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Kunze KN, Varady NH, Khorana A, Rodeo SA, Warren RF, Wickiewicz TL, Williams RJ. Defining clinically relevant outcome thresholds for pain and function after osteochondral autograft transplantation of the knee. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39126271 DOI: 10.1002/ksa.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 07/16/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE To define the minimal clinically important difference (MCID) for measures of pain and function at 2, 5 and 10 years after osteochondral autograft transplantations (OATs). METHODS Patients undergoing OATs of the knee were identified from a prospectively maintained cartilage surgery registry. Baseline demographic, injury and surgical factors were collected. Patient-reported outcome scores (PROMs) were collected at baseline, 2-, 5- and 10-year follow-up, including the International Knee Documentation Committee (IKDC) score, Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS), Marx activity scale and Visual Analogue Scale (VAS) for pain. The MCIDs were quantified for each metric utilizing a distribution-based method equivalent to one-half the standard deviation of the mean change in outcome score. The percentage of patients achieving MCID as a function of time was assessed. RESULTS Of 63 consecutive patients who underwent OATs, 47 (74.6%) patients were eligible for follow-up (surgical date before October 2021) and had fully completed preoperative PROMs. A total of 39 patients (83%) were available for a minimum 2-year follow-up, with a mean (±standard deviation) follow-up of 5.8 ± 3.4 years. The MCIDs were determined to be 9.3 for IKDC, 2.5 for Marx, 7.4 for KOS-ADLS and 12.9 for pain. At 2 years, 78.1% of patients achieved MCID for IKDC, 77.8% for Marx, 75% for KOS-ADLS and 57.9% for pain. These results were generally maintained through 10-year follow-ups, with 75% of patients achieving MCID for IKDC, 80% for Marx, 80% for KOS-ADLS and 69.8% for pain. CONCLUSIONS The majority of patients achieved a clinically relevant outcome improvement after OATs of the knee, with results sustained through 10-year follow-up. Patients who experience clinically relevant outcome improvement after OATs in the short term continue to experience sustained benefits at longer-term follow-up. These data provide valuable prognostic information when discussing patient candidacy and the expected trajectory of recovery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Arjun Khorana
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Russell F Warren
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Thomas L Wickiewicz
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
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Eshraghi N, Mirghaderi P, Omid R, Sajadi M, Pashapour‐Yeganeh A, Mortazavi SMJ. Cross-cultural adaptation and measurement properties of the Persian version of the modified Cincinnati knee rating system. J Exp Orthop 2024; 11:e70003. [PMID: 39193486 PMCID: PMC11347933 DOI: 10.1002/jeo2.70003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/31/2024] [Accepted: 06/11/2024] [Indexed: 08/29/2024] Open
Abstract
Purpose To validate and assess the cross-sectional adaptation of the modified Cincinnati knee rating system (MCRKS) Persian translation. Methods To assess test-pretest reliability, 102 participants were asked to fill out the MCRKS (Per) scale after anterior cruciate ligament (ACL) reconstruction surgery. Internal consistency (Cronbach's α), reliability (intraclass correlation coefficients), construct validity (Pearson's r) and sensitivity (floor/ceiling effect) were determined. In addition, patients completed other relevant measures as the ACL return to sports after injury (ACL-RSI) survey, hospital for special surgery ACL satisfaction survey (HSS ACL-SS), visual analogue scale (VAS) of pain and patient's satisfaction, Tegner activity score (TAS), single assessment numeric evaluation, and Lysholm score. Results Using MCRKS (Per), the internal consistency (Cronbach's α) was 0.9 (if item deleted: 0.81-0.86); the construct validity (Pearson's r) varied between -0.50 (for VAS pain scale) and 0.79 (for Lysholm score); the reliability (ICC value) varied between 0.82 and 0.97; furthermore, no ceiling or floor effect was present. Conclusion The MCRKS (Per) has adequate measurement properties and is considered a valid, reliable and sensitive instrument which can identify clinical outcomes after ACLR surgery. Level of Evidence Level IV.
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Affiliation(s)
- Nasim Eshraghi
- Surgical Research Society (SRS), Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Peyman Mirghaderi
- Surgical Research Society (SRS), Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Reza Omid
- Surgical Research Society (SRS), Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Mohamad Sajadi
- Surgical Research Society (SRS), Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Amirreza Pashapour‐Yeganeh
- Surgical Research Society (SRS), Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
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Schroeder HS, Israeli A, Liebergall M(I, Or O, Abu Ahmed W, Paltiel O, Justo D, Zimlichman E. Home Versus Hospital Rehabilitation of Older Adults Following Hip Fracture Yields Similar Patient-Reported Outcome Measures. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241230293. [PMID: 38491840 PMCID: PMC10943717 DOI: 10.1177/00469580241230293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 03/18/2024]
Abstract
The increase in hip fractures (HF) due to aging of the population and the rise in attractiveness of services provided at home following the COVID-19 pandemic, emphasize the need to compare outcomes of home versus hospital HF rehabilitation. To date, studies comparing the 2 services have focused primarily on clinical outcomes rather than patient-reported outcomes (PROs). This longitudinal observational study evaluated PROs of older adults with HF in the 2 settings. The SF36 questionnaire was used to measure PROs 3 times after surgery. The first PRO was retrospective and reflected pre-fracture health status. Descriptive statistics and mixed-effect logistic regression were used. Of 86 patients participating in the study, 41 had home rehabilitation and 45 had hospital rehabilitation. In both groups, the mental and physical scores plummeted 2 weeks after the HF, compared to pre-fracture status. The difference in improvement from pre-fracture status to recovery in both groups, were not significantly (P < .05) different, except for the pain domain. PROs of home versus hospital rehabilitation were similar, suggesting that rehabilitation at home can be as effective as hospital rehabilitation for suitable patients. This knowledge can improve quality of care in an aging global population.
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Affiliation(s)
- Hanna S. Schroeder
- Hebrew University of Jerusalem, Jerusalem, Israel
- Israeli Ministry of Health, Israel
| | - Avi Israeli
- Israeli Ministry of Health, Israel
- Dr. Julien Rozan Professor of Healthcare, Hebrew University – Hadassah Medical School
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Omer Or
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Ora Paltiel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Justo
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Zimlichman
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
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Schroeder H, Israeli A, Liebergall M, Or O, Abu Ahmad W, Paltiel O, Justo D, Zimlichman E. Utilising patient-reported outcomes for goal-directed therapy of hip fracture patients: a sequential controlled trial. BMJ Open Qual 2023; 12:e002402. [PMID: 38154820 PMCID: PMC10759100 DOI: 10.1136/bmjoq-2023-002402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 12/02/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Hip fracture patients (HFPs) frequently have multiple underlying conditions, necessitating that agreed-upon goals take these complications into consideration. Communication regarding goals between medical-personnel and patients is not always effective. Patient-reported outcomes (PROs) can outline personal goals and help promote quality health care in HFPs. Few studies have been published on this topic. The study's aim was to outline the process of using PROs for goal-directed therapy among HFPs. METHODS This sequential controlled trial was conducted among HFPs from two medical centres. The control and the intervention group received integrative rehabilitation. PROs were measured in both groups using the SF36 questionnaire three times postsurgery: 24-48 hours, 2 weeks and 3 months. During the first round of questioning, only the intervention group was asked 'what matters most to you?' during the rehabilitative process. Accordingly, agreed-upon goals that were determined by the SF36's eight topics and were incorporated into the HFP's rehabilitative process. A Likert scale of 1-5, '1' indicating no-achievement and '5' full-achievement, was used to assess the goal achievement 4-6 months post-fracture. RESULTS 84 HFPs participated in the study: 40 and 44 in the intervention and control group, respectively. In both groups, PROs declined after the HF, then improved somewhat 3 months later, but did not return to prefracture scores. Among the intervention group, 39% reached their specific goals (Likert level 5). Patients who achieved their goals had better PROs in comparison to others. The intervention group indicated PROs helped them articulate their desires and introduced them to new areas of care. CONCLUSIONS Shifting from asking 'what's the matter?' to 'what matters most to you?' can improve the understanding of HFPs' own priorities, promote quality outcomes and enhance patient-centred care. Using PROs as a guide for goal-directed therapy can create a more inclusive process that includes the patients' most important health determinants and needs.
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Affiliation(s)
- Hanna Schroeder
- School of Nursing in the Faculty of Medicine, Henrietta Szold Hadassah, Hebrew University of Jerusalem, Jerusalem, Israel
- Strategic and Economic Planning Administration, Israel Ministry of Health, Jerusalem, Israel
| | - Avi Israeli
- Dr. Julien Rozan Professor of Healthcare, Hebrew University - Hadassah Medical School, Jerusalem, Israel
- Office of the Chief Scientist, Israel Ministry of Health, Jerusalem, Israel
- Hadassah University Medical Center, Jerusalem, Israel
| | - Meir Liebergall
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Omer Or
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wiessam Abu Ahmad
- Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Justo
- Geriatrics Division, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eyal Zimlichman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
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Valladares N, Cabrero Montes MA, Jacobo-Jimenez GJ, Zavala-Cerna MG. Rapid Recovery after Reparation of Full-Thickness Chondral Defects of the Knee with the Use of Hyaluronan (HA)-Based 3-D Scaffold. J Funct Biomater 2023; 14:491. [PMID: 37888156 PMCID: PMC10607491 DOI: 10.3390/jfb14100491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Articular cartilage injuries are found in up to 60% of patients who undergo an arthroscopic knee procedure, and those that totally affect articular cartilage (grade IV) have limited regenerative capacity and extended time for recovery. 3-D scaffolds represent a novel solution to address this type of injury. Our purpose was to analyze the MRI findings and functional status of patients that underwent repair of chondral defects either by microfractures or Hyaluronan (HA) 3-D scaffolding. We conducted a retrospective study of patients with chondral defects. The outcomes analyzed in this study included anatomical changes evaluated by the Henderson score (based on MRI findings) at baseline, 6, and 12 months after surgery, and improvement in functionality evaluated by the Modified Cincinnati Knee Rating System (MCKRS) at baseline and 6 months after surgery. Clinical and demographic characteristics were similar for both groups. There was a statistically significant improvement in Henderson score for the 3-D scaffold-treated group at 6 months versus the microfracture group (p < 0.0001). Improvement in functionality, measured by the MCKRS, was more frequently found in the 3-D scaffold-treated group. In conclusion, the use of HA 3-D scaffolding was superior, with faster recovery evident 6 months after the surgery that progressed to full recovery in all patients a year after surgery. Future studies with a randomized design might help to support our findings. This study provides level III evidence.
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Affiliation(s)
| | | | | | - Maria G Zavala-Cerna
- Laboratorio de Investigación en Inmunología, Unidad Académica Ciencias de la Salud, Universidad Autónoma de Guadalajara, Zapopan 45129, Mexico
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Minoonejad H, Henteh MA, Keshavarz R, Safarzadeh M, Montazeri A. Translation and psychometric evaluation of the Persian version of Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS). BMC Musculoskelet Disord 2023; 24:687. [PMID: 37644479 PMCID: PMC10464003 DOI: 10.1186/s12891-023-06823-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The present study aimed to translate and validate the Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) in Iran. METHODS Following standard forward and backward translation procedure, content and face validity were tested by specialists and a sample of 32 patients. Then, in a cross sectional study, a sample of patients with knee disorders, recruited through simple sampling, completed the KOS-ADLS and the Short-Form Health Survey (SF-36) in their first visit to physiotherapy clinics in Tehran. Regarding construct validity, the Spearman's correlation (rs) and one-way ANOVA were employed to evaluate the correlations between the Persian KOS-ADLS and SF-36 subscales (convergent validity) and known groups comparison, respectively. Test-retest reliability and internal consistency were evaluated by intraclass correlation coefficient (ICC) and the Cronbach's α coefficient. RESULTS In total 101 patients were included in the study. The mean age of patients was 42.39 (SD = 9.2). The finding indicated that the KOS-ADLS had strong correlations with SF-36 physical functioning, bodily pain subscales, and also physical component summary while it had lower correlations with other subscales of the SF-36 as expected. The KOS-ADLS was able to differentiate between the subgroups of patients who differed in BMI. The acceptable level of intraclass correlation coefficient (ICC = 0.91) and Cronbach's α coefficient (α = 0.91) was obtained for the Persian KOS-ADLS. Also no floor and ceiling effects were observed for the questionnaire. CONCLUSIONS The Persian version of KOS-ADLS was found to be a reliable and valid outcome measure for assessing daily living activities in patients who suffer from knee pathological conditions.
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Affiliation(s)
- Hooman Minoonejad
- Department of Sports Injury and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
| | - Mohammad Amin Henteh
- Department of Sports Injury and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran.
| | - Roshanak Keshavarz
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Safarzadeh
- Department of Sports Injury and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, Tehran, Iran.
- Faculty of Humanity Sciences, University of Science and Culture, Tehran, Iran.
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Szczepanik M, Jabłoński J, Bejer A, Bazarnik-Mucha K, Majewska J, Snela S, Szymczyk D. Validation of the Polish Version of Knee Outcome Survey Activities of the Daily Living Scale in a Group of Patients after Arthroscopic Anterior Cruciate Ligament Reconstruction. J Clin Med 2023; 12:4317. [PMID: 37445350 DOI: 10.3390/jcm12134317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The study aimed to assess the reliability, validity, and responsiveness of the Polish version of Knee Outcome Survey Activities of the Daily Living Scale (KOS-ADLS) in a group of patients after arthroscopic reconstruction of the anterior cruciate ligament (ACL). METHODS The study was a longitudinal study with repeated measures. One hundred and twelve subjects who qualified for arthroscopic ACL reconstruction (mean age = 31.8 years) were initially enrolled in this study. The Polish version of KOS-ADLS and Short Form-36 v. 2.0 (SF-36) were used. RESULTS The Polish version of KOS-ADLS in subjects after ACL rupture demonstrated excellent internal consistency (Cronbach's alpha for KOS-ADLS- total = 0.91), and test-retest reliability using the intraclass correlation coefficient (ICC-total = 0.98). The standard error of measurement (SEM) value was 0.81 and the minimal detectable change (MDC) was 2.23 for KOS-ADLS-total. The validity analysis showed a moderate and low correlation between KOS-ADLS and different domains of SF-36 from r = 0.354 between KOS-ADLS activity and the physical component scale (PCS) of SF-36: to r = 0.206 between KOS-ADLS activity and the mental component scale (MCS) of SF-36. CONCLUSIONS The Polish version of KOS-ADLS turned out to be a reliable, valid and responsive self-reported outcome measure, allowing for the self-assessment of symptoms and function related to the knee joint impairment after ACL reconstruction. Therefore, the scale can be applied in clinical practice and research.
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Affiliation(s)
- Magdalena Szczepanik
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland
| | - Jarosław Jabłoński
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland
- Orthopaedics and Traumatology Clinic for Adults, Clinical Hospital No. 2, 35-301 Rzeszow, Poland
| | - Agnieszka Bejer
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland
| | - Katarzyna Bazarnik-Mucha
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland
| | - Joanna Majewska
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland
| | - Sławomir Snela
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland
- Orthopaedics and Traumatology Clinic for Adults, Clinical Hospital No. 2, 35-301 Rzeszow, Poland
| | - Daniel Szymczyk
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland
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Alrabai HM, Algarni AD, Alshehri AA, Alshihri AF, Almansour AS, Alrawaf RK, Al-Ahaideb AS. Arabic Translation of the Knee Outcome Survey-Sports Activities Scale With Cross-cultural Adaptation and Validation. Orthop J Sports Med 2023; 11:23259671231175895. [PMID: 37347030 PMCID: PMC10280548 DOI: 10.1177/23259671231175895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/02/2023] [Indexed: 06/23/2023] Open
Abstract
Background There are few sports-specific knee functional scales in the Arabic language. The Knee Outcome Survey-Sports Activities Scale (KOS-SAS) is a validated sports-specific patient-reported outcome measure that assesses knee function in an athletic population. Purpose To provide a validated Arabic version of the KOS-SAS (KOS-SAS-Ar) while achieving cross-cultural adaptation for use in an Arabic-speaking population with sports-related knee disorders. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods There were 2 independent translators who conducted a forward translation of the KOS-SAS, followed by a backward translation by different translators. Subsequently, researchers and expert invitees judged the conceptual content and cultural adaptations of the final translation. A total of 276 patients completed the KOS-SAS-Ar as well as the International Knee Documentation Committee (IKDC) subjective assessment of knee function and a visual analog scale (VAS) for pain. Statistical analysis was performed for test-retest reliability, convergent validity, construct validity, and factor analysis. Results The test-retest reliability of the KOS-SAS-Ar was high (r = 0.9). The items of the KOS-SAS-Ar had statistically significant internal consistency, with a Cronbach alpha of .924 (P < .0001). The KOS-SAS-Ar Symptoms subscore correlated with the VAS pain score (P < .0001), and the KOS-SAS-Ar Functional Limitations subscore correlated with the IKDC subjective score (P < .0001). The construct validity of the KOS-SAS-Ar was satisfactory (Kaiser-Meyer-Olkin value = 0.868; Bartlett test: P < .0001). Factor analysis showed a statistical correlation among the 11 items of the KOS-SAS-Ar. Conclusion The KOS-SAS-Ar demonstrated favorable reliability and validity, and it appears to be a suitable tool for Arabic-speaking patients with sports-related knee conditions.
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Affiliation(s)
- Hamza M. Alrabai
- Department of Orthopedics, College of
Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman D. Algarni
- Department of Orthopedics, College of
Medicine, King Saud University, Riyadh, Saudi Arabia
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Deviandri R, van der Veen HC, Lubis AM, Postma MJ, van den Akker-Scheek I. Translation, Validity, and Reliability of the Indonesian Version of the Anterior Cruciate Ligament-Return to Sport After Injury Scale. Orthop J Sports Med 2023; 11:23259671231157769. [PMID: 37152552 PMCID: PMC10161318 DOI: 10.1177/23259671231157769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/01/2023] [Indexed: 05/09/2023] Open
Abstract
Background The Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale measures athletes' emotion, confidence, and risk appraisal when returning to sports after an anterior cruciate ligament (ACL) injury and/or ACL reconstruction (ACLR). Purpose To translate the ACL-RSI into the Indonesian language and to assess its validity and reliability in Indonesian-speaking patients after ACLR. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods After a forward-and-backward translation procedure, the validity and reliability of the Indonesian version of the ACL-RSI (I-ACL-RSI) were investigated. Patients who had undergone ACLR at a single hospital were asked to complete 4 questionnaires: I-ACL-RSI, Injury-Psychological Readiness to Return to Sport, Tampa Scale of Kinesiophobia, and International Knee Documentation Committee. After a 2-week interval, patients were asked to complete the I-ACL-RSI a second time. Following the COSMIN reporting guidelines (Consensus-Based Standards for the Selection of Health Measurement Instruments), we determined construct validity using hypothesis testing, as well as test-retest reliability, internal consistency, floor and ceiling effects, and measurement error. Results Of 200 eligible patients, 102 (51%) were included in the analysis. All predefined hypotheses on correlations between the I-ACL-RSI and the other questionnaires were confirmed, indicating good construct validity. An intraclass correlation coefficient of 0.90 (2-way random, type agreement) was found for the first and second I-ACL-RSI scores, indicating good test-retest reliability. A Cronbach α of 0.95 indicated good internal consistency, and no floor or ceiling effects were found. The standard error of measurement was 3.9, with the minimal detectable change calculated as 10.9 points at the individual level and 1.1 points at the group level. Conclusion Based on the study findings, the I-ACL-RSI can be considered a valid and reliable questionnaire for Indonesian-speaking patients after ACL injury and/or ACLR.
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Affiliation(s)
- Romy Deviandri
- Department of Orthopedics Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Physiology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
- Division of Orthopedics–Sports Injury, Arifin Achmad Hospital, Pekanbaru, Indonesia
- Romy Deviandri, MD, Faculty of Medicine, Universitas Riau, Diponegoro Street No. 1, Pekanbaru, Indonesia 28133 (; )
| | - Hugo C. van der Veen
- Department of Orthopedics Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Andri M.T. Lubis
- Department of Orthopedics, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Maarten J. Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, the Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands
- Department of Pharmacology and Therapy, Universitas Airlangga, Surabaya, Indonesia
- Investigation performed at the Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Berk AN, Piasecki DP, Fleischli JE, Trofa DP, Saltzman BM. Trends in Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Orthop J Sports Med 2023; 11:23259671231174472. [PMID: 37284137 PMCID: PMC10240869 DOI: 10.1177/23259671231174472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/08/2023] [Indexed: 06/08/2023] Open
Abstract
Background Despite the prevalence of patient-reported outcomes (PROs) to evaluate results after anterior cruciate ligament (ACL) reconstruction, there exists little standardization in how these metrics are reported, which can make wider comparisons difficult. Purpose To systematically review the literature on ACL reconstruction and report on the variability and temporal trends in PRO utilization. Study Design Systematic review. Methods We queried the PubMed Central and MEDLINE databases from inception through August 2022 to identify clinical studies reporting ≥1 PRO after ACL reconstruction. Only studies with ≥50 patients and a mean 24-month follow-up were considered for inclusion. Year of publication, study design, PROs, and reporting of return to sport (RTS) were documented. Results Across 510 studies, 72 unique PROs were identified, the most common of which were the International Knee Documentation Committee score (63.3%), Tegner Activity Scale (52.4%), Lysholm score (51.0%), and Knee injury and Osteoarthritis Outcome Score (35.7%). Of the identified PROs, 89% were utilized in <10% of studies. The most common study designs were retrospective (40.6%), prospective cohort (27.1%), and prospective randomized controlled trials (19.4%). Some consistency in PROs was observed among randomized controlled trials, with the most common PROs being the International Knee Documentation Committee score (71/99, 71.7%), Tegner Activity Scale (60/99, 60.6%), and Lysholm score (54/99, 54.5%). The mean number of PROs reported per study across all years was 2.89 (range, 1-8), with an increase from 2.1 (range, 1-4) in studies published before 2000 to 3.1 (range, 1-8) in those published after 2020. Only 105 studies (20.6%) discretely reported RTS rates, with more studies utilizing this metric after 2020 (55.1%) than before 2000 (15.0%). Conclusion There exists marked heterogeneity and inconsistency regarding which validated PROs are used in studies related to ACL reconstruction. Significant variability was observed, with 89% of measures being reported in <10% of studies. RTS was discretely reported in only 20.6% of studies. Greater standardization of outcomes reporting is required to better promote objective comparisons, understand technique-specific outcomes, and facilitate value determination.
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Affiliation(s)
- Alexander N. Berk
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Dana P. Piasecki
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - James E. Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - David P. Trofa
- Department of Orthopaedics, NewYork–Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Bryan M. Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
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Translation, cross-cultural adaptation and validation of the Italian version of the knee outcome survey - activities of daily living scale. Musculoskelet Sci Pract 2023; 63:102716. [PMID: 36630780 DOI: 10.1016/j.msksp.2023.102716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
PURPOSE The Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS) is a joint-specific questionnaire measuring symptoms and functional limitations experienced by individuals with painful knee disorders. The original version of the KOS-ADLS has been shown to be reliable, valid and responsive to change. The purpose of this study was to perform a translation and cross-cultural adaptation of the KOS-ADLS into Italian and to assess its reliability and validity. METHODS In accordance with standard procedures, the original version of the KOS-ADLS was translated and cross-culturally adapted into Italian (KOS-ADLS-I). Then, the KOS-ADLS-I was administered to 150 patients with knee disorders. A subsample of patients compiled the KOS-ADLS-I again after five/seven days later to evaluate test-retest reliability. Symptoms and function-oriented questionnaires were also completed to evaluate construct validity. Structural validity (Explanatory Factor Analysis [EFA]), internal consistency (Cronbach's alpha), test-retest reliability (Intraclass Correlation Coefficient [ICC]), measurement error (Standard Error of the Measurement [SEM], Minimal Detectable Change [MDC]), and construct validity (hypothesis testing) were assessed. RESULTS The cross-cultural adaptation procedure revealed no major problems. EFA revealed a unidimensional structure. Internal consistency was high (Cronbach's alpha = 0.976) and the test-retest reliability was excellent (ICC = 0.990, 95%CI: 0.980-0.995) with low measurement error (SEM = 2.6 points; MDC = 7.1 points). The construct validity resulted to be satisfactory, as 100% a-priori hypothesis were met. CONCLUSIONS The KOS-ADLS-I is a reliable and valid questionnaire for the assessment of symptoms and functional limitations in individuals with musculoskeletal knee disorders and it can be used in clinical practice and research.
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Schroeder HS, Israeli A, Liebergall MI, Or O, Andrews CS, Justo D, Zimlichman E. The Suitability of Measuring Patient-Reported Outcomes in Older Adults Following a Hip Fracture Using the Short-Form 36 Questionnaire: A Qualitative Description Approach. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231171819. [PMID: 37183709 DOI: 10.1177/00469580231171819] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Hip-fractures (HF) in older adults are associated with poor outcomes and high costs. Measuring quality-of-care of HF patients has focused on clinical definitions rather than on measuring outcomes that are meaningful to the patient. Healthcare systems worldwide are increasingly interested in patient-reported outcome measures (PROs). The Short-form (SF36) questionnaire is a recommended measure among older adults however it's comprehensiveness and uniqueness for specific patients after a HF is not clear. The aims of this study were to: understand the perspective of the older adults experience following HF, to assess the suitability of the SF36 as a PRO for HF and to determine the best timing for questioning. A qualitative description approach was used. This took place in 2 large academic medical-centers in Israel. The inquiry was done in 2 parts by semi-structured interview. A total 15 HF patients were interviewed. Categories and themes emerging from their responses were similar to the 8 domains of the SF36 questionnaire, but the participants added clarity regarding their own needs for setting goals. In the second part, participants agreed that the SF36 reflected common issues and served as an adequate measure for personal-goal setting. The study encourages patient-centered care in older adults recovering from HF, providing evidence that the SF36 is a suitable tool for measuring PROs in HF patients. Healthcare systems focus on clinical-outcome indicators and do not reflect how the patient views his outcomes. This study provides evidence that care should be customized for each person.
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Affiliation(s)
- Hanna S Schroeder
- Braun School of Public Health, the Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Avi Israeli
- Dr. Julien Rozan Professor of Family Medicine and Health Promotion, Hebrew University - Hadassah Medical School
- Department of Health Policy, Health Care Management and Health Economics, Hebrew University - Hadassah Faculty of Medicine
- Chief Scientist, Israel Ministry of Health
| | - Meir Iri Liebergall
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University, Jerusalem Israel
| | - Omer Or
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University, Jerusalem Israel
| | | | - Dan Justo
- Geriatics Department, Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Zimlichman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Central Management,Sheba Medical Center, Ramat-Gan, Israel
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Norozian B, Arabi S, Marashipour SM, Khademi Kalantari K, Akbarzadeh Baghban A, Kazemi SM, Jamebozorgi AA. Recovery of Quadriceps Strength and Knee Function Using Adjuvant EMG-BF After Primary ACL Reconstruction. J Lasers Med Sci 2023; 14:e6. [PMID: 37089769 PMCID: PMC10114001 DOI: 10.34172/jlms.2023.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/17/2022] [Indexed: 04/25/2023]
Abstract
Introduction: Immobility and limited usage of operated limbs lead to weakness and atrophy of the muscle after anterior cruciate ligament (ACL) reconstruction. However, training programs for preventing biomechanical risk factors such as lower limb alignment and increased muscular contraction are very limited. Thus, the current study was carried out to evaluate the recovery of quadriceps muscle strength and the improvement of knee function using adjuvant electromyographic biofeedback (EMG-BF) after ACL reconstruction. Methods: This prospective randomized controlled trial was conducted among 40 patients (20=EMG-BF group, 20=Control group) with ACL reconstruction, who were referred to Akhtar Hospital from 2021 to 2022. In the EMG-BF group, EMG BFB was added to the standard rehabilitation protocol, and in the control group, the standard rehabilitation protocol with full postoperative weight-bearing, knee brace (zero degree of extension, 90 degrees of flexion), and electrical stimulation with maximal voluntary isometric knee extension was performed. Each group was intervened for 4 weeks and three sessions of 30 minutes per week. It should be noted that each patient participated in 16 outpatient physiotherapy sessions after surgery. Nicholas Hand-Held Dynamometer (HHD) was used for measuring quadriceps strength, and Knee Outcome Survey-Activities of Daily Living (KOS-ADLs) and Knee Outcome Survey Sports Activities Scale (KOS-SAS) questionnaires were used for assessing the knee function. Results: Four weeks after the treatment, the EMG-BF group showed a significant increase in quadriceps strength (P=0.0001). Quadriceps strength had a significant difference before and after 4 weeks of intervention (P=0.0001), but in the control group, no significant difference was observed (P=0.368). The EMG-BF group had a significant increase in KOS-ADLs and KOS-SAS scores after 4 weeks of intervention (P=0.0001). Conclusion: In our study, isometric strengthening of quadriceps with adjuvant EMG-BF significantly increased the strength of quadriceps and knee function during 4 weeks. EMG-BF is a low risk, low cost, and less invasive intervention and has high safety and adjustment ability. It is a valuable adjuvant method for achieving better functional recovery in a shorter time.
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Affiliation(s)
- Bahman Norozian
- Department of Occupational Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Arabi
- Department of Occupational Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Mahta Marashipour
- Department of Occupational Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi Kalantari
- Department of Physiotherapy Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Morteza Kazemi
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedics hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Asghar Jamebozorgi
- Department of Occupational Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Correspondence to Ali Asghar Jamebozorgi,
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Al-Dadah O, Shepstone L, Donell ST. Patient reported outcome measures in anterior cruciate ligament rupture and reconstruction: The significance of outcome score prediction. World J Clin Cases 2022; 10:10939-10955. [PMID: 36338237 PMCID: PMC9631133 DOI: 10.12998/wjcc.v10.i30.10939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/05/2022] [Accepted: 09/19/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Numerous anterior cruciate ligament (ACL) clinical outcome measures exist. However, the result of one score does not equate to the findings of another even when evaluating the same patient group.
AIM To investigate if statistically derived formulae can be used to predict the outcome of one knee scoring system when the result of another is known in patients with ACL rupture before and after reconstruction.
METHODS Fifty patients with ACL rupture were evaluated using nine clinical outcome measures. These included Tegner Activity Score, Lysholm Knee Score, Cincinnati Knee Score, International Knee Documentation Committee (IKDC) Objective Knee Score, Tapper and Hoover Meniscal Grading Score, IKDC Subjective Knee Score, Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), Short Form-12 Item Health Survey and Knee Injury and Osteoarthritis Outcome Score. Thirty-four patients underwent an ACL reconstruction and were reassessed post-operatively.
RESULTS The mean total of each of the nine outcome scores appreciably differed from each other. Significant correlations and regressions were found between most of the outcome scores and were stronger post-operatively. The strongest correlation was found between Cincinnati and KOS-ADLS (r = 0.91, P < 0.001). The strongest regression formula was also found between Cincinnati and KOS-ADLS (R2 = 0.84, P < 0.001).
CONCLUSION The formulae produced from this study can be used to predict the outcome of one knee score when the results of the other are known. These formulae could facilitate the conduct of systematic reviews and meta-analysis in studies relating to ACL injuries by allowing the pooling of substantially more data.
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Affiliation(s)
- Oday Al-Dadah
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne NE2 4HH, Tyne and Wear, United Kingdom
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Shields NE34 0PL, Tyne and Wear, United Kingdom
| | - Lee Shepstone
- Department of Medical Statistics, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, Norfolk, United Kingdom
| | - Simon T Donell
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, Norfolk, United Kingdom
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Bley JA, Master H, Huston LJ, Block S, Pennings JS, Coronado RA, Cox CL, Sullivan JP, Dale KM, Saluan PM, Spindler KP, Archer KR. Return to Sports After Anterior Cruciate Ligament Reconstruction: Validity and Reliability of the SPORTS Score at 6 and 12 Months. Orthop J Sports Med 2022; 10:23259671221098436. [PMID: 35693459 PMCID: PMC9185013 DOI: 10.1177/23259671221098436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The Subjective Patient Outcome for Return to Sports (SPORTS) score is a
single-item scale that measures athletes' ability to return to their
preinjury sport based on effort and performance. Purpose/Hypothesis: The purpose of this study was to examine the psychometric properties of the
SPORTS score and a modified score within the first year after anterior
cruciate ligament reconstruction (ACLR). The modified version replaced “same
sport” with “any sport” in the answer choices. It was hypothesized that both
versions of the SPORTS score would have acceptable floor and ceiling effects
and internal responsiveness, moderate convergent validity, and excellent
test-retest reliability. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients were recruited preoperatively from 2 academic medical centers. The
authors collected responses to the 1-item SPORTS scores at 6 and 12 months
after ACLR and the Tegner activity scale, Lysholm knee score, Knee injury
and Osteoarthritis Outcome Score (KOOS)–sport/recreation subscale, and Marx
activity rating scale preoperatively and 6 and 12 months after ACLR. Ceiling
and floor effects and responsiveness were assessed using descriptive
statistics and cross-tabulations, respectively, at both follow-up time
points. Spearman correlations and intraclass correlation coefficients were
used to examine convergent validity and test-retest reliability,
respectively. Results: Follow-up rates at 6 and 12 months were 100% and 99%, respectively.
Test-retest follow-up was 77%. Floor effects for the SPORTS scores were not
observed, while ceiling effects at 12 months ranged from 38% to 40%.
Cross-tabulation of the SPORTS scores showed that 64% to 66% of patients
reported a change in their score from 6 to 12 months, with significant
differences noted between the proportions that improved versus worsened for
return to any sport. Convergent validity was observed at 6 and 12 months via
moderate correlations with the Tegner, Lysholm, KOOS–sport/recreation, and
Marx scores (r = 0.31 to 0.47). Fair to good test-retest
reliability (intraclass correlation coefficient, 0.58 and 0.60) was found at
12 months after ACLR. Conclusion: The SPORTS score appears to be a reliable, responsive, and valid 1-item scale
that can be used during the first year after ACLR. No differences in
psychometric properties were found between the SPORTS score and the modified
version.
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Affiliation(s)
- Jordan A Bley
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hiral Master
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura J Huston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shannon Block
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles L Cox
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jaron P Sullivan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin M Dale
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul M Saluan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic Florida Region, Weston, Florida, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Patient-Reported Outcome Measures Following Surgical Intervention for Pediatric Sports-Related Injuries to the Knee: a Systematic Review. Curr Rev Musculoskelet Med 2022; 15:187-193. [DOI: 10.1007/s12178-022-09756-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/26/2022]
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Giummarra M, Vocale L, King M. Efficacy of non-surgical management and functional outcomes of partial ACL tears. A systematic review of randomised trials. BMC Musculoskelet Disord 2022; 23:332. [PMID: 35395764 PMCID: PMC8991495 DOI: 10.1186/s12891-022-05278-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/22/2022] [Indexed: 01/13/2023] Open
Abstract
Background The incidence of anterior cruciate ligament (ACL) injuries represents a large burden of knee injuries in both the general and sporting populations, often requiring surgical intervention. Although there is much research on complete ACL tears including outcomes and indications for surgery, little is known about the short- and long-term outcomes of non-operative, physiotherapy led intervention in partial ACL tears. The primary aim of this study was to evaluate studies looking at the effectiveness of physiotherapy led interventions in improving pain and function in young and middle-aged adults with partial ACL tears. Additionally, the secondary aim was to evaluate the completeness of exercise prescription in randomised trials for physiotherapy led interventions in the management in partial ACL tears. Methods A comprehensive and systematic search was performed on six databases (Medline, CINAHL, EMBASE, PEDro, Scopus, SPORTDiscus and Cochrane). The search strategy consisted of two main concepts: (i) partial ACL tears, and (ii) non-operative management. 7,587 papers were identified by the search. After screening of eligible articles by two independent reviewers, 2 randomised studies were included for analysis. The same two reviewers assessed the completeness of reporting using the Toigio and Boutellier mechanobiological exercise descriptions and Template for Intervention Description and Replication (TIDieR) checklist. Group mean standard deviations (SD) for the main outcomes was extracted from both papers for analysis. Prospero Registration Number: CRD42020179892. Results The search strategy identified two studies; one looking at Tai Chi and the other Pilates. The analysis indicated that Tai Chi was significant in reducing pain scores and both Tai Chi and Pilates were found to increase Muscle Peak Torque Strength (MPTS) at 180 degrees. Furthermore, Tai Chi showed a significant increase in proprioception. Conclusions Physiotherapy led interventions such as Pilates, and Tai Chi may improve pain, proprioception and strength in young and middle-aged adults with partial ACL tears, however full scale, high-quality randomised studies are required with long term outcomes recorded. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05278-w.
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Affiliation(s)
- Michael Giummarra
- Australasian College of Sport and Exercise Physicians, Melbourne, Australia
| | - Loretta Vocale
- School of Health and Biomedical Sciences, RMIT University, 124 Latrobe Street, Melbourne, VIC, 3000, Australia.
| | - Matthew King
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
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Adames DNB, González-Lucena G, Ruales JIS, Cudos BG, Ginés-Cespedosa A. Outcome Assessment Performance of the SF-36, Manchester-Oxford Foot Questionnaire and AOFAS in Forefoot Reconstruction Surgery. J Foot Ankle Surg 2022; 61:248-252. [PMID: 34364761 DOI: 10.1053/j.jfas.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to investigate the measurement properties of the Short Form 36 (SF-36) to detect real change after forefoot reconstruction surgery. Responsiveness and minimally important change estimates were compared with those from the Manchester-Oxford Foot Questionnaire (MOXFQ) and the American Orthopaedic Foot and Ankle Society (AOFAS) measures. Eighty-three patients awaiting surgery were recruited. Patients completed pre- and 12 months postoperative the SF-36 and the MOXFQ. A surgeon assessed the AOFAS scores. The responsiveness to change was determined using the effect size (ES), the minimal detectable change (MDC) and the minimal clinically important change. Two subscales of the SF-36 demonstrated significant improvement, bodily pain (BP) and mental health. Only the BP domain appeared the most responsive with an ES of 0.73. All domains of the MOXFQ and AOFAS produced much larger effect sizes (ES > 1.5). MDC values for the majority of the SF-36 domains fell within measurement error except for the BP domain. Fewer patients showed significant improvement when compared with the MOXFQ pain domain. In conclusion, the SF-36 measuring tool proved to be neither reliable nor responsive enough to detect real change after forefoot surgery. Though the BP domain appeared to be the most responsive, it failed to detect meaningful change when compared to the MOXFQ-Pain and the Visual Analogue Scale.
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Monaco E, Pisanu G, Carrozzo A, Giuliani A, Conteduca J, Oliviero M, Ceroni L, Sonnery-Cottet B, Ferretti A. Translation, cross-cultural adaptation, and validation of the Italian version of the anterior cruciate ligament–return to sport after injury (ACL-RSI) scale and its integration into the K-STARTS test. J Orthop Traumatol 2022; 23:11. [PMID: 35190905 PMCID: PMC8861218 DOI: 10.1186/s10195-021-00622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background The timing of a return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) represents a major subject of debate in sports medicine practice. Recently, the Knee Santy Athletic Return to Sport (K-STARTS) composite test was validated. This consists of a battery of physical tests and a psychological evaluation using the anterior cruciate ligament–return to sport after injury scale (ACL-RSI). This study aimed to translate the ACL-RSI and K-STARTS from English to Italian and determine the scale’s reliability and validity in an Italian context. Methods The translation and cultural adaptation process was performed according to the guidelines for the cross-cultural adaptation of self-report measures. The patients were asked to fill an anonymized online form created for this purpose that included the KOOS, the Lysholm, the IKDC-SKF, and the Italian translation of the ACL-RSI (ACL-RSI-It). After 1 week, the attendees were asked to repeat the ACL-RSI-It to investigate the test–retest reliability. Results The final study population comprised 115 patients who underwent ACLR, with a mean follow-up of 37.37 ± 26.56 months. The ACL-RSI-It showed axcellent internal consistency (Cronbach’s α = 0.963), reliability (test–retest ICC = 0.966), and good construct validity (positive correlations with the other scales were above 75%). Conclusions The ACL-RSI-It is valid, reliable, and comparable to the original English version of the questionnaire for Italian-speaking patients. It can be used to assess the psychological readiness of patients for a RTS after primary and unilateral ACLR, and can be integrated into the Italian K-STARTS test. Level of evidence Level II. Supplementary Information The online version contains supplementary material available at 10.1186/s10195-021-00622-7.
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Turhan S, Buyuk A. Evaluation of sexual quality of life after bilateral total hip arthroplasty surgery. Orthop Traumatol Surg Res 2022; 108:103125. [PMID: 34700057 DOI: 10.1016/j.otsr.2021.103125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/07/2021] [Accepted: 09/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients experience limitation of hip joint movement due to coxarthrosis, such limitation may affect the quality of sexual activity in patients. We aimed at investigating the postoperative quality of sexual life and evaluating the clinical satisfaction of patients who underwent bilateral total hip arthroplasty. HYPOTHESIS Postoperative sexual life quality improvement in patients undergoing bilateral total hip arthroplasty increases clinical satisfaction. METHODS The study included patients who underwent staged bilateral total hip arthroplasty surgery between June 2016 and January 2019. Each patient was evaluated using the sexual quality of life-female (SQOL-F) or Sexual quality of life-male (SQOL-M) questionnaire containing similar questions for both genders regarding sexual satisfaction. RESULTS Among all the individuals, 32 were sexually active (13 females, 19 males), and seven were not sexually active (6 females, 1 male) before the surgery. Among the 29 individuals (18 females, 11 males) who thought that their sexual life was negatively affected even before the surgery, 10 (1 female, 9 males) were found not to be negatively affected. Moreover, the sexual life of 18 females was negatively affected 27.93±14.5 months (range, 12-43) before hip arthroplasty and 11 males was negatively affected 19.5±11.0 months (range, 8-31) before the surgery as well. Twenty (10 females, 10 males) individuals stated an improvement in their sexual life, 13 (6 females, 7 males) individuals stated no change. Unfortunately, 6 (3 females, 3 males) individuals stated a degradation of their sexual activity after hip arthroplasty. Patients gained more than 60 degrees of hip range of motion and experienced significant reduction in pain after hip joint movements after surgery. DISCUSSIONS In our study, we evaluated sexual limitations before and after total hip arthroplasty surgery and postoperative sexual quality of life. Due to the increased range of motion of patients after surgery, the proportion of sexually active individuals increased and the sexual quality of life reached a satisfactory level. LEVEL OF EVIDENCE III; retrospective cohort study.
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Affiliation(s)
- Sadullah Turhan
- Department of Orthopedics and Traumatology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey.
| | - Alime Buyuk
- Department of Physiotherapy and Rehabilitation Antalya, Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
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Deviandri R, der Veen HCV, Lubis AM, Postma MJ, van den Akker-Scheek I. Translation and Psychometric Analysis of the Indonesian Versions of the Lysholm and Tegner Scores for Patients With Anterior Cruciate Ligament Injuries. Orthop J Sports Med 2022; 10:23259671211066506. [PMID: 35097144 PMCID: PMC8793459 DOI: 10.1177/23259671211066506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The Lysholm knee score and Tegner activity scale are frequently used patient-reported outcome measures in patients with anterior cruciate ligament (ACL) injuries because of their excellent psychometric properties. These questionnaires were originally developed in the English language. Purpose: To translate and cross-culturally adapt these measures into the Indonesian language and study their validity and reliability so that they can be used in the Indonesian-speaking population with ACL injuries. Study Design: Cohort study (diagnosis/symptom prevalence); Level of evidence, 2. Methods: After a forward-backward translation procedure and cross-cultural adaptation, validity and reliability were investigated. A total of 253 patients with an ACL injury were sent 4 questionnaires (36-Item Short Form Health Survey, Kujala anterior knee pain scale, Indonesian Lysholm knee score [I-LK], and Indonesian Tegner activity scale [I-TS]). The responses of those patients were analyzed. Following COSMIN guidelines, construct validity, test-retest reliability, internal consistency, floor and ceiling effects, and measurement errors were determined. The Bland-Altman method was used to explore absolute agreement. Results: A total of 106 patients (42% response rate) were included in this study. Construct validity was considered to be good, as more than 75% of the predefined hypotheses on correlations between the I-LK, I-TS, and other measures were confirmed. Reliability proved excellent, with a high test-retest correlation for both questionnaires (intraclass correlation coefficient = 0.99). Bland-Altman analysis showed no systematic bias between testing and retesting. The internal consistency of the I-LK was good (Cronbach alpha = 0.73). For the I-LK and I-TS, floor and ceiling effects were less than 15% (floor: 0% and 4.7%, respectively; ceiling: 12.3% and 3.8%, respectively); the standard error of measurement was 1.8 and 0.9, respectively; the minimal detectable change at the individual level was 5.1 and 0.6, respectively; and the minimal detectable change at the group level was 2.4 and 0.5, respectively. Conclusion: Both the I-LK and I-TS appear to be good evaluation tools for Indonesian-speaking patients with an ACL injury.
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Affiliation(s)
- Romy Deviandri
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Physiology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
- Division of Orthopedics-Sports Injury, Arifin Achmad Hospital, Pekanbaru, Indonesia
| | - Hugo C. van der Veen
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Andri M.T. Lubis
- Department of Orthopedics, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Maarten J. Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, the Netherlands
- Department of Pharmacology and Therapy, Universitas Airlangga, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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22
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Al-Dadah O, Shepstone L, Donell ST. Clinical Outcome Measures in Arthroscopic Meniscectomy: Clinician versus Patient Completed Knee Scores. Rev Bras Ortop 2022; 57:1014-1021. [PMID: 36540730 PMCID: PMC9757960 DOI: 10.1055/s-0041-1740470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/13/2021] [Indexed: 10/19/2022] Open
Abstract
Objective The aim of the present study was to investigate the difference between clinician-completed and patient-completed outcome scores in detecting improvement following arthroscopic meniscectomy in patients with meniscal tears of the knee. Methods Thirty-four patients with meniscal tears were prospectively assessed using 9 clinical outcome measures. The five clinician-completed knee scores included the Tegner Activity Score, the Lysholm Knee Score, the Cincinnati Knee Score, the International Knee Documentation Committee (IKDC) Examination Knee Score, and the Tapper and Hoover Meniscal Grading Score. The four patient-completed knee scores included the IKDC Subjective Knee Score, the Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), the Short Form-12 Item Health Survey (SF-12), and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Twenty-nine of the 34 patients underwent an arthroscopic meniscectomy and were reassessed with all 9 outcome scores upon their follow-up review. Results A significant longitudinal improvement was observed in 4 of the 5 clinician-completed scores (Tegner [ p < 0.001], Lysholm [ p = 0.004], Cincinnati [p = 0.002] and Tapper and Hoover [ p < 0.001], but not in the IKDC Examination [ p = 0.332]. However, the IKDC Subjective score ( p = 0.021) was the only patient-completed score to demonstrate significant improvement postoperatively. Conclusion Overall, clinician-completed scoring systems were found to be inconsistent with those of patient-completed instruments. The mode of administering outcome measures can have a significant influence on the outcome results both for research and for clinical practice. A combination of both a clinician-completed with a patient-completed instrument may be a more balanced approach to assessing and quantifying meniscus tears and the outcome following arthroscopic meniscectomy.
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Affiliation(s)
- Oday Al-Dadah
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle-upon-Tyne, Reino Unido,Departamento de Trauma e Cirurgia Ortopédica, South Tyneside Hospital, Harton Lane, South Tyneside, Reino Unido,Endereço para correspondência Oday Al-Dadah, MBChB, FRCS (Eng), MD, FRCS (Tr & Orth) Consultant Orthopaedic Surgeon and Honorary Clinical Senior Lecturer, Newcastle University, Translational and Clinical Research InstituteFramlington Place, Newcastle-upon-Tyne, Tyne and Wear NE2 4HHUnited Kingdom
| | - Lee Shepstone
- Medical School, University of East Anglia, Earlham Road, Norwich, Reino Unido
| | - Simon T. Donell
- Medical School, University of East Anglia, Earlham Road, Norwich, Reino Unido
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23
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Hoburg A, Niemeyer P, Laute V, Zinser W, Becher C, Kolombe T, Fay J, Pietsch S, Kuźma T, Widuchowski W, Fickert S. Matrix-Associated Autologous Chondrocyte Implantation with Spheroid Technology Is Superior to Arthroscopic Microfracture at 36 Months Regarding Activities of Daily Living and Sporting Activities after Treatment. Cartilage 2021; 13:437S-448S. [PMID: 31893951 PMCID: PMC8808956 DOI: 10.1177/1947603519897290] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Matrix-associated autologous chondrocyte implantation (ACI) and microfracture (MF) are well-established treatments for cartilage defects of the knee. However, high-level evidence comparing microfracture and spheroid technology ACI is limited. DESIGN Prospective, phase III clinical trial with patients randomized to ACI (N = 52) or MF (N = 50). Level of evidence: 1, randomized controlled trial. Both procedures followed standard protocols. For ACI 10 to 70 spheroids/cm2 were administered. Primary outcome measure was the Knee Injury and Osteoarthritis Outcome Score (KOOS). This report presents results for 36 months after treatment. RESULTS Both ACI and MF showed significant improvement over the entire 3-year observation period. For the overall KOOS, noninferiority of ACI (the intended primary goal of the study) was formally confirmed; additionally, for the subscores "Activities of Daily Living" and "Sport and Recreation," superiority of ACI over MF was shown at descriptive level. Occurrence of adverse events were not different between both treatments (ACI 77%; MF 74%). Four patients in the MF group required reoperation which was defined as treatment failure. No treatment failure was reported for the ACI group. CONCLUSIONS Patients treated with matrix-associated ACI with spheroid technology showed substantial improvement in various clinical outcomes after 36 months. The advantages of ACI compared with microfracture was underlined by demonstrating noninferiority, in overall KOOS and superiority in the KOOS subscores "Activities of Daily Living" and "Sport and Recreation." In the present study, subgroups comparing different age groups and defect sizes showed comparable clinical outcomes.
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Affiliation(s)
- Arnd Hoburg
- Joint and Spine Centre Steglitz, Berlin,
Germany,Arnd Hoburg, Joint and Spine Centre
Steglitz, Kieler Straße 1, Berlin, 12163, Germany.
| | - Philipp Niemeyer
- Department of Orthopedic Surgery and
Traumatology, University Hospital, Freiburg, Germany,OCM Clinic, Munich, Germany
| | - Volker Laute
- Joint and Spine Centre Steglitz, Berlin,
Germany
| | - Wolfgang Zinser
- Department of Orthopedic Surgery and
Traumatology, St. Vinzenz-Hospital, Dinslaken, Germany
| | - Christoph Becher
- Department of Orthopedic Surgery,
Medical University Annastift, Hannover, Germany
| | - Thomas Kolombe
- Traumatology and Reconstructive Surgery,
DRK Hospital, Luckenwalde, Germany
| | - Jakob Fay
- Department of Traumatology and
Arthroscopic Surgery, Lubinus Clinicum, Kiel, Germany
| | - Stefan Pietsch
- Department of Orthopedic Surgery and
Traumatology, Rudolf Elle Hospital, Eisenberg, Germany
| | - Tomasz Kuźma
- Department of Orthopedic Surgery and
Traumatology, Center of Sports Medicine, Orthopedic Clinic, Warsaw, Poland
| | | | - Stefan Fickert
- Sporthopaedicum Straubing, Straubing,
Germany,Department of Orthopedic Surgery and
Traumatology, Medical Faculty Mannheim, University Medical Centre Mannheim,
University of Heidelberg, Mannheim, Germany
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24
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Wang D, Nawabi DH, Krych AJ, Jones KJ, Nguyen J, Elbuluk AM, Farshad-Amacker NA, Potter HG, Williams RJ. Synthetic Biphasic Scaffolds versus Microfracture for Articular Cartilage Defects of the Knee: A Retrospective Comparative Study. Cartilage 2021; 13:1002S-1013S. [PMID: 32046514 PMCID: PMC8808844 DOI: 10.1177/1947603520903418] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare the results of a biphasic synthetic scaffold (TruFit, Smith & Nephew) to microfracture for the treatment of knee cartilage defects and identify patient- and lesion-specific factors that influence outcomes. DESIGN Prospectively collected data from 132 patients (mean age, 41.8 years; 69% male) with isolated chondral or osteochondral femoral defects treated with biphasic synthetic scaffolds (n = 66) or microfracture (n = 66) were reviewed. Clinical outcomes were evaluated longitudinally over 5 years with the Short Form-36 (SF-36), Activities of Daily Living of the Knee Outcome Survey (KOS-ADL), International Knee Documentation Committee (IKDC), and Marx Activity Scale. Cartilage-sensitive magnetic resonance imaging (MRI) was performed to evaluate osseous integration and cartilage fill in a subgroup of patients. Multivariate regression analysis was used to identify predictors of clinical outcomes within the scaffold group. RESULTS Both groups demonstrated clinically significant improvements in knee clinical scores over 5 years (P < 0.01). There were no significant differences in KOS-ADL and IKDC scores between groups up to 5 years postoperatively. Marx activity level scores in the microfracture group declined over time, while significant improvements in activity level scores were observed in the scaffold group over 5 years (P < 0.01). Good-quality tissue fill and cartilage isointensity were more often observed in the scaffold group compared with the microfracture group, particularly with longer time intervals. Increasing age, high body mass index, prior microfracture, and traumatic etiology were predictors for inferior outcomes in the scaffold group. CONCLUSIONS Activity level and MRI appearance following treatment of cartilage lesions with the biphasic synthetic scaffold were superior to microfracture over time in this nonrandomized, retrospective comparison.
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Affiliation(s)
- Dean Wang
- Department of Orthopaedic Surgery,
University of California Irvine, Orange, CA, USA,Dean Wang, UC Irvine Health, 101 The City
Drive South, Pavilion III, Building 29A, Orange, CA 92868, USA.
| | - Danyal H. Nawabi
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | - Aaron J. Krych
- Department of Orthopaedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, David
Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph Nguyen
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | - Ameer M. Elbuluk
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | | | - Hollis G. Potter
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | - Riley J. Williams
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
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25
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Chamorro-Moriana G, Perez-Cabezas V, Espuny-Ruiz F, Torres-Enamorado D, Ridao-Fernández C. Assessing knee functionality: systematic review of validated outcome measures. Ann Phys Rehabil Med 2021; 65:101608. [PMID: 34808424 DOI: 10.1016/j.rehab.2021.101608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 08/10/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Functional rating scales allow clinicians to document and quantify alterations and progression of recovery processes. There is neither awareness of numerous knee scales nor are they easy to find or compare to select the most suitable. OBJECTIVES We aimed to compile validated knee functional rating tools and analyse the methodological quality of their validation studies. Also, we aimed to provide an operational document of the outcome measures addressing descriptions of parameters, implementations, instructions, interpretations and languages, to identify the most appropriate for future interventions. METHODS A systematic review involved a search of PubMed, Web of Science, CINAHL, Scopus, and Dialnet databases from inception through September 2020. The main inclusion criteria were available functional rating scales/questionnaires/indexes for knees and validation studies. Methodological quality was analyzed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and COnsensus-based Standards for the selection of health Measurement Instruments Risk of Bias (COSMIN-RB). RESULTS We selected 73 studies. The studies investigated 41 knee rating tools (general, 46%, and specific, 54%) and 71 validations, including 29,742 individuals with knee disorders. QUADAS-2 obtained the best results in patient selection and index test (applicability section). COSMIN-RB showed the highest quality in construct validity (most analyzed metric property). The specific tools were mainly designed for prosthesis and patellofemoral and anterior cruciate ligament injuries. More considered issues were specific function (93%), especially gait, pain/sensitivity (81%), and physical activity/sports (56%). CONCLUSIONS AND IMPLICATIONS We conducted a necessary, useful, unlimited-by-time and feasible compilation of validated tools for assessing knee functional recovery. The methodological quality of the validations was limited. The best validations were for the Copenhagen Knee Range of Motion Scale in osteoarthritis and arthroplasties, Knee Outcome Survey Activities of Daily Living and Lysholm Knee Score for general knee disorders and the Tegner Activity Score for anterior cruciate ligament injuries. The operational document for the scales provides necessary data to identify the most appropriate.
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26
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Meyer VM, Beydoun HA, Gyenai L, Goble NM, Hunter MM, McGill RJ. The Effect of Preoperative Behavioral Intervention on Pain, Anxiety, Opioid Use, and Function in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Study. Mil Med 2021; 188:e1010-e1017. [PMID: 34791356 DOI: 10.1093/milmed/usab424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/26/2021] [Accepted: 10/04/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of preoperative cognitive-behavioral psychoeducation (CBE) for improved pain, anxiety, opioid use, and postoperative function in total knee arthroplasty (TKA) patients. METHODS A randomized controlled trial was conducted among 36 military health system beneficiaries attending preoperative education for TKA. The standard of care (SOC) group (n = 18) received information on home safety, rehabilitation, postoperative precautions, and pain management. In addition, the occupational therapy led CBE group (n = 16) received information on principles of holistic wellness (healing process, effects of stress on healing, heart-rate control through diaphragmatic breathing, anti-inflammatory nutrition, goal setting, and mental imagery). Outcomes of interest: knee active range of motion, pain (Defense and Veterans Pain Rating Scale), opioid medication use, heart-rate coherence (emwave2), anxiety (Generalized Anxiety Disorder Scale), and function (Knee Outcome Survey Activities of Daily Living [KOS-ADL], modified Functional Independence Measure, and Global Rate of Change). RESULTS The CBE group demonstrated significantly greater decline in pain overall, with activity, and during sleep in relation to the SOC group when comparing visit 1 to visit 5. Opioid medication use was significantly lower for CBE versus SOC. Postoperative General Anxiety Disorder-7 scores decreased significantly among CBE participants with similar increase in high heart rate coherence. Function significantly improved postoperatively based on KOS-ADL and Global Rate of Change scores. Twice as many CBE participants had same-day discharge compared to SOC participants and most CBE participants continued with healthy lifestyle recommendations at the 3-month follow-up. CONCLUSION A cognitive-behavioral approach to preoperative education may improve postoperative pain, anxiety, and function while decreasing opioid use among TKA patients. Findings from this pilot study support further research to examine similar interventions among distinct surgical populations and encourage further evaluation on the effects of CBE to enhance health and healthcare delivery.
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Affiliation(s)
- Vanessa M Meyer
- Department of Orthopedics and Rehabilitation, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Leonora Gyenai
- Department of Orthopedics and Rehabilitation, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Nicole M Goble
- Department of Orthopedics and Rehabilitation, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Michelle M Hunter
- Department of Orthopedics and Rehabilitation, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Robert J McGill
- Department of Orthopedics and Rehabilitation, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
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27
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The Comprehensive Aachen Knee Score: Development and validation of a new patient-reported outcome measure for patellofemoral pathologies. Knee 2021; 32:112-120. [PMID: 34461387 DOI: 10.1016/j.knee.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/17/2021] [Accepted: 08/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Existing patient-reported outcome measures (PROMs) that assess knee pain and symptoms show insufficient quality regarding their psychometric properties. We developed and validated a new PROM assessing knee pain and especially patellofemoral pathologies, the COMPrehensive AaChen Knee Score (COMPACK). METHODS We followed a three-phase process of development and validation. (1) Scale development: we conducted a systematic literature research to collect and analyse the most commonly used PROMs for knee and patellofemoral pathologies to identify appropriate items. (2) Pilot testing: we assessed the content validity of the COMPACK based on interviews with patients and health experts regarding relevance, comprehensibility and comprehensiveness of the used items. (3) Field testing: we used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines to evaluate the structural validity, internal consistency and test-retest reliability of the COMPACK. RESULTS The COMPACK scale showed good structural validity, with two subscales measuring pain intensity and frequency. Further, scores of the COMPACK correlated positively with those obtained from the International Knee Documentation Committee Subjective Knee Form (IKDC) (r = 0.64) and the 12-item Short Form Health Survey subscale of physical function: (r = 0.43). Both the total scale and the two subscales showed good internal consistency (Cronbach's α > 0.82) and good to excellent test-retest reliability (Cronbach's α > 0.82). CONCLUSIONS The final COMPACK score was shown to be a valid and reliable instrument and thus meets the most important psychometric quality criteria. In its development, we specifically focused on its content validity, structural validity and applicability.
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28
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Chen C, Li SQ, Bao T, Zhang L, Seluzicki C, Mao JJ. A Systematic Review of CheeZheng Pain Relieving Plaster for Musculoskeletal Pain: Implications for Oncology Research and Practice. Integr Cancer Ther 2021; 19:1534735420918933. [PMID: 32880472 PMCID: PMC7485161 DOI: 10.1177/1534735420918933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Musculoskeletal pain is a common and debilitating condition for cancer patients. Existing therapies for these pain conditions have substantial limitations. To identify an integrative approach to pain management, we conducted a systematic review to evaluate the safety and efficacy of a Tibetan herbal-based topical agent, CheeZheng Pain Relieving Plaster (PRP), for the treatment of osteoarthritis (OA) pain. METHODS We extracted citations from PubMed and Chinese databases (CNKI, WanFang Data, and CQVIP). We included randomized clinical trials evaluating the effectiveness and safety of CheeZheng PRP compared to conventional OA pain treatments. RESULTS Twenty-two randomized clinical trials (n = 2556 participants) compared CheeZheng PRP against nonsteroidal anti-inflammatory drugs (11), glucosamine (2), intraarticular corticosteroid (2), hyaluronic acid injections (6), and acetaminophen (1). Ten studies found a statistically greater effectiveness (assessed by ≥30% reduction in symptom severity) of CheeZheng PRP in improving OA pain (measured by the Visual Analogue Scale), stiffness, and function compared to control. Ten studies reported that 4.8% of participants experienced application site skin irritation that resolved after discontinuing the plaster. Randomization was not sufficiently described in most studies, and no placebo-controlled trials were identified. CONCLUSIONS There is promising evidence for the safety and clinical effectiveness of CheeZheng PRP to treat OA; however, lack of placebo control and unclear descriptions of randomization increase the potential risk for bias. Future randomized, placebo-controlled trials are needed to establish the safety and efficacy of CheeZheng PRP for pain management in oncology settings.
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Affiliation(s)
- Connie Chen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan Q Li
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lily Zhang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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29
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Ramkumar PN, Karnuta JM, Haeberle HS, Rodeo SA, Nwachukwu BU, Williams RJ. Effect of Preoperative Imaging and Patient Factors on Clinically Meaningful Outcomes and Quality of Life After Osteochondral Allograft Transplantation: A Machine Learning Analysis of Cartilage Defects of the Knee. Am J Sports Med 2021; 49:2177-2186. [PMID: 34048288 DOI: 10.1177/03635465211015179] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fresh osteochondral allograft transplantation (OCA) is an effective method of treating symptomatic cartilage defects of the knee. This restoration technique involves the single-stage implantation of viable, mature hyaline cartilage into a chondral or osteochondral lesion. The extent to which preoperative imaging and patient factors predict achieving clinically meaningful outcomes among patients undergoing OCA for cartilage lesions of the knee remains unknown. PURPOSE To determine the predictive relationship of preoperative imaging, preoperative patient-reported outcome measures (PROMs), and patient demographics with achievement of the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for functional and quality-of-life PROMs at 2 years after OCA for symptomatic cartilage defects of the knee. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were analyzed for patients who underwent OCA before May 1, 2018, by 2 high-volume fellowship-trained cartilage surgeons. The International Knee Documentation Committee (IKDC) subjective form, Knee Outcome Survey-Activities of Daily Living (KOS-ADL), and mental and physical component summaries of the SF-36 were administered preoperatively and at 2 years postoperatively. A total of 42 predictive models were created using 7 unique architectures to detect achievement of the MCID for each of the 4 outcome measures and the SCB for the IKDC and KOS-ADL. Data inputted into the models included sex, age, body mass index, baseline PROMs, lesion size, concomitant ligamentous or meniscal tear, and presence of "bone bruise" or osseous edema. Shapley additive explanations plot analysis identified predictors of reaching the MCID and SCB. RESULTS Of the 185 patients who underwent OCA for the knee and met eligibility criteria from an institutional cartilage registry, 153 (83%) had 2-year follow-up. Preoperative magnetic resonance imaging (MRI), baseline PROMs, and patient demographics best predicted reaching the 2-year MCID and SCB of the IKDC and KOS-ADL PROMs, with areas under the receiver operating characteristic curve of the top-performing models ranging from good (0.88) to excellent (0.91). MRI faired poorly (areas under the curve, 0.60-0.68) in predicting the MCID for the mental and physical component summaries. Higher body mass index, knee malalignment, absence of preoperative osseous edema, concomitant anterior cruciate ligament or meniscal injury, larger defect size, and the implantation of >1 OCA graft were consistent findings contributing to failure to achieve the MCID or SCB at 2 years postoperatively. CONCLUSION Our machine learning models demonstrated that preoperative MRI, baseline PROMs, and patient demographics reliably predict the ability to reach clinically meaningful thresholds for functional knee outcomes 2 years after OCA for cartilage defects. Although clinical improvement in knee function can be reliably predicted, improvements in quality of life after OCA depend on a comprehensive preoperative assessment of the patient's perception of his or her mental and physical health. Absence of osseous edema, concomitant anterior cruciate ligament or meniscal injury, larger lesion size on MRI, knee malalignment, and elevated body mass index are predictive of failure to achieve 2-year functional benefits after OCA of the knee.
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Affiliation(s)
- Prem N Ramkumar
- Orthopaedic Machine Learning Laboratory, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaret M Karnuta
- Orthopaedic Machine Learning Laboratory, Cleveland Clinic, Cleveland, Ohio, USA
| | - Heather S Haeberle
- Orthopaedic Machine Learning Laboratory, Cleveland Clinic, Cleveland, Ohio, USA.,Sports Medicine and Shoulder Service, Institute for Cartilage Repair Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Sports Medicine and Shoulder Service, Institute for Cartilage Repair Hospital for Special Surgery, New York, New York, USA
| | - Benedict U Nwachukwu
- Sports Medicine and Shoulder Service, Institute for Cartilage Repair Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Sports Medicine and Shoulder Service, Institute for Cartilage Repair Hospital for Special Surgery, New York, New York, USA
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30
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Wang D, Marom N, Coxe FR, Kalia V, Burge AJ, Jones KJ, Rodeo SA, Williams RJ. Preoperative Grades of Osteoarthritis and Meniscus Volume Correlate with Clinical Outcomes of Osteochondral Graft Treatment for Cartilage Defects in the Knee. Cartilage 2021; 12:344-353. [PMID: 31161779 PMCID: PMC8236652 DOI: 10.1177/1947603519852402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To identify preoperative imaging-based indicators of knee degeneration that correlate with graft failure risk and postoperative clinical outcome scores after osteochondral graft treatment for chondral defects of the knee. DESIGN Prospectively collected data from 113 patients (mean age, 34 years; 65% male) treated with mosaicplasty or osteochondral allograft transplantation (OCA) was reviewed. Four different aspects of knee degeneration were examined based on preoperative radiographs or magnetic resonance imaging: (1) Osteoarthritis using the Kellgren-Lawrence (KL) grading system, (2) meniscus volume, (3) meniscus quality, and (4) synovitis. Primary outcomes included graft failure, defined by removal/revision of the graft or conversion to arthroplasty, and patient responses to clinical outcome scores. RESULTS Forty-one knees (36%) underwent mosaicplasty, and 72 knees (64%) underwent OCA. Mean duration of follow-up was 4.5 years (range, 2-14 years). A preoperative KL grade of ≥3 was correlated with increased failure rates (P = 0.01), lower postoperative International Knee Documentation Committee form (IKDC), Activities of Daily Living of the Knee Outcome Survey (KOS-ADL), and Overall Condition scores (P < 0.01), and decreased improvement in Overall Condition scores (P = 0.01). Within an individual tibiofemoral compartment, a preoperative meniscus volume grade of ≥3 (indicating <50% meniscus volume remaining) was correlated with increased condylar graft failure rates (P < 0.01). Preoperative meniscus quality and synovitis grades were not associated with graft failure rates or clinically meaningful differences in postoperative outcome scores. CONCLUSIONS Greater preoperative osteoarthritis and meniscus volume loss were correlated with increased graft failure rates after osteochondral graft treatment for chondral defects of the knee.
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Affiliation(s)
- Dean Wang
- Department of Orthopaedic Surgery, University of California Irvine, Orange, CA, USA,Dean Wang, Department of Orthopaedic Surgery, UC Irvine Health, 101 The City Drive South, Pavilion 3, Building 29A, Orange, CA 92868, USA.
| | - Niv Marom
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Francesca R. Coxe
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Vivek Kalia
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Alissa J. Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Scott A. Rodeo
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Riley J. Williams
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
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Ribeiro PPA, Berni KCDS. Relationship between Knee Symptoms and Biological Features in Recreational Runners. Rev Bras Ortop 2021; 56:168-174. [PMID: 33935312 PMCID: PMC8075652 DOI: 10.1055/s-0040-1713758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 04/15/2020] [Indexed: 11/27/2022] Open
Abstract
Objective
The main objective of the present study was to compare the subjective perception of pain and symptoms of anterior knee pain with the different body mass index (BMI) classifications. The secondary objective was to verify the association between biological and anthropometric variables with the results of subjective questionnaires.
Methods
A total of 126 recreational runners from both genders, aged between 20 and 59 years old, were recruited. Data regarding the biological variable (age), anthropometric variables (weight, height), visual analog scale (VAS), and Lysholm and Kujala questionnaires scores were collected. Information was obtained with a digital platform, available through a single link, allowing volunteers to answer these questions using electronic devices. Normality was verified by the Shapiro-Wilk test. T-tests and Wilcoxon tests were used to compare mean values. The association between variables was determined by the Pearson linear correlation.
Results
There were significant differences in height between overweight and grade 1 obesity subjects (
p
= 0.029), in weight and BMI comparing normal weight subjects and both overweight and grade 1 obesity subjects (
p
< 0.001 and
p
< 0.05, respectively). An unclear significant correlation was observed between BMI values and specific questionnaires and subjective scale scores (
p
< 0.05).
Conclusion
Recreational runners who present high BMI values are more likely to experience knee pain than those with normal BMI values.
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Al-Dadah O, Shepstone L, Donell ST. Patient reported outcome measures in meniscal tears and arthroscopic meniscectomy: The value of outcome score prediction. Orthop Traumatol Surg Res 2021; 107:102803. [PMID: 33434690 DOI: 10.1016/j.otsr.2021.102803] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/20/2020] [Accepted: 06/29/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are several clinical outcome scores relating to meniscal injuries reported in the literature. However, the result of one scoring system is often different from that of the others even when assessing the same group of patients. This makes the comparison of results of studies who have used different outcome measures restrictive and difficult. HYPOTHESIS Statistically derived formulae can be used to predict the outcome of one knee scoring system when the result of another is known in patients with meniscal tears before and after arthroscopic meniscectomy. PATIENTS AND METHODS Thirty-four patients with meniscal tears were evaluated using nine clinical outcome scores. These included Tegner Activity Score, Lysholm Knee Score, Cincinnati Knee Score, International Knee Documentation Committee (IKDC) Objective Knee Score, Tapper and Hoover Meniscal Grading Score, IKDC Subjective Knee Score, Knee Outcome Survey-Activities of Daily Living Scale, Short Form-12 Item Health Survey (SF-12) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Twenty-nine patients underwent an arthroscopic meniscectomy and were reassessed 3 months post-operatively. RESULTS There were considerable differences between the mean total of each of the nine outcome measures. Significant correlations and regressions were found between most of the outcome scores and were stronger following surgery. The strongest correlation was found between IKDC Subjective and SF-12 Physical Component Summary sub-score (r=0.94, P<0.001). The strongest regression formula was found between IKDC Subjective and KOOS (R2=0.93, P<0.001). DISCUSSION The outcome of one knee score can be predicted when the results of the other are known through formulae calculations produced from this study. This could facilitate the conduct of systematic reviews and meta-analysis in research pertaining to meniscal injuries by allowing the pooling of substantially more data. LEVEL OF EVIDENCE II; prospective non-randomized trial.
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Affiliation(s)
- Oday Al-Dadah
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle-upon-Tyne, NE2 4HH, United Kingdom; Department of Trauma and Orthopaedic Surgery, South Tyneside Hospital, Harton Lane, South Tyneside, NE34 0PL, United Kingdom.
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Earlham Road, Norwich, NR4 7TJ, United kingdom
| | - Simon T Donell
- Norwich Medical School, University of East Anglia, Earlham Road, Norwich, NR4 7TJ, United kingdom
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33
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Ajani K, Nimavat D, Vidja M, Moradiya A, Panchasara D, Bhalodiya S, Miyatra K, Tank KD. Translation, Reliability, and Validity Test of Gujarati Version of Menopause Rating Scale in Postmenopausal Women for Menopause-Related Symptoms. Indian J Community Med 2021; 46:40-44. [PMID: 34035574 PMCID: PMC8117906 DOI: 10.4103/ijcm.ijcm_163_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 02/02/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Women's health has been a global concern for many decades. As menopause is midway between the challenges of adulthood and despair of old age, comes the changes of menopause in women. The menopause rating scale (MRS) is widely used to assess menopause-related symptoms. The MRS was first published in 1990 for assessing menopause symptoms. However, no reliable and valid tools are available in the Gujarati language to assess the individuals with menopause symptoms. Aim: The aim of the study was to translate and find out reliability and validity of the Gujarati version of MRS in postmenopausal women. Methods: The study was carried out in three phases: The first phase was the translation of scale into the Gujarati language; the second phase was a pilot study on 30 postmenopausal women age assesses the comprehensibility of the prefinal version; and the third phase was to find out the reliability and validity of the final version of scale. Results: The total value of intraclass correlation coefficient of test–retest reliability was 0.88, with the all items having individual intraclass correlation coefficients score ranging from 0.74 to 0.92. Reliability estimated by internal consistency reached a Cronbach's alpha of 0.94 and ranging from 0.85 to 0.95 test–retest. Conclusion: The Gujarati version of MRS is a reliable and valid tool for assessing the menopausal symptoms and health-related quality of life in Guajarati-speaking populations.
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Affiliation(s)
- Khushali Ajani
- Department of Community Physiotherapy, School of Physiotherapy, RK University, Rajkot, Gujarat, India
| | - Dhvani Nimavat
- Department of Community Physiotherapy, School of Physiotherapy, RK University, Rajkot, Gujarat, India
| | - Monika Vidja
- Department of Community Physiotherapy, School of Physiotherapy, RK University, Rajkot, Gujarat, India
| | - Anjali Moradiya
- Department of Community Physiotherapy, School of Physiotherapy, RK University, Rajkot, Gujarat, India
| | - Dharti Panchasara
- Department of Community Physiotherapy, School of Physiotherapy, RK University, Rajkot, Gujarat, India
| | - Sonali Bhalodiya
- Department of Community Physiotherapy, School of Physiotherapy, RK University, Rajkot, Gujarat, India
| | - Krupali Miyatra
- Department of Community Physiotherapy, School of Physiotherapy, RK University, Rajkot, Gujarat, India
| | - Krupa Dharmeshkumar Tank
- Department of Community Physiotherapy, School of Physiotherapy, RK University, Rajkot, Gujarat, India
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34
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Ramkumar PN, Karnuta JM, Haeberle HS, Owusu-Akyaw KA, Warner TS, Rodeo SA, Nwachukwu BU, Williams RJ. Association Between Preoperative Mental Health and Clinically Meaningful Outcomes After Osteochondral Allograft for Cartilage Defects of the Knee: A Machine Learning Analysis. Am J Sports Med 2021; 49:948-957. [PMID: 33555931 DOI: 10.1177/0363546520988021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fresh osteochondral allograft transplantation (OCA) is an effective method of treating symptomatic cartilage defects of the knee. This cartilage restoration technique involves the single-stage implantation of viable, mature hyaline cartilage into the chondral or osteochondral lesion. Predictive models for reaching the clinically meaningful outcome among patients undergoing OCA for cartilage lesions of the knee remain under investigation. PURPOSE To apply machine learning to determine which preoperative variables are predictive for achieving the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) at 1 and 2 years after OCA for cartilage lesions of the knee. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were analyzed for patients who underwent OCA of the knee by 2 high-volume fellowship-trained cartilage surgeons before May 1, 2018. The International Knee Documentation Committee questionnaire (IKDC), Knee Outcome Survey-Activities of Daily Living (KOS-ADL), and Mental Component (MCS) and Physical Component (PCS) Summaries of the 36-Item Short Form Health Survey (SF-36) were administered preoperatively and at 1 and 2 years postoperatively. A total of 84 predictive models were created using 7 unique architectures to detect achievement of the MCID for each of the 4 outcome measures and the SCB for the IKDC and KOS-ADL at both time points. Data inputted into the models included previous and concomitant surgical history, laterality, sex, age, body mass index (BMI), intraoperative findings, and patient-reported outcome measures (PROMs). Shapley Additive Explanations (SHAP) analysis identified predictors of reaching the MCID and SCB. RESULTS Of the 185 patients who underwent OCA for the knee and met eligibility criteria from an institutional cartilage registry, 135 (73%) patients were available for the 1-year follow-up and 153 (83%) patients for the 2-year follow-up. In predicting outcomes after OCA in terms of the IKDC, KOS-ADL, MCS, and PCS at 1 and 2 years, areas under the receiver operating characteristic curve (AUCs) of the top-performing models ranged from fair (0.72) to excellent (0.94). Lower baseline mental health (MCS), higher baseline physical health (PCS) and knee function scores (KOS-ADL, IKDC Subjective), lower baseline activity demand (Marx, Cincinnati sports), worse pain symptoms (Cincinnati pain, SF-36 pain), and higher BMI were thematic predictors contributing to failure to achieve the MCID or SCB at 1 and 2 years postoperatively. CONCLUSION Our machine learning models were effective in predicting outcomes and elucidating the relationships between baseline factors contributing to achieving the MCID for OCA of the knee. Patients who preoperatively report poor mental health, catastrophize pain symptoms, compensate with higher physical health and knee function, and exhibit lower activity demands are at risk for failing to reach clinically meaningful outcomes after OCA of the knee.
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Affiliation(s)
- Prem N Ramkumar
- Orthopaedic Machine Learning Laboratory, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaret M Karnuta
- Orthopaedic Machine Learning Laboratory, Cleveland Clinic, Cleveland, Ohio, USA
| | - Heather S Haeberle
- Orthopaedic Machine Learning Laboratory, Cleveland Clinic, Cleveland, Ohio, USA.,Sports Medicine and Shoulder Service-Institute for Cartilage Repair, Hospital for Special Surgery, New York, New York, USA
| | - Kwadwo A Owusu-Akyaw
- Sports Medicine and Shoulder Service-Institute for Cartilage Repair, Hospital for Special Surgery, New York, New York, USA
| | - Tyler S Warner
- Sports Medicine and Shoulder Service-Institute for Cartilage Repair, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Sports Medicine and Shoulder Service-Institute for Cartilage Repair, Hospital for Special Surgery, New York, New York, USA
| | - Benedict U Nwachukwu
- Sports Medicine and Shoulder Service-Institute for Cartilage Repair, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Sports Medicine and Shoulder Service-Institute for Cartilage Repair, Hospital for Special Surgery, New York, New York, USA
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CRITERION-BASED REHABILITATION PROGRAM WITH RETURN TO SPORT TESTING FOLLOWING ACL RECONSTRUCTION: A CASE SERIES. Int J Sports Phys Ther 2020; 15:1151-1173. [PMID: 33344032 DOI: 10.26603/ijspt20201151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Less than 50% of those sustaining an anterior cruciate ligament (ACL) injury return to their preinjury level of sports participation or participate in competitive sport at two to seven years post ACL reconstruction (ACLR). After ACLR, it has been reported that frequency of subsequent ACL tears has reached as high as 31%. Purpose The purpose of this case series was to evaluate return to sport and reinjury rates following the use of a criterion-based rehabilitation protocol with a final return to sport test that utilizes minimal equipment following ACL reconstruction. Study Design Case series. Methods Following ACL reconstruction, participants were included if they had a goal of returning to their pre-injury sport or level of activity, were between 16 and 50 years of age at the time of evaluation, had at least 25 physical therapy visits covered by insurance, and planned to complete physical therapy until clearance for return to sport. Results Forty-three participants met the inclusion criteria and enrolled in the study. Twenty-one participants completed the full course of rehabilitation including passing their return to sport test and nineteen participants completed the two-year follow-up. Data obtained at two years indicated that 84% were able to return to their preinjury level of sports competition. A smaller percentage (16%) were able to return to a reduced level of sport and only one participant reported a second ACL injury. Conclusion Participants that completed the full course of rehabilitation and passed return to sport testing had a larger percentage that were able to return to preinjury participation levels than currently reported in the literature. This case series did not exclude participants based on graft type, single vs double bundle procedure, ACL revision surgeries, nor concomitant procedures or injuries. Level of Evidence Level 4.
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36
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McHugh M, Droy E, Muscatelli S, Gagnier JJ. Measures of Adult Knee Function. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:219-249. [DOI: 10.1002/acr.24235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/21/2020] [Indexed: 12/23/2022]
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37
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Johnson JL, Irrgang JJ, Risberg MA, Snyder-Mackler L. Comparing the Responsiveness of the Global Rating Scale With Legacy Knee Outcome Scores: A Delaware-Oslo Cohort Study. Am J Sports Med 2020; 48:1953-1960. [PMID: 32515989 PMCID: PMC7448061 DOI: 10.1177/0363546520924817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The selection of patient-reported outcome measures (PROMs) is essential for obtaining meaningful information to treat a patient, determine a plan of care, and make clinical decisions; however, the process of selecting PROMs for clinical care is difficult, with the need to balance these multiple factors. Variation makes it difficult to compare data across providers and studies. HYPOTHESIS/PURPOSE The purpose was to determine the responsiveness of 4 PROMs via effect size and the presence of a ceiling effect in the 5 years after anterior cruciate ligament reconstruction (ACLR). We hypothesized that the single-item Global Rating Scale (GRS) would have an effect size and ceiling effect similar to the commonly used legacy PROMs. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Of the 300 participants, 218 had ACLR, completed postoperative progressive criterion-based rehabilitation early after surgery, and were followed for 5 years. We collected data based on the GRS, the Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), the International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF), and the KOOS (Knee injury and Osteoarthritis Outcome Score) before and after training and at 6, 12, 24, and 60 months after ACLR. RESULTS The IKDC-SKF had the largest effect sizes and lowest ceiling effects. The GRS had a similar size and change in both effect size and ceiling effect when compared with the longer PROMs. The GRS and IKDC-SKF had a correlation of 0.72, and the GRS had a minimal detectable change of 2.9 or 4.8, depending on methodology. CONCLUSION The GRS responded similarly to the IKDC-SKF, KOS-ADLS, and KOOS and was responsive to patient change. The ease of use and patient-specific nature of the question means that it may be appropriate to use the GRS in clinical care as a consistent measure throughout the course of rehabilitation.
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Affiliation(s)
- Jessica L Johnson
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - James J Irrgang
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - May Arna Risberg
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway,Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Department of Physical Therapy, University of Delaware, Newark, DE, USA
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Cross-Cultural Adaptation of the Dance Functional Outcome Survey (DFOS) for Spanish Dancers. Diagnostics (Basel) 2020; 10:diagnostics10030169. [PMID: 32245063 PMCID: PMC7151173 DOI: 10.3390/diagnostics10030169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 11/26/2022] Open
Abstract
A growing number of research papers regarding Spanish-speaking dancers justifies the need for an adapted Spanish version of the Dance Functional Outcome Survey (DFOS). The objective of this study was to cross-culturally adapt and validate the DFOS for Spanish-speaking dancers. A sample of 127 healthy and injured professional and pre-professional dancers were recruited. Test-retest reliability of DFOS-Sp was examined using intraclass correlation coefficients. Construct validity compared DFOS-Sp to the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) using Pearson correlations. Principal component analysis identified factors and internal-item consistency. Sensitivity was evaluated by generating receiver operating characteristic and area under the curve analyses. A subgroup of 51 injured dancers were followed across three time-points to examine responsiveness using repeated measures analysis of variance. Injured scores were analyzed for floor and ceiling effects. The DFOS-Sp showed high test-retest reliability (ICC2,1 ≥ 0.92). DFOS-Sp scores had moderate construct validity compared with SF-36 physical component summary scores (r ≥ 0.56). Principal component analysis (PCA) supported uni-dimensionality explaining 58% of the variance with high internal consistency (α = 0.91).Area under the curve (AUC) sensitivity values were excellent (AUC ≥ 0.82). There were significant differences across time (p < 0.001), demonstrating responsiveness to change, with no floor or ceiling effects. The DFOS-Sp demonstrated acceptable test-retest reliability and validity in Spanish-speaking dancers, with comparable psychometric performance to the English-language version.
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Farnsworth Ii JL, Evans T, Binkley H, Kang M. Evaluation of Knee-Specific Patient-Reported Outcome Measures Using Rasch Analysis. J Sport Rehabil 2020; 30:278-285. [PMID: 32106079 DOI: 10.1123/jsr.2019-0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/11/2019] [Accepted: 01/02/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Documentation of patient outcomes following injury is critical to ensure that patients are receiving the best care. Several patient-reported outcome measures (PROMs) have been developed to assess knee-related function following injury; however, there is limited data investigating the measurement properties of these instruments using Rasch model analyses. OBJECTIVE To evaluate the measurement properties of several PROMs through application of the Rasch measurement model. DESIGN Cross-sectional study. SETTING Clinical setting. PATIENTS OR OTHER PARTICIPANTS A convenience sample of 160 adults (mean age = 28.08 [10.95] y; male = 38.10%) were recruited for this study. Data collected were combined with existing pilot data from an earlier study containing de-identified Knee Injury and Osteoarthritis Outcome Score (KOOS) data from 79 adults with knee injuries resulting in a total sample size of 239 adults. INTERVENTION(S) Psychometric evaluation of the KOOS, International Knee Documentation Committee subjective knee form, and the Marx Activity Rating Scale using the Rasch partial credit model. MAIN OUTCOME MEASURES Infit and outfit statistics, item step difficulties, person ability parameters, category function, and item and test information functions. RESULTS Large ceiling effects were present in the KOOS and International Knee Documentation Committee subjective knee form. Of the 65 items examined in this study, 35 items showed poor measurement properties. Item step difficulty for the remaining 30 items ranged from -5.45 (least difficult) to 0.57 logits (most difficult). The 5-category response options did not function well. Measurement precision decreased significantly as ability score increased beyond 0.30 logits. CONCLUSIONS Despite their use in clinical practice, several items showed poor measurement properties. Future studies are needed to develop and evaluate novel items that are suitable for measuring knee-related function in high-functioning populations to ensure continuity of PROMs as individuals recover from injuries.
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Hong G, Huang X, Lv T, Li X. An analysis on the effect of the three-incision combined approach for complex fracture of tibial plateau involving the posterolateral tibial plateau. J Orthop Surg Res 2020; 15:43. [PMID: 32046762 PMCID: PMC7014713 DOI: 10.1186/s13018-020-1572-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background The clinical effect of the three-incision combined approach for complex fracture of tibial plateau involving the posterior tibial plateau was discussed. Methods A retrospective analysis was performed for 13 cases receiving surgery for complex fracture of tibial plateau from July 2015 to June 2019. They received surgery via the three-incision combined approach, and regular postoperative reexamination was performed at the outpatient clinic. During the last follow-up, Hospital for Special Surgery (HSS) Knee Scoring System was used to assess the knee joint function; the Lysholm score was used to assess the knee mobility. The anterior, posterior, and rotational stabilities of the knee joint were assessed by the Lachman test and pivot-shift test. Results There was no nonunion and delayed union, implant loosening and fracture, or refracture, and neither were there neurological symptoms or restricted mobility in daily life. During the follow-up, none of the cases were found with restriction of knee mobility caused by internal fixation or apparent pain. The HSS score during the last follow-up was 86–100 (average, 90.2 ± 6.8), and the excellent and good rate was 100%; the Lysholm score was 86–100 (average, 95.7 ± 2.6). All cases were negative for the Lachman test and pivot-shift test. The knee flexion mobility was 100~140° (average, 127.2° ± 11.4°). Postoperative X-ray indicated anatomical reduction of bone fractures in all cases. Loss of reduction or loosening and fracture of internal fixation was not observed by postoperative regular reexaminations. The posterior tibial slope at 6 months after surgery was 6~16° (average, 10.66 ± 2.58°), the varus angle was 84~89° (average, 86.52 ± 1.46°), the Rasmussen radiological score was 12~18 (average, 16.12 ± 1.35), and the excellent and good rate was 100%. Conclusion The three-incision combined approach proved safe and reliable for complex fracture of tibial plateau involving the posterior tibial plateau and is worthy of further popularization.
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Affiliation(s)
- Guqi Hong
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, 210029, People's Republic of China
| | - Xiaowen Huang
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, 210029, People's Republic of China
| | - Tianrun Lv
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, 210029, People's Republic of China.
| | - Xiang Li
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, 210029, People's Republic of China
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Perelli S, Ibañez F, Gelber PE, Erquicia JI, Pelfort X, Monllau JC. Selective bundle reconstruction in partial ACL tears leads to excellent long-term functional outcomes and a low percentage of failures. Knee 2019; 26:1262-1270. [PMID: 31628076 DOI: 10.1016/j.knee.2019.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 06/13/2019] [Accepted: 09/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The optimal treatment of partial anterior cruciate ligament (ACL) tears continues to be debatable. Short-term results of selective bundle reconstruction have already been widely shown. The purpose of this study was to assess functional outcomes, subjective satisfaction and the failure rate of selective bundle reconstructions for partial ACL tears over a five to nine year follow-up period. METHODS Patients who underwent ACL selective bundle reconstruction between October 2008 and October 2012 were studied. Functional assessment was performed with the objective International Knee Documentation Committee (IKDC) ligament evaluation form, the Lysholm knee scale and the Tegner activity level scale. Cumulative failure and level of satisfaction have also been investigated. RESULTS Seventy-six patients were included. The average follow-up period was 85 months (range 65-110). Thirty-four had AMB tear and 42 had PLB tears. An overall statistically significant improvement (p < 0.001) was obtained in terms of the subjective IKDC and the Lysholm questionnaire between preoperative and last follow-up. The same or no more than one level lower Tegner score was restored in 97.3% of the cases. Cumulative failure was observed in two patients (2.6%). Dissatisfied patient percentage was 15% (4/76). CONCLUSIONS Selective bundle reconstruction in partial ACL tears leads to excellent long-term functional outcomes, a low percentage of failures and a high degree of subjective satisfaction in patients. LEVEL OF EVIDENCE Therapeutic case series; level 4.
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Affiliation(s)
- Simone Perelli
- ICATME-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, C/Sabino Arana 5, 08028 Barcelona, Spain.
| | - Federico Ibañez
- ICATME-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, C/Sabino Arana 5, 08028 Barcelona, Spain
| | - Pablo Eduardo Gelber
- ICATME-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, C/Sabino Arana 5, 08028 Barcelona, Spain; Department of Orthopaedic Surgery, Hospital de la Sta Creu i Sant Pau, Universitat Autònoma de Barcelona, C/Sant Quintí 89, 08041 Barcelona, Spain
| | - Juan Ignacio Erquicia
- ICATME-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, C/Sabino Arana 5, 08028 Barcelona, Spain
| | - Xavier Pelfort
- ICATME-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, C/Sabino Arana 5, 08028 Barcelona, Spain
| | - Juan Carlos Monllau
- ICATME-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, C/Sabino Arana 5, 08028 Barcelona, Spain; Department of Orthopaedic Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Maritim, 25, 08003 Barcelona, Spain
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Clinical and Biomechanical Efficacies of Mechanical Perturbation Training After Anterior Cruciate Ligament Rupture. J Sport Rehabil 2019; 28:877-886. [PMID: 30300071 DOI: 10.1123/jsr.2017-0363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 08/11/2018] [Accepted: 08/27/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Manual perturbation training improves knee functional performance and mitigates abnormal gait in patients with anterior cruciate ligament (ACL) rupture. However, manual perturbation training is time- and labor-intensive for therapists. OBJECTIVE To investigate whether perturbation training administered using a mechanical device can provide effects similar to manual training on clinical measures and knee biomechanics after ACL rupture. DESIGN Prospective cohort (therapeutic) study. A 2 × 2 analysis of variance was used for statistical analysis. SETTING A clinical and biomechanical laboratory. PATIENTS Eighteen level I/II patients with acute ACL ruptures participated in this preliminary study. INTERVENTION Nine patients received mechanical perturbation training on an automated mechanical device (mechanical group), and 9 patients received manual perturbation training (manual group). OUTCOME MEASURES Patients completed performance-based testing (quadriceps strength and single-legged hop tests), patient-reported questionnaires (Knee Outcome Survey-Activities of Daily Living Scale, Global Rating Score, and International Knee Documentation Committee 2000), and 3-dimensional gait analysis before (pretesting) and after (posttesting) training. RESULTS There was no significant group-by-time interaction found for all measures (P ≥ .18). Main effects of time were found for International Knee Documentation Committee 2000 (pretesting: 69.10 [10.95], posttesting: 75.14 [7.19]), knee excursion during weight-acceptance (pretesting: 16.01° [3.99°]; posttesting: 17.28° [3.99°]) and midstance (pretesting: 14.78° [4.13°]; posttesting: 16.92° [4.53°]) and external knee-flexion moment (pretesting: 0.43 [0.11] N m/kg/m; posttesting: 0.48 [0.11] N m/kg/m) (P ≤ .04). After accounting for pretesting groups' differences, the mechanical group scored significantly higher on triple hops (mechanical: 96.73% [6.65%]; manual: 84.97% [6.83%]) and 6-m timed hops (mechanical: 102.07% [9.50%]; manual: 91.21 [9.42%]) (P ≤ .047) compared with manual group. CONCLUSION The clinical significance of this study is the mechanical perturbation training produced effects similar to manual training, with both training methods were equally effective at improving patients' perception of knee function and increasing knee excursion and external flexion moment during walking after acute ACL rupture. Mechanical perturbation training is a potential treatment to improve patients' functional and biomechanical outcomes after ACL rupture.
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Shazadeh Safavi P, Janney C, Jupiter D, Kunzler D, Bui R, Panchbhavi VK. A Systematic Review of the Outcome Evaluation Tools for the Foot and Ankle. Foot Ankle Spec 2019; 12:461-470. [PMID: 30338697 DOI: 10.1177/1938640018803747] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The goal of this systematic review is to determine the most commonly used outcome measurement tools used by foot and ankle specialists and determine their limitations, such as whether they are validated, have floor/ceiling effects, and so on. Methods. A literature search was conducted to identify primary publications between January 1, 2012 and July 1, 2017 that concern care of the foot and ankle and use any established grading criteria to evaluate patients. Results. In 669 publications, 76 scoring systems were used. The 10 most common were American Orthopaedic Foot and Ankle Score (AOFAS), visual analog scale (VAS), Short Form-36 (SF-36), Foot Function Index (FFI), Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), SF-12, Short Musculoskeletal Function Assessment (SMFA), Ankle Osteoarthritis Scale (AOS), and Foot and Ankle Disability Index (FADI). AOFAS was used in 393 articles, VAS in 308, and SF-36 in 133 publications. AOFAS, VAS, and SF-36 were used to evaluate 23,352, 20,759, and 13,184 patients respectively. AOFAS and VAS were used simultaneously in 172 publications. Conclusion. While there are many different scoring systems available for foot and ankle specialists to use to assess or demonstrate the effectiveness of treatments, the AOFAS, while it is an unvalidated scoring system, is the most commonly used scoring system in this review. Clinical Relevance. This review presents data about commonly used patient reported outcomes systems in foot and ankle surgery. Levels of Evidence: Level III: Systematic review.
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Affiliation(s)
- Pejma Shazadeh Safavi
- University of Texas Medical Branch at Galveston, Galveston, Texas (PSS, CJ, DJ, DK, VKB).,United States Navy (CJ)
| | - Cory Janney
- University of Texas Medical Branch at Galveston, Galveston, Texas (PSS, CJ, DJ, DK, VKB).,United States Navy (CJ)
| | - Daniel Jupiter
- University of Texas Medical Branch at Galveston, Galveston, Texas (PSS, CJ, DJ, DK, VKB).,United States Navy (CJ)
| | - Daniel Kunzler
- University of Texas Medical Branch at Galveston, Galveston, Texas (PSS, CJ, DJ, DK, VKB).,United States Navy (CJ)
| | - Roger Bui
- University of Texas Medical Branch at Galveston, Galveston, Texas (PSS, CJ, DJ, DK, VKB).,United States Navy (CJ)
| | - Vinod K Panchbhavi
- University of Texas Medical Branch at Galveston, Galveston, Texas (PSS, CJ, DJ, DK, VKB).,United States Navy (CJ)
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Ithurburn MP, Zbojniewicz AM, Thomas S, Evans KD, Pennell ML, Magnussen RA, Paterno MV, Schmitt LC. Lower patient-reported function at 2 years is associated with elevated knee cartilage T1rho and T2 relaxation times at 5 years in young athletes after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:2643-2652. [PMID: 30446784 DOI: 10.1007/s00167-018-5291-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 11/09/2018] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose was to test the following hypotheses: (1) magnetic resonance imaging (MRI) markers of early knee cartilage degeneration would be present in the involved limb of young athletes after anterior cruciate ligament reconstruction (ACLR) and (2) poor knee function would be associated with MRI markers of cartilage degeneration. METHODS Twenty-five young athletes after primary, unilateral ACLR (mean age, 16.7 years) were followed to 5-year post-return-to-sport (RTS) clearance, as a part of a larger, prospective cohort study in young athletes post-ACLR. At 2-year post-RTS, patient-reported knee function was evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS). At 5-year post-RTS, qualitative MRI sequences (3 T) and quantitative T1rho and T2 maps segmented into six regions at the femur and tibia were performed for the involved and uninvolved knee cartilages. Relaxation times were compared between knees using Holm-corrected paired t tests. Linear regression was used to examine the association between KOOS scores at 2 years and relaxation times at 5 years. RESULTS Elevated T1rho and T2 relaxation times were observed in the involved knee at the anterior medial femoral condyle compared to the uninvolved knee (p = 0.006, p = 0.024, respectively). Lower KOOS-Pain, KOOS-Symptoms, KOOS-ADL, and KOOS-Sport scores at 2-year post-RTS were associated with higher T1rho or T2 relaxation times in various regions of the involved knee at 5-year post-RTS (all p < 0.05). CONCLUSIONS MRI markers of early cartilage degeneration were identified in the medial compartment of the involved knee in young athletes 5-year post-RTS after ACLR. Lower KOOS scores at 2-year post-RTS were associated with elevated knee cartilage T1rho and T2 relaxation times at 5-year post-RTS. Evaluating patient-reported function over time after ACLR appears to provide insight into future degenerative changes in the knee cartilage matrix.
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Affiliation(s)
- Matthew P Ithurburn
- Department of Physical Therapy and Center for Exercise Medicine, University of Alabama at Birmingham, SHPB 386, 1720 2nd Avenue South, Birmingham, AL, USA.,School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Columbus, OH, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Andrew M Zbojniewicz
- Advanced Radiology Services, 3264 North Evergreen Drive, Grand Rapids, MI, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Staci Thomas
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 10001, Cincinnati, OH, USA
| | - Kevin D Evans
- School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Columbus, OH, USA
| | - Michael L Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, 250 Cunz Hall, 1841 Neil Avenue, Columbus, OH, USA
| | - Robert A Magnussen
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Columbus, OH, USA
| | - Mark V Paterno
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 10001, Cincinnati, OH, USA.,Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 10001, Cincinnati, OH, USA
| | - Laura C Schmitt
- School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Columbus, OH, USA. .,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA. .,Division of Physical Therapy, The Ohio State University, 453 W 10th Avenue, 516 Atwell Hall, Columbus, OH, USA.
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LIANG H, LI ZR, CHEN J, LUO HW. The effect of five-knee-point acupuncture combined with herbal package warm compress for knee osteoarthritis. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2019. [DOI: 10.1016/j.wjam.2019.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang D, Rebolledo BJ, Dare DM, Pais MD, Cohn MR, Jones KJ, Williams RJ. Osteochondral Allograft Transplantation of the Knee in Patients with an Elevated Body Mass Index. Cartilage 2019; 10:214-221. [PMID: 29424234 PMCID: PMC6425548 DOI: 10.1177/1947603518754630] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To characterize the graft survivorship and clinical outcomes of osteochondral allograft transplantation (OCA) of the knee in patients with an elevated body mass index (BMI). DESIGN Prospective data on 38 consecutive patients with a BMI ≥30 kg/m2 treated with OCA from 2000 to 2015 were reviewed. Complications, reoperations, and patient responses to validated outcome measures were examined. Failures were defined by any removal/revision of the allograft or conversion to arthroplasty. RESULTS Thirty-one knees in 31 patients (mean age, 35.4 years [range, 17-61 years]; 87% male) met the inclusion criteria. Mean BMI was 32.9 kg/m2 (range, 30-39 kg/m2). Mean chondral defect size was 6.4 cm2 (range, 1.0-15.3 cm2). Prior to OCA, 23 patients (74%) had undergone previous surgery to the ipsilateral knee. Mean duration of follow-up was 4.1 years (range, 2-11 years). After OCA, 5 knees (13%) underwent conversion to unicompartmental (1) or total (4) knee arthroplasty. Two- and 5-year graft survivorship were 87% and 83%, respectively. At final follow-up, clinically significant improvements were noted in the pain (49.3-72.6) and physical functioning (52.9-81.3) subscales of the Short Form-36 ( P ≤ 0.001), International Knee Documentation Committee subjective form (43.5-67.0; P = 0.002), Knee Outcome Survey-Activities of Daily Living (58.2-80.4; P = 0.002), and overall condition subscale of the Cincinnati Knee Rating System (4.7-6.9; P = 0.046). CONCLUSIONS OCA can be a successful midterm treatment option for focal cartilage defects of the knee in select patients with a BMI ≥30 kg/m2.
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Affiliation(s)
- Dean Wang
- Sports Medicine Service, Hospital for Special Surgery, New York, NY, USA,Dean Wang, Sports Medicine Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | | | - David M. Dare
- Sports Medicine Service, Hospital for Special Surgery, New York, NY, USA
| | - Mollyann D. Pais
- Sports Medicine Service, Hospital for Special Surgery, New York, NY, USA
| | - Matthew R. Cohn
- Sports Medicine Service, Hospital for Special Surgery, New York, NY, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Riley J. Williams
- Sports Medicine Service, Hospital for Special Surgery, New York, NY, USA
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Morris R, Pallister I, Trickett RW. Measuring outcomes following tibial fracture. Injury 2019; 50:521-533. [PMID: 30482409 DOI: 10.1016/j.injury.2018.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/31/2018] [Accepted: 11/08/2018] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study was to determine how outcome is measured following adult tibial fracture in the modern era of functional outcome measurement and patient reported outcomes. METHODS A systematic review of publications since 2009 was performed, looking specifically at acute, adult tibial shaft fractures. Ovid Medline, Embase, PubMed and PsycINFO databases were searched for relevant titles which were then screened by two authors with adjudication where necessary by a third. Relevant articles were reviewed in full and data was extracted concerning the study participants, study design and any measures that were used to quantify the results following fracture. The results were collated and patient reported outcome measures were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) standards. RESULTS A total of 943 titles and articles were reviewed, with 117 included for full analysis. A wide range of clinical and radiological "outcomes" were described, along with named clinician- and patient-reported outcome measures. There was considerable heterogeneity and lack of detail in the description of the simplest outcomes, such as union, infection or reoperation. Reported clinician and patient reported outcome measures are variably used. None of the identified patient reported outcome measures have been validated for use following tibial fracture. CONCLUSION We recommend definition of a core outcome set for use following tibial fracture. This will standardise outcome reporting following these injuries. Furthermore, there is need for a validated patient reported outcome measure to better assess patient important outcomes in this patient group.
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Affiliation(s)
- R Morris
- Department of Trauma & Orthopaedics, Abertawe Bro Morgannwg University Health Board, Morriston Hospital, Swansea, SA6 6NL, UK
| | - I Pallister
- Department of Trauma & Orthopaedics, Abertawe Bro Morgannwg University Health Board, Morriston Hospital, Swansea, SA6 6NL, UK
| | - R W Trickett
- Department of Trauma & Orthopaedics, Abertawe Bro Morgannwg University Health Board, Morriston Hospital, Swansea, SA6 6NL, UK.
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Abstract
BACKGROUND Quantitative evaluation of the functional results of surgically managed tibial tubercle fractures in adolescents is unreported in the orthopaedic literature. METHODS All patients treated surgically for unilateral tibial tubercle fractures at a single institution from 2007 to 2011 were invited to return for functional evaluation. Fractures were classified using the Ogden classification system. Clinical examination at follow-up included passive knee range of motion and thigh circumference. Side-to-side knee extension strength deficits were evaluated using a Biodex dynamometer. Patient-reported outcomes were assessed using the Pediatric-International Knee Documentation Committee Subjective Knee Form (Pedi-IKDC), Tegner-Lysholm Knee Scoring Scale, and Visual Analog Pain Scale. Chart review was performed to determine postoperative protocols including the use of physical therapy and protected weight bearing. Functional parameters were compared between the involved and uninvolved extremities using the Wilcoxon Signed Ranks Test and the Spearman correlations were performed to identify any relationships between perioperative factors, functional parameters, and subjective outcomes. RESULTS In total, 19 of 42 patients completed clinical and functional testing and 18 of 19 completed all outcome surveys. Average age at injury was 13.9 years and average follow-up was 3.0 years. There was no statistical difference in knee range of motion between sides, however, thigh circumference was slightly smaller in the injured extremity (median difference, 1.7 cm at 15 cm above the patella and 4.0 cm at 50% of the length of the thigh). In total 5/19 subjects (26%) had a significant quadriceps extension strength deficit on the involved leg compared with the contralateral side. The median Visual Analog Pain Scale for affected limbs was 8/100 and for unaffected limbs was 6/100 (P=0.017). The Tegner-Lysholm Scale revealed 9 excellent results, 5 good, 4 fair, and 1 poor (median, 90/100). Results of the Pedi-IKDC were 11 excellent, 3 good, 2 fair, and 3 poor results (median, 91/100). Outcome scores did not correlate to diminished strength or thigh circumference. No difference in outcome based upon body mass index, postoperative weight-bearing status, Ogden classification, or postoperative physical therapy was noted using regression analysis. CONCLUSIONS Despite promising objective results, clinical outcomes measured by subjective validated surveys are not all excellent. LEVEL OF EVIDENCE Level III.
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Psychometric Properties of the Dance Functional Outcome Survey (DFOS): Reliability, Validity, and Responsiveness. J Orthop Sports Phys Ther 2019; 49:64-79. [PMID: 30053790 DOI: 10.2519/jospt.2019.8247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are no outcomes measures that focus on the unique functional requirements of dancers. OBJECTIVES To evaluate test-retest reliability, internal consistency, construct validity, sensitivity, and responsiveness of the Dance Functional Outcome Survey (DFOS) in professional and preprofessional adult dancers. METHODS This prospective cohort study examined test-retest reliability of the DFOS in 198 healthy and injured dancers over 2 weeks, using intraclass correlation coefficients (ICC2,1). In a sample of 725 healthy and injured dancers, the following were examined: (1) construct validity, by comparing the DFOS to the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) using Pearson correlations; (2) exploratory factor analysis and internal consistency; and (3) sensitivity, by generating receiver operating characteristic curves and determining area under the curve (AUC). In a subgroup of 47 injured dancers, we determined internal responsiveness across 4 time points using repeated-measures analysis of variance (P<.05). Injured dancers' scores were analyzed for floor and ceiling effects. RESULTS The DFOS demonstrated high test-retest reliability (ICC≥0.93). Single-factor loading in exploratory factor analysis supported unidimensionality of the scale, with high internal consistency (α = .96). The DFOS total score and activities-of-daily-living (ADL) and dance technique subscores had strong construct validity compared with scores on the SF-36 physical component summary (r≥0.77). This study found excellent sensitivity, with high AUC values (AUC≥0.91). There were significant differences across time for DFOS scores (P<.001), demonstrating responsiveness to change. There were no floor or ceiling effects. CONCLUSION The DFOS demonstrates acceptable psychometric performance as an outcome and screening measure for dancers. The DFOS is a useful tool to monitor both healthy state and functional limitation following lower extremity or low back injury in adult ballet and modern dancers. J Orthop Sports Phys Ther 2019;49(2):64-79. Epub 27 Jul 2018. doi: 10.2519/jospt.2019.8247.
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Wang D, Chang B, Coxe FR, Pais MD, Wickiewicz TL, Warren RF, Rodeo SA, Williams RJ. Clinically Meaningful Improvement After Treatment of Cartilage Defects of the Knee With Osteochondral Grafts. Am J Sports Med 2019; 47:71-81. [PMID: 30481044 DOI: 10.1177/0363546518808030] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mosaicplasty and fresh osteochondral allograft transplantation (OCA) are popular cartilage restoration techniques that involve the single-stage implantation of viable, mature hyaline cartilage-bone dowels into chondral lesions of the knee. Recently, there has been greater focus on what represents a clinically relevant change in outcomes reporting, and commonly applied metrics for measuring clinical significance include the minimal clinically important difference (MCID) and substantial clinical benefit (SCB). PURPOSE To define the MCID and SCB after mosaicplasty or OCA for the International Knee Documentation Committee (IKDC) subjective form and Knee Outcome Survey-Activities of Daily Living (KOS-ADL) and to determine patient factors that are predictive of achieving the MCID and SCB after mosaicplasty or OCA. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS An institutional cartilage registry was reviewed to identify patients who underwent mosaicplasty or OCA. The decision to perform either mosaicplasty or OCA was generally based on chondral defect size. The IKDC and KOS-ADL were administered preoperatively and at a minimum of 2 years postoperatively. Patient responses to the outcome measures were aggregated, and the MCID and SCB of these outcome scores were calculated with anchor-based methods. Multivariate analysis adjusted for age and sex was performed to identify patient factors predictive of achieving the MCID and SCB. RESULTS Of the 372 eligible patients, 151 (41%) were lost to follow-up, 46 (12%) had incomplete preoperative outcome scores and 2 were treated with OCA of the tibia and therefore excluded. In total, 173 knees were analyzed (n = 173 patients; mean age, 33.0 years; 37% female). Seventy-five (43%) and 98 (57%) knees were treated with mosaicplasty and OCA, respectively. The mean ± SD MCIDs for the IKDC and KOS-ADL were 17 ± 3.9 and 10 ± 3.7, respectively. The SCBs for the IKDC and KOS-ADL were 30 ± 6.9 and 17 ± 3.9, respectively. Univariate analysis demonstrated no association between procedure (mosaicplasty or OCA) and likelihood of achieving the MCID or SCB. In the multivariate analysis, lower preoperative IKDC and KOS-ADL scores, higher preoperative Marx Activity Rating Scale scores, lower preoperative 36-Item Short Form Health Survey pain scores, and a history of ≤1 prior ipsilateral knee surgical procedure were predictive of achieving the MCID and/or SCB. CONCLUSION These values can be used to define a clinically meaningful improvement for future outcome studies. For surgeons considering mosaicplasty or OCA for their patients, these results can help guide clinical decision making and manage patient expectations before surgery.
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Affiliation(s)
- Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA.,Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Brenda Chang
- Biostatistics Core, Hospital for Special Surgery, New York, New York, USA
| | - Francesca R Coxe
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Mollyann D Pais
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Thomas L Wickiewicz
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Russell F Warren
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
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