), with an average age and BMI of 61.26 ± 9.74 and 27.42 ± 6.02, respectively. Differences in preoperative and 5-year postoperative PROs were statistically significant for each of the four measures (p<0.001). The MCID threshold values for the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Sport-Specific (HOS-SS) subscale, modified Harris Hip Score (mHHS), and the international Hip Outcome Tool-12 (iHOT) were calculated to be 13.1, 14.5, 12.6 and 11.2 respectively. The PASS scores of HOS-ADL, HOS-SS, mHHS and iHOT were calculated to be 85.6, 79.7, 68.2 and 60.5 respectively. In addition, 86.1% of patients achieved either MCID or PASS postoperatively, with 90.9% and 69.8% reaching at least 1 threshold score for achieving MCID and PASS respectively, and 69.7% achieving both any MCID and any PASS. Conclusions: In patients undergoing open or endoscopic gluteus medius repair, our study defines MCID and PASS at mid-term follow-up. A majority of patients achieved any MCID (90.9%) and any PASS (69.7%) at 5-years postoperatively.
Paper 60: Objective Diagnosis of Multidirectional Instability in Adolescent Patients Based on Glenohumeral Joint Capsule Dimensions on MR Analysis
Authors: Yoder Mason , Veerkamp Matthew , McDonald Colin , Parikh Shital 
Published: July 2022

Objectives: Multidirectional Instability (MDI) of shoulder in adolescents is a clinical diagnosis and there are no defined objective criteria to validate the diagnosis. Most patients with MDI have no identifiable labral or capsular tear pattern on MR imaging. The objective of this study was to identify objective criteria for MDI diagnosis based on rotator interval and glenohumeral capsular dimensions on MR imaging in surgically confirmed adolescents with MDI. Methods: In a comparative retrospective study, the clinical records and MR arthrogram of adolescent patients treated for shoulder instability at our center between 2008 and 2019 were reviewed. Twenty-four adolescents with surgically confirmed MDI were age-matched to 25 control patients. The width and depth of the rotator interval and multiple linear dimensions of the glenohumeral capsule were measured on sagittal-oblique MR arthrography sequences, after controlling for glenoid size (Fig 1). The measurements that differed significantly were identified using unpaired t-tests. These values were plotted on receiver operator characteristic (ROC) curves, which were used to determine threshold values for identifying MDI. Power analysis showed a sample size of 16 in each group to be sufficient to detect 5 mm difference in average capsular dimension of 20 mm (power 0.8) Results: 24 patients (28 shoulders) 20 females, 4 males were in the MDI group; average age at time of surgery was 15.2 years (range, 8-20 yrs). The control group consisted of 25 patients (27 shoulders), 9 females, 16 males; average age was 15.4 years (range, 11-18 yrs). Rotator interval depth was significantly greater in the MDI group vs control (MDI 8.5mm; Control 6.1mm) (p <0.01), as were the inferior, posteroinferior, and posterior dimensions of the glenohumeral joint capsule (24.5 vs 20.4mm, 26.4 vs 21.9mm, and 22.5 vs 19.3mm, respectively; p <0.01) (Table 1). Rotator interval width and anterior capsular dimensions were not significantly different between groups. The ROC-derived threshold values for identifying MDI using MR arthrography were Rotator interval depth = 7.4mm; Posterior capsule = 20.9mm; Inferior capsule = 22.4mm; Posteroinferior capsule = 24.0mm. Conclusions: Rotator interval depth and dimensions of glenohumeral joint capsule in the inferior, posterior and posteroinferior quadrant on MR arthrography were significantly greater in adolescent patients with MDI. Measurement of rotator interval depth and glenohumeral capsular dimensions on MR arthrography can be used to supplement clinical diagnosis of MDI. [Table: see text]
Paper 62: Influence of Gender, Race/Ethnicity & Socioeconomic Factors on Meniscus Treatment with Pediatric and Adolescent ACL Reconstruction
Authors: Mercurio Angela , Coene Ryan , Cook Danielle , Feldman Lanna , Milewski Matthew 
Published: July 2022

Objectives: The rate of anterior cruciate ligament reconstruction (ACLR) in pediatric/adolescent populations has increased over time. However, there is less evidence to support the relative change in concomitant meniscus procedures over time. Demographics and socioeconomic (SES) factors may be implicated in the rate and usage of meniscectomy vs. meniscal repair as treatment. The purpose of this study is to assess if the rate of concomitant meniscus procedure with ACLR is increasing and what factors may be contributing to this rise. We hypothesize that age, sex, race/ethnicity, income, or insurance type may affect the rate of concomitant meniscus procedures. Methods: The Pediatric Health Information System (PHIS) Database was queried for all patients 18 years or younger who underwent ACLR with or without concomitant meniscus procedures based on CPT code from 2015-2019. Data from 39 out of 52 centers were included based on completeness of their data. Basic demographic information including age, sex, self-identified race/ethnicity, and insurance status was collected. Urban and rural designation was identified based on rural-urban commuting area (RUCA) codes. Based on the 2015 Department Health & Human Services Federal Poverty Guidelines (FPL), patients were stratified into lower (<199% of FPL) and higher (≥200% of FPL) income brackets. Linear regression was used to model trends and multiple logistic regression modeling was used to test for associations. Results: 14,398 patients underwent ACLR during the study period with 8,337 patients (58%) having concomitant meniscal procedures with a 1.24-fold increase over five years (Figure 1). Of the 8,337 patients with concomitant meniscus treatment, 46% had a meniscectomy and 54% had a meniscus repair. There was a 0.86-fold change in meniscectomy and a 1.70-fold increase in meniscus repair during the study period (Figure 2). Males, older patients, Black race, living in an urban area, and those with non-private insurance had increased odds of undergoing a concomitant meniscus procedure (all p<0.05). Patients of Black or other race and those with non-private insurance had increased odds of having a meniscectomy vs. meniscus repair (all p£0.01). There were no associations detected between income bracket and our outcomes. Conclusions: This study shows that in pediatric and adolescent patients undergoing ACLR, there is a rise in concomitant meniscus procedures from 2015-2019. In addition, patients of non-white race and those with non-private insurance have increased odds of undergoing meniscectomy vs. meniscus repair. This study identifies access and inequality issues in ACLR with concomitant meniscus procedures in pediatric and adolescent populations. [Figure: see text][Figure: see text]
Paper 69: Traumatic Rotator Cuff Tears Have Greater Improvements in Functional Outcomes than Non-Traumatic Tears Following Arthroscopic Rotator Cuff Repair
Authors: Godshaw Brian , Hughes Jonathan , Lin Albert , Lesniak Bryson , Boden Stephanie 
Published: July 2022

Objectives: Rotator cuff tears may occur due to a traumatic event that causes acute tearing of the rotator cuff tendons or secondary to chronic tendon degeneration and subsequent atraumatic tearing. The role that tear etiology plays in outcomes after repair is not well understood. The purpose of this study is to determine if a difference exists in outcomes after rotator cuff repair based on tear etiology. Methods: 221 consecutive patients who underwent arthroscopic rotator cuff repair were evaluated with prospectively collected preoperative and at least 2-year postoperative data via chart review. Shoulder range-of-motion, strength and standard shoulder physical exam findings were recorded both preoperatively and postoperatively. Outcome measures including visual acuity scale pain score (VAS), subjective shoulder value (SSV), Patient-Reported Outcomes Measurement Information System (PROMIS) scores (both mental and physical components), and American Shoulder and Elbow Surgeons Scores (ASES) were examined. Results: Of the 221 patients, 73 had traumatic tears and 148 had atraumatic/degenerative tears. There were no differences in age, body-mass-index, or Charlson comorbidity index between groups. Patients in the atraumatic cohort had significantly longer duration of symptoms prior to presentation (17.9 months vs 6.5 months, p<0.05). Preoperatively, the traumatic cohort had less motion to forward elevation (138.0° vs 151.7°, p<0.05). Postoperatively, both groups experienced significant improvements in VAS and SSV scores (p<0.05). However, only the traumatic cohort demonstrated improvements in ASES and the physical PROMIS scores. Patients with traumatic rotator cuff tears had greater improvements in SSV (40.6% vs 29.2%, p<0.05), forward elevation (21.6° vs 2.3°, p<0.05), and strength to forward elevation, external rotation, and internal rotation compared to those with atraumatic tears (p<0.05). Conclusions: Patients with traumatic rotator cuff tears experience greater improvements in range-of-motion, strength, and perceived shoulder function than those with degenerative/atraumatic tears.
Paper 74: Psychopathology and Volitional Instability: Who should we be operating on?
Authors: Duchman Kyle , Cohen Brian , Wolf Brian , Bishop Julie , Baumgarten Keith , Shoulder MOON , Brophy Robert , Hettrich Carolyn , Dunn Warren 
Published: July 2022

Objectives: There has been a hesitation by surgeons to operate on shoulder instability patients with maladaptive psychopathological traits, especially those with volitional instability, as these may portend a poor prognosis. The purpose of this study was to investigate the prevalence of maladaptive psychopathological traits, volitional instability, and their effect on two-year outcomes in patients undergoing shoulder stabilization surgery. Methods: A prospective multi-center cohort study led by the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group targeted all subjects having surgical shoulder stabilization and collected patient-reported outcomes at baseline and at two years postoperatively. Psychopathological traits were assessed using the Personality Assessment Screener (PAS), a validated personality assessment tool. Longitudinal analyses were performed using multivariable regression models to determine predictors of two-year outcomes adjusting for confounders measured at index such as age, sex, smoking, BMI, volitional instability, and intraarticular pathology. Results: The cohort (n = 890) was 80% male with a median age of 21.5 years. The prevalence of psychopathological traits was 20%. While all patients improved between baseline and 2 years, with adjusted analyses, the presence of maladaptive psychological traits present at the time of index surgery were predictive of lower WOSI (p = 0.001), ASES (p = 0.016), SANE (p = 0.03), and SF-36 MCS (p = 0.001) scores as well as a higher risk of failure (p = 0.04) at two years. As a main effect, volitional instability was not a predictor of WOSI, ASES, SANE, SF-36 or failure at two years. However, all models allowed for the interaction between volitional instability and the PAS, and this interaction was significant for WOSI (p = 0.006), SANE (p = 0.03), and SF-36 MCS (p = 0.003) scores at two years. In other words, the effect of volitional instability on the WOSI, SANE, and SF-36 MCS scores depends on the value of the PAS, and with high PAS scores it is associated with worse outcomes. This data is depicted in Figures 1-3. Conclusions: While all patients improved, the presence of maladaptive psychopathological traits at the time of index surgery was a predictor of poorer outcomes at two years. Voluntary dislocators did similarly as non-voluntary dislocators up to a PAS score of ˜ 20, where above this they had worse WOSI, SANE, SF-36 MCS and higher failure rates at 2 years post-operatively. [Figure: see text][Figure: see text][Figure: see text]
Paper 75: Development and Validation of the KOOS-ACL: A Short-form Version of the KOOS for Young Patients with ACL Tears
Authors: Tremblay Paul , Getgood Alan , Bryant Dianne , Marmura Hana 
Published: July 2022

Objectives: To develop and validate a short form, disease-specific version of the KOOS appropriate for the young active ACL deficient population: the KOOS-ACL. Methods: A baseline dataset of 605 young patients (< 25 years) with ACL tears was divided into a development and validation sample. Exploratory factor analyses were conducted in the development sample to identify the underlying factor structure and reduce the number of KOOS items based on statistical and conceptual indicators. Confirmatory factor analyses were conducted to check fit indices of the proposed KOOS-ACL model in both samples. Structural validity, reliability, and responsiveness to change were assessed in the full sample at five timepoints: baseline and 3 months, 6 months, 12 months and 24 months post-operatively. Results: Two factors were deemed most appropriate for the KOOS-ACL: Functionality and Sport. Fifteen items were removed from the full length KOOS based on discriminant validity (i.e., lack of distinctiveness between some proposed constructs) and another fifteen items were removed for repetitive content. The final KOOS-ACL model showed acceptable structural validity (CFI and TLI > 0.9, RMSEA and SRMR < 0.08), internal consistency reliability (a > 0.8), and responsiveness to change (effect size > 0.8) at all five timepoints in the dataset. The KOOS-ACL showed strong and significant correlations to the original KOOS and IKDC at all timepoints (r > 0.7). Conclusions: The new KOOS-ACL questionnaire contains 12 items and two subscales relevant to young active ACL patients. The KOOS-ACL would reduce patient burden by more than two thirds and provides improved structural validity compared to the full length KOOS while maintaining adequate psychometric properties and relatedness to other popular outcome measures currently used following ACL injuries. The KOOS-ACL may be a more relevant outcome to use with young active ACL patients within the two years of surgery.