Citations

Background Overhead athletes are susceptible to shoulder injuries, among which rotator cuff injuries are common and often directly associated with muscle weakness. Therefore, valid and reliable measures of rotator cuff strength at sport specific positions may be a vital part of sports physical therapy practice. Purpose: The current study aimed to determine the inter- and intra-tester reliability of measuring shoulder internal rotation (IR) and external rotation (ER) strength at a novel testing position, 130° of abduction and compared to the 90°/90° position. A secondary aim was to assess concurrent validity between measurements taken with the Humac® Norm™ Isokinetic Dynamometer (IKD) and Microfet® 2 hand-held dynamometer (HHD). Study Design Inter-Rater and Intra-Rater Reliability and Criterion Validity Methods Twenty-five (n=25) healthy participants were recruited for this study. Exclusion criteria included prior shoulder surgery, shoulder injury within the last three months, and contraindications to exercise according to ACSM guidelines. Participants performed maximal isometric shoulder external and internal rotation strength testing at both 90° and 130° of shoulder abduction. On the first day, participants were tested on the IKD at both positions, followed by each tester using the HHD. Participants returned 7-14 days later for repeat testing using the HHD only. ICC values were calculated for each rater, instrument, and testing position. Bland-Altman plots were created to establish limits of agreement. Minimal detectable change values were calculated. Results Inter- and intra-rater reliability for testing isometric strength using a hand-held dynamometer was good to excellent for both shoulder positions with ICC values consistently above 0.8. Concurrent validity between the HHD and IKD was poor to moderate with ICC values ranging from 0.1-0.4. However, Bland-Altman plots demonstrated that the difference in strength measures was within the limits of agreement. Conclusion Shoulder IR and ER strength testing at 130° of abduction shows strong inter-rater and intra-rater reliability for measurement in sport specific positions. Level of Evidence Level 3

Abstract Introduction: Periacetabular osteotomy (PAO) is a complex procedure historically requiring inpatient stay. There is increased emphasis for these to be performed on an outpatient basis by insurance companies. The purpose of this study was to investigate the proportion of various surgical listing classifications (outpatient, outpatient-overnight, inpatient), the incidence of subsequent denial/request for additional documentation for approval of inpatient stay, and to characterize the average length of stay (LOS) following PAO. Methods: A retrospective chart review was performed to identify all PAOs, performed by four participating surgeons, at a single academic institution over a two-year period. The initial listing status as an outpatient-overnight or inpatient procedure was identified. Whether a preoperative peer review was required for approval of inpatient listings as well as if additional documentation was necessary to convert outpatient-overnight listings to inpatient stays were also recorded. Results: A total of 140 PAOs amongst 117 patients were performed with 25 (17.9%) initially listed as an inpatient stay and 115 (82.1%) listed as outpatient-overnight. Of the 25 PAOs listed as inpatient, 2 (8.0%) required a preoperative peer review process to justify or clarify listing status. The average LOS was 1.9 ± 1.4 days with 55.7% (78/140) of PAOs staying two or more nights in the hospital. Only 6 PAOs (4.3%) went home the same day as surgery. Of the 115 PAOs listed as an outpatient-overnight, 53 (46.1%) converted to an inpatient stay. Conclusion: Over half of PAOs performed required inpatient stay beyond outpatient-overnight status. Preoperative peer-to-peer review for inpatient stay approval was modestly frequent (8% of inpatient listings), and all conversions to inpatient required additional service documentation to support status conversion. Understanding trends in postoperative hospitalizations and LOS might allow for better informed partnerships between surgeons and insurance companies creating more efficient pre-authorizations, billing practices, and expected patterns of patient care and discharge.

Abstract Background Most oncology therapeutics have limited distribution into the brain, and developing strategies to overcome this limitation would be clinically impactful. While therapeutic radiation is often cited as a strategy to accomplish this, there are no published studies demonstrating the effect of radiation on drug distribution into the brain or brain tumors. Methods Mice were treated with brain radiation (6 Gy × 5, 4 Gy × 10; 40 Gy × 1) and dosed with drugs (levetiracetam, cefazolin, nedisertib, brigimadlin, apitolisib, or GNE-317) at times ranging from just prior to months after radiation. Plasma and tissue drug concentrations were measured by LC-MS/MS. Results Radiation did not significantly enhance drug delivery into brain tissue for levetiracetam, cefazolin, GNE-317, apitolisib, or nedisertib at any time post-radiation. Even a single, supra-therapeutic dose of radiation (40 Gy) did not significantly affect brain distribution of GNE-317 or apitolisib (P ≥ .07) from 16 to 160 hours post-radiation. For brigimadlin, radiation (6 Gy × 5) was associated with a modest but significant increase in drug accumulation only at 72 hours post-radiation (brain-to-plasma ratio 0.014 ± 0.006 vs. 0.025 ± 0.010, respectively; P = .04), but not at any other timepoint (24 hours, 15, 28, 94, 133, 183 days; P > .05). Similarly, radiation (6 Gy × 5) of orthotopic tumors did not increase levels of brigimadlin in GBM10 or GBM108 or nedisertib in GBM108 (P > .05). Conclusions Radiation had no meaningful impact on drug delivery into brain or brain tumors for the drugs tested.

Abstract Aims Artificial intelligence (AI) has the potential to transform cardiac electrophysiology (EP), particularly in arrhythmia detection, procedural optimization, and patient outcome prediction. However, a standardized approach to reporting and understanding AI-related research in EP is lacking. This scientific statement aims to develop and apply a checklist for AI-related research reporting in EP to enhance transparency, reproducibility, and understandability in the field. Methods and results An AI checklist specific to EP was developed with expert input from the writing group and voted on using a modified Delphi process, leading to the development of a 29-item checklist. The checklist was subsequently applied to assess reporting practices to identify areas where improvements could be made and provide an overview of the state of the art in AI-related EP research in three domains from May 2021 until May 2024: atrial fibrillation (AF) management, sudden cardiac death (SCD), and EP lab applications. The EHRA AI checklist was applied to 31 studies in AF management, 18 studies in SCD, and 6 studies in EP lab applications. Results differed between the different domains, but in no domain reporting of a specific item exceeded 55% of included papers. Key areas such as trial registration, participant details, data handling, and training performance were underreported (<20%). The checklist application highlighted areas where reporting practices could be improved to promote clearer, more comprehensive AI research in EP. Conclusion The EHRA AI checklist provides a structured framework for reporting AI research in EP. Its use can improve understanding but also enhance the reproducibility and transparency of AI studies, fostering more robust and reliable integration of AI into clinical EP practice.

Abstract Background: Prior studies have evaluated the efficacy of subchondroplasty for the management of subchondral cysts of the knee, yet few studies to date evaluate minimum 2-year outcomes following subchondroplasty of the acetabulum. Purpose: The purpose of this study was to evaluate minimum two-year outcomes following arthroscopic subchondroplasty for the treatment of acetabular subchondral cysts and to identify variables associated with total hip arthroplasty (THA) conversion following subchondroplasty. Study Design: Cases Series, Level of Evidence IV. Methods: A retrospective review of prospectively maintained data was performed on patients who underwent primary hip arthroscopy May 2019 to September 2021 by a single surgeon. Consecutive patients who underwent subchondroplasty for acetabular subchondral cysts with minimum two-year follow-up were identified. Demographics, magnetic resonance imaging (MRI), intraoperative findings, and clinical outcomes were evaluated. Cross-sectional area of the subchondral cysts was measured on MRI. Clinical outcomes included Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports Subscale (HOS-SS), international Hip Outcome Score-12 (iHOT-12), and visual analog scale for pain (VAS-Pain). Conversion to THA was recorded. The patients who converted to THA were compared to those who did not. Continuous variables associated with THA conversion were analyzed with receiver operating characteristic (ROC) curves to identify thresholds associated with THA conversion. Results: Twenty-nine patients underwent subchondroplasty for acetabular subchondral cysts with minimum two-year follow up (age: 48.2±11.1 years, body mass index: 29.9±6.6kg/m2, 52.0% female). The THA-free survivorship rate was 62.1%. Patients who achieved THA-free survivorship had smaller subchondral cysts (88.5±59.2 mm2 vs. 147.1±54.8, P=0.013) and a lower prevalence of high-grade femoral head chondral defects (16.7% vs. 54.5%, P=0.048) compared to patients who converted to THA. ROC analysis identified patients with a subchondral cyst <133 mm2 were 21.3 times more likely to achieve THA-free survivorship (P=0.001). The THA-free survivors demonstrated significant improvements across all measured PROs (P≤0.015). Conclusions: Subchondroplasty for acetabular subchondral cysts demonstrated a 62.1% THA-free survivorship at minimum 2-year follow-up, with survivors demonstrating significantly improved PROs. Patients with cysts <133 mm2 were 21.3 times more likely to achieve THA-free survivorship than patients with larger cysts. Keywords: Hip, Acetabulum, Subchondral Cysts, Subchondroplasty

Abstract Background: Osteochondral allograft and autograft transplantation for femoral head defects have emerged as promising treatments for concomitant cartilage and subchondral bone injuries in young patients. The purpose of this study was to evaluate the clinical and radiological outcomes of patients who underwent osteochondral allograft or autograft transplantation for femoral head defects and access any risk factors that may lead to conversion to THA. Methods: All patients who underwent osteochondral allograft or autograft transplantation for femoral head defects were analyzed. All patients had symptomatic femoral head osteochondral defects identifiable on advanced imaging such as computed tomography or magnetic resonance imaging. Clinical outcomes were assessed at final follow-up with the modified Harris Hip Score (mHHS), Hip Outcome Score – Activities of Daily Living (HOS-ADL), Hip Outcome Score – Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool (iHOT-12). Additionally, patients were assessed radiographically preoperatively and at a final postoperative visit using anterior-posterior and lateral radiographs for osteoarthritis using Tönnis grading. Results: A total of 27 patients were included in this study (19 osteochondral allograft transplantation, 8 osteochondral autograft transplantation). The overall mean follow-up was 4.7 years. The average mHHS, HOS-ADL, HOS-SSS, and iHOT-12 for the allograft cohort were 86.7, 92.8, 81.4, and 79.0, respectively, while for the autograft cohort it was 87.6, 92.7, 83.1, and 82.0, respectively. For the allograft cohort, there were a total of 5 reoperations (26.3%) consisting of 4 THA at a mean of 1.9 years and 1 trochanteric osteotomy nonunion at 0.7 year. For the remaining allograft patients who did not undergo treatment failure, only one (6.7%) had radiographic osteoarthritis progression. None of the patients in the autograft cohort underwent THA. Overall, conversion to THA was 14.8%. Conclusion: Osteochondral allograft and autograft transplantation for femoral head defects demonstrated overall favorable clinical outcomes and conversion to THA at mean 5-year follow-up and should be considered for patients with focal femoral head defects.

Abstract Introduction: Labral injury at the time of open and arthroscopic hip preservation surgery for symptomatic femoroacetabular impingement (FAI) is managed with debridement versus refixation by the treating surgeon based on tear pattern, tissue quality, and hip morphology. While refixation has been favored based on mid-term outcomes in some series, differences in the long-term patient reported outcomes (PROMS) have not been defined in well-designed and matched prospective series. Methods: This study consisted of a prospective, multi-center cohort that underwent primary surgical treatment for symptomatic FAI. Patients were included if they underwent corrective osteoplasty and a labral refixation or a labral debridement procedure. Using a ratio of 1:1, hips with labral refixation and labral debridement were matched by age, sex, and surgical approach. Postoperative assessments were conducted at a minimum 8 years after surgery using PROMS and assessment of reoperations. Results: A total of 237 hips (n=188 labral refixation, n=49 labral debridement) met the inclusion criteria for the current study. 48 hips from the labral refixation and 48 hips from debridement groups with mean follow-up of 10.3±1.7 years and 10.6±2.1 years respectively were included. No significant differences were observed in the femoral head, acetabular cartilage grade, or labral grade between the groups. The mHHS improved 19.8±19.6 and 23.4±16.8 from baseline to the final follow-up in the labral refixation and debridement groups, respectively (p=0.43). There were no significant differences in PROMS between the labral refixation and debridement groups. Overall, 66% and 76% of the labral refixation and debridement groups achieved the MCID for the mHHS respectively (p=0.30). There were more revision surgeries with labral refixation than with debridement (10.4% vs. 2.1%, p=0.09), but more conversions to total hip replacement in the labral debridement group (8.3% vs. 4.2%, p=0.38), but neither of these differences were statistically significant. Discussion: Both labral refixation and debridement are effective with durable improvement in PROMS at a mean of 10 years in a prospective cohort of patients treated surgically for symptomatic FAI. No significant differences in baseline or final PROMS were observed, and similar rates of revision and conversion to hip replacement were observed in the debridement and refixation groups.

Summary Introduction Peroral plication of the esophagus (POPE) can reduce sump size and improve symptoms in end-stage achalasia. However, its long-term efficacy and safety are unknown. Methods Patients with end-stage achalasia who underwent POPE at our institution (2016–2024) were identified. Data were abstracted for patient demographics, procedural details, and clinical and radiographic outcomes. Results Twelve patients underwent POPE. The technical success rate was 100%, with mean procedural time of 57 minutes and without adverse events. Symptomatic improvement occurred in 75% of patients (mean follow-up of 15 months), while 86% had radiographic improvement in sump size. Repeat POPE in 6 (50%) patients a mean of 2.6 years after index POPE and a third POPE in four (33%) patients a mean of 3.1 years later was performed, with similar technical success rates and outcomes to the index POPE. Conclusions POPE is a safe and repeatable long-term therapeutic option in end-stage achalasia.