Citations

Purpose To evaluate the agreement between a simple magnetic resonance imaging‐based measurement method for determining the patellar tendon‐to‐lateral trochlear ridge (PT‐LTR) distance using an external adhesive marker and a previously validated conventional measurement technique. Methods Patients diagnosed with patellofemoral instability before undergoing primary patellar stabilization surgery at a single institution between 2020 and 2024 were eligible for inclusion. PT‐LTR distances were measured in a blinded fashion by 2 musculoskeletal‐trained radiologists using the conventional technique and by an orthopaedic group using the simple technique. Interrater reliability between the musculoskeletal‐trained radiologists and between the orthopaedic groups was calculated using intraclass correlation coefficients (ICCs) and concordance correlation coefficients (CCCs) and subsequently intermethod reliability between the 2 groups. The measurements were plotted on concordance correlation graphs. Results One hundred knees (38 right, 62 left) from 97 patients (37 men, 60 women; mean age 22 ± 9 years) were included. The average distance for PT‐LTR measured by the radiologists using the conventional technique was 10.9 ± 7.5 mm and by the orthopaedic group using the simple technique was 9.3 ± 6.8 mm. Excellent interobserver agreement was noted for the radiologist group (ICC 0.941, 95% confidence interval [CI], 0.914‐0.960; CCC 0.941, 95% CI, 0.915‐0.959) and orthopaedic group (ICC 0.976, 95% CI, 0.964‐0.985; CCC 0.976, 95% CI, 0.965‐0.984). Excellent intermethod agreement was noted between the 2 techniques (ICC 0.903, 95% CI, 0.775‐0.942; CCC 0.902, 95% CI, 0.861‐0.932). Conclusions There was excellent interobserver reliability for measuring PT‐LTR distance using both the conventional radiologist‐based technique and the external adhesive marker technique. Excellent intermethod agreement was also shown between the 2 techniques, with comparable mean measurements between groups; thus, the simple technique can be used as a reproducible alternative for PT‐LTR distance. Level of Evidence Level III, retrospective comparative study.

Abstract ICLA14 - The Extra-Articular Masterclass: Endoscopic Repairs, Ischiofemoral Fixes, and Complex Alignment, Auditorium A (BMCC Level 1), October 9, 2026, 14:00 - 16:00 Introduction Female patients presenting with hip and groin pain are frequently evaluated for pre-arthritic hip conditions including femoroacetabular impingement, acetabular dysplasia, and labral tears. However, extra-articular pelvic pain generators may mimic intra-articular hip disorders in female patients, potentially leading to misdiagnosis, delays in care, and unnecessary interventions. The purpose of this study is to characterize and distinguish pelvic sources of pain in patients presenting for evaluation of hip joint pathology. Methods Consecutive female patients aged 20-75 years referred for evaluation of hip pain at a tertiary level hip preservation center were identified. Patients determined to have pain due to primary extra-articular pelvic etiologies were included in the series. Clinical characteristics incorporating clinical history, physical examination, diagnostic imaging studies, and appropriate referrals and interventions were included for review. Results In this retrospective study, twenty cases were identified where female patients had intrapelvic etiologies that were found to contribute to their symptoms of hip pain. Eleven patients demonstrated normal hip radiographs (55%) and seven had mild degenerative changes (35%). Two had a normal hip physical exam (10%), with eleven having positive FADDIR (Flexion, Adduction, Internal Rotation, 55%) and seven having tenderness in the groin/adductor (35%). Cross-sectional imaging identified intrapelvic etiologies of pain in eighteen cases (90%) with two being extra-articular but idiopathic (10%). Eight were pelvic congestion (40%), four were endometriosis (20%), three were leiomyomas (15%), and three were ovarian cysts (15%). Eight underwent pelvic floor therapy (40%). Seventeen had gynecologic referral (85%) and four had vascular surgery or interventional radiology referral (20%). Six underwent surgical hip intervention (30%) and twelve underwent surgical extra-articular intervention (60%). Discussion It is essential for hip preservation surgeons to recognize that, while rare, intrapelvic sources of hip pain should be considered in female patients seeking care for pre-arthritic hip conditions. Discordance of clinical history, physical examination, or radiograph findings warrants further workup for an extra-articular source, often including advanced imaging of the abdomen and pelvis and referral to gynecologic and pelvic physical therapy specialists. A thorough history and physical exam complemented by cross sectional imaging can help reach an accurate diagnosis and facilitate appropriate management.

Purpose: To assess chest computed tomography (CT) manifestations of Legionella pneumonia (LP) in a large, well-characterized immunocompetent and immunocompromised patient cohort. Materials and Methods: This retrospective study identified LP patients across a multicenter hospital system over 84-months. Chest CTs were reviewed for presence and distibution of ground-glass opacity (GGO), consolidation, and numerous other findings. CT findings were categorized into lobar, bronchopneumonia, atypical, and mixed patterns. Evolution on follow-up CT was assessed. Results: 311/346 patients (median age 66.6 y [IQR: 55.9, 74.8]; 178 [57.2%] male) had CT examinations available. GGO (98.1%, 305/311) and consolidation (92%, 286/311) were the most prevalent findings, commonly coexisting. The segmental pattern occurred most frequently. The GGO and reverse halo signs occurred in 6.1% (19/311) and 3.5% (11/311), respectively. Follow-up CT occurred in 58.5% (182/311) (median=47.5 d), demonstrating improvement in 84.1% (153/182), worsening in 10.4% (19/182), stability in 5.5% (10/182), and new CT patterns in 12.6% (23/182). Respiratory co-infection occurred in 27.0% (84/311), commonly bacterial. Cavitation occurred in 7.1% (22/311), more frequently among co-infected patients (14.3%, 12/84) than isolated LP (4.4%, 10/227, P =0.005), even more common among immunocompromised patients (12.0% [18/150] vs. 2.5% [4/161], P =0.001), the highest prevalence among co-infected immunocompromised patients (21.3%, 10/47). Co-infection (odds ratio [OR]=3.26, 95% CI=1.33-8.00; P =0.01) and immunocompromise (OR=4.93, 95% CI=1.61-15.1; P =0.005) were independently associated with cavitation. Conclusions: LP presents nonspecifically with a multilobar segmental pattern of GGO and consolidation. Respiratory co-infection was common, often heralded by cavitation. CT findings improve after LP diagnosis.

Background The development and evaluation of anti-amyloid beta monoclonal antibodies (mAbs) for the treatment of Alzheimer’s disease have been accompanied by extensive ethical debate spanning clinical trials, regulatory processes, prescribing practices, and healthcare delivery. This scoping review examined literature published between 2006 and 2026 to identify and clarify the landscape of ethical considerations surrounding the implementation, prescribing, and delivery of anti-amyloid mAbs across both research and clinical settings. Methods We searched PubMed, Scopus, Web of Science, Embase, and Ovid EBM Reviews (including CENTRAL and CDSR) from 2006 to March 2026 using a structured search strategy. Eligible publications focused on ethical issues associated with the clinical translation of anti-amyloid mAbs. Two reviewers independently screened titles, abstracts, and full-text articles, with duplicate extraction performed on an initial subset of publications. The review was conducted using JBI guidance and reported according to PRISMA-ScR. Results We identified 84 publications from 23 countries published between 2014 and 2026, including 12 original research studies, 1 systematic review, and 71 commentaries, narrative reviews, legal analyses, or practice guidelines. Analysis identified 32 subthemes, which were synthesized into 7 overarching themes: (1) beneficence and nonmaleficence, (2) respect for persons, (3) equity and accessibility, (4) evidence and trial integrity, (5) governance and stewardship, (6) relational and social impacts, and (7) health system readiness and sustainability. Among the 32 subthemes, uncertain clinical benefit and risk of harm (both within the beneficence and nonmaleficence theme) were discussed most frequently within the literature, each appearing in 61 publications. Conclusions The biomedical literature documents a broad range of ethical considerations relating to anti-amyloid mAbs. Despite this growing literature, it is primarily based on commentary, with few empirical studies, and even fewer incorporating the perspectives of patients, families, and clinicians. Doing so may add further context and nuance to ethical discussion about mAbs in the years ahead.

The immune tumor microenvironment (iTME) plays a crucial role in disease biology of plasma cell (PC) dyscrasias, but remains poorly characterized in self-identified Black individuals, a population at increased risk. Mass cytometry and scRNA-seq of 128 bone marrow aspirates revealed significant changes in immune cell composition across the disease spectrum, including shifts from naïve to effector T cells with declines in B cells, MAIT, pDCs, and increases in monocytes with disease progression. Self-identified Black patients had higher relative proportions of terminally differentiated T cells and lower monocytes in newly diagnosed and treated multiple myeloma (MM). ScRNA-seq revealed genes overexpressed in self-identified Black individuals were enriched for E2F targets and G2-M checkpoints, while reduced genes were enriched for TNF-α/NF-kB, interferon and inflammatory responses pathways. These findings were supported by genetic ancestry and validated in an independent dataset of 286 patients with MM from the MMRF Immune Atlas. Self-identified race and African genetic similarity are significantly associated with remodeling the MM iTME, with potential implications for disease biology and treatment response.

Abstract Systematic reviews condense clinical trials into evidence tables, yet clinicians can interrogate these tables only through database queries, and many questions concern attributes that the table does not record, such as a drug’s target class or a harmonised endpoint. Here we introduce FD-SCoPE, a language-model framework that answers both kinds of question, exposes the query, the selected trials and the derivation rule behind every answer, and learns from expert corrections. On an oncology evidence table of 159 immune checkpoint inhibitor trial records, FD-SCoPE completed all 140 clinician-style tasks (alternatives, 90.7–97.9%). For questions needing derived attributes it retrieved 99.3% of relevant trial records at a positive predictive value of 89.8% and outperformed four alternative approaches (derived-value F1 77.7% versus 64.8–73.4%). Corrections on 299 questions, simulated from reference answers, raised F1 on 1,201 unseen questions from 77.9% to 84.9%. Language models coupled with executable queries, verified programs and expert feedback can give clinicians auditable access to trial evidence.

Importance Rapid whole-genome sequencing (WGS) has advanced inpatient genetic diagnosis, although most evidence comes from neonatal and pediatric intensive care unit (ICU) populations. Its utility for pediatric neurology inpatients across broader acute settings remains insufficiently established. Objective To assess the diagnostic yield, clinical impact, and factors associated with phenotype-concordant rapid WGS diagnoses. Design, Setting, and Participants This was a retrospective cohort study conducted from June 1, 2022, through January 17, 2026, at a tertiary medical center. Pediatric inpatients in the neonatal ICU, pediatric ICU, or general floor with an unexplained neurologic presentation were included. Those with established nongenetic etiology were excluded from analyses. Exposures Trio (77.8%), duo (9.1%), or singleton (13.1%) rapid WGS. Main Outcomes and Measures The primary outcome was the initial phenotype-concordant diagnostic yield at the point of care. Secondary outcomes were reanalysis yield (new diagnoses from reinterpreting nondiagnostic cases prompted by a new unexplained phenotype or family request), cumulative yield, and management change. Associations were assessed by logistic regression (odds ratios [ORs] and 95% CIs). Results Among 175 children (median [IQR] age, 4 months [1 day-4 years]; 93 male [53.1%]) who met inclusion criteria (82 neonates, 93 nonneonates), initial rapid WGS established a phenotype-concordant diagnosis in 79 (45.1%), higher in nonneonates (49 of 93 [52.7%]) than neonates (30 of 82 [36.6%]). Preliminary results returned at mean (SD) 4.0 (1.6) days and final reports at 10.4 (4.5) days. Positive nonconcordant findings occurred in 33 children (18.9%). Reanalysis of 14 nondiagnostic cases yielded 3 additional diagnoses, for a cumulative yield of 82 of 175 children (46.9%). Most diagnoses were monogenic (63 [76.8%]). Management changed in 54 of 82 phenotype-concordant cases (65.9%; 53 at the point of care, 1 after reanalysis) and 8 of 33 (24.2%) positive nonconcordant cases. Family history was most strongly associated with diagnosis (adjusted OR [aOR], 6.46; 95% CI, 3.23-12.93; P < .001), followed by multisystem involvement (aOR, 2.85; 95% CI, 1.24-6.54; P = .01) and congenital anomaly or dysmorphism (aOR, 2.47; 95% CI, 1.07-5.68; P = .03). Hypotonia was most strongly associated in neonates (OR, 20.63; 95% CI, 5.46-77.87; P < .001); ICU admission (OR, 10.25; 95% CI, 2.79-37.67; P < .001) predominated in nonneonates. Conclusions and Relevance Results of this cohort study suggest that rapid WGS diagnosed nearly half of pediatric neurology inpatients and changed management in two-thirds of diagnosed cases, supporting its potential use as early diagnostic testing. Associated features may guide patient selection, and reanalysis extends yield longitudinally.

Abstract ICLB03 - The Labral Reconstruction Masterclass: Autografts, Allografts, and Technical Frontiers, Session Room 12 (BMCC Level 3), October 8, 2026, 10:30 - 12:30 Purpose The purpose of this study was to compare patient-reported outcomes and incidence of revision surgery based on tear location, size, and number of anchors placed at minimum 10-year follow-up in patients undergoing hip arthroscopy. Methods A retrospective cohort study was conducted of patients undergoing primary hip arthroscopic labral repair between January 2011 and December 2014 at a single academic institution. Patients with revision procedures, prior ipsilateral hip surgery, labral debridement, or <10-year follow-up were excluded. Tear arc size and number of anchors were recorded from operative reports. Patient-reported outcome measures (PROMs) included modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports (HOS-Sports), Tegner, Visual Analog Score (VAS), and satisfaction (0-10). Associations between number of anchors and tear size with PROMs were assessed with univariate and multivariate linear regression. Multivariate logistic regression was used to evaluate predictors of reoperation or conversion to total hip arthroplasty (THA). Results Seventy-three hips were included (mean age 36.2±10.8 years; 72.6% female) with mean follow-up 10.9±0.7 years (range: 10.0-13.0). At ≥10 years, mean mHHS was 79.6±17.2, HOS-ADL 83.4±17.1, HOS-Sports 72.8±25.5, Tegner 3.8±1.5, VAS 2.4±2.7 (rest) and 2.7±2.7 (use), and satisfaction 8.5±2.4. Tear arc was not associated with any PROMs on regression analysis. In multivariable analysis, each additional anchor was associated with lower HOS-ADL (β=-5.6, p=0.048) and HOS-Sports (β=-8.5, p=0.044) and higher VAS pain at rest (β=0.8, p=0.048). No association was observed between anchor number or tear arc size and subsequent surgery. Conclusions After 10 years following arthroscopic labral repair, tear arc size was not associated with PROMs or revision/THA risk. Higher anchor number was associated with modestly lower PROMs but did not increase reoperations rates. Repairs of both small and large tears, when appropriately stabilized, demonstrate durable long-term benefit.

ABSTRACT Background Atrial fibrillation (AF) has been observed in adults with anomalous pulmonary venous return (APVR), but data on catheter ablation outcomes in this population remain limited to case reports and small series. Methods We retrospectively reviewed 14 adult patients with confirmed APVR who underwent catheter ablation for AF at three tertiary academic centers in the United States between July 2003 and May 2025. Baseline, procedural, electroanatomic mapping, and outcome data were collected. Freedom from atrial arrhythmia recurrence was estimated by Kaplan-Meier analysis. Results Mean age was 56 ± 13 years and 79% were male. Heart failure was present in 64%, and hypertension and coronary artery disease in 43% each. Most had partial APVR (86%), and 57% had prior surgical correction. Radiofrequency ablation was used in all patients, combined with pulsed-field ablation in one. Acute success was achieved in all patients, although areas with residual pulmonary vein or SVC electrical activity were left untreated in 3 (21%). Non-pulmonary-vein electrical activity was more common in patients with prior surgical correction than in those without (43% vs 17%). Median follow-up was 3.4 years (IQR, 2.0-9.6). Freedom from arrhythmia recurrence was 78.6% at 1 year and 53.9% at 5 years. Two patients (14%) required reablation; complications occurred in 3 (21%) without long-term sequelae. Conclusions Catheter ablation was acutely successful in all patients in this largest reported APVR cohort, despite substantial comorbidity burden and anatomic complexity. The arrhythmogenic substrate often extended beyond the anomalous vein, particularly in surgically corrected patients, supporting individualized, substrate-guided ablation in this population. CLINICAL PERSPECTIVE What Is Known Atrial fibrillation has been reported in adults with anomalous pulmonary venous return (APVR), but data on catheter ablation outcomes in this population are limited to case reports and small series. What the Study Adds In the largest reported cohort of patients with APVR undergoing catheter ablation for atrial fibrillation, pulmonary vein isolation achieved acute success in all patients despite substantial comorbidity burden and anatomic complexity. Non-pulmonary-vein sites of electrical activity were more common among patients with prior surgical correction, and postsurgical scar and epicardial venoatrial connections were also arrhythmogenic, indicating that the arrhythmogenic substrate in APVR often extends beyond the anomalous vein itself. These findings support individualized, substrate-guided mapping in patients with APVR, particularly those with a surgical history, and suggest a role for pulsed-field ablation near critical structures such as the phrenic nerve.