Orthopedics Commons^™

Anterior Cruciate Ligament Hybrid Remnant Preservation Reconstruction Demonstrates Similar Outcomes As Traditional Reconstruction After 6 Months: A Randomized Control Trial, Joshua P. Castle, Eleftherios L. Halkias, Brittaney Pratt, Ashley Frei, Matthew A. Gasparro, Vasilios Moutzouros

Medical Student Research Symposium

Background

The anterior cruciate ligament (ACL) is often debrided during reconstruction (ACLR) to improve visualization. However, remnant ACL tissue contains nerve fibers and including remnant tissue in ACLR could provide benefit. Therefore, a technique was developed that preserves the tibial remnant and incorporates it into ACLR: Hybrid Remnant Preservation Reconstruction (HRPR) ACLR. This study compares HRPR-ACLR to traditional reconstruction by comparing patient reported outcomes and complications.

Methods

Patients presenting to one surgeon's clinic with an ACL injury are screened. Exclusion criteria are patient age<14 years, multi-ligament injury, chronic tears, and revision ACLR. Patients are consented and randomized to HRPR or traditional ACLR. Demographics, patient-reported outcomes, range of motion (ROM) and complications were collected.

Results

Thirty-three patients were included, 20 HRPR and 13 controls. No demographic differences were noted. PROMIS-PF, …

Tendon Rupture And Tendonitis In Low-Profile Dorsal Versus Volar Plating For Distal Radius Fractures: A Systematic Review And Meta-Analysis, Matthew Myhand, Shreya Balusu, Alex Lindahl Bs, Hardy Evans Md, Charles Day Dr., Eric Jiang Dr.

Medical Student Research Symposium

Tendon Rupture and Tendonitis in Low-Profile Dorsal versus Volar Plating for Distal Radius Fractures: A Systematic Review and Meta-Analysis

Background: Dorsal plating of distal radius fractures has historically been associated with high rates of hardware removal, tendonitis, and tendon rupture. Newer generation low-profile dorsal plates are thinner (<1.6mm thick) with improved characteristics. We examine whether low-profile dorsal plates still have higher rates of tendon complications than volar locking plates.

Methods: We searched Ovid MEDLINE, Web of Science, and EMBASE for published literature describing tendon complications in association with plating of distal radius fractures. Inclusion criteria encompasses any primary study of low-profile dorsal plates that included data on tendon complications. Studies that included both low-profile dorsal and volar plating arms were included …

A Systematic Review Of The Social Determinants Of Health In Shoulder Arthroplasty Outcomes, Allison Boland, John Pum, Michael Gaudiani, Matthew A. Gasparro

Medical Student Research Symposium

This systematic review investigates the impact of social determinants of health (SDOH) on outcomes in shoulder arthroplasty (SA). SA, a common orthopedic procedure, has seen an increasing focus on SDOH influencing postoperative results. The study aims to comprehensively assess this impact on both surgical and patient-reported outcomes.

Through a systematic search of databases, 34 studies (2011-2021) met the inclusion criteria, involving 4,825,547 patients. Explored SDOH included insurance status, race/ethnicity, age, sex, income, social support, and veteran status. Outcomes considered were length of stay, American Shoulder and Elbow Surgeons scores, total SA rates, revision rates, complication rates, and discharge status.

Findings …

Worse Postoperative Outcomes And Higher Reoperation In Smokers Compared To Nonsmokers For Arthroscopic Rotator Cuff Repair, Susan G. Wager, Spencer Brown, Michael Gaudiani, Joshua P. Castle, Eric Jiang, Vasilios Moutzouros, Eric Makhni, Stephanie J. Muh

Medical Student Research Symposium

Introduction: Smoking impairs healing potential and is a significant risk factor for complications following orthopaedic surgeries. The purpose of this study was to determine if a cohort of former or current smokers at time of surgery met the minimally clinical important difference (MCID) for Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE), Depression (PROMIS-D), and Pain Interference (PROMIS-PI) scores in comparison to nonsmokers.

Methods: A retrospective review of patients who underwent rotator cuff repair was performed. Patients who completed preoperative and 6-month postoperative PROMIS scores were included. The MCID was calculated using a distribution technique with a threshold of 0.5 …

The Top 50 Most Cited Articles On The Medial Patellofemoral Ligament (Mpfl): A Bibliometric Analysis, Varag Abed, Alex Duvall, Jonathan D. Rexroth, Alyssa Goodwin, Joseph Liu, Austin Stone

Medical Student Research Symposium

Objectives: To determine which original articles on the topic of the medial patellofemoral ligament (MPFL) have been cited the most in the literature utilizing a bibliometric approach. Secondarily, to determine temporal trends between article types.

Methods: Articles on the topic of the MPFL were identified by utilizing the Web of Science Database. The search yielded 1,596 results and the top 50 cited original articles were collected for further analysis. The following information was gathered for all included articles: title, first author's name, journal name, year of publication, impact factor of the journal in 2021, total number of citations of the …

Preoperative Promis Depression Scores Can Predict Failure To Improve After Trapeziectomy And Lrti, Shreya Balusu, Hardy Evans Md, Eric Jiang Md, Matthew Myhand, Noopur Ranganathan, Charles Day Md

Medical Student Research Symposium

INTRODUCTION: Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been utilized in setting realistic post-intervention expectations. Having a model to stratify likelihood of improvement based on pre-operative variables may allow for better decision making and patient counseling. We hypothesized that preoperative PROMIS scores correlate with patients’ subjective level of improvement after trapeziectomy and ligament reconstruction with tendon interposition (LRTI)

METHODS: Retrospective chart review was performed to identify patients who underwent trapeziectomy and LRTI. Demographic data along with preoperative PROMIS Upper Extremity (UE), Pain Interference (PI), Depression (DP), and QuickDASH (QD) scores were collected. At their follow-up appointment, patients were asked …

Preoperative Promis Depression Scores Can Predict Failure To Improve After Trapeziectomy And Lrti, Shreya Balusu, Hardy Evans Md, Eric Jiang Md, Matthew Myhand, Noopur Ranganathan, Charles Day Md

Medical Student Research Symposium

Introduction

Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been utilized in setting realistic post-intervention expectations. Predicting likelihood of improvement based on pre-operative variables may allow for better decision-making and patient counseling. We hypothesized that preoperative PROMIS scores correlate with patients’ subjective level of improvement after trapeziectomy and ligament reconstruction with tendon interposition (LRTI)

Methods

Retrospective chart review was performed to identify patients who underwent trapeziectomy and LRTI. Preoperative PROMIS Upper Extremity (UE), Pain Interference (PI), Depression (DP), and QuickDASH (QD) scores were collected. At follow-up appointments, patients were asked an anchor question: “Since your treatment, how would you rate …

High Variability Exists In Reporting Clinical And Patient-Reported Outcome Measures Following Meniscal Surgery, Leah Shephard, Varag Abed, Michael Nichols, Andrew Kennedy, Camille Khalily, Caitlin Conley, Cale Jacobs, Austin V. Stone

Medical Student Research Symposium

Purpose: To evaluate the variability in outcomes following surgical meniscal repair and compare responsiveness between patient reported outcome measures (PROMs).

Methods: A systematic search of the PubMed/MEDLINE and Web of Science databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A total of 257 unique studies met inclusion criteria. Patient and study attributes were extracted, including pre- and postoperative means for PROMs. Of the studies that met inclusion criteria for responsiveness analysis (2+ PROMs reported, 1-year minimum follow-up; n=172), we compared the responsiveness between PROM instruments using effect size and relative efficiency (RE) if …

Do Lower Extremity Injuries Of Nfl Players Affect Their Yearly Income?, Abdullah Sahyouni, Robert De La Torre, Gautham Pavar, Kinan Sawar, Yasmeen Alcodray, Bohdan Matsko, Justin Bennie, Nicole Xu, Harika Bollineni

Medical Student Research Symposium

Introduction: Injuries are arguably the most daunting career setbacks professional sports players have to face. To better understand the drawbacks of sports injuries, we decided to examine players’ annual income before and after sports injuries. Income is arguably the most important metric of success for professional athletes. To make the study more relevant for the US, we collected data on one of the most viewed professional sports leagues in the country: the National Football League (NFL).

Methods: We examined the NFL’s weekly injury reports for seasons from 2016 to 2020, and recorded players with lower extremity injuries (LEI) (Hamstring, Calves, …

Towards Standardized, Safe And Efficacious Screening Approaches To Patients With Lower Extremity Peripheral Arterial Disease In The Setting Of Lower Extremity Arthroplasty, Zaina N. Khoury, Adam Pearl, Ahmad Hassan, Mohamed Awad, Khaled Saleh

Medical Student Research Symposium

INTRODUCTION: Peripheral arterial disease (PAD) impedes recovery from lower extremity arthroplasties (LEA) and increases risk of complications/mortality, yet there aren’t standards for screening PAD patients pre-LEA. This review proposes some.

METHODS: This review searched databases for articles containing relevant terms. Non-English articles, those unrelated to LEA, and duplicates were excluded. Articles were cross-referenced to find other relevant papers for a total of 111.

RESULTS: Up to 49.2% of PAD patients have CAD. Wagner grade III/IV ulcers increase amputations and decrease wound closures. The Wound, Ischemia, and Foot Infection (WIfI) system provides more accurate, and therefore actionable, assessment. Overlooking PAD in …

Promis Mcid And Scb Achievement In Rotator Cuff Repair, Nikhil Yedulla, Joseph S. Tramer, Alexander Ziedas, Sreten Franovic, Mit Patel, Stephanie Muh, Eric C. Makhni

Medical Student Research Symposium

The purpose of this study was to establish threshold score changes to determine minimal clinically important difference (MCID) and substantial clinical benefit (SCB) in PROMIS computer adaptive test (CAT) scores following rotator cuff repair (RCR). Patients undergoing arthroscopic RCR were identified over a 24-month period. PROMIS CAT forms for upper extremity physical function (PROMIS-UE), pain interference (PROMIS-PI), and depression (PROMIS-D) were utilized. Analysis of variance testing with post hoc least significant difference pairwise comparisons and Tukey’s B subset analysis were used in determining if anchor question responses showed statistically significant differences between answers. These findings were used to establish two …

Recovery Time Following Operative Versus Nonoperative Humeral Shaft Fracture Treatment, Susan Wager, Trevor D. Wolterink, Jager Haan, Yash Hedge, Chrystina James, Stephanie J. Muh

Medical Student Research Symposium

INTRODUCTION: Humeral shaft fractures represent approximately 5% of fractures in the United States. Treatment modalities include nonoperative, and operative with open reduction internal fixation (ORIF) or intramedullary nail (IMN). There is no consensus on which option is best. The purpose of this study was to compare the length of time from fracture care to radiographic union between nonoperative, ORIF, and IMN treatments for humeral shaft fractures.

METHODS: This retrospective study analyzed trends in the management of midshaft humerus fracture between July of 2013 and December of 2020. Fracture characteristics and treatment outcomes were recorded from patients with humeral shaft fractures …

Time-To-Surgery And Short-Term Outcomes Of Trimalleolar Ankle Fracture During The Covid-19 Pandemic, Gabriel Burdick Bs, Rami Beydoun Bs, Alexander Pietroski Ms, Jonathan Warren Bs, Bushra Fathima Bs, Trevor Wolterink Bs, Michael Mcintosh Bs, Neethi Sriranga Bs, Stephanie Muh Md

Medical Student Research Symposium

PURPOSE: The purpose of this study was to evaluate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on time-to-surgery, complication rates, and functional outcomes of open reduction and internal fixation (ORIF) for trimalleolar ankle fracture.

METHODS: This retrospective cohort study compared patients who underwent ORIF for trimalleolar ankle fracture between April and July of 2020 of the COVID-19 pandemic (COVID group) to a pre-pandemic cohort treated in 2018 (2018 group). Demographic information, fracture characteristics, and surgical outcomes were collected from patients’ medical charts.

RESULTS: The COVID and 2018 groups consisted of 32 and 100 patients, respectively. The two groups …

Corticosteroid Injection Exhibits Symptomatic Improvement In Cts Patients With Negative Emgs, Brooke G. Garnica, Aaron R. Prater, Elizabeth A. Washnock-Schmid, Alaa Hazime, Dr. Charles S. Day

Medical Student Research Symposium

Introduction

While corticosteroid injections for carpal tunnel syndrome (CTS) are effective in patients with mild EMGs, no literature has examined the effectiveness of injections in patients with negative EMGs. We hypothesized that patients with negative EMGs will have minimal symptomatic and functional improvement.

Methods

The Boston Carpal Tunnel Questionnaire (BCTQ) was administered to patients clinically diagnosed with CTS and a negative or mild EMG prior to corticosteroid injection. The BCTQ comprises functional (FSS) and symptom status (SSS) questions. The patient was re-evaluated at 2-weeks, 1-, 3-, and 6-months post-injection. Data were analyzed via one-way ANOVA tests. A post-hoc Benjamini-Hochberg FDR …

Hospital-Acquired Venous Thromboembolism Or Bleeding Following Total Joint Arthroplasty: A Systematic Review And Meta-Analysis For The Association Of The Gene Polymorphism., Michael Debeau

Medical Student Research Symposium

This review seeks to understand the current existing literature on genetic polymorphisms to VTE following orthopedic surgery. Using PRISMA guidelines, 234 studies were retrieved from PubMed and Cochrane. The eligibility assessment yielded 16 studies including a systematic review. A STREGA and STROBE quality assessment found these studies to have high methodological quality. A significant association was found between the PAI-1 4G/4G genotype and resistance to anticoagulation therapy (OR = 2.692; 95% CI = 1.302 - 4.702). Moreover, the MTHFR C677T and A1298C polymorphisms significantly increased the incidence of VTE in patients that are compound heterozygotes (OR = 2.89; 95% CI …

When Do Patients Achieve Promis Milestones Following Anterior Cruciate Ligament Reconstruction?, Kareem Elhage, Nikhil R. Yedull, Nabil Mehta, David N. Bernstein, Eric C. Makhni

Medical Student Research Symposium

National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive test (CAT) assessments have become increasingly utilized within sports medicine due to their efficient administration and favorable correlation with traditional patient reported outcome measures (PROMs). One key advantage of CAT forms is the ability to draw from hundreds of item bank questions while utilizing very few questions in order to produce an accurate quantitative health measurement for the patient.



The Computer Adaptive Tests (CAT) algorithm assigns questions based on previous answers by the patient. The purpose of this study is to utilize this feature of the PROMIS …

Can Opioids Be Eliminated After Arthroscopic Meniscus Surgery? A Prospective Randomized Controlled Trial, Muhammad J. Abbas Bs, Toufic R. Jildeh Md, Kelechi R. Okoroha Md, Noah Kuhlmann Bs, Austin Cross Bs, Vasilios Moutzouros Md

Medical Student Research Symposium

Purpose: To compare a multimodal nonopioid pain protocol to traditional opioid medication in controlling postoperative pain following arthroscopic meniscal surgery.

Methods: Ninety-nine patients undergoing primary meniscectomy or meniscal repair were assessed for participation. A prospective randomized control trial was performed in accordance with the Consolidated Standards of Reporting Trials 2010 (CONSORT) statement. The two arms of the study included a multimodal non-opioid analgesic protocol and a standard opioid regimen with a primary outcome of postoperative pain level (visual analog scale) for 10 days. Secondary outcomes included patient reported outcomes, complications and patient satisfaction. Randomization was achieved using a random number …

Comparison Of Pre- And Post-Operative Shoulder Muscle Emg Profiles In Reverse Total Shoulder Arthroplasty Patients, Emily Lau, Sreten Franovic, Noah Kuhlmann, Eric C. Makhni Md, Stephanie Muh Md

Medical Student Research Symposium

Background: Deltoid muscle function is central in reverse total shoulder arthroplasty (RTSA) function; however, there is limited information available regarding changes in deltoid activity before and after surgery. Few tests exist to evaluate specific muscle metrics pre and post operatively. Surface Electromyographic (EMG) is non-invasive and allows for observation of motions with multifaceted analysis of movement with minimal patient demand. Understanding the changes in shoulder muscle activation, namely in the deltoid, in patients pre and post-RTSA can further advance understanding of the procedure and rehabilitation efforts.

Methods: Nine individuals were recruited for this study: all patients underwent RTSA by a …

Application Of Laser Technology In The Non-Surgical Management Of Periprosthetic Joint Infection (Pji); Novel Insights From Peri-Implantitis, Kareem Giovanni Elhage, Mohamed Awad, Ahmad Hasan, Brendan Farley, Khaled Saleh

Medical Student Research Symposium

Introduction: The management of periprosthetic joint infection (PJI) is challenging, and its socio-economic impact is significant. Moreover, the incidence of MRSA and other resistant organisms are on the rise. Recently, laser technology has been incorporated into treatment protocols of dental peri-implantitis. This review explores the possibility of using laser technology to manage peri-implantitis.

Methods: This article will provide a detailed, comprehensive, and perspective review of the existing evidence of laser technology in management of dental peri-implantitis.

Results: Dental literature investigated the efficacy of several types of lasers. It was shown that diode lasers improved periodontal probing depth (PPD) and bleeding …

The Use Of Urine Drug Testing For Risk Stratification And Efficacious Drug Monitoring In Pain Management Settings, Ahmad I. Hasan, Kareem Elhage, Brendan Farley, Khaled J. Saleh

Medical Student Research Symposium

Objective: To understand the current landscape of urine drug testing (UDT) guidelines as part of risk assessment for opioid abuse, and to offer recommendations towards adopting universal screening guidelines.

Background: There has been an opioid epidemic within the United States, and the role of prescription opioids has been well established. Despite proposed recommendations, there has yet to be a published universal screening guideline on the use of UDT in the setting of opioid abuse risk stratification as well as postoperative drug monitoring.

Methods: We explored current guidelines for UDT on two levels. First, we explore general indications for UDT within …

Upper-Extremity Injuries Are The 2nd Most Common Workplace Injuries From 1992 To 2018, Nikhil R. Yedulla, Dylan S. Koolmees, Eric B. Battista, Syed S. Raza, Zachary A. Montgomery, Charles S. Day

Medical Student Research Symposium

Musculoskeletal injuries occur frequently in the workplace, yet it is unclear whether upper-extremity, lower-extremity, or trunk injuries are the most prevalent. We hypothesize that: (1) trunk injuries are the most common in the overall workplace, and (2) upper-extremity injuries are more common in labor-based industries than non-labor industries. Workplace related injury data from 1992 to 2018 was collected from the Bureau of Labor Statistics “Workplace Injuries & Illnesses” database. Occurrence of trunk, upper-extremity, and lower-extremity injuries in major industries (agriculture, construction, manufacturing, and healthcare) were aggregated during this time period and compared. Overall workplace related injury occurrence in major industries …