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Abstract Background and aims BotulinumtoxinA (BoNT-A) is a guideline-recommended treatment for spasticity following stroke. We evaluated BoNT-A treatment persistence drivers of discontinuation and predictors of non-persistence in patients with stroke. Methods Eligible adults had received ≥1 treatment cycle with BoNT-A at the Mayo Clinic (January 2010–June 2023) and had an International Classification of Diseases (ICD9/10) code for stroke. Patients with ICD9/10 codes for migraine, cerebral palsy, cervical dystonia, or bladder dysfunction were excluded. Index date (baseline) was the date of first BoNT-A treatment; follow-up was 2 years post-index. Patients were persistent if all treatment intervals post-index were ≤the 80th percentile of all patients. Reasons for discontinuation were identified by AI natural language processing analysis of physicians’ free-text notes. Baseline characteristics associated with non-persistence were identified using step-wise logistic regression analyses. Results Overall, 407 patients were included. The 80th percentile of the BoNT-A treatment interval was 154 days; 5.7% of patients were persistent. Mean (95%CI) number of BoNT-A treatments over the 2-year follow-up was 2.43 (2.24–2.63) cycles. Comorbidity burden was high (Table 1). The most common reasons for BoNT-A discontinuation were patient- and physician-reported lack of treatment effectiveness (Table 2). Older age, Hispanic/Latino/unknown/undisclosed ethnicity, presence of comorbidities, and use of medications of interest at baseline (skeletal muscle relaxants, antidepressants, anticonvulsants, opiates, sedatives/hypnotics, NSAIDs) were significantly associated with non-persistence (Table 3). Conclusions Over 2 years, BoNT-A treatment persistence was low. Lack of treatment effectiveness was the most common reason for discontinuation. Addressing drivers of non-persistence may help improve BoNT-A treatment outcomes. Conflict of interest Funding: Ipsen. Disclosure of Conflicts of Interest: Michael Wainberg: has received consulting fees from Ipsen. Billie Schultz: has received consulting fees from Ipsen. Jinming Zhang, Simon Page, Jonathan Bouchard, Amandeep Mann, Mathieu Beneteau are employees of Ipsen. Table 1 - belongs to Conclusions Table 2 - belongs to Conclusions Table 3 - belongs to Conclusions

Abstract: In knee arthroscopy procedures, maintaining the opening of the medial compartment requires an assistant. Creating the posterior portal in knee arthroscopy is also a challenge because of the shape changes of the thick muscle. The leg is usually placed on the surgical bed, is angled off the lateral aspect of the bed, or drapes over the surgical bed in which the leg plates are removed. However, the aforementioned positions have some limits because of surgical convenience and procedural stability. In this Technical Note, we propose an approach to improve the existing knee positions using a metal round stool as a foot support. The method aims to reduce reliance on human assistants during knee arthroscopy procedures and restore the natural positioning of leg muscles, potentially improving procedural outcomes. Technique Video video See video under supplementary data.