bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paper 76: Utilization of Validated Outcome Scores in Evaluating Treatment of Osteochondral Lesions: A Comparison of Ankle Versus Knee Literature
Authors: Bhargava Kathrine , Docter Shgufta , Park Sam Si-Hyeong , Lee Jong Min 
Published: July 2022

Objectives: Osteochondral lesions (OCLs) are commonly seen in the ankle and knee joints, and present difficult challenges for treatment. Evaluating the effectiveness of a treatment is dependent on how well constructed, content specific, reliable, and responsive the outcome measures used are. Currently, a considerable variety of outcome scores are used to assess the treatment effect of OCLs. The purpose of this study was to compare the frequency of validated outcome scores utilized in the ankle versus knee literature. Methods: A computerized search of multiple electronic databases was performed for all clinical studies from 2011 to 2020 assessing treatment outcome of ankle and knee OCLs. Eligible studies were independently screened by two reviewers. Outcome scores used in each eligible study were recorded and the overall frequency calculated. Correlation coefficients were used to determine if there was an association between use of validated outcome score with journal impact factor, publication year, or study level of evidence. Results: A total of 75 eligible ankle OCL studies were identified, with 27 different outcome scores utilized. The most frequently used scores were the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating Systems (47.7%), Visual Analog Scale (VAS) (34.4%), and Foot and Ankle Outcome Score (FAOS) (6.3%). Validated outcome scores were used in only 14.7% of all ankle OCL studies. There was no correlation between the use of validated outcome scores and journal impact factor (p=0.72), publication year (p=0.45), or level of evidence (p=0.66). A total of 239 eligible knee OCL studies were identified, with 34 different outcome scores utilized. The most frequently used scores were the International Knee Documentation Committee subjective knee forms (IKDC) (33.2%), Knee injury and Osteoarthritis Outcome Score (KOOS) (19.8%), and Tegner Activity Scale (TAS) (17.1%). Validated outcome scores were utilized in 87.4% of all knee OCL studies, compared to 14.7% in ankle OCL studies (p<0.001). There was no correlation between the use of validated outcome scores and journal impact factor (p=0.19), publication year (p=0.58), or level of evidence (p=0.62). Conclusions: Validated outcome scores were more frequently utilized in knee OCL studies compared to ankle OCL studies. Nearly half the ankle OCL studies utilized the AOFAS score despite the score not being shown to be valid or reliable. The extremely low frequency of validated scores used within the ankle literature may limit how well treatment effectiveness in ankle OCLs is appropriately evaluated.
Poster 123: Concussion Rates in Youth Lacrosse
Authors: Macknofsky Brandon , Brown Shimron , Lavin Alessia , Sabesan Vani 
Published: July 2022

Objectives: Sport related concussions are estimated to occur up to 3.8 million times per year in the United States. Despite the popularity of youth sports in the US, there has been little focus on concussions in youth lacrosse. The purpose of this study was to provide a descriptive analysis of the epidemiology and incidence of concussions in youth lacrosse and compare our results to well-documented analyses of concussions in American football. Methods: The National Electronic Injury Surveillance System (NEISS) was used to collect data on concussion injuries occurring during lacrosse in pediatric patients from 2006-2019. Nationwide estimation of injury incidence was determined using weighted calculations and combined participation data obtained from the U.S. Lacrosse membership records. A comparison dataset was collected for football using the NEISS data on football related concussions. Type of lacrosse contact was categorized into player-to-player, player-to-stick, player-to-ball, and player-to-ground. Incidence was compared over each year, by age and gender. Results: The database yielded 1,302 concussions related to lacrosse over the study period, of which 67.6% occurred in males. National participation in lacrosse steadily increased from 2006 to 2012 by an average of 10.27% annually and then experienced a lower annual growth rate of 2.53% from 2012 to 2019. There was a statistically significant increase in incidence of concussions for girls and boys from 2006 to 2012 which then declined for the duration of the study period. An increase in incidence of concussions was also seen in football players through 2012, but then marginally declined from 2012 to 2019. The average concussion incident rate for youth lacrosse was 23.29% per 100,000 participants which was significantly higher than the incident rate for football (7.19% per 100,000 participants). Conclusions: Lacrosse has experienced a lower annual rate of growth in participation over recent years. As participation rates increased from 2006 to 2012, the relative rates of concussions in both genders rose as well. However, since 2012, the rate of concussions has declined which may be attributed to the declining rate of growth in the sport and rule changes in lacrosse which varied by gender. While the incidence of concussion in lacrosse is declining, it remains at a much higher rate per participant than what is observed in football. Future studies should focus on education and increased prevention efforts for concussions in lacrosse given the higher incidence than youth football.
Poster 129: Reliability and Accuracy of Telemedicine-Based Shoulder Examinations
Authors: Fiedler Anna , Warth Ryan , Bailey Lane , Shupe Paul , Gregory James , Wang Grace 
Published: July 2022

Objectives: Telemedicine has become a critical component in the evaluation and management of patients with shoulder pathology. However, the reliability and accuracy of findings on a virtual physical exam relative to in-person evaluation is unclear. The purpose of this study is to determine the reliability and accuracy of a recorded telemedicine physical exam for diagnosis of shoulder pathology compared to the traditional in-person physical exam performed in an outpatient shoulder clinic. Methods: This study is a randomized controlled trial. New patients presenting with unilateral shoulder pain to a singlesurgeon shoulder clinic were recruited between July and November 2020. In a single visit, patients were evaluated with standardized in-person and telemedicine physical exams, and the order was randomized. The telemedicine exam was recorded and consisted of a pre-recorded video guide displaying self-directed shoulder exam maneuvers that patients performed under remote coaching by an independent observer. The in-person physical exam was performed by the treating physician and results were used as the gold standard. The telemedicine videos were evaluated by two independent observers for inter-observer reliability. The treating physician subsequently evaluated the telemedicine videos after a minimum 2-month washout period for intra-observer reliability. Inter- and intra-observer reliability analyses were conducted using the Kuder-Richardson 20 (KR-20) formula. Results: Thirty-two patients (17 male, 15 female; average age 50.2 ±16.2 years) were enrolled and included in the analysis. Overall KR-20 reliability across all 40 physical exam maneuvers was 0.391±0.332 (76.4% ± 15.4% agreement) between the in-person and telemedicine exams. Maneuvers conducted via telemedicine that examined range of motion (ROM) limitations had the highest degree of reliability, sensitivity, specificity, and likelihood of also producing a positive finding on the in-person exam (0.700±0.114, 66.5%, 81.0%, and 6.06, respectively). Exam maneuvers conducted via telemedicine that relied on identifying apprehension associated with glenohumeral instability were found to have the lowest reliability, sensitivity, and likelihood of producing a positive finding on the in-person exam (0.176±0.440, 23.5% and 0.518, respectively). All included patients were satisfied with their telemedicine experience. Conclusions: Overall reliability of telemedicine physical examination maneuvers was poor. ROM limitations identified on the telemedicine exams were found to be the most reliable and accurate, while techniques used to evaluate instability were found to be the least reliable and accurate. While the telemedicine exam can be reliable as a screening tool in certain pathologic conditions, providers should use the in-person exam and imaging results to confirm any suspected diagnoses. [Table: see text][Table: see text][Table: see text]
Poster 135: Minimum 2 year Clinical Outcomes after Latarjet for anterior shoulder instability: clinical and imaging factors that correlate with success or failure
Authors: Millett Peter , Provencher Matthew , Casp Aaron , Lee Simon , Rakowski Dylan , Peebles Annalise , Ernat Justin 
Published: July 2022

Objectives: The open Latarjet procedure has been demonstrated to be reliable in achieving acceptable patient reported outcomes (PROs). However, clinical predictors of outcome, return to sport and complications/failures have been more variable. The purpose of this study is to report patient reported outcomes (PROs), clinical correlations, and predictors of failure in patients who have received an open Latarjet surgery. Methods: Patients who received an open Latarjet with by two fellowship–trained surgeons between August 2006 - November 2018 were included. Prospectively collected data was reviewed, and PROs included ASES, SF–12 PCS, SANE, QuickDASH, and satisfaction. Age, sex, sports participation, pain, primary vs. revision (prior failed arthroscopic/open Bankart) surgery, dislocation number, glenoid bone loss (GBL), glenoid track concept, and projected glenoid track were evaluated. Projected track was calculated using the axial diameter of the corcoid as part of the glenoid track concept. Postoperative ASES <70, recurrent dislocation, or revision instability surgery were considered failures. Results: 126 shoulders (125 patients) met inclusion criteria with mean age of 28.1 years (range 15–57). 7/126 (5.5%) had revision surgery prior to final follow-up and were excluded from outcomes analyses. Mean follow-up 3.7 years (range 2–9.3 years) was attained in 86.6% (103/119) of patients. All PROs significantly improved from preoperative baseline (ASES: 69.7→90.2; SANE: 55.8→85.9; QuickDASH: 28.4→10.5). PROs did not differ with sex, sport participation type, dislocation with/without sports, primary/revision, and preoperative dislocation number. No correlations existed between PROs and age, GBL, or number of previous surgeries. On-track (50/105, 47.6%) and projected on-track (90/105, 85.7%) lesions correlated with better patient satisfaction, but not PROs. A total of 97% (86/89) returned to sport, with 74% (66/89) at the same/slightly below pre-injury level. Failures included 13/126 (10.3%) postoperative dislocations and 6/126 (4.7%) with ASES scores <70. Conclusions: The open Latarjet procedure lead to significant improvements in all PROs, and overall 97% of patients returned to sport. On-track and projected on-track measurements correlated with better patient satisfaction, but not improved PROs. No other factors were predictive of outcomes, nor clinically correlated with failure.
Poster 143: Variation in Postoperative Tendon Migration Does Not Result in Significant Differences in Patient Reported Outcomes in Patients Undergoing Arthroscopic or Open Biceps Tenodesis Using All-Suture Suture Anchor and Interference Screw
Authors: Berlinberg Elyse , Forlenza Enrico , Patel Harsh , Williams Brady , Chahla Jorge , Yanke Adam , Cole Brian , Verma Nikhil , Forsythe Brian 
Published: July 2022

Objectives: It is unknown whether the degree of biceps tendon migration influences patient outcomes following biceps tenodesis (BT). We aimed to assess the relationship between in vivo tendon migration and patient reported outcomes (PROs) following arthroscopic and open BT using suture anchor (SA) and interference screw (IS) constructs. Methods: One hundred twenty patients undergoing arthroscopic and open BT with SA or IS fixation at a single academic center were prospectively enrolled. Postoperative biceps tendon migration was measured via RSA, using a tantalum bead as a radio-opaque marker for tendon migration, with radiographs at 3- and 12-weeks postoperatively. PROs (Constant, SANE and PROMIS) were collected preoperatively, and at 6 months, 1 year, and 2 years. A Bonferroni correction was made for multiple comparisons. Results: Preoperative PRO completion was as follows: 20 (16.7%) ASES, 64 (53.3%) Constant, 96 (80.0%) SANE, and 108 (90.0%) PROMIS-UE. Patients with an open SA had a younger median age (48.4, IQR 38-55.4, P=0.014) and fewer dominant-sided surgeries (8/33 patients or 24.2%, P=0.003). PRO scores did not differ by groups for any questionnaire at all timepoints. There were no significant differences in likelihood of achieving MCID for ASES (P>0.99), Constant (P=0.87), SANE (P=0.68), or PROMIS-UE (P>0.99) between groups. In univariable analysis, no patient- or surgery-related factors served as significant predictors of achieving MCID at 6 months. Notably, neither RSA bead migration>3cm (Constant: OR= -0.54, 95%CI -2.53-1.45, P=0.60; SANE: collinear; PROMIS-UE: collinear) nor Popeye deformities (Collinear for all PROs) were negatively associated with likelihood of achieving MCID. Conclusions: Patient-reported outcomes are similar for patients undergoing arthroscopic BT via IS and SA, and open BT via IS and SA. No significant predictors of achieving MCID at 6 months were identified, including migration of the RSA bead. Biceps tendon migration was not significantly correlated with patient reported outcomes. [Table: see text][Figure: see text][Figure: see text][Figure: see text]
Poster 145: Posterior Glenoid Osteotomy with Capsulolabral Repair Restores Force in a Critical Bone Loss Biomechanical Model
Authors: Marcaccio Stephen , O’Donnell Ryan , Owens Brett , Bokshan Steven 
Published: July 2022

Objectives: Bone loss in posterior shoulder instability is an increasingly recognized clinical phenomenon. There is no widespread consensus on the surgical treatment of posterior shoulder instability with critical posterior glenoid bone loss. Here, we study the effect of opening posterior wedge osteotomy on resistance force of soft tissue repair alone in the setting of 20% critical bone loss. Methods: Native glenoid retroversion was measured on 9 cadavers. The humerus was potted in 90 degrees of forward flexion and 30 degrees of internal rotation relative to the scapula and a posterior dislocation was performed in order to create a posterior capsulolabral injury model. The specimens were each taken through a fixed sequence of testing: (1) posteroinferior capsulolabral tear, (2) no glenoid bone loss with posteroinferior capsulolabral repair, (3) 20% posterior glenoid bone loss with posteroinferior capsulolabral repair, (4) and 20% glenoid bone loss with posterior glenoid opening wedge osteotomy and posteroinferior capsulolabral repair. The resultant peak forces with 1 centimeter of posterior translation were measured. A one-way repeated-measures analysis of variance (RM-ANOVA) was used to compare mean force values. Results: Following the initial dislocation event, all shoulder had a resultant posterior capsulolabral injury. Repairing the capsulolabral complex in the 20% posterior glenoid bone loss group did not result in a statistically significant increase in resistance force compared to the labral deficient group, p = 0.068. When 20% posterior bone loss was created, the posterior glenoid osteotomy with capsulolabral repair was significantly stronger than the posterior repair alone both with and without bone loss, p = 0.008 and p = 0.045, respectively. Conclusions: In the setting of critical posterior glenoid bone loss, an opening wedge posterior glenoid osteotomy with capsulolabral repair significantly improved resistance to posterior humeral translation compared to capsulolabral repair alone.
Poster 169: Prior Rotator Cuff Repair Is Not Associated with Worse Outcomes After Subsequent Superior Capsular Reconstruction: A Comparative Analysis
Authors: Chao Richard , Solomon David , Vyas Dharmesh , Curley Andrew 
Published: July 2022

Objectives: To compare the outcomes of two patient cohorts: (1) primary SCR and (2) SCR after failed rotator cuff repair. Methods: A retrospective review was performed of all patients who had a SCR at our institution from 2015 to 2020. Data was collected for patient demographics, prior rotator cuff surgery, comorbidities, and preoperative and postoperative range of motion, strength testing, visual analog scale (VAS) pain scores, Patient-Reported Outcomes Measurement Information System (PROMIS) 10 scores, American Shoulder and Elbow Surgeons (ASES) score, Brophy-Marx shoulder activity scale, and revision surgeries. Missing data points were excluded from analysis at that time point. Comparative analysis was used to assess for differences between patients that underwent an SCR only versus SCR after rotator cuff repair. Results: Fifty-four patients met inclusion criteria, consisting of 33 SCR only patients (61 ± 10 years, BMI 30 ± 6, 79% male) and 21 SCR after rotator cuff repair patients (59 ± 8 years, BMI 32 ± 5, 95% male). In the SCR only and SCR after rotator cuff repair groups, no significant difference was observed in age, BMI, gender, comorbidities, preoperative and postoperative range of motion, strength testing, VAS pain scores, PROMIS 10 scores, ASES score, Brophy-Marx shoulder activity scale, and revision surgeries (p>0.05). Conclusions: Similar outcomes were observed in patients who underwent primary SCR versus SCR after a failed rotator cuff repair, suggesting that surgeons should attempt to repair the rotator cuff at the index surgery if possible.
Poster 229: Improved Epiphyseal Socket Placement with Intraoperative 3D Fluoroscopy: Consecutive Series of Pediatric All-epiphyseal Anterior Cruciate Ligament Reconstruction.
Authors: Aitchison Alexandra , Cordasco Frank , Green Daniel 
Published: July 2022

Objectives: All-epiphyseal anterior cruciate ligament reconstruction (ACLR) is a safe procedure for skeletally immature patients with ACL tears because the sockets are contained within the epiphysis and do not cross the growth plate. However, due to the undulation of the distal femoral physis, accidental disturbance of the growth plate during tunnel placement is possible. It is imperative to obtain intraoperative imaging to view the trajectory of the guide wire prior to reaming the socket. The purpose of this study was to investigate the effect of the use of 3D intraoperative fluoroscopy on socket placement in patients undergoing all-epiphyseal ACLR. We hypothesized that 3D imaging would allow for better intraoperative visualization of the growth plate and a smaller incidence of growth plate violation. Methods: Patients under the age of 18 who underwent a primary ACLR between 2011 and 2018 by the senior authors were retrospectively reviewed. Patients that underwent an all-epiphyseal ACLR with an available postoperative MRI were included. Demographic data, surgical details and type of intraoperative fluoroscopy were collected. The minimal distances between the femoral socket and distal femoral physis (DFP) and tibial socket and proximal tibial physis (PTP) were recorded. Sockets that touched the physis or extended into the metaphysis were recorded as zero. Patients were split into two groups; a 2D imaging group that received intraoperative anterior to posterior and lateral fluoroscopic radiographs and a 3D fluoroscopy imaging group. Interrater reliability of radiographic measurements was evaluated using intraclass correlation coefficient (ICC). Statistical analysis was performed using a student’s t-test to determine differences between groups. Results: 72 patients fit the inclusion criteria and were retrospectively reviewed. 54 patients had 2D imaging and 18 patients had 3D imaging. The mean age of the cohort at time of surgery was 12.3 ± 1.5 years, 79% of patients were male, and 54% tore their left ACL. The mean time from surgery to postoperative MRI was 2.0 ± 1.1 years. The ICC was 0.92 (95% CI 0.35-0.98), indicating almost perfect interrater reliability. The mean difference in distance between the tibial socket and the PTP was significantly less in the 2D imaging group than the 3D imaging group (1.2 ± 1.7mm vs 2.5 ± 2.2mm, p=0.03). (Table 1). The femoral socket touched or extended beyond the DFP significantly less in the 2D group than in the 3D group (13% vs 43%, p<0.000). Conclusions: There was a significantly decreased incidence of DFP violation with use of 3D intraoperative imaging for all-epiphyseal ACLR socket placement. Surgeons should consider utilizing 3D imaging to potentially decrease the rate of growth disturbance due to physis violation in these patients. [Table: see text]
Poster 235: Surgical Management of Patellar Instability in Adolescents with High Grade Trochlear Dysplasia
Authors: Nunally Kianna , Cook Danielle , Hussain Zaamin , Zheng Evan , Yen Yi-Meng , Kramer Dennis , Micheli Lyle , Kocher Mininder , Heyworth Benton , Wilson Benjamin 
Published: July 2022

Objectives: High-grade trochlear dysplasia (HGTD) has previously been identified as a risk factor for failure of surgical management of patellofemoral instability (PFI). However, limited data exists on the influence of the type of surgical procedure performed on postoperative outcomes in these patients. The purpose of this study was to identify the rates of failure of primary PFI surgery in patients with HGTD compared to those without HGTD and to assess the effect of the type of surgery on recurrent instability and return to OR. Methods: We retrospectively reviewed patients aged ≤19 years who underwent primary surgery for PFI at our institution between 2008 and 2017. Patients underwent procedures including medial retinacular plication (MRP), medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy (TTO), or combined procedures. We excluded patients with incomplete imaging data, BMI >30kg/m2, those that underwent surgery for fixation of a chondral fracture >1cm, and patients with a diagnosis of syndromic disorder. Trochlear dysplasia was evaluated based on pre-operative MRI. Patients were divided between those that had HGTD and those without HGTD. Comparisons were made between the two groups and logistic regression analysis was utilized to determine if surgery category was associated with rate of recurrence in the HGTD patients. Results: Three-hundred three patients, average age 15.1 years, underwent primary surgical stabilization for PFI with median follow up time of 3.0 years. Forty-nine percent (149/303) of the cohort had HGTD. Demographics were comparable between HGTD groups (Table 1). When compared to the patients without HGTD, patients with HGTD showed similar rates of recurrent instability, return to the OR for instability, and return to the OR for other reasons. Looking at patients with just HGTD, there was a significant association between surgery type and outcomes (Table 2). HGTD patients who underwent MPFLR had a 63% decrease in the odds of experiencing recurrent instability compared to those undergoing MRP (OR=0.37; p=0.03). Similarly, the TTO surgery group had an 80% decrease in the odds of experiencing recurrent instability compared to patients undergoing MRP (OR=0.20; p=0.002). Conclusions: While adolescents with PFI and HGTD overall have similar results after surgical stabilization, there is a significant effect of the type of surgery performed. Patients with HGTD that underwent MRP had significantly more instability and return to the OR for instability surgeries than patients that underwent other procedures. Based on this data, adolescents with PFI and HGTD should be considered for more powerful surgeries to limit the risk of recurrence or return to the OR. [Table: see text][Table: see text]