bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paper 95: Adolescent Tarsal Navicular Bone Stress Injuries: A Multicenter Retrospective Analysis of 110 Patients
Authors: Mehta Shayna , Zheng Evan , Segovia Nicole , Rizzone Katherine , Halstead Mark , Bohon Tiffany , Brown Naomi , Stinson Zachary , Nussbaum Eric , Gray Aaron , Kraus Emily , Heyworth Benton 
Published: July 2022

Objectives: To describe demographic and presenting clinical characteristics, diagnostic features, treatment approaches, and clinical outcomes of adolescent tarsal navicular BSI’s. Methods: A retrospective chart review of patients with tarsal navicular BSIs was performed at eight academic centers. Diagnosis was confirmed by radiologic imaging in all cases. The following variables were collected utilizing a REDCap database and analyzed with basic descriptive and comparative statistics: age, sex, primary sport, physical exam (PE) findings, diagnostic imaging modality, treatment modalities, surgical technique (when applicable), time of protected weight-bearing, time to running, and time to return to sport. Results: 110 patients (mean age: 14.7 years +/-2.7 years; 65% female) met inclusion criteria, 103 (94%) of whom reported a primary sport, most commonly cross country/track and field (33%) and gymnastics/dance (27%). Common PE findings included navicular tenderness (96%), pain with walking (89%), and pain with resisted inversion (55%). Both x-ray and MRI were obtained in the majority of patients (91%), while CT was obtained for 30%. A radiologically detectable fracture line was present in 44%, most commonly on the dorsal navicular cortex. Non-operative treatment was successful in 85% of patients, consisting of protective boot (79%) or cast (21%). Operative treatment was pursued for 15% of patients, with 73% treated with open reduction internal fixation and 27% undergoing percutaneous screw fixation. All operative patients underwent fixation with either 1 (50%) or 2 screws (50%). Bone grafting was performed in 5 patients (31%). Significant differences between non-operative and operative cohorts included presence of fracture line (38% vs. 88%, P<0.001), age (14.3 years vs. 17.1, P<0.001), time of protected weightbearing (7 weeks vs 10 weeks, P=0.012), time to running (12 weeks vs 18 weeks, P=0.001), and time to return to sport (14 weeks vs 20 weeks, P=0.001). Conclusions: Adolescent tarsal navicular BSIs occur most commonly in sports involving repetitive loading, such as cross country, track and field, gymnastics, and dance. The most common PE findings are navicular tenderness to palpation, pain with walking, and pain with resisted inversion. Patients that ultimately require surgical treatment were more likely to have a radiologic fracture line, prolonged return to weightbearing, running and sport than those successfully treated non-operatively. [Table: see text][Table: see text]
Poster 104: The Role of Patient Demographic Factors in the Composition of Bone Marrow Aspirate Concentrate: A Flow Cytometry Analysis
Authors: Tauro Tracy , Credille Kevin , Dandu Navya , Wong Stephanie , Chahla Jorge , Forsythe Brian , Yanke Adam , Cole Brian , Verma Nikhil , Huddleston Hailey 
Published: July 2022

Objectives: Bone marrow aspirate concentrate (BMAC) is one type of orthobiologic that has gained increased popularity over the last decade for a variety of orthopedic procedures. Multiple factors have been demonstrated to influence the MSCs concentration and chondrogenic potential in BMA and thus BMAC, ranging from aspiration location to amount extracted to peripheral blood platelet count. Some studies have suggested that age may affect chondrogenic potential of BMAC derived MSCs but may not affect initial MSC concentration. Therefore, the purpose of this study was to 1) investigate the concentration value and variance BMAC content and 2) investigate the effects of donor age, sex, and other demographic factors on the amount of MSCs as measured by flow cytometry in bone marrow aspirate concentrate (BMAC). Methods: A review of patients who underwent BMAC treatment as part of a clinical trial were enrolled and complete BMAC flow cytometry data were included in analysis. Chart review was performed to identify patient demographic factors to determine their relationship to flow cytometry cell count. Flow cytometry was performed on both patient bone marrow aspirate (BMA) and BMAC samples to identify multipotent MSC phenotype defined as cell-surface co-expression of the antigens CD105, CD73, and CD90 (≥95% positive) and the absence of hematopoietic lineage markers CD45, CD34, CD14 or CD11b, CD79a or CD19, and HLA-DR (≤2% positive). The ratio of cells in BMA: BMAC samples was calculated, and Spearman correlations and Kruskall-Wallis tests were used to determine the relationship of cell concentration to demographic factors. Results: A total of 80 patients were included in analysis (49% male, mean age: 49.93±12.17 years). Mean concentration of BMA and BMAC was 2,048.13±2,004.14 MSCs/mL and 5618.87±7568.54 MSC/mL, respectively, with a mean BMAC:BMA ratio of 4.35 ± 2.09 (Figure 1). A significantly higher MSC concentration was observed in the BMAC samples (P=0.005). No patient demographic factors (age, sex, height, weight, BMI, smoking status) significantly impacted MSC concentration in the BMAC samples. Conclusions: This study validates that BMAC concentrates and increases MSCs from BMA approximately four-fold. In addition, in opposition to our hypothesis, no demographic factors affected the final number of MSCs observed with flow cytometry analysis. These preliminary results suggest that BMAC successfully concentrates BMA and provides a higher number of MSCs. Baseline patient characteristics likely have minimal effects on the number and concentration of MSCs in BMAC, and therefore may not limit patient selection for BMAC for clinical use. [Figure: see text]
Poster 111: Poor Inter-observer Reliability of TT-TG Measurement Among Orthopaedic Sports Medicine Surgeons Regardless of Measurement Technique
Authors: Cullen Matthew , Sequeira Sean , Douoguih Wiemi , Lincoln Andrew , Svoboda Steven , Gould Heath 
Published: July 2022

Objectives: Tibial tubercle-trochlear groove distance (TT-TG) is an important radiologic parameter in the diagnosis and treatment of patellar instability. However, there is substantial heterogeneity in the literature regarding the most appropriate measurement protocol for assessing TT-TG distance. The objective of this study was to evaluate the inter- and intra-observer reliability of TT-TG distance measurement in healthy knees performed by fellowship-trained orthopaedic sports medicine surgeons. Methods: A convenience sample of 29 magnetic resonance imaging scans (MRIs) of the knee was assembled after screening to ensure there was no ligamentous rupture, meniscal pathology, cartilage injury, subchondral edema, or abnormal masses in the bone or muscle. An a priori power analysis determined that this number of MRIs would provide greater than 90% power to detect a statistically significant difference in intraclass correlation of 0.95 (a < 0.05). Three fellowship-trained orthopaedic sports medicine surgeons read the MRIs and recorded the TT-TG distance using their method of choice. After a minimum of 5 months, the MRIs were read again, this time using a standardized evidence-based method to measure the TT-TG distance. Kappa statistics were calculated to evaluate inter- and intra-observer reliability. Results: Among the initial TT-TG distance measurements, kappa was equal to -0.006 (P = 0.690) when assessing inter-observer reliability. Introduction of the standardized measurement protocol was associated with no significant change in inter-observer reliability (kappa = 0.124, P = 0.070). The individual TT slice that was selected for TT-TG distance measurement demonstrated a kappa statistic of 0.192 (P < 0.001) for the surgeons’ method of choice and a kappa statistic of 0.037 (P = 0.455) for the standardized method. Similarly, TG slice selection using the surgeons’ method of choice yielded a kappa statistic of -0.005 (P = 0.949) and a kappa statistic of -0.102 (P = 0.140) for the standardized method. Conclusions: Our findings demonstrate poor inter-observer reliability of TT-TG distance measurement in healthy knees that was not improved with the application of a standardized evidence-based measurement protocol. TT and TG slices selected by surgeons varied widely. Future research should focus on comparing TT-TG distance measurements across a wider variety of knees (ranging from healthy to those with patellar instability), as this may improve the inter-observer reliability of TT-TG measurement. [Table: see text]
Poster 119: Outcomes after Surgery for Thoracic Outlet Syndrome in Professional Baseball Players: A Matched Cohort Analysis
Authors: Chalmers Peter , Erickson Brandon , Thompson Robert , Pearl Gregory , Romeo Anthony , Hoenecke Heinz , Fronek Jan , Chauhan Aakash 
Published: July 2022

Objectives: Determine the performance and return to play (RTP) outcomes for professional baseball players that undergo surgical treatment for thoracic outlet syndrome. Methods: All professional baseball players who underwent surgical treatment of TOS between 2010-2017 were identified using the major league baseball (MLB) HITS (Health and Injury Tracking System) database. Demographic and performance data (pre and post-surgery) for each player was recorded. Standard demographic and return to play outcomes were measured for all players and compared between different types of TOS and league status. Performance variables were analyzed for pitchers and compared to a 1:1 matched set of control pitchers. Results: Overall, 52 players underwent surgery for TOS of which 46 (88%) were pitchers. Neurogenic TOS was the most common and seen in 69% of players. Venous TOS was seen in 29% of players, and a single player had arterial TOS. Following TOS surgery, 79% of players returned to play at the same level (RTSP) and played at least 3 years after surgery. There was no differences in RTSP rate based on the type of TOS. There was no statistically significant difference in RTP and RTSP rates between major and minor league players. In pitchers only, there was a 76% RTSP, which was not different from the natural attrition of control pitchers (p=0.874). Following TOS surgery, pitchers saw a decline in several performance metrics, but not statistically different when compared to the control pitchers. This indicated that the decline in performance following TOS surgery was similar to the decline seen in healthy professional pitchers as they age. Conclusions: The most common type of TOS seen in professional baseball players is neurogenic. The RTSP rate following surgery for TOS in all professional baseball players is 79%. There was no statistically significant difference in ability to RTP based on the type of TOS or league status. Pitchers who underwent surgery for TOS had no significant difference in pitching performance metrics following surgery compared to matched controls. Overall, surgery for thoracic outlet syndrome can help prolong a professional baseball players career and help pitchers maintain their performance over time similar to their peers who have not had surgery for TOS. [Table: see text][Table: see text][Table: see text][Table: see text]
Poster 142: Identifying the Bony and Soft Tissue Mechanisms Responsible for Glenohumeral Internal Rotation Range of Motion
Authors: Erickson Brandon , Cohen Steven , Ciccotti Michael , Hefta Michael , Buchheit Paul , Rauch Joseph , Fcasni Shawn , Plum Alexander , Hoback Aaron , Thomas Stephen , Paul Ryan 
Published: July 2022

Objectives: Shoulder and elbow injuries account for about one-fourth of the total injuries in professional baseball players. The loss of shoulder internal rotation range of motion (IR ROM) has been identified as a significant risk factor for upper extremity injuries in pitchers across all ages. Several anatomic structures have been independently associated with IR ROM. First, greater amounts of humeral retroversion (HR) have been related to decreased IR ROM. Second, increased posterior capsule thickness (PCT) has also been related to decreased IR ROM. Lastly, adaptations to the teres minor muscle pennation angle (PA) has been related to losses in IR ROM and the PA of both the infraspinatus and teres minor have been related to the acute decrease in IR ROM following pitching. However, these three anatomic structures have not been collectively measured in baseball pitchers to determine the underlying mechanisms responsible for IR ROM. Therefore, this study will determine the contributions of HR, PCT, and posterior rotator cuff PA on IR ROM in healthy professional baseball pitchers. We hypothesized that HR, PCT, and posterior rotator cuff PA would have a significant contribution to IR ROM. Methods: 51 healthy professional pitchers were recruited for this cross-sectional study at the beginning of the 2021 Major League Baseball spring training. Participants received a bilateral IR ROM assessment while laying supine with the shoulder at 90 degrees of abduction and the scapula stabilized. Ultrasound imaging was also performed bilaterally to assess HR, PCT, infraspinatus (superficial + deep) PA, and teres minor (superficial + deep) PA. All ultrasound imaging was performed utilizing a previously published standardized technique. A stepwise regression was performed which included both arms to determine the mechanisms of IR ROM. Results: The first variable to enter into the stepwise regression model was HR which had a moderate relationship with IR ROM (regression coefficient of -0.502). PCT also entered the model, as measuring both HR and PCT improved the relationship with IR ROM from moderate to strong (regression coefficient of -0.657). Infraspinatus and teres minor PA did not enter the predictive model of IR ROM. Conclusions: HR and PCT were found to be the primary anatomic mechanisms responsible for glenohumeral IR ROM. Surprisingly, the posterior rotator cuff PA was not found to be a significant predictor of IR ROM. The posterior rotator cuff may instead contribute more to the acute decrease in IR ROM following pitching, which has recently been reported. As deficits in IR ROM can have harmful effects in baseball pitchers, understanding which anatomic structures are most responsible for IR ROM is important for injury prevention and treatment. [Figure: see text][Table: see text]
Poster 147: Operative Treatment of Acromioclavicular Injuries in the Military: Trends and Complications
Authors: Feeley Scott 
Published: July 2022

Objectives: To identify the demographics and characteristics of operative acromioclavicular joint separations, as well as characterize reconstruction techniques and associated complications. Methods: The United States Military Health System Data Repository was queried for patients with a Current Procedural Terminology (CPT) code for coracoclavicular ligament reconstruction between October 2013 and March 2020. Patient demographics, radiology and operative reports, and clinical notes were reviewed to characterize reconstruction techniques and associated postoperative complications. Results: A total of 956 coracoclavicular ligament reconstructions (896 primary repairs or reconstructions, 60 revision reconstructions) were performed between October 2013 and March 2020. The 896 primary coracoclavicular ligament reconstructions were indicated for a range of acromioclavicular joint separation severities: three grade two separations, 392 grade three separations, 48 grade four separations, and 386 grade 5 separations; the remaining 67 patients did not have a definitive injury grade defined by the treating surgeon. Of the primary procedures, 356 were performed acutely within 6 weeks of injury, while 538 were performed greater than 6 weeks after injury. Two hundred and twenty eight primary procedures were categorized as repairs, while 652 were categorized as reconstructions utilizing a graft. Following these procedures, there were 104 major complications requiring return to the operating room, including 48 symptomatic failures requiring revision, 18 fractures of the clavicle or coracoid, 25 deep surgical site infections and 9 cases of symptomatic hardware requiring removal of hardware, and 4 cases of adhesive capsulitis requiring manipulation under anesthesia. There were 160 minor postoperative complications, including 5 non-operative fractures of the clavicle or coracoid, 16 superficial surgical site infections, 7 cases of non-operative adhesive capsulitis, 57 cases of neuropathy, 1 deep venous thrombosis, and 74 cases of persistent acromioclavicular joint pain. There were no significant differences in complication rates between injury grade, acute versus chronic treatment, repair versus reconstruction, or suspensory versus non-suspensory technique. The rate of major complications was 1.8 per 100 person-years and the rate of minor complications was 2.77 per 100 person-years. The overall complication rate was 4.57 per 100 person-years. At the conclusion of the acromioclavicular joint separation care, 60 service members necessitated medical separation from the military. Conclusions: Coracoclavicular ligament reconstruction is a relatively common and safe procedure in a physically active population. The rate of major complication was 1.8 per 100 person-years, while the overall complication rate in our series was 4.57 complications per 100 person-years. Complications are rare, however, when they occur, they frequently require one or more secondary surgeries to treat.
Poster 183: Acromial Morphology Predicts Glenoid Bone Loss in Patients with Posterior Glenohumeral Instability
Authors: Livesey Michael , Tran Andrew , Baird Michael , LeClere Lance , Kilcoyne Kelly , Gilotra Mohit , Dickens Jonathan , Bedrin Micheal 
Published: July 2022

Objectives: The relationship between acromial morphology and glenohumeral instability is not well understood. It is unknown whether a flatter acromion predisposes a nonarthritic shoulder to increased posterior glenoid bone loss (GBL). The purpose of this study was to determine whether acromial morphology influences the extent or pattern of posterior glenoid bone loss in a cohort of patients with posterior glenohumeral instability. Methods: A comprehensive review of case logs between two academic institutions was performed to identify patients treated for primary posterior glenohumeral instability. MRI and/or CT scans were examined by two independent reviewers and the following measurements were obtained: total area glenoid bone loss (GBL) using the perfect circle technique, glenoid version, obliquity of GBL relative to the long axis of the glenoid, arc of GBL, acromial tilt, posterior acromial height (PAH), and anterior/posterior acromial coverage. The primary outcome was the association between acromial morphology parameters and glenoid bone loss. Results: A total of 89 shoulders with primary posterior glenohumeral instability were included. The mean age was 28.3 years (range 18-49), and male:female ratio was 11:1. Fifty-nine patients had measurable posterior glenoid bone loss and 30 patients had posterior labral tears without bone loss. Linear regression analysis revealed a significant negative correlation between acromial tilt and posterior GBL (R2= 0.09, p=0.005), a positive correlation between PAH and posterior GBL (R2= 0.04, p=0.046), and a negative correlation between posterior acromial coverage and posterior GBL (R2= 0.03, p=0.005). Increasing PAH and decreasing posterior acromial coverage were associated with a more superior extent of GBL (R2= 0.1, p=0.044 and 0.024, respectively). Subgroup analysis stratified by total area of GBL demonstrated that the area of posterior glenoid bone loss increases as the acromial tilt decreases. Conclusions: A flatter, higher acromion with less posterior coverage relative to the center of the glenoid is associated with increased posterior glenoid bone loss in patients with posterior glenohumeral instability. [Table: see text]
Poster 186: Repair of the Distal Biceps Tendon: A Systematic Review & Network Meta-Analysis of Biomechanical Performance
Authors: Lavoie-Gagne Ophelie , Parvaresh Kevin , Agarwalla Avinesh , Forsythe Brian , Forlenza Enrico 
Published: July 2022

Objectives: Rupture of the distal biceps is common and demonstrates excellent short- and long-term clinical outcomes following surgical repair. Prior studies have individually evaluated the biomechanical construct strength of multiple fixation devices, but none has comprehensively evaluated constructs in a head-to-head comparison. We sought to compare the failure strength, maximum strength, stiffness and displacement of available constructs for distal biceps repair. Methods: A network meta-analysis was conducted to determine the relative performance of 2 all-suture suture anchors, 2 intramedullary cortical buttons, 2 suture anchors, extramedullary cortical buttons, extramedullary cortical button plus interference screw, interference screw, single intramedullary cortical button, single suture anchor, trans-osseous suture, tension slide technique and tension slide technique plus suture tape. Analysis consisted of arm-based network meta-analysis under Bayesian random-effects model with Markov Chain Monte Carlo (MCMC) sampling. Geometry of the network was represented visually via a network plot with nodes representing treatments and edges representing direct comparative evidence. Biomechanical outcomes of fixation techniques were summarized as treatment effects and their corresponding 95% confidence intervals (CI). Rank probabilities were calculated and used to generate each treatment’s surface under the cumulative ranking (SUCRA) curve. Results: A total of 21 studies were included in the network meta-analysis. For failure strength, the two intramedullary cortical buttons ranked highest (92.73%). For maximum strength, the extramedullary cortical button alone (86.96%) and extramedullary button plus interference screw (83.40%) ranked highest. The two intramedullary cortical buttons ranked highest in stiffness (98.75%), followed by the extramedullary cortical button with interference screw (88.75%) and extramedullary cortical button (75.00%). Finally, with respect to demonstrating the least displacement after loading, the two suture anchors (89.43%) ranked highest, followed by tension slide technique with suture tape (73.14%) and extramedullary cortical button (72.71%). Conclusions: The fixation constructs that demonstrated the greatest overall biomechanical performance in distal biceps tendon repair were the extramedullary cortical button and two intramedullary cortical buttons. Two suture anchors demonstrated the least displacement after loading. [Figure: see text][Figure: see text][Figure: see text]