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Sproul D, Agarwal A, Malyavko A, Mathur A, Kreulen RT, Thakkar SC, Best MJ. Graft failure within 2 years of isolated anterior cruciate ligament reconstruction is associated with increased risk of secondary meniscus tears. Knee Surg Sports Traumatol Arthrosc 2023; 31:5823-5829. [PMID: 37938327 DOI: 10.1007/s00167-023-07653-z] [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: 06/09/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE A debilitating complication following anterior cruciate ligament reconstruction is a secondary meniscus tear. Currently, the literature is mixed regarding the risk factors associated with the incidence of secondary meniscus tears. The aim of this study was to investigate risk factors associated with meniscus tears following an isolated primary anterior cruciate ligament reconstruction. ACL graft failure was hypothesized to be the strongest risk factor for secondary meniscal injury occurrence. METHODS A retrospective cohort analysis was performed using the PearlDiver Database. Patients with a primary anterior cruciate ligament reconstruction were identified in the database. Patients with concomitant knee ligament injury or meniscus injury present at the time the index procedure were excluded. Patients were grouped to those who had a secondary meniscus tear within 2 years following anterior cruciate ligament reconstruction and those who did not. Univariate analysis and multivariable regression analysis was conducted to identify significant risk factors for a secondary meniscus tear. RESULTS There were 25,622 patients meeting criteria for inclusion in this study. Within 2 years from the primary anterior cruciate ligament reconstruction, there were 1,781 patients (7.0%) that experienced a meniscus tear. Graft failure had the highest odds of having a postoperative meniscus tear within 2 years (OR: 4.1; CI 3.5-4.8; p < 0.002). Additional significant risk factors included tobacco use (OR: 2.0; CI 1.0-3.1; p < 0.001), increased Charlson Comorbidity Index (OR: 1.2; CI 1.1-1.4), male gender (OR: 1.1; CI 1.1-1.2; p < 0.001), obesity (OR: 1.1; CI 1.1-1.2; p < 0.001), delayed surgery (OR:1.1; CI 1.1-1.2; p < 0.002), and patients age 30 and older (OR: 1.0; CI 1.0-1.0; p < 0.001). CONCLUSIONS This study found that anterior cruciate ligament graft failure is the strongest predictor of post-operative meniscus tears. Other risk factors, including tobacco use, increased CCI, male gender, obesity, delayed surgery, and age 30 and older, were established, with several being modifiable. Therefore, targeted preoperative optimization of modifiable risk factors and postoperative protocols may reduce the risk of secondary meniscus tears. LEVEL OF EVIDENCE Level III, prognostic trial.
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Affiliation(s)
- David Sproul
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA.
| | - Amil Agarwal
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA
| | - Alisa Malyavko
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA
| | - Abhay Mathur
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA
| | - R Timothy Kreulen
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
| | - Savyasachi C Thakkar
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
| | - Matthew J Best
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
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Zhang H, Hao M, Li Y, Hu Z, Liu Z, Jiang S, Jin L, Wang X. Assessment of Physical Resilience Using Residual Methods and Its Association With Adverse Outcomes in Older Adults. Innov Aging 2023; 7:igad118. [PMID: 38024329 PMCID: PMC10652184 DOI: 10.1093/geroni/igad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Objectives Physical resilience (PR) is recognized as the ability to recover from the adverse effects of a stressor. However, there is a lack of consensus on how to optimally measure PR in older adults in general. We aimed to measure PR using residuals from regression analyses and investigated its association with adverse outcomes in older adults. Research Design and Methods A total of 6 508 older adults were included from the National Health and Aging Trends Study, which was a population-based prospective cohort study. PR was assessed using residual methods from a linear model regressing the short physical performance battery on clinical diseases, age, sex, race/ethnicity, and health condition. Adverse outcomes included all-cause mortality, falls, and overnight hospitalization. Results The mean age was 77.48 (7.84) years. Increased PR was associated with a lower risk of all-cause mortality (hazard ratio [HR] = 0.85, 95% confidence interval [CI]: 0.83-0.87). Compared to participants with reduced PR, those with normal PR had a lower risk for mortality (HR = 0.51, 95% CI: 0.46-0.56). Specifically, restricted cubic spline regression revealed a dose-response relationship between PR and all-cause mortality (p-overall < .0001, p-nonlinear = .011). Additionally, we also found significant associations of increased PR with lower risks of falls (HR = 0.98, 95% CI: 0.96-0.99) and overnight hospitalization (HR = 0.98, 95% CI: 0.97-1.00). Discussion and Implications PR, measured by residual methods, was robustly and independently associated with all-cause mortality, falls, and overnight hospitalization. Our findings provide evidence that this approach may be a simple and feasible strategy to assess PR.
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Affiliation(s)
- Hui Zhang
- Human Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai, China
| | - Meng Hao
- Human Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai, China
- Fudan Zhangjiang Institute, Shanghai, China
| | - Yi Li
- Human Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai, China
| | - Zixin Hu
- Artificial Intelligence Innovation and Incubation Institute, Fudan University, Shanghai, China
| | - Zuyun Liu
- School of Public Health and the Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shuai Jiang
- Department of Vascular Surgery, Shanghai Key Laboratory of Vascular Lesion Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Li Jin
- Human Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai, China
| | - Xiaofeng Wang
- Human Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai, China
- National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Varadhan R, Zhu J, Bandeen-Roche K. Identifying predictors of resilience to stressors in single-arm studies of pre-post change. Biostatistics 2023:kxad018. [PMID: 37542423 DOI: 10.1093/biostatistics/kxad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/07/2023] Open
Abstract
Many older adults experience a major stressor at some point in their lives. The ability to recover well after a major stressor is known as resilience. An important goal of geriatric research is to identify factors that influence resilience to stressors. Studies of resilience in older adults are typically conducted with a single-arm where everyone experiences the stressor. The simplistic approach of regressing change versus baseline yields biased estimates due to mathematical coupling and regression to the mean (RTM). We develop a method to correct the bias. We extend the method to include covariates. Our approach considers a counterfactual control group and involves sensitivity analyses to evaluate different settings of control group parameters. Only minimal distributional assumptions are required. Simulation studies demonstrate the validity of the method. We illustrate the method using a large, registry of older adults (N =7239) who underwent total knee replacement (TKR). We demonstrate how external data can be utilized to constrain the sensitivity analysis. Naive analyses implicated several treatment effect modifiers including baseline function, age, body-mass index (BMI), gender, number of comorbidities, income, and race. Corrected analysis revealed that baseline (pre-stressor) function was not strongly linked to recovery after TKR and among the covariates, only age and number of comorbidities were consistently and negatively associated with post-stressor recovery in all functional domains. Correction of mathematical coupling and RTM is necessary for drawing valid inferences regarding the effect of covariates and baseline status on pre-post change. Our method provides a simple estimator to this end.
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Affiliation(s)
- Ravi Varadhan
- Quantitative Sciences Division, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, 550 N. Broadway Street, Baltimore, MD 21205, USA
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street Baltimore, MD 21205, USA
| | - Jiafeng Zhu
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street Baltimore, MD 21205, USA
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Walston J, Varadhan R, Xue QL, Buta B, Sieber F, Oni J, Imus P, Crews DC, Artz A, Schrack J, Kalyani RR, Abadir P, Carlson M, Hladek M, DeMarco MM, Jones R, Johnson A, Shafi T, Newman AB, Bandeen-Roche K. A Study of Physical Resilience and Aging (SPRING): Conceptual framework, rationale, and study design. J Am Geriatr Soc 2023; 71:2393-2405. [PMID: 37386913 PMCID: PMC10608799 DOI: 10.1111/jgs.18483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 07/01/2023]
Abstract
Understanding the physiological basis of physical resilience to clinical stressors is crucial for the well-being of older adults. This article presents a novel framework to discover the biological underpinnings of physical resilience in older adults as part of the "Characterizing Resiliencies to Physical Stressors in Older Adults: A Dynamical Physiological Systems Approach" study, also known as The Study of Physical Resilience and Aging (SPRING). Physical resilience, defined as the capacity of a person to withstand clinical stressors and quickly recover or improve upon a baseline functional level, is examined in adults aged 55 years and older by studying the dynamics of stress response systems. The hypothesis is that well-regulated stress response systems promote physical resilience. The study employs dynamic stimulation tests to assess energy metabolism, the hypothalamic-pituitary-adrenal axis, the autonomic nervous system, and the innate immune system. Baseline characteristics influencing resilience outcomes are identified through deep phenotyping of physical and cognitive function, as well as of biological, environmental, and psychosocial characteristics. SPRING aims to study participants undergoing knee replacement surgery (n = 100), bone and marrow transplantation (n = 100), or anticipating dialysis initiation (n = 60). Phenotypic and functional measures are collected pre-stressor and at multiple times after stressor for up to 12 months to examine resilience trajectories. By improving our understanding of physical resilience in older adults, SPRING has the potential to enhance resilient outcomes to major clinical stressors. The article provides an overview of the study's background, rationale, design, pilot phase, implementation, and implications for improving the health and well-being of older adults.
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Affiliation(s)
- Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine
- Johns Hopkins School of Nursing
| | - Ravi Varadhan
- Department of Oncology, Division of Quantitative Sciences, Sidney Kimmel Cancer Center, Johns Hopkins University
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Brian Buta
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Frederick Sieber
- Dept of Anesthesiology and Critical Care Medicine, Johns Hopkins Bayview Medical Center
| | - Julius Oni
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine
| | - Phil Imus
- Department of Oncology, Division of Hematologic Malignancy, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center
| | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope
| | - Jennifer Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine
| | - Peter Abadir
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Michelle Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | | | | | - Rick Jones
- Department of Oncology, Division of Hematologic Malignancy, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center
| | | | - Tariq Shafi
- Division of Nephrology, Department of Medicine, Houston Methodist Hospital, Houston, TX
| | - Anne B. Newman
- Departments of Epidemiology and Medicine, University of Pittsburgh
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
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Li J, Chhetri JK, Ma L. Physical resilience in older adults: Potential use in promoting healthy aging. Ageing Res Rev 2022; 81:101701. [PMID: 35905815 DOI: 10.1016/j.arr.2022.101701] [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: 05/21/2022] [Revised: 07/06/2022] [Accepted: 07/25/2022] [Indexed: 01/31/2023]
Abstract
Physical resilience is a dynamic concept referring to the physiological response when the body is exposed to stressors. The level of physical resilience is the sum of underlying physiological reserves. Moreover, it may not only be determined by age, genetics, or exposure to a variety of diseases, but is also closely related to the psychological, social, and environmental factors of an individual. This paper summarizes our present understanding of the relationship between physical resilience and other concepts closely related to it. Furthermore, we illustrate the current research progress on physical resilience models and clinical resilience assessment. Besides, this paper intends to present a better understanding of physical resilience and its use in treatment decision-making, personalized diagnosis and disease management, and prevention and rehabilitation strategies.
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Affiliation(s)
- Jiatong Li
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - Jagadish K Chhetri
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China.
| | - Lina Ma
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China.
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Hladek MD, Zhu J, Crews DC, McAdams-DeMarco MA, Buta B, Varadhan R, Shafi T, Walston JD, Bandeen-Roche K. Physical Resilience Phenotype Trajectories in Incident Hemodialysis: Characterization and Mortality Risk Assessment. Kidney Int Rep 2022; 7:2006-2015. [PMID: 36090502 PMCID: PMC9459128 DOI: 10.1016/j.ekir.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/13/2022] [Indexed: 12/19/2022] Open
Abstract
Introduction Methods Results Conclusion
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