bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paper 80: Biomechanical Analysis of Tibial Motion and ACL Graft Forces After ACLR With and Without LET at Varying Tibial Slopes
Authors: Bryniarski Anna , Gruskay Jordan , Brady Alex , Bartolomei Christopher , Vidal Armando , Godin Jonathan , Pearce Stephanie 
Published: July 2022

Objectives: Lateral extra-articular tenodesis (LET) is being performed more frequently with anterior cruciate ligament reconstruction (ACLR) to decrease graft failure rates. Posterior tibial slope (PTS) affects ACL graft failure rates.2 The impact of LET plus ACLR on tibial motion and graft forces with increasing PTS has not been elucidated. We hypothesized LET will decrease anterior tibial translation (ATT), tibial rotation, and ACL graft force versus ACLR alone with increasing tibial slope throughout knee range of motion. Methods: Twelve cadaveric knees (40.5 mean age, all female) were tested in four conditions (intact, ACL cut, ACLR, ACLR + LET) with varying PTS (5°, 10°, 15°, 20°) at three flexion angles (0°, 30°, 60°). Specimens were mounted to a load frame which applied a 500-N axial load with 1 Nm of internal rotation (IR) torque (Figure 1). The amount of tibial translation, IR, and graft forces were measured. Results: Increasing PTS revealed a linear and statistically significant increase in graft force at all flexion angles. LET reduced graft force by 8.3% (6N) compared to ACLR alone at 30° of flexion. At the same position, slope-correcting osteotomy reduced graft force by 17-22% per 5° of slope correction, with a 46% reduction seen from 20° to 5°slope correction. For ATT, ACLR returned tibial translation to pre-injury levels, as did ACLR + LET at all flexion angles, except full extension where ACLR + LET over-reduced ATT by 2.47mm (p<0.05). Conclusions: Increased PTS was confirmed to increase graft forces linearly. Additionally, while the ACLR + LET reduced graft force compared to ACLR alone, slope correcting osteotomies are a more powerful method to minimize graft force. No other clinically significant differences were noted between ACLR with or without LET in regards to graft force, ATT, or IR. Many authors have proposed LET in the setting of ACLR, revision surgery, hyperlaxity, high grade pivot shift and elevated PTS, but the indications remain unclear. The biomechanical performance of LET plus ACLR at varying PTSs may impact daily practice and provide clarity on these indications.
Paper 83: Clinical Outcomes of ACL Reconstruction vs ACL Repair: A Matched-Pair Analysis
Authors: Ferreira Alexandre , Carrozzo Alessandro , Guy Sylvain , Vieira Thais , Barth Johannes , Sonnery-Cottet Bertrand , Saithna Adnan 
Published: July 2022

Objectives: Renewed interest in ACL repair is supported by promising early results from case series. However, comparative studies are currently lacking. The purpose of this study was to compare the clinical and functional outcomes of ACL repair versus ACL reconstruction, at a minimum follow-up of two years. Methods: A retrospective analysis of prospectively collected data was undertaken. Patients who underwent ACL repair were propensity matched (based on variables including age, gender, BMI, time between injury and surgery, knee laxity parameters, the presence of meniscal lesions, pre-operative activity level and sports participation) in a 1:1 ratio, to those who underwent ACL reconstruction during the same period. Isokinetic testing was used to evaluate strength deficits compared to the contralateral limb at 6 months post-operatively. At final follow-up, knee laxity parameters, return to sport, and outcome measures including Lysholm, Tegner, IKDC, ACL-RSI, and the Forgotten Joint Score-12 (FJS) were recorded. Results: 75 matched pairs were evaluated. The ACL repair group had significantly better mean hamstring muscle strength (+1.7% ± 12.8, compared to contralateral limb) when compared to their counterparts who underwent ACL reconstruction (-10.0% ± 12.8, compared to contralateral limb) (p<0.0001) (Table 1). At a mean final follow-up of 30 ± 4.8 months, the ACL repair group had significantly better FJS (82.0 ± 15.1) compared to the reconstruction group (74.2 ± 21.7) (p=0.017). No significant differences were demonstrated between groups with respect to Lysholm, Tegner, and ACL-RSI scores (Table 2). Non-inferiority criteria were met for the ACL repair group, when compared to ACL reconstruction with respect to subjective IKDC scores and knee laxity parameters (side to side antero-posterior laxity difference and pivot shift). There were no significant differences in the rate of return to the pre-injury level of sport (repair group 74.7% vs reconstruction group 60%, p=0.078). However, a significant difference was observed regarding the occurrence of ACL re-rupture (failure rates: ACL repair, 5,3%; ACL reconstruction, 0%; p=0.045). Patients experiencing failure of ACL repair were significantly younger than those that did not (26.8 years vs 40.7 years, p=0.013). There was no significant difference in rupture rates between groups when only patients aged over 22 years were considered (age >22, failure rates: ACL repair 2.8%; ACL reconstruction 0%, p=0.157) Conclusions: ACL repair was associated with significantly better isokinetic strength tests at 6 months, better FJS at final follow-up, and non-inferior IKDC, Lysholm, Tegner, ACL-RSI and knee laxity parameters. However, the rate of re-rupture was significantly higher when compared to ACL reconstruction and younger patients were particularly at risk [Table: see text]
Paper 91: Anteroinferior Glenoid Rim Fractures in Shoulder Instability Patients Over 50: A Matched Cohort Analysis of Risk Factors, Treatment Strategies, and Outcomes
Authors: Smartt Anne , Song Bryant , Wilbur Ryan , Reinholz Anna , Till Sara , Okoroha Kelechi , Krych Aaron , Camp Christopher 
Published: July 2022

Objectives: Background: Although they are common, there remains a paucity of data regarding traumatic anterior shoulder dislocations (ASI) associated with anteroinferior glenoid rim fractures (AGRF) in older patients. Purpose: To describe the incidence of AGRF in this population following ASI, identify risk factors for AGRF, compare treatment strategies, and compare clinical outcomes of patients with and without an associated AGRF. Methods: An established geographic medical record system was used to identify patients >50 years of age with ASI between 1994 and 2016. Patients with radiographic evidence of AGRF were identified and matched 1:1 to patients without AGRF. Comparative analysis was conducted to determine differences between groups. Results: Overall, 186 patients were identified with a mean follow-up of 10.4 years (range, 2.0 – 25.4). Of these, 42 (22.6%) had AGRF and were matched to 42 control patients without AGRF. Average age was 58.9 and 58.2 years for the AGRF and control groups, respectively. Rates of surgical intervention (29% vs. 43%), recurrent instability (14% vs. 17%), progression of osteoarthritis (34% vs. 39%), and conversion to arthroplasty (2% vs. 5%) were similar between AGRF and control cohorts. Control patients were more likely to report recurrent pain (p=.046). For patients with AGRF, increased bone fragment size (OR 1.1) and increased BMI (OR 1.2) correlated with an increased risk for surgery. The cut-off value for surgery in patients with AGRF was a fragment size ≥33% of the glenoid width. Conclusions: In patients ≥ 50 years at presentation of ASI, 22.6% presented with an associated AGRF. Increased fragment size and greater patient BMI were significant factors associated with undergoing surgical intervention; however, most patients did not require surgery. Patients without AGRF were more likely to report recurrent pain, possibly due to a higher prevalence of rotator cuff derangement. Overall, the presence of an AGRF did not portend a worse prognosis as treatment strategies and long-term outcomes in terms of recurrent instability, progression of osteoarthritis, and conversion to arthroplasty were similar between patients with and without AGRF at the time of ASI diagnosis.
Poster 106: Commonly Used Orthopaedic Clinical Therapeutics Affect the Cytokine Activity of Culture-Expanded Mesenchymal Stem Cells
Authors: Bonfield Tracey , Furdock Ryan , Harrison Laurie , Fletcher David , Rudo Evan , Calcei Jacob , Voos James 
Published: July 2022

Objectives: Hyaluronic acid (HA), platelet-rich plasma (PRP), and methylprednisolone are widely used for the non-operative management of osteoarthritis (OA). More recently, human bone marrow derived mesenchymal stem cells (BM-MSCs) have garnered significant interest as a non-operative means for symptom modification of OA. Anti-inflammatory cytokine secretion is a major component of proposed BM-MSC action. We sought to describe the effect of HA, PRP, and methylprednisolone on the cytokine profile of BM-MSCs at multiple stages of culture expansion. Methods: Following Institutional Review Board and United States Food and Drug Administration approval, nine BM-MSC cell lines from 4 human donors underwent three stages of culture expansion: passage 2 (P2), passage 3 (P3), and passage 4 (P4). Levels of OA-related cytokines (IL-1β, IL-6, IL-8, IL-10, Stem cell Factor [SCF], Stem Cell Derived Factor-alpha [SDF-α]) were measured using Luminex multiplexing technology. Each of the BM-MSC preparations were evaluated at each passage, 24 hours following exposure to HA, PRP, or methylprednisolone. Paired T-tests and Wilcoxon signed-rank testing were performed as appropriate following assessment of normality. Significance was set at p<0.05. Results: Culture expansion significantly altered cytokine production, however treatment with current OA therapeutics further altered these responses implicating the potential of combined treatment of culture expanded hMSCs and OA therapeutics. Figure 1 demonstrates the behavior of selected cytokines after exposure to HA, PRP or methylprednisolone preparations. Further, we tested different concentrations of each of the therapeutics to determine optimal dosing. Exposure to increasing doses of HA led to reductions in BM-MSC expression of SCF, SDF-α, VEGF, CCL20, and adiponectin (p<0.05 for all). PRP increased IL-1 levels in P2 and P3 (p<0.05 for both), IL-6 in P2 (100 pg/mL vs 5500 pg/mL, p<0.001), and IL-8 in P3 (900 pg/mL vs 3900 pg/mL, p<0.001). PRP did not affect IL-10 expression (p>0.05). Aside from an increase in IL-6 production for P2 (200 pg/mL vs 1500 pg/mL, p<0.05), methylprednisolone did not have significant effects on cytokine expression. Conclusions: Orthopaedic therapeutic adjuvants influence the inflammatory cytokine profile of BM-MSCs at multiple stages of culture expansion. Although further study is needed, these therapeutics have potential to be used in tandem with BM-MSCs to create an optimal cytokine environment for treatment of degenerative joint disease. [Figure: see text]
Poster 118: The Accuracy of a Smartphone App in Measuring Shoulder Range of Motion
Authors: Borman Nicole , Shi Jing , Damodar Dhanur , Pillai Raji , Mehran Nima , Soeters Rupali 
Published: July 2022

Objectives: Measuring shoulder movements, specifically range of motion (ROM) of the shoulder joint is an important clinical parameter related to glenohumeral disorders and for functional evaluation of the shoulder before and after treatment, which may include surgery. Currently shoulder ROM measurements are performed in an office setting by the provider or alternatively may be performed by a physical therapist, traditionally with the use of a goniometer. The purpose of this study was to determine the accuracy of a smartphone-based digital ROM tool in assessing active shoulder ROM, compared to traditional goniometry measured by a physical therapist in an office setting. Methods: A prospective, non-blinded study was conducted at a single institution (University of St. Augustine, Austin< TX). Thirty (30) eligible and consenting participants with normal shoulder ROM were recruited. Each participant self-assessed their active shoulder ROM using the smartphone App. A physical therapist concurrently measured each participant’s active shoulder ROM using a hand-held goniometer. This concurrent data collection was designed for greater efficiency and minimal bias. Forward flexion (FF), abduction (AB) external rotation (ER), internal rotation (IR) and extension (EX) were measured. Agreement between the smartphone App and goniometric measurements, as well as intra-rater reliability (precision) was assessed using intraclass correlation coefficients (ICC) and Limits of Agreement analysis. Each measurement was performed in duplicate to assess precision. Statistical analysis was performed using R (https://www.r-project.org/) Results: Data were analyzed for 60 shoulders (30 right, 30 left) from 30 participants (mean age was 31.4, 92% female.) The inter-rater reliability between the two methods was excellent for all movements, with ICC ranging from 0.9 to 0.96. For all movements except AB, the mean difference in the measurements between PT and App was less than 1.3 degrees, and the difference was within 6 degrees of the mean differences for 80% of the participants. For AB, the mean difference was 2.08, and the difference was within 15 degrees of the mean difference for 80% of the participants. The intra-rater reliability or precision ranged from good to excellent. For all movements except IR, both PT and App showed excellent intra-rater reliability (ICCs > 0.90). For IR, good intra-rater reliability (ICCs >= 0.75) was observed. Conclusions: These data provide evidence that the smartphone App can be a reliable and valid tool for measuring shoulder ROM. Smartphone Apps enable self-assessment of ROM by patients at the convenience of their home and allow for remote monitoring at zero visit cost to the patient.
Poster 122: Characterizing Health Events and Return to Sport in Elite Collegiate Swimmers
Authors: Greig Danielle , Schroeder Grant , Kremen Thomas , Trikha Rishi 
Published: July 2022

Objectives: Competitive swimming is a common activity among pediatric, collegiate and masters-level athletic populations. It is also one of the most prestigious sports in the United States with regard to medal-winning at international competitions, however, epidemiologic studies describing the incidence of health events and outcomes in an elite swimming population are lacking. This study aimed to identify the most common injuries and illnesses among elite swimmers as well as how these injuries and illnesses affect return to sport following injury. Methods: This retrospective study utilized a de-identified injury and illness database of NCAA Division I collegiate swimmers in the United States from 2016 to 2020. Analysis included musculoskeletal injuries stratified by body location, as well as non-musculoskeletal injuries and illnesses. Relative risk (RR) was used to compare the percentage of athletes affected between males and females, with statistical significance being defined by a relative risk 95% confidence interval (CI) not including 1 ( P < 0.05). Results: 641 collegiate swimmers (301 male, 340 female) who were on a collegiate roster from 2016-2020 were included for analysis. A total of 1030 health events among 277 females and 173 males were analyzed. Of these 1030 health events, 635 (61.7%) occurred in females and 395 (38.3%) in males. Females were at a significantly higher risk of suffering musculoskeletal injury than males (RR = 1.5, 95% CI: 1.22 – 1.83). Females were also at a significantly higher risk of suffering a non-musculoskeletal injury/illness than males (RR = 1.32, 95% CI: 1.04 – 1.68). The most common of the 540 musculoskeletal injuries reported involved the shoulder (126, 23.3%), spine (95, 17.6%), foot/ankle/lower leg (81, 15.0%), knee/thigh injuries (67, 12.4%) and hand/wrist/forearm (52, 9.6%). The most common of the 490 non-musculoskeletal health events were respiratory tract infections (119, 24.3%), unspecified medical illness (93, 19.0%), concussions (58, 11.8%), ear infections (25, 5.1%) and gastrointestinal illnesses (24, 4.9%). Of the 58 documented concussions, 22 (37.9%) were season-ending. Fourteen of those 22 (63.6%) concussions were career-ending. Females had significantly higher rates of concussions (RR = 2.11, 95% CI: 1.13 – 3.96), 9.1% vs. 4.3%. Five out of 67 knee injuries (7.5%) were career-ending whereas only 1 out of 126 (0.8%) shoulder injuries was career-ending. Conclusions: This retrospective study identifies the most common injuries and illnesses as well as the most common season-ending or career-ending injuries and illnesses among elite collegiate swimmers. Awareness of the incidence and outcome of injuries and illnesses that affect competitive swimmers may allow for more targeted analysis and injury prevention strategies. [Table: see text][Table: see text][Table: see text]
Poster 132: Long Term Outcomes of Distal Biceps Injuries: A Comparative Study of Surgical and Non-operative Management at a Mean Follow Up of 13 years
Authors: Till Sara , Song Bryant , Wilbur Ryan , Reinholz Anna , Sanchez-Sotelo Joaquin , Barlow Jonathan , Camp Christopher , Tagliero Adam 
Published: July 2022

Objectives: Distal biceps tendon tears, although rare, significantly impair patient’s elbow mobility and function. There is a paucity of contemporary literature reporting long term outcomes of distal biceps (DB) injuries. Therefore, the authors sought to identify magnetic resonance imaging (MRI) confirmed distal bicep tears and report on (1) patient demographics and injury characteristics of all patients with distal bicep pathology, (2) outcomes of all patients with non-operatively managed DB pathology, and (3) outcomes of all patients with operatively managed DB pathology. Methods: Patients with an MRI-confirmed distal biceps rupture from 1996 to 2016 were identified through an institutional image database. Patients from the initial search were then cross-referenced with the [REDACTED]1 to ensure record availability. Patients were included if they had complete medical records and ≥5 years of clinical follow-up. Patients with inflammatory arthritis and enthesitis, polytrauma, or incidental findings without clinical assessment were excluded. Medical records were reviewed to confirm the diagnosis of distal biceps tears and obtain further subject details. Results: A total of 158 patients (22 female, 136 male) with a mean age 51.5 years (44.8-61.2) were identified and included. Baseline patient demographics including BMI, smoking status, dominant-handedness, laborer occupation, and gender were gathered (Table 1). Patients had a mean clinical follow-up of almost 14 years (Table 1, range 8.4 -17.8). Outcomes of the 52 non-operative and 106 operatively managed patients, included severe complications, functional outcomes, and health-related productivity loss are reported in Table 2. There were 7 re-operations (4%), 5 re-ruptures (3%), and overall 35% of the operatively treated cohort experienced a complication. Conclusions: Patients with distal bicep pathology tended to be a male laborer in their 50s without clinically significantly associated risk factors. The majority of patients regained full ROM, and 83% were able to return to work without modifications, irregardless of operative or non-operative management. At long term follow up, patients treated operatively were more likely to report missing time from work and averaged more days missed than their non-operatively treated counterparts. Additionally, operative patients had no statistically significant gains functional outcomes, and were subject to potential post-operative complications. Surgeon bias may play a role in deciding treatment for distal biceps tears. As such, careful patient selection for surgical intervention for distal biceps pathology should be employed; surgeons should consider restricting surgical intervention to patients who have significant clinical symptoms or fail non-operative management. [Table: see text][Table: see text]
Poster 154: MLB Player Workload and Performance Following Arthroscopic Shoulder Labral Repair
Authors: Cotter Daniel , Lau Emily , Abbas Muhammad , Kadouh Ali , Fehmi Ziad , Jildeh Toufic , Moutzouros Vasilios , Castle Joshua 
Published: July 2022

Objectives: To investigate the impact of arthroscopic shoulder labral repair on return to play (RTP), career longevity, workload, and performance of Major League Baseball (MLB) athletes Methods: A retrospective review of MLB players after arthroscopic shoulder labral repair from 2004-2018 was performed. A 2:1 control group matched by demographic information was used. Demographics, workload, and performance metrics were collected. Statistical analysis examined workload/performance at one and three-years after injury compared to one-year before. Workload/performance percentage relative to baseline was also compared. Results: 26/ 39 (66%) pitchers and 18/25 (72%) positional players RTP and were matched with 54 and 34 controls, respectively. Following surgery, players experienced shorter careers (2.3 ± 2.6 vs 5.8 ± 2.8, p<0.001, pitchers), (2.9 ± 2.5 vs 5.3 ± 2.3, p=0.002, positional players). One-year post-index, pitchers had reduced games played (GP) (22.0 ± 21.3 vs 32.1 ± 21.0, p=0.002), started (15.0 ± 14.1 vs 6.1 ± 6.5, p =0.0038), and innings (109.5 ± 73.2 vs 44.7 ± 29.3, p =0.0004), and increased walks/hits-per-inning-pitched (WHIP) (1.3 ± 0.2 vs 1.5 ± 0.3, p =0.0035). One-year post-index, positional players had reduced GP (98.0 ± 50.7 vs 75.7 ± 47.1, p =0.0399), innings (778.9 ± 431.6 vs 528.6 ± 429.9, p =0.0263), on-base-percentage (OBP) (0.3 ± 0.1 vs 0.3 ± 0.1, p =0.0116), and on-base-plus-slugging-percentage (OPS) (0.7 ± 0.2 vs 0.6 ± 0.2, p =0.0281). Both pitchers and positional players experienced no reduction in any metric at three-years post-index. Compared to controls, pitchers had decreased GP (50 ± 40 vs 150 ± 180, p <0.001) and innings (40 ± 30 vs 150 ± 190, p <0.001), with increased WHIP when calculated as a percentage from baseline (120 ± 20 vs 100 ± 20, p =0.027) one-year post-index. Positional players had decreased OBP (80 ± 30 vs 110 ± 40, p =0.017) and OPS (80 ± 30 vs 100 ± 20, p =0.019) from baseline one-year post-index and decreased OBP three-years post-index (90 ± 20 vs 100 ± 20, p =0.017). Conclusions: Following RTP after arthroscopic shoulder labral repair, MLB players had reduced career longevity and workload/performance one-year post-index, but these stats returned towards baseline at three-years post-index. [Figure: see text][Figure: see text][Table: see text][Table: see text]