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Pinheiro VH, Laughlin M, Borque KA, Ngo D, Kent MR, Jones M, Neves N, Fonseca F, Williams A. Career Length After Surgically Treated ACL Plus Collateral Ligament Injury in Elite Athletes. Am J Sports Med 2024:3635465241262440. [PMID: 39097768 DOI: 10.1177/03635465241262440] [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] [Indexed: 08/05/2024]
Abstract
BACKGROUND Limited data are available regarding career length and competition level after combined anterior cruciate ligament (ACL) and medial- or lateral-sided surgeries in elite athletes. PURPOSE To evaluate career length after surgical treatment of combined ACL plus medial collateral ligament (MCL) and ACL plus posterolateral corner (PLC) injuries in elite athletes and, in a subgroup analysis of male professional soccer players, to compare career length and competition level after combined ACL+MCL or ACL+PLC surgeries with a cohort who underwent isolated ACL reconstruction (ACLR). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A consecutive cohort of elite athletes undergoing combined ACL+MCL and ACL+PLC surgery was analyzed between February 2001 and October 2019. A subgroup of male elite soccer players from this population was compared with a previously identified cohort having had isolated primary ACLR without other ligament surgery. A minimum 2-year follow-up was required. Outcome measures were career length and competition level. RESULTS A total of 98 elite athletes met the inclusion criteria, comprising 50 ACL+PLC and 48 ACL+MCL surgeries. The mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Return-to-play (RTP) time was significantly longer for ACL+PLC injuries (12.8 months; P = .019) than for ACL+MCL injuries (10.9 months). In the subgroup analysis of soccer players, a significantly lower number of players with combined ACL+PLC surgery were able to RTP (88%; P = .003) compared with 100% for ACL+MCL surgery and 97% for isolated ACLR, as well as requiring an almost 3 months longer RTP timeline (12.9 months; P = .002) when compared with the isolated ACL (10.2 months) and combined ACL+MCL (10.0 months) groups. However, career length and competition level were not significantly different between groups. CONCLUSION Among elite athletes, the mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Professional soccer players with combined ACL+PLC surgery returned at a lower rate and required a longer RTP time when compared with the players with isolated ACL or combined ACL+MCL injuries. However, those who did RTP had the same career longevity and competition level.
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Affiliation(s)
| | - Mitzi Laughlin
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Kyle A Borque
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Dylan Ngo
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Madison R Kent
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Mary Jones
- Fortius Clinic, London, UK
- FIFA Medical Centre of Excellence, London, UK
| | - Nuno Neves
- Orthopaedic Department, Hospital CUF Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | | | - Andy Williams
- Fortius Clinic, London, UK
- FIFA Medical Centre of Excellence, London, UK
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Królikowska A, Reichert P, Senorski EH, Karlsson J, Becker R, Prill R. Scores and sores: Exploring patient-reported outcomes for knee evaluation in orthopaedics, sports medicine and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39072858 DOI: 10.1002/ksa.12334] [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: 04/25/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 07/30/2024]
Abstract
Recognizing and addressing the controversies surrounding using patient-reported outcome measures (PROMs) is crucial for enhancing evaluation standards in clinical studies in orthopedics, sports medicine, and rehabilitation. The article comprehensively described the challenges of using PROMs to evaluate knee conditions in these fields. Apart from defining and characterizing patient-reported outcomes and their measures, the article discussed controversies around them, such as using them as primary outcomes. It highlighted the importance of standardizing and validating PROMs. Several initiatives taken to improve the selection of appropriate outcomes for clinical research purposes were described. Additionally, the potential of technology, mainly digital health tools and mobile applications, was mentioned in the context of enhancing the collection and analysis of PROMs. The article also raised the issue of the readability of PROMs, defined as the ease with which they can be read and understood by patients. The article concluded that adopting a complementary approach to treatment evaluation by integrating subjective and objective measures is imperative for accurately assessing efficacy. This comprehensive approach provides a more holistic understanding of patient outcomes, forms the foundation for evidence-based medicine, and informs future healthcare policies. Proactive measures are urgently needed to address concerns and improve the reliability and validity of PROMs for clinical practice and research. LEVEL OF EVIDENCE: level V.
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Affiliation(s)
- Aleksandra Królikowska
- Ergonomics and Biomedical Monitoring Laboratory, Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Reichert
- Department of Orthopaedics, Traumatology and Hand Surgery, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Eric Hamrin Senorski
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roland Becker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
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Martinkėnienė VB, Austys D, Šaikus A, Brazaitis A, Bernotavičius G, Makulavičius A, Verkauskas G. The Significance of Selecting an Appropriate Patient-Reported Outcome Measure (PROM): A Cross-Cultural Adaptation of the Specific Paediatric International Documentation Committee Subjective (Pedi-IKDC) Knee Form. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1930. [PMID: 38136132 PMCID: PMC10742502 DOI: 10.3390/children10121930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION The selection of an appropriate PROM is a crucial aspect in assessing outcomes. Questionnaires that have not been designed or validated for a paediatric population are routinely used. Using a questionnaire requires translation, cultural adaptation, and testing the psychometric properties of the translated questionnaire. There is no applicable questionnaire in our country for children with knee-specific conditions in sports orthopaedics. Therefore, this study aims to translate, culturally adapt, and assess the psychometric properties of the Paediatric IKDC (Pedi-IKDC) questionnaire within the Lithuanian paediatric population. METHODS The translation was conducted in accordance with international standards. Patients aged 11-17 years with various knee disorders participated in three surveys and completed the Pedi-IKDC, Lysholm, and PedsQL questionnaires. Interviews with patients following the translation process, in addition to floor and ceiling effects, were used to assess content validity. Cronbach alpha (α) statistics and the intraclass correlation coefficient (ICC) were applied to measure internal consistency and reproducibility, respectively. The standard error of measurement (SEM) and smallest detectable change (SDC) were calculated to assess reliability. Pearson correlations were calculated between Pedi-IKDC and Lysholm PedsQL scores to determine criteria validity. The effect size (ES) and standardised response mean (SRM) were calculated to assess the responsiveness to change. RESULTS Cronbach's alpha (α) was 0.91 for the total score, 0.75 for symptoms, and 0.92 for the sport/function component. The ICC for overall scores was 0.98, with each question ranging from 0.87 to 0.98. The SEM was 2.97, and the SDC was 8.23. Lysholm and PedsQL physical functioning domain scores had moderate correlations (0.8 > r > 0.5), and the overall PedsQL score had a weak correlation (0.5 > r > 0.2) to the Pedi-IKDC score. The floor and ceiling effects were 3.3% and 1.6%, respectively. The SRM was 1.72 and the ES was 1.98. CONCLUSIONS The Lithuanian Pedi-IKDC version is an appropriate evaluation instrument for assessing outcomes in children with knee disorders. All of the psychometric features produced acceptable results.
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Affiliation(s)
- Viktorija Brogaitė Martinkėnienė
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Department of Children’s Orthopedics and Traumatology, Vilnius University Hospital Santaros Klinikos, LT-08406 Vilnius, Lithuania (G.B.)
| | - Donatas Austys
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
| | - Andrius Šaikus
- Department of Children’s Orthopedics and Traumatology, Vilnius University Hospital Santaros Klinikos, LT-08406 Vilnius, Lithuania (G.B.)
| | - Andrius Brazaitis
- Centre for Radiology and Nuclear Medicine, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Giedrius Bernotavičius
- Department of Children’s Orthopedics and Traumatology, Vilnius University Hospital Santaros Klinikos, LT-08406 Vilnius, Lithuania (G.B.)
- Clinic of Gastroenterology, Nefrourology and Surgery, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Aleksas Makulavičius
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Gilvydas Verkauskas
- Clinic of Gastroenterology, Nefrourology and Surgery, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
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Pinheiro VH, Borque KA, Laughlin MS, Jones M, Balendra G, Kent MR, Ajgaonkar R, Williams A. Determinants of Performance in Professional Soccer Players at 2 and 5 Years After ACL Reconstruction. Am J Sports Med 2023; 51:3649-3657. [PMID: 37960868 DOI: 10.1177/03635465231207832] [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] [Indexed: 11/15/2023]
Abstract
BACKGROUND A number of studies have investigated return to play after anterior cruciate ligament reconstruction (ACLR) in professional soccer players, but it is unclear which factors are associated with a return to the preinjury performance and ability to play over time. PURPOSE To identify factors that contribute to a professional soccer player's return to preinjury performance after ACLR, as well as to report their playing performance at 2 and 5 years after ACLR compared with their preinjury performance. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A consecutive cohort of professional soccer players undergoing primary ACLR were analyzed between 2005 and 2019. A minimum 2-year follow-up was required. The effect of patient, surgical, and postoperative factors on performance rates, defined as a combination of league level and playing time, was evaluated with univariate and multivariate logistic regression models. RESULTS A total of 200 male professional soccer players were included. When combining league level and playing time, 30% of athletes returned to their preinjury performance at 2 years and 22% at 5 years. However, 53% of athletes returned to their preinjury performance for at least 1 season by year 5. At 2 years, a chondral lesion of grade 3 or 4 decreased the odds of return to preinjury performance (odds ratio [OR], 0.37; P = .010). Athletes receiving an ACLR with the addition of a lateral extra-articular tenodesis procedure were 2.42 times more likely to return to preinjury performance at 2 years than athletes with ACLR alone (P = .004). By 5 years after ACLR, athletes aged ≥25 years at the time of reconstruction were 3 times less likely to be performing at their preinjury performance (OR, 0.32; P < .001), and those with a grade ≥3 chondral lesion were >2 times less likely to be performing at their preinjury performance (OR, 0.43; P = .033). CONCLUSION The presence of >50% thickness chondral pathology, ACLR without lateral extra-articular tenodesis, and age >25 years at the time of surgery were all significant risk factors of worse performance rates after ACLR. Significant decreases in performance rates were noted at 2 and 5 years postoperatively.
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Affiliation(s)
| | - Kyle A Borque
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Mitzi S Laughlin
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Mary Jones
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
| | - Ganesh Balendra
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
| | | | - Ryan Ajgaonkar
- University of Texas Rio Grande Valley Medical School, Edinburg, Texas, USA
| | - Andy Williams
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
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Jones M, Hugo Pinheiro V, Balendra G, Borque K, Williams A. No difference in return to play rates between different elite sports after primary autograft ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:5924-5931. [PMID: 37947828 DOI: 10.1007/s00167-023-07654-y] [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: 08/04/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To demonstrate return to play (RTP) rates, the level of RTP and time taken to RTP in different sports after anterior cruciate ligament reconstruction (ACL-R) and compare the differences between football and rugby. The secondary aims were to compare the differences in intra articular injuries and their treatments and reoperation rates between these sports. METHODS A retrospective review of a consecutive series of all primary ACL-R undertaken by the senior author between 2005 and 2019 was undertaken. Patients were included if they were elite athletes and were a minimum of 2 year post-primary autograft ACL-R. The outcomes measured were RTP (defined as participation in a professional match or in national/international-level competition in amateur sports), time to RTP after surgery and RTP level (Tegner score). RESULTS Three hundred and ninety-four elite athletes, with 420 ACL-Rs were included. 235 (55.9%) were in footballers and 125 (29.8%) were in rugby players. 399 (95.0%) of all elite athletes returned to competition at an average of 10.3 months after ACL-R. 386 (90.2% played at the same or higher level post-surgery. Although there was no difference in RTP rates between different sports, rugby players RTP significantly faster than footballers (9.6 vs 10.6 months, (p = 0.027). Footballers were more likely to rupture their ACL during jumping/landing manoeuvres and to receive a PT graft than rugby players. There were no other significant differences between football and rugby players regarding patient characteristics, intraoperative findings, re-rupture and re-operation rates. CONCLUSIONS Over 95% of all elite athletes RTP after primary ACL-R with 90% able to play at the same level. Rugby players RTP significantly faster than footballers. LEVEL OF EVIENCE Level IV.
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Affiliation(s)
- Mary Jones
- Fortius Clinic, 17 Fitzhardinge Street, London, W1H 6EQ, UK.
- FIFA Medical Centre of Excellence, London, UK.
| | - Vitor Hugo Pinheiro
- Fortius Clinic, 17 Fitzhardinge Street, London, W1H 6EQ, UK
- FIFA Medical Centre of Excellence, London, UK
| | - Ganesh Balendra
- Fortius Clinic, 17 Fitzhardinge Street, London, W1H 6EQ, UK
- FIFA Medical Centre of Excellence, London, UK
| | - Kyle Borque
- Houston Methodist Orthopedics and Sports Medicine, Houston, TX, USA
| | - Andy Williams
- Fortius Clinic, 17 Fitzhardinge Street, London, W1H 6EQ, UK
- FIFA Medical Centre of Excellence, London, UK
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Djurtoft C, Yona T, Roos EM, Thorborg K, Hölmich P, Rasmussen S, Olesen JL, Rathleff MS. Quality of life in adolescents with longstanding non-traumatic knee pain: An analysis of 316 adolescents with Patellofemoral Pain and Osgood-Schlatter Disease. Phys Ther Sport 2023; 61:156-164. [PMID: 37062163 DOI: 10.1016/j.ptsp.2023.04.001] [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: 01/23/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVES To describe the Quality of Life (QoL) among adolescents with Patellofemoral Pain (PFP) and Osgood-Schlatter Disease (OSD) and investigate characteristics associated with QoL. STUDY DESIGN Cross-sectional. PARTICIPANTS 316 adolescents with PFP or OSD. MAIN OUTCOME MEASURES QoL subscale of The Knee injury and Osteoarthritis Outcome Score (KOOS) and the EuroQol 5-dimensions (EQ-5D). RESULTS The KOOS-QoL was 51 ± 18, and the total index score for the EQ5D was 0.67 ± 0.21. KOOS-QoL subscale showed that 60% reported being aware of their knee problems daily or constantly, 38% reported severe to extreme lack of confidence in their knees, 28% reported severe to extreme difficulty with their knees, and 20% reported severely or totally modifying their lifestyle to avoid potentially damaging activities to their knee. EQ-5D showed that 79% experienced problems with everyday activities, 48% reported mobility problems, 17% felt worried, sad, or unhappy, and 7% reported problems looking after themselves. CONCLUSIONS Many adolescents with longstanding non-traumatic knee pain experience low QoL. More than half were aware of their knee problems at least daily, one in three reported a severe lack of confidence in their knee, and one in six felt worried, sad, or unhappy.
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Affiliation(s)
- Chris Djurtoft
- Center for General Practice at Aalborg University, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Denmark.
| | - Tomer Yona
- Department of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Ewa Maria Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Center for Muscle and Joint Health, Institute of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Hvidovre, Denmark; Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Hvidovre, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Hvidovre, Denmark; Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sten Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Orthopedic Surgery, Aalborg University Hospital, Denmark
| | - Jens Lykkegaard Olesen
- Center for General Practice at Aalborg University, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Denmark; Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
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MCID and PASS in Knee Surgeries. Theoretical Aspects and Clinical Relevance References. Knee Surg Sports Traumatol Arthrosc 2023; 31:2060-2067. [PMID: 36897384 DOI: 10.1007/s00167-023-07359-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
The application and interpretation of patient-reported outcome measures (PROM), following knee injuries, pathologies, and interventions, can be challenging. In recent years, the literature has been enriched with metrics to facilitate our understanding and interpretation of these outcome measures. Two commonly utilized tools include the minimal clinically important difference (MCID) and the patient acceptable symptoms state (PASS). These measures have demonstrated clinical value, however, they have often been under- or mis-reported. It is paramount to use them to understand the clinical significance of any statistically significant results. Still, it remains important to know their caveats and limitations. In this focused report on MCID and PASS, their definitions, methods of calculations, clinical relevance, interpretations, and limitations are reviewed and presented in a simple approach.
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Laigaard J, Hansen CF, Overgaard S, Overgaard S. Harmonization of pain scores: comment on Osteoarthritis and Cartilage 2023;31(1):83-95. Osteoarthritis Cartilage 2023; 31:839-840. [PMID: 36871814 DOI: 10.1016/j.joca.2023.02.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Affiliation(s)
- J Laigaard
- Department of Orthopedic Surgery and Traumatology, Bispebjerg Hospital, Copenhagen, Denmark.
| | - C F Hansen
- Department of Orthopedic Surgery and Traumatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - S Overgaard
- Department of Orthopedic Surgery and Traumatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - S Overgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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