bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster 170: Preoperative Advanced Imaging Predicts Coracoid Graft Size and Restoration of the Glenoid Track in Patients Undergoing Latarjet Procedures
Authors: Godshaw Brian , Hughes Jonathan , Lin Albert , Lesniak Bryson , Boden Stephanie 
Published: July 2022

Objectives: The Latarjet procedure is commonly used in management of anterior shoulder instability with bipolar bone deficiency. Persistent off-track Hill-Sachs (HS) lesions after Latarjet procedure is associated with significantly higher rates of failure and recurrent instability. Preoperative prediction of which lesions will remain off-track is crucial for improving outcomes and decreasing failure rates. The purpose of this study was to determine if preoperative advanced imaging can predict coracoid graft size and conversion of off-track to on-track Hill-Sachs lesions in patients undergoing Latarjet procedures. Methods: Patients who underwent Latarjet procedure for shoulder instability at a single institution from 2012-2020 were evaluated. Inclusion criteria consisted of pre- and post-operative advanced imaging - computerized topography or magnetic resonance imaging. Glenoid diameter, HS interval (HSI), and coracoid length, depth, and height were measured on preoperative imaging. Glenoid track (GT), percent glenoid bone loss, predicted restoration of glenoid track, and the difference between HSI and GT (DHSI-GT) were calculated. These values were then compared with postoperative measurements of the glenoid diameter and coracoid graft width and height. Results: Seventeen patients with a mean age of 24.6 ± 8.6 years met inclusion criteria. The average glenoid bone loss preoperatively was 23.6 ± 7.3% and the average HSI was 27.2 ± 4.9mm. The Latarjet procedure was able to reconstruct 115.8 ± 7.6% of the native glenoid, and 103.8 ± 7.9% of the predicted diameter. Of the 15 patients that had off-track lesions preoperatively, 11 were successfully converted to on-track lesions (73.3%). The 4 lesions that remained off-track postoperatively had a significantly higher HSI (32.4 ± 2.4 mm vs. 25.6 ± 4.3 mm, p=0.002 ) and 3 of these had insufficient coracoid graft to convert to an on-track lesion based on the preoperative DHSI-GT values in comparison to coracoid graft size. Preoperative measurements accurately predicted postoperative glenoid track status 94.1% of cases. Conclusions: The Latarjet procedure was able to reconstruct 115.8 ± 7.6% of the native glenoid and converted 73.3% of off-track lesions to on-track lesions. The glenoid was reconstructed to 103.8 ± 7.9% of the predicted diameter. Preoperative advanced imaging measurements accurately predicted graft size, restoration of the glenoid track, and ability to convert off-track to on-track lesions.
Poster 174: The Role of Familial Predisposition in Imaging-Confirmed Atraumatic Rotator Cuff Tears
Authors: Ly Amanda , Reddy Yashas , Jain Nitin , Du Lichen , Atem Folefac , Khazzam Michael 
Published: July 2022

Objectives: The etiology of rotator cuff tears is not completely understood. Several studies have identified age, smoking, hypercholesterolemia, diabetes, and hypertension as potential risk factors of rotator cuff tears. Limited data suggests the role of genetic and familial predisposition in the etiology of rotator cuff tears. Our objective was to assess whether there is an increased likelihood of rotator cuff tears in family members of patients with rotator cuff tears versus those without tears. This would provide evidence for whether there is a familial predisposition to rotator cuff tears. Methods: Patients presenting to a shoulder clinic with pain, stiffness, or instability were recruited in this study. Patients that completed a shoulder outcomes questionnaire, were age 18 years or older, and had an available MRI or CT arthrogram of the symptomatic shoulder were included in the study. Any individuals with acute traumatic rotator cuff tears were excluded from analysis. On the questionnaire, patients provided information on demographics, personal medical history, shoulder symptoms, and family history of rotator cuff tears. The diagnosis of rotator cuff tears was based on imaging (MRI or CT arthrogram) confirmation of a structural defect in the rotator cuff. The association between family history of rotator cuff problems and the likelihood of an imaging-confirmed rotator cuff tear diagnosis was evaluated using multivariate logistic regression, adjusting for age, sex, race and ethnicity, smoking, hypertension, diabetes, and depression. Results: In our cohort of 2,337 patients, 52.7% (n=1,231) of patients had an imaging-confirmed atraumatic rotator cuff tear. Among patients with tears, 18.0% (n=221) of patients reported a family history of rotator cuff issues versus 11% (n=123) in patients without tears. A family history of rotator cuff problems was significantly associated with the diagnosis of an imaging-confirmed rotator cuff tear (Odds Ratio=2.27, 95% CI = 1.72, 3.01). Increasing age (Odds Ratio=1.06, 95% CI = 1.05, 1.07) and Hispanic race and ethnicity (Odds Ratio=1.49, 95% CI = 1.06, 2.11 in Hispanic patients versus those of Non-Hispanic White ancestry) were also significantly associated with a rotator cuff tear diagnosis. Sex, smoking, hypertension, diabetes, and depression were not significantly associated with rotator cuff tears. Conclusions: Our study shows that individuals with rotator cuff tears were over two times as likely to have a family member with a rotator cuff tear as compared with patients without tears. These results support previous studies which have suggested a genetic component in the development of tendinopathies1.In a similar study by Assunção et al., individuals with familial history of treatment for rotator cuff tears were 3.3 times as likely to experience a cuff tear2. In another study by Harvie et al, siblings of patients with a full-thickness tear were 2.42 times more likely to experience a tear
Poster 178: Blood Flow Restriction Therapy Before and After Arthroscopic Rotator Cuff Repair
Authors: Castle Joshua , Jildeh Toufic , McGee Anna , Abbas Muhammad , Buckley Patrick , Okoroha Kelechi , Kolowich Patricia , Moutzouros Vasilios , Tramer Joseph 
Published: July 2022

Objectives: To evaluate the effect of blood flow restriction (BFR) therapy conducted before and after rotator cuff repair (RCR) on rotator cuff strength and patient reported outcomes. Methods: A total of 30 patients (22 male, 8 female; age 58.2 ± 9.0 years) presenting for surgical treatment of a rotator cuff tear were randomized into two groups, BFR (N=15) and Control (N=15). Rotator cuff strength was measured utilizing a handheld dynamometer in order to calculate peak force, average force and time to peak force. Strength measurements included supraspinatus, infraspinatus and subscapularis testing in multiple positions. Prior to surgery, patients completed a rotator cuff strengthening program, with and without the use of BFR. All patients underwent arthroscopic RCR and a standardized period of post-operative immobilization. Following surgery, patients underwent physical therapy utilizing standard post-RCR therapy protocols, with exercises performed with and without the use of BFR in each respective group. The BFR group was instructed to perform these exercises with a pneumatic cuff set to 80% of limb occlusion pressure placed over the proximal arm, under the direction of a physical therapist. Patient Reported Outcome Measurement System Upper Extremity (PROMIS-UE), American Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion were collected on the day of surgery as well as 2 weeks, 6 weeks and 3 months after surgery. Rotator cuff strength measurements were completed the day of surgery and repeated three months following RCR. Results: No significant differences were noted between the BFR and control groups in peak rotator cuff muscle force generation, time to peak force or average force at any timepoints (P>0.05). At six weeks post-surgery, the BFR group had significantly higher PROMIS-UE scores (30.3 ± 4.7 versus 26.3 ± 6.3, p=0.03, Figure 1) and active range of motion in abduction (82.4º ± 24.7 versus 65.1º ± 18.8, p=0.03) compared to the control group. These differences were not apparent at 3 month follow up. Conclusions: Blood flow restriction therapy following RCR results in improved patient reported outcomes scores and range of motion at six week follow up. At three months post-surgery, there was no noted improvement in rotator cuff strength when utilizing BFR compared to standard physical therapy.
Poster 180: Diagnostic Algorithm and Outcomes of Treatment for Neurogenic Pectoralis Minor Syndrome
Authors: McCarty Leroy 
Published: July 2022

Objectives: Neurogenic pectoralis minor syndrome can generate chronic anterior shoulder pain and a variety of non – specific neurologic symptoms in an affected upper extremity. This study presents a diagnostic algorithm used to identify neurogenic pectoralis minor syndrome and reports short-term outcomes for a series of patients who underwent either open or arthroscopic, coracoid – based, pectoralis minor tenotomy to treat the condition. Methods: Following IRB approval, the senior investigator’s operative records were queried for pectoralis minor release performed between January 2012 and July 2021. Demographic, surgical, and outcomes data was extracted from each subject’s medical record. Only subjects with a minimum of 30-day follow-up were considered in data analysis. Generalized descriptive statistical analysis, along with ANOVAs and post-hoc t-tests were performed to compare outcomes of pectoralis minor release. Results: Twenty-one subjects were identified meeting enrollment criteria. Mean age at time of diagnosis was 44.3years (range 17-70 years). Subjects had undergone prior shoulder surgery in 16/21 (76.2%) of cases and 18 (85.7%) were Worker’s Compensation related injuries. All patients had undergone a minimum of 3 months of a structured physical therapy program preoperatively. All patients underwent a diagnostic, ultrasound – guided pectoralis minor block with temporary resolution of self – reported symptoms. Symptoms prior to treatment included anterior shoulder pain and neurologic symptoms in 20/21 (95.2%) cases, with a mean duration of 15.7 months (range 3-40 months). Pretreatment ASES score was mean 41.5 (range 13.3-73.3) with mean pain of 4.9/10 (range 1-9/10). At mean 6.8 months post-release, patients reported mean 9.5 point increase in ASES score versus index score (p<0.05) and 85.0% (17/20 with pre-operative neurologic symptoms) reported complete resolution or improvement of neurologic symptoms related to neurogenic pectoralis minor syndrome. Conclusions: Findings of insertional pectoralis minor tenderness to palpation with or without reproduction of neurologic symptoms, a positive diagnostic, ultrasound – guided pectoralis minor block and anterior shoulder pain can be useful findings to establish the difficult diagnosis of neurogenic pectoralis minor syndrome. In select patients either open or arthroscopic release of the pectoralis minor insertion on the medial aspect of the coracoid process can alleviate symptoms.
Poster 191: Suture Anchor-Based Quadriceps Tendon Repair Results in Improved Patient Reported Outcomes Compared to the Transosseous Tunnel Technique
Authors: Trasolini Nicholas , Walsh Justin , Darbandi Azad , Rice Richard , Forsythe Brian , Verma Nikhil , Cole Brian , Yanke Adam , Dandu Navya 
Published: July 2022

Objectives: Recent biomechanical studies have compared traditional transosseus (TO) quadriceps tendon repairs to newer techniques for suture anchor (SA) repair. However, clinical studies comparing the two techniques are limited. The purpose of this study was to compare failure rates and patient reported outcomes between TO and SA quadriceps tendon repairs. Methods: Following IRB approval, patients who underwent primary repair for quadriceps tendon rupture with transosseus tunnel (TO) or suture anchor (SA) techniques between January 2009 and August 2018 were identified from a prospectively maintained institutional database and retrospectively reviewed. Patients were contacted by email or telephone interview for satisfaction (1-10 scale), current function (1-100 scale), failure (retear), and revision surgeries; International Knee Documentation Committee score (IKDC), Knee Injury and Osteoarthritis Outcomes Score (KOOS), Lysholm questionnaire outcomes were also collected. Results: Seventy patients (92.1%) were available by phone or email at a mean of 4.64±2.53 years postoperatively (transosseus sutures: 34 and suture anchor: 42). Out of these 70 patients, there were 10 failures for an overall failure rate of 14.29% (Table 1). Failure rates were not significantly different between treatment groups (TO: 5/34, 14.71% vs SA: 5/42, 11.90%, p=.622) (Figure 1). Patients in each repair group had similar satisfaction ratings (SA: 9.17±1.95 vs TO: 8.31±2.30, p=.102). The SA group reported higher subjective function (SA: 89.08±8.40 vs TO: 76.14±23.52, p=.003) and significantly greater final IKDC scores (72.30 ± 22.08 vs 56.80 ± 16.62; p=.041). Conclusions: In conclusion, there is no significant difference in failure rate between transosseus and suture anchor repairs for quadriceps tendon ruptures at a mean of 4.64±2.53 years of follow-up. Most failures occur secondary to a traumatic reinjury within the first year post-operatively. Patients who underwent suture anchor repair reported significantly greater subjective function and final IKDC, KOOS Pain, and KOOS Quality of Life scores. [Figure: see text][Table: see text]
Poster 198: Risk of Injury During Proximal Hamstring Repair: Anatomy of the Posterior Femoral Cutaneous Nerve
Authors: Gould Heath , Dreese James , Remy Lindsay 
Published: July 2022

Objectives: Injury to the posterior femoral cutaneous nerve (PFCN) has been described after proximal hamstring repair and fixation of ischial tuberosity avulsion fractures. Variations in the location of the PFCN and its branches have not been described. The purpose of this study was to identify the location and number of branches of the PFCN in relation to the origin of the proximal hamstring tendons. Methods: Fifteen lower torso human cadaveric specimens were dissected in prone position. Skin and subcutaneous tissues were reflected to expose the gluteal and hamstring musculature. The distances between the ischial tuberosity and lateral border of the hamstring, PFCN, perineal branch of the PFCN, and descending femoral branch of the PFCN were measured with digital calipers. Measurements were repeated 3 times and averaged. Results: The PFCN was 30.5 ±11.4 mm lateral to the central tip of the ischial tuberosity (range, 15.7 to 52.0 mm). The average longitudinal distance from the tip of the ischial tuberosity to the point where the perineal branch crossed the hamstrings was 24.1 ±15.0 mm (range, 9.9 to 52.2 mm). The average longitudinal distance to the point where the descending cutaneous branch crossed the hamstrings was 83.3 ±21.3 mm (range, 41.3 to 110.3 mm). The PFCN was nearest to the inferior border of the gluteus maximus 45.8±13.6 mm lateral to the ischial tuberosity (range, 13.6 to 62.1 mm). Eleven specimens had one identifiable perineal branch; four had two distinct perineal branches. Conclusions: The PFCN was in close proximity to the surgical approach utilized during proximal hamstring repair, with the perineal branch consistently crossing the surgical field transversely. The location of these nerves varied substantially among the specimens tested, with some nerves positioned less than 1cm from the ischial tuberosity and some specimens having two perineal branches.
Poster 233: The Presence of a Jumping J-Sign is Driven Primarily by Trochlear Factors and not Patella Alta or TT-TG Distance
Authors: Hevesi Mario , Cregar William , Zavras Athan , Trasolini Nicholas , Yanke Adam , Dandu Navya 
Published: July 2022

Objectives: The J-sign is a commonly utilized physical exam measurement in the assessment of a patellar instability patient. A severe preoperative J-sign, classified as a “jumping J sign”, has demonstrated associations with poorer short-term postoperative outcomes, and a jumping quality may persist as a bothersome symptom even after successful stabilization. Successful surgical treatment requires an understanding of the anatomic drivers of the jumping quality of a J-sign. Therefore, the objective of this study is to determine the underlying anatomic factors which contribute to a jumping J-sign. Methods: All patients undergoing evaluation for patellar instability at a single institution between 2013-2021 with an available knee MRI were included. Patients with a prior history of knee surgery were excluded. The presence of a jumping J-sign and its relationship to patellofemoral measures including Caton Deschamps Index (CDI), trochlear dysplasia, tibial tubercle to trochlear groove distance (TT-TG), tibial tubercle lateralization, coronal mechanical axis, trochlear bump height, and knee rotation angle were recorded based on measurements using standardized 1.5T MRIs. Statistical analysis was performed in RStudio (software version 4.1.0, R Foundation for Statistical Computing, Vienna, Austria). Results: 67 patients met inclusion criteria (42 female, 25 male, age: 20.3±8.2 years) and were evaluated. Thirteen patients (19%) demonstrated a jumping J-sign on physical exam. On univariate analysis, increasing CDI (Odds Ratio [OR] increase of 1.5 per 0.1 increase in CDI, p=0.048) and increasing trochlear bump height (1.7 OR increase per mm bump height) were significantly associated with a jumping J-sign. Additionally, a jumping J-sign was associated with the presence of Dejour A (Odds Ratio [OR]: 1.1, p=0.02) and Dejour B (OR: 2.4, p<0.01) but not Dejour C (p=0.14) or D (p>0.99) trochlear dysplasia. In contrast, TT-TG, tubercle lateralization, mechanical axis, and knee rotation angle were not significant drivers of a jumping J-sign (p³0.17). On multivariate analysis, Dejour A (OR: 1.25, p=0.04) and Dejour B (OR: 1.4, p<0.01) trochlear dysplasia as well as trochlear bump height (1.09 OR increase per mm bump height, p=0.01) were significantly associated with a jumping J-sign. Patella alta was not associated with a jumping J-sign after accounting for trochlear dysplasia and bump height (OR: 1.04, p=0.12). Conclusions: The presence of a jumping J-sign is determined by the interaction of trochlear dysplasia and bump height. While patients with increasing degrees of patella alta demonstrate an increased incidence of a jumping J-sign, this physical exam finding has a multifactorial etiology and is driven primarily by correlation with underlying trochlear factors including dysplasia.
Poster 239: Limb Malalignment Fails to Influence Clinical Outcomes of Meniscal Repair
Authors: Palumbo Reid , Cavendish Parker , Milliron Eric , Milliron Eric , Dibartola Alex , Duerr Robert , Magnussen Robert , Kaeding Christopher , Flanigan David , Swinehart Steven 
Published: July 2022

Objectives: Lower limb malalignment causes differences in tibiofemoral contact pressures and may influence outcomes following meniscal repair. Our objective was to evaluate clinical outcomes of meniscal repair in malaligned knees to determine if limb malalignment portends an inferior outcome. We hypothesized that medial meniscus repairs performed in varus knees and lateral meniscus repairs performed in valgus knees would result in poorer patient-reported outcomes when compared to a neutrally aligned knee. Methods: Patients who underwent meniscal repair at a single institution between 2006 and 2018 were identified by retrospective chart review. Patients between the ages of 18 and 65 with full-length weight bearing lower limb radiographs were included. Patients with varus alignment (> 3 degrees) and a medial meniscus repair, or valgus alignment (>3 degrees) and a lateral meniscus repair were considered “at-risk”. Outcomes were assessed through identification of additional surgery on the index meniscus and patient-reported outcome measures (PROMs): Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx activity score, and International Knee Documentation Committee subjective score (IKDC). Failure rates and PROMs were compared between the at-risk and not at risk groups. Results: A total of 58 patients were included with a mean follow-up of 1.6 years. A total of 12 patients were classified as “at-risk”. Repeat surgery on the index meniscus was performed in 1 of 12 “at risk” patients (8.3%) and 7 of 46 (15.2%) in the “not at risk” group (p = 1.00). There were no significant differences between the two groups in KOOS subscales: pain (82.8 vs 85.6, p = 0.55), symptoms (78.2 vs 80.8, p = 0.64), ADLs (88.4 vs 92.9, p = 0.27), Sport/Rec Function (63.8 vs 69.2, p = 0.57), or QOL (58.9 vs 62.3, p = 0.69). There was also no difference in IKDC score (66.9 vs 72.5, p = 0.41) or Marx score (4.2 vs 5.0, p = 0.63) between the two groups. Conclusions: Pre-operative knee malalignment does not appear to negatively influence clinical outcomes of meniscal repair when compared to normal knee alignment. [Table: see text]
Poster 245: Periarticular Local Infiltrative Anesthesia after Anterior Cruciate Ligament Reconstruction: A Comparison to Regional Adductor Canal Block with Matched Sub-Analysis
Authors: Schaver Andrew , Glass Natalie , Duchman Kyle , Wolf Brian , Westermann Robert 
Published: July 2022

Objectives: There is a paucity of literature that directly compares postoperative pain control and hospital recovery after using periarticular local infiltrative anesthesia (LIA) or regional anesthesia with an adductor canal block (ACB) for ambulatory anterior cruciate ligament reconstruction (ACLR) surgery. Additional studies are needed to investigate the analgesic efficacy of both ACB and LIA in patients undergoing ACLR surgery with concomitant procedures. The purpose of this study is to compare postoperative pain and recovery after anterior cruciate ligament reconstruction (ACLR) in patients who received an adductor canal block (ACB) or periarticular local infiltrative anesthesia (LIA). Methods: Study Design: Retrospective comparison studyA retrospective review of a prospectively collected ACL registry was performed. Patients underwent ACLR at a single institution between January 2015 and September 2020 and received long-acting local anesthesia with a pre-operative ultrasound-guided ACB or peri-articular LIA after surgery. Visual Analog Scale (VAS) pain scores, milligram morphine equivalents (MME) consumed in the post-anesthesia care unit (PACU), and total hospital recovery time were compared. Univariate analysis was used to compare VAS pain and MME totals between overall groups and groups matched for age, sex, BMI, graft type, and meniscal treatment. A p-value < 0.05 indicated statistical significance. Results: There were 265 knees (253 patients) included (LIA, 157 knees; ACB, 108 knees). Overall, VAS pain scores before hospital discharge (LIA 2.6 ± 1.5 vs. ACB 2.4 ± 1.4, p=0.334) and total MMEs were similar (LIA 17.6 ± 7.6 vs. ACB 18.5 ± 6.7 (MME), p=0.134). Total time to discharge also did not significantly differ (LIA 137.5 (IQR:116-178) vs. ACB 147 (IQR:123-183) (min), p=0.118). Matched sub-analysis (LIA and ACB, n=94) did not reveal significant differences in VAS pain before discharge (LIA 2.4 ± 1.4 vs ACB: 2.7 ± 1.5, p=0.122) or total MMEs (LIA 18.6 ± 6.7 vs. ACB 17.9 ± 7.1, p=0.532). Conclusions: The use of ACB or LIA resulted in similar pain levels and opioid consumption during early recovery after ACLR surgery.