bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster 157: Total Intravenous Anesthesia (TIVA) Compared to Traditional General Anesthesia in Shoulder Arthroscopy in the Beach Chair Position
Authors: Sharareh Behnam , Tamma Poornima , Shah Anup , Barrera Lindsay 
Published: July 2022

Objectives: Shoulder arthroscopy is commonly performed in the beach chair position, which has been linked to cerebral oxygen desaturation. Previous studies comparing general anesthesia to total intravenous anesthesia (TIVA) using propofol indicate that TIVA can preserve cerebral perfusion and autoregulation, as well as shorten recovery time and reduce the incidence of postoperative nausea and vomiting. However, few studies have evaluated the use of TIVA in shoulder arthroscopy. Thus, this study seeks to determine if TIVA is superior to traditional general anesthesia methods in terms of improving operating room efficiency, shortening recovery time, and reducing adverse events while theoretically preserving cerebral autoregulation in patients undergoing shoulder arthroscopy in the beach chair position. Methods: This is a retrospective study of patients undergoing shoulder arthroscopy in the beach chair position, comparing two anesthetic techniques. 150 patients were included (75 TIVA and 75 general anesthesia). Unpaired t-tests were used to determine statistical significance. Outcome measures included operating room times, recovery times, and adverse events. Results: Compared to general anesthesia, TIVA significantly improved total recovery time (120.3 ± 31.0 min compared to 131.5 ± 36.8 min; p = 0.048). TIVA also decreased time from case finish to out-of-room (6.5 ± 3.5 min compared to 8.4 ± 6.3 min; p = 0.021). However, the in-room to case start time was slightly longer for the TIVA group (31.8 ± 7.22 min compared to 29.2 ± 4.92 min; p = 0.012). There were fewer readmissions in the TIVA group compared to the general anesthesia group (p = 0.08), and TIVA had lower rates of postoperative nausea and vomiting (p = 0.22), and higher intraoperative MAPs (87.1 ± 11.4 mmHg in the TIVA group, compared to 85.0 ± 9.3 mmHg in the general anesthesia group; p = 0.22). Conclusions: TIVA may be a safe and efficient alternative to general anesthesia in shoulder arthroscopy in the beach chair position. Larger scale studies are needed to evaluate the risk of adverse events related to impaired cerebral autoregulation in the beach chair position. [Table: see text][Table: see text][Table: see text]
Poster 160: Outcomes of Revision Posterior Shoulder Capsulolabral Repair in Adolescents
Authors: Arner Justin , Bradley James , Edwards Callee , Whicker Emily 
Published: July 2022

Objectives: Posterior arthroscopic capsulolabral repair has been shown to be successful in the athletic population. Adolescents provide a unique set of challenges to the surgeon due to their young age and potential length of time remaining in competitive athletics. Small studies have identified risk factors for failure, but there a paucity of literature evaluating adolescent specifically. The purpose of this study was to determine failure rates of adolescents who underwent arthroscopic posterior capsulolabral repair and to compare clinical outcomes and return to play between adolescents who required revision versus those who did not. It was hypothesized that adolescent athletes who require revision arthroscopic posterior unidirectional capsulolabral repair will have poorer outcomes and return to play and will undergo revision surgery at a higher rate than adults. Methods: A total of 718 patients who underwent posterior shoulder stabilization between 2000-19 with a minimum of 2-year follow-up were reviewed. Patients <11 years and >19 years of age and those with multidirectional instability were excluded. Revision surgery was defined as repeat arthroscopic posterior capsular repair. The ability to return to play, clinical outcomes scores (American Shoulder and Elbow Surgeons scoring system (ASES) and Visual Analog Scale (VAS)), and patient reported perception of range of motion, strength, and whether the surgery was worthwhile were recorded. Comparisons were made using the Chi-square or the Mann-Whitney U tests with P <0.05. Results: 184 patients met inclusion criteria, with an average follow-up of 6.1 years. Nineteen patients required revision surgery, for an overall revision rate of 10.3%. At final follow-up, patients who underwent revision surgery returned to sport less frequently (86.7% vs 68.4%, p=0.04) and less likely to return to their pre-surgery level of play (Table 1). Non-revision patient had higher ASES score, as well as greater strength and range of motion. However, both groups had similar pain scores and reported that surgical repair was worthwhile (93.2% vs. 89.5%, p=0.55). Conclusions: Adolescent patients underwent revision posterior capsulolabral repair at a slightly higher rate (10.3%) when compared with athletes of all ages. Patients requiring revision had poorer outcomes scores when compared to those who did not undergo revision surgery but were able to return to sport at a high level and had a high level of satisfaction. Adolescent athletes return to play at high levels following arthroscopic posterior capsulolabral repair with a low rate of revision; however, those that require revision have poorer outcomes but high satisfaction. [Table: see text]
Poster 162: Glenoid Bone Loss Directly Affects Hill-Sachs Morphology: An Advanced 3-Dimensional Analysis
Authors: Golijanin Petar , Peebles Annalise , Douglass Brenton , Arner Justin , Provencher Matthew , Peebles Liam 
Published: July 2022

Objectives: The purpose of this study was to 1.) qualitatively and quantitatively analyze the interplay between glenoid bone loss (GBL) and Hill-Sachs lesions (HSL) in a cohort of anterior instability patients using 3-dimensional (3-D) imaging software and 2.) assess the relationships between GBL and HSL characteristics. Methods: Patients with anterior shoulder instability with a minimum of 5% GBL with evidence of HSL confirmed on computed tomography were identified. 3-D models of the unilateral proximal humeral head and en face sagittal oblique view of the glenoid were reconstructed using Mimics (Materialise NV, Leuven, Belgium) software. GBL as well as surface area (SA), width, defect length, and glenoid track width was quantified. The volume, SA, width, and depth of identified HSLs were quantified along with their location (medial, superior, and inferior extent) on the humeral head. The severity of glenoid bone loss was categorized by low grade (0-10%), moderate grade (>10% to 20%), high grade (>20% to 30%), and extensive (>30%). Analysis of variance was then computed to determine significance (p < 0.05) between severity of GBL and associated HSL parameters. Results: 100 patients met inclusion criteria (mean age: 27.9 years, range: 18 to 43 years), which included 58 right shoulders and 42 left shoulders (84 male, 16 female). Among groups, 32 patients presented with low grade GBL (μ GBL = 6.1%), 38 patients with moderate grade (μ GBL = 16.2%), 17 with high grade ( μ GBL = 23.7%), and 13 with extensive GBL (μ GBL = 34.0%), with an overall mean GBL of 18.1% (range 5% - 39%). Patients with 0-10% GBL had significantly narrower (average and max width) ( p < 0.03) and deeper (average depth) (p = 0.002) HSLs compared with all other GBL groups, while greater GBL was associated with wider and shallower HSLs. GBL width, percent width loss, defect length, and glenoid track width all significantly differed across the four GBL groups (p < 0.05). Conclusions: Hill-Sachs Lesions (HSLs) have different morphological characteristics depending on the amount of glenoid bone loss (GBL). GBL is directly related to the characteristics of HSLs. Smaller glenoid defect size is associated with narrower and deeper HSLs. Management of the humeral head and glenoid must be appropriately tailored given the distinct interplay between GBL severity and HSL.
Poster 163: Evaluating the Role of Subacromial Impingement in Rotator Cuff Tendinopathy: Development and Analysis of a Novel Rat Model
Authors: Deng Xianghua , Rodeo Scott , Liu Yulei 
Published: July 2022

Objectives: Subacromial impingement of the rotator cuff caused by variations in acromial anatomy is an extrinsic factor that leads to inflammation and degeneration of the rotator cuff, ultimately contributing to the development of tendinopathy. However, microscopic and molecular changes in the impinged tendon remain poorly understood, and a robust rat model for studying rotator cuff tendinopathy is still lacking. Methods: Our study was approved by the Institutional Animal Care and Use Committee. A total of 44 adult male Sprague-Dawley rats were included in the study. Animals were randomly allocated to one of four study groups: intact control group (Group 1, n=11); bilateral subacromial surgical clip placement to induce supraspinatus impingement for 2 weeks (Group 2, n=11), 4 weeks (Group 3, n=11) and 8 weeks (Group 4, n=11). At time of sacrifice, bilateral shoulder specimens were harvested for biomechanical testing, histological and quantitative real-time polymerase chain reaction (qRT-PCR) analysis. One-way analysis of variance (ANOVA) with the post-hoc Tukey test was used to analyze differences among groups. Results: Radiography confirmed that all microvascular clips remained in stable position in the subacromial space. Gross inspection of supraspinatus tendon specimens in the impingement groups revealed frayed and hazy tendon discoloration at the enthesis and mid-substance. Biomechanical evaluation demonstrated decreased supraspinatus tendon failure force and tissue stiffness at all time points compared to control group. Histologic specimens demonstrated significant, persistent tendinopathic changes over 8 weeks, with the mean modified Bonar scores significantly increased in the clip impingement groups compared to the control group (control: 1.56±0.86; 2 weeks group: 9.17±0.76; 4 weeks group: 9.11±0.65; and 8 weeks group: 6.56±0.50. P <0.001 for all comparisons). qRT-PCR analysis of impinged tendon specimens demonstrated upregulation of gene expression for Col3 and MMP14 in the impingement groups compared with control groups (P =0.001 and 0.015 respectively). In muscle samples, significant upregulation was seen in the expression of genes that are commonly associated with muscle atrophy (MURF1: P <0.001 and UBE2B: P <0.001) and fatty infiltration (FABP4: P =0.002, PPARγ2: P =0.006, and KLF15: P =0.001). Conclusions: In conclusion, we developed a novel rat model of subacromial impingement and found consistent and sustained histologic, biomechanical, and gene expression changes that are consistent with findings in human tendinopathy. This model will allow future studies to further evaluate the underlying cellular and molecular mechanisms of tendinopathy, as well as evaluation of novel therapeutic approaches for treatment of this common problem. [Figure: see text][Figure: see text][Figure: see text]
Poster 166: Biomechanical Evaluation of Open Bankart and Soft Tissue Bristow Procedures with 10% Glenoid Bone Loss
Authors: Griffith Rebecca , Tibone James , McGarry Michelle , Adamson Gregory , Lee Thay 
Published: July 2022

Objectives: Chronic anterior shoulder instability can be debilitating for a wide number of individuals from the general populations, high level and recreational athletes, laborers and the members of the military. Glenoid bone loss presents a more difficult problem to treat as it negates the positive results that can be achieved with arthroscopic labral repair alone. The optimal procedure for subcritical bone loss of 10% or less is undetermined. In young competitive contact athletes, there is still a high failure rate with arthroscopic procedures. Therefore, the purpose of this study was to biomechanically characterize the effects of soft tissue Bristow (conjoint tendon transfer) and open Bankart repair in a 10% glenoid defect model. Methods: Eight fresh cadavers were studied using a custom shoulder testing system. The rotator cuff muscles were loaded to simulate physiologic muscle conditions. Range of motion, anterior-inferior translation at 60° of external rotation with 20, 30 and 40N of force were tested in scapular and coronal planes. Stiffness and the force required to dislocate in the anterior-inferior direction were also quantified in the coronal plane. 4 different states were examined including: (1) intact capsule (2) Bankart lesion with 10% bone loss, (3) soft tissue Bristow (conjoint tendon transfer), and (4) open Bankart repair. Repeated measures ANOVA with Bonferroni correction was used for statistical analysis. Results: The bony Bankart (injury model) increased range of motion in both the scapular and coronal planes. The conjoint tendon transfer had little effect on range of motion, and the Bankart repair decreased the range of motion to a similar state with that of the pre-injury model. The injury state showed increased translation which was decreased with both the conjoint tendon transfer and the Bankart repair (Figure 1A). The conjoint tendon transfer shifts the humeral head posteriorly in 0° and 30° of external rotation in the scapular plane. There was no difference in stiffness during dislocation between conjoint tendon transfer and Bankart repair (Figure 1B). Conclusions: Both the soft tissue Bristow and the open Bankart repair were noted to decrease anterior translation in this shoulder instability model. Both open repair models significantly decreased anterior translation and are valid surgical options for the treatment of instability with 10% glenoid bone loss. Surgically, an open Bankart repair is more anatomic and may be the preferred technique.
Poster 171: No Difference in Clinical Outcomes for Arthroscopic Suprapectoral versus Open Subpectoral Bicep Tenodesis: A Randomized Prospective Analysis
Authors: Diaz Connor , Berlinberg Elyse , Korrapati Avinaash , Cole Brian , Cvetanovich Gregory , Yanke Adam , Romeo Anthony , Verma Nikhil , Forsythe Brian 
Published: July 2022

Objectives: Our group has previously reported the 1-year outcomes arthroscopic suprapectoral biceps tenodesis (ASPBT) versus open subpectoral biceps for the management of long head of the biceps tendon (LHBT) pathology. While patients had similar 1-year biceps strength and pain, any ongoing changes in functional outcomes is yet unknown. We aimed to directly compare clinical outcomes of ASPBT versus OSPBT with interference screw fixation, distal to the bony bicipital groove, at 2 years follow-up. Methods: Eighty-seven patients undergoing biceps tenodesis for LHBT disease were randomized into the ASPBT group or OSPBT group. Both techniques utilized polyether ether ketone (PEEK) inference screws for tenodesis fixation. Patients completed American Shoulder and Elbow Surgeon (ASES), Constant subjective, and Single Assessment Numeric Evaluation (SANE) questionnaires preoperatively, and again at 6 months, 12 months and final follow-up at minimum 24 months. Results: Seven-five patients (37/46 randomized to ASPBT [80%], 38/41 randomized to OSPBT [93%]) with a mean age of 50.3 ± 10.4 years and a mean body mass index of 28.9 ± 6.3 were included in clinical outcome analyses. Mean final follow-up was 35.1 months (ASPBT: 35.4 months, OSPBT: 34.9 months, range 24-63 months). Comparison of demographic characteristics and intraoperative findings showed no significant difference in age, gender, concomitant procedures, and rotator cuff disease. No statistically significant differences in ASES (P =.26), Constant subjective scores (P = .60), and SANE scores (P = .74) were found at final follow-up. Clinical outcomes scores showed no significant improvement from 12.6 months to final follow-up at 35.1 months (ASPBT: ASES, P=0.42; Constant, P=0.23; SANE, P=0.43 v. OSPBT: ASES, P=0.76; Constant, P=0.57; SANE, P=0.64). The mean SANE score in the ASPBT group had a statistically nonsignificant, 6.1-point increase from 1 to 3 years post-operatively (p = .23), which was greater than the minimal clinically importance difference (MCID). No patients required revision of biceps tenodesis in either group. Conclusions: No significant differences in patient-reported outcomes and complication rates were found at any time point between subjects undergoing ASPBT or OSPBT, utilizing the same interference screw technique, for the management of LHBT pathology. [Table: see text][Table: see text][Table: see text][Table: see text]
Poster 192: Femoroacetabular Impingement in Elite Skiers and Snowboarders: Return to Sport and Outcomes after Hip Arthroscopy
Authors: Waltz Robert , Comfort Spencer , Philippon Marc 
Published: July 2022

Objectives: Hip arthroscopy has been shown to be an effective treatment for femoroacetabular impingement (FAI) in high level athletes; however, limited outcomes and return to play data exists for hip arthroscopy in skiers and snowboarders. The purpose of this study is to determine the return to sport rate of elite skiers and snowboarders who have undergone hip arthroscopic surgery for FAI and to assess hip-related outcomes at a minimum 2-years follow up. Methods: Elite skiers and snowboarders who underwent hip arthroscopy for the treatment of FAI between 2005 and 2018 were identified through a retrospective review of prospectively collected data. Data was obtained from www.fis-ski.org, www.usskiandsnowboard.org, www.xgames.com, and www.wikipedia.org, including information on each players’ career length, participation on a national team, and time between surgery and first competition post-surgery. Patient reported outcome measures (PROs) were prospectively collected pre-operatively and at minimum 2 years post-operatively. Results: Twenty-six elite skiers and snowboarders (34 hips) were included. The mean age at surgery was 24.5 ± 6.7 years (range 18.7-46.8). A total of 85% returned to elite level competition at 8.9 months (range 2.9-23.7) with an average career length of 3.6 ± 2.7 years. Four athletes required revision arthroscopy with adhesions being the most frequent indication. At mean follow-up of 7.7 ± 3.2 years, significant improvement in PROs was demonstrated for HOS-ADL (76 ± 20 to 95 ±6), HOS-SSS (63 ± 28 to 92 ± 14), mHHS (70 ± 19 to 89 ± 12), and SF12-PCS (45 ± 11 to 54 ± 8). Patient acceptable symptom state (PASS) was achieved in 88% for HOS-ADL, 88% for HOS-SSS, and 83% for mHHS. Median patient satisfaction was 10. Conclusions: The return to competition rate in elite skiers and snowboarders after hip arthroscopy for FAI is 85% at an average of 8.9 months with a career length of 3.6 years after surgery. Significant improvement in PROs was demonstrated for HOS-ADL, HOS-SSS, mHHS, and SF12-PCS with median patient satisfaction score of 10. These findings support hip arthroscopy as an effective procedure for the treatment of FAI in elite skiers and snowboards with symptomatic activity limiting hip pain allowing them to return to their previously level of competition at a high rate.
Poster 205: The Effect of Increased Tibial Tubercle Trochlear Groove Distance on Post-Operative Outcomes Following Anterior Cruciate Ligament Reconstruction
Authors: Johnson Emma , Hall Anya , Clements Ari , Bishop Meghan , Ciccotti Michael , Cohen Steven , Erickson Brandon , Paul Ryan 
Published: July 2022

Objectives: Outcomes following anterior cruciate ligament reconstruction (ACLR) are generally good/excellent. While some risk factors for poor outcomes following ACLR have been determined, there are many that remain unknown. It is unclear if an elevated tibial tubercle trochlear groove (TT-TG) distance is a risk factor for poor outcomes following ACLR. Therefore, the purpose of this study was to determine if an elevated TT-TG increases risk of failure following ACLR. The authors hypothesized that patients with an elevated TT-TG will have an increased risk of failure following ACLR. Methods: All patients who underwent primary ACLR at a single institution between July 2018-June 2019 with a minimum of 2-year follow-up were eligible for inclusion. TT-TG distance was measured on preoperative magnetic resonance imaging (MRI) scans by 2 independent investigators. Clinical outcomes, complication rates, ability to RTS, and Lysholm scores were compared between patients with a TT-TG < 12.5mm (normal) and those with a TT-TG ≥ 12.5mm (elevated). Sub-analyses comparing normal and elevated TT-TG distance were also made after isolating athletes and bone-patellar tendon-bone (BTB) graft patients. Results: Overall, 159 patients were included, 98 with normal TT-TG distance and 61 with elevated TT-TG distance. There were no differences in demographics, concomitant procedures or injury mechanism between groups. There were also no differences in rates of reinjury, post-operative complications, need for revision ACLR, or RTS rates (all p>0.05). Patients with an elevated TT-TG distance had worse post-operative Lysholm scores than patients with a normal TT-TG distance (83.0 vs. 95.0, p=0.010), and also had differing rates of subjective instability (13.1% vs. 5.1%, p=0.083) and reoperation (13.1% vs. 4.1%, p=0.060) that trended towards significant. In patients who received a bone-patellar tendon-bone (BTB) graft, an elevated TT-TG distance was associated with higher rates of subjective instability (13.0% vs. 3.0%, p=0.041), reoperation (13.0% vs. 1.5%, p=0.012), and post-operative complications (25.0% vs. 8.2%, p=0.026), as well as lower ACL psychological readiness scores (324.1 vs. 446.7, p=0.015). Conclusions: Following ACLR, patients with an elevated TT-TG distance have worse Lysholm scores with a minimum 2-year follow-up. Patients with an elevated TT-TG who underwent ACLR with BTB grafts had significantly higher rates of subjective instability, reoperation, and post-operative complications, while no differences in reinjury, complication, revision, or RTS rates were observed. [Table: see text][Table: see text]