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Petrucci A, Guglielmino D, Pecci J, Pareja-Galeano H. The effects of isokinetic training in athletes after knee surgery: a systematic review. PHYSICIAN SPORTSMED 2024; 52:309-316. [PMID: 38124233 DOI: 10.1080/00913847.2023.2297666] [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: 09/24/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To review the effectiveness of isokinetic training as an alternative method to traditional isotonic resistance training. MATERIALS AND METHODS Researchers examined data from PubMed, CENTRAL, MEDLINE COMPLETE, and Web of Science until February 2023. A total of 365 entries were obtained from databases, including studies that analyzed the effects of isokinetic vs. isotonic-based rehabilitation in athletes (16-50 years) after a surgical knee intervention. Return to sport (RTS), strength of the flex/extensor compartment of the thigh, muscle mass of the thigh, and knee function were screened as main outcomes. Two reviewers independently screened the studies for eligibility and assessed the risk of bias of the included ones. RESULTS Six studies involving 181 athletes were included. Isokinetic training demonstrated significant benefits in peak torque for knee flexor-extensor muscles in four studies. Two studies favored isokinetic training over isotonic for strength. Muscle mass findings were mixed, with one study favoring isokinetic significantly and two showing no significant differences. In terms of returning to sport, the isotonic group displayed slightly better limb symmetry index values, but without significance. Isokinetic training outperformed isotonic in two functionality questionnaire studies, while two others showed no significant differences. CONCLUSIONS Isokinetic training appears equally, if not more effective than isotonic, for restoring strength balance between hamstrings and quadriceps. This could lead to more favorable muscle mass changes. Isokinetic training also parallels isotonic rehabilitation for functional outcomes and meeting return-to-sport criteria. Therefore, isokinetic training should be included as one of the main strength restoration strategies after knee surgery, especially in early and middle rehabilitation stages. REGISTRATION NUMBER The present systematic review was registered on PROSPERO (registration number: CRD42022370398).
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Affiliation(s)
- Angelo Petrucci
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Dario Guglielmino
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Javier Pecci
- Department of Physical Education, Sport and Human Movement. Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, Madrid, Spain
- Department of Physical Education and Sport, Universidad de Sevilla, Sevilla, Spain
| | - Helios Pareja-Galeano
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Department of Physical Education, Sport and Human Movement. Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, Madrid, Spain
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Leahy KG, Lowenstein NA, Collins JE, Mazzocca JL, Matzkin EG. Preoperative Low Resilience Is Associated With Female Patients, Whereas High Resilience Is Associated With Improved Mental Health Scores During Anterior Cruciate Ligament Reconstruction. Arthroscopy 2024:S0749-8063(24)00168-3. [PMID: 38453097 DOI: 10.1016/j.arthro.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To evaluate the relationship between resilience, as measured by the Brief Resilience Scale (BRS), and patient-reported outcome measures (PROMs) after primary anterior cruciate ligament reconstruction (ACLR). METHODS A cohort of 72 patients undergoing primary ACLR were followed for a minimum of 2 years. Preoperative BRS scores were collected, and patients were categorized into low resilience (LR), normal resilience (NR), and high resilience (HR). PROMs including the visual analog scale (VAS), measuring overall pain level from 0 to 10, the Veterans Rand (VR) 12-Item Health Survey Physical Component and Mental Components, Knee Injury and Osteoarthritis Outcomes Score, and Marx Activity Rating Scale were collected preoperatively as well as up to 2 years postoperatively and compared among the various resilience groups. RESULTS BRS scores were significantly associated with VAS, VR 12-Item Health Survey Mental Component, and KOOS outcome scores. There was a significant difference among all 3 resilience groups (P = .0382) in change of VAS score from baseline to 2 years postoperatively, with a mean difference of 2.5 points, 1.1 points, and 0.7 points for LR, NR, and HR groups, respectively. There was a significant association of greater VR 12-Item Health Survey Mental Component scores, with greater resilience scores preoperatively (P < .0001) and at both 1 (P = .0034) and 2 years (P = .0235) postoperatively. Greater resilience scores were associated with greater KOOS scores at 1 year postoperatively (P = .0270). Female patients were more likely to fall into the LR group (80%). CONCLUSIONS In this cohort of patients undergoing ACLR, low resilience is positively associated with greater improvement in pain, and female patients tend to fall more into the LR group. At 1 year postoperatively, greater resilience scores were positively associated with greater aggregated KOOS scores. At 1 and 2 years postoperatively, greater resilience was positively associated with improved VR-12M scores. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Kirsten G Leahy
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Natalie A Lowenstein
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Jamie E Collins
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Jillian L Mazzocca
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Elizabeth G Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.; Harvard Medical School, Boston, Massachusetts, U.S.A..
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Lowenstein NA, Chang Y, Mass H, Mercurio AM, Ukogu C, Katz JN, Matzkin EG. Preoperative Predictors of Arthroscopic Partial Meniscectomy Outcomes: The APM Index Score. Am J Sports Med 2024; 52:116-123. [PMID: 38164686 DOI: 10.1177/03635465231210303] [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: 01/03/2024]
Abstract
BACKGROUND Preoperative risk factors contributing to poor outcomes after arthroscopic partial meniscectomy (APM) have not yet been consolidated and codified into an index scoring system used to predict APM success. PURPOSE To create an index score using available preoperative factors to predict the likelihood of favorable postoperative outcomes after APM. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A consecutive cohort of patients undergoing primary APM were enrolled in this study. Patients completed pre- and postoperative patient-reported outcome measure (PROM) questionnaires that included the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Veterans RAND 12-Item Health Survey (VR-12 Physical and Mental), and Marx Activity Rating Scale (MARS). Multivariable logistic regression models were performed to evaluate independent predictors of KOOS Pain, Symptoms, and Activities of Daily Living scores and achievement of the minimal clinically important difference (MCID) and substantial clinical benefit (SCB). The authors assigned points to each variable proportional to its odds ratio, rounded to the nearest integer, to generate the index score. RESULTS In total, 468 patients (mean age, 49 years [SD, 10.4 years; range, 19-81 years]) were included in this study. In the univariate analysis, shorter symptom duration, lower Kellgren-Lawrence (KL) grade, lower preoperative KOOS Pain value, and lower VR-12 Physical score were associated with a higher likelihood of clinical improvement at 1 year. In the multivariable model for clinical improvement with MCID, symptom duration (<3 months: OR, 3.00 [95% CI, 1.45-6.19]; 3-6 months: OR, 2.03 [95% CI, 1.10-3.72], compared with >6 months), KL grade (grade 0: OR, 3.54 [95% CI, 1.66-7.54]; grade 1: OR, 3.04 [95% CI, 1.48-6.26]; grade 2: OR, 2.31 [95% CI, 1.02-5.27], compared with grade 3), and preoperative KOOS Pain value (score <45: OR, 3.00 [95% CI, 1.57-5.76]; score of 45-60: OR, 2.80 [95% CI, 1.47-5.35], compared with score >60) were independent significant predictors for clinical improvement. The scoring algorithm demonstrated that a higher total score predicted a higher likelihood of achieving the MCID: 0 = 40%, 1 = 68%, 2 = 80%, 3 = 89%, and 4 = 96%. CONCLUSION Using this model, the authors developed an index score that, using preoperative factors, can help identify which patients will achieve clinical improvement after APM. Longer symptom duration and higher KL grade were associated with a decreased likelihood of clinical improvement as measured by KOOS Pain at 1 year postoperatively.
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Affiliation(s)
- Natalie A Lowenstein
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hanna Mass
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Angela M Mercurio
- Harvard Medical School, Boston, Massachusetts, USA. Presented at the annual meeting of the AOSSM, Washington, DC, July 2023
| | - Chierika Ukogu
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey N Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth G Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ingelsrud LH, Terluin B, Thorlund JB, Pedersen JR, Roos EM. Knee Injury and Osteoarthritis Outcome Score Interpretation Thresholds at 3 and 12 Months After Arthroscopic Meniscal Surgery. What Changes, and What Stays the Same? J Orthop Sports Phys Ther 2023; 53:685-702. [PMID: 37787579 DOI: 10.2519/jospt.2023.11993] [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: 10/04/2023]
Abstract
OBJECTIVE: To evaluate the change in minimal important change (MIC), patient acceptable symptom state (PASS), and treatment failure (TF) thresholds for the Knee injury and Osteoarthritis Outcome Score (KOOS) from 3 to 12 months following arthroscopic meniscus surgery. DESIGN: Retrospective cohort study. METHODS: We included patients from the Knee Arthroscopy Cohort Southern Denmark who had meniscus surgery between 2013 and 2015. We calculated the interpretation threshold values for MIC, PASS, and TF using an anchor-based adjusted predictive modeling method. Thresholds at 3 and 12 months postoperatively were compared to evaluate changes over time. RESULTS: The proportions of people who reported a clinically relevant improvement, or their symptoms being acceptable, increased by 10% to 15% points from 3 to 12 months after surgery. MIC thresholds for the 5 KOOS subscales remained stable from 3 to 12 months with statistically nonsignificant differences (95% confidence intervals) ranging from -0.3 (-3.0, 2.6) to -2.4 (-6.1, 1.3). All PASS thresholds except for quality of life (QOL) decreased by -6.5 (-11.8, -1.5) to -3.7 (-7.1, -0.4) points, indicating that higher symptom levels were accepted at 12 months. In contrast, the proportion reporting their treatment to have failed remained stable over time (19% and 17%). For QOL, a 7.4 (2.0, 13.2) higher TF threshold at 12 months suggested that improved QOL was required to not consider that the treatment had failed. CONCLUSION: More patients reported being improved at 1 year compared to at 3 months following meniscus surgery. The KOOS MIC thresholds were stable over time, whereas time-specific PASS values should be applied after meniscus surgery. J Orthop Sports Phys Ther 2023;53(11):685-702. Epub 3 October 2023. doi:10.2519/jospt.2023.11993.
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Lee MK, Zaniletti I, Larson DR, Lewallen DG, Berry DJ, Kremers HM. Nuts and Bolts of Patient-Reported Outcomes in Orthopaedics. J Arthroplasty 2023; 38:616-621. [PMID: 36481287 PMCID: PMC10010940 DOI: 10.1016/j.arth.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/01/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Patient-reported outcomes (PROs) are commonly used in orthopaedic clinical practice, comparative effectiveness research (CER), and label claims. In this paper, we provide an overview of PROs, their development, validation, and use in orthopaedic research with examples and conclude with practical guidelines for researchers and reviewers. We discuss considerations for conceptual framework, validity, reliability, factor analysis, and measurement of change with Knee Injury and Osteoarthritis Outcome score (KOOS), as an example. We also describe advantages of instruments developed based on item response theory and statistical analyses for data collected using PRO measures. Please visit the following (https://www.youtube.com/watch?v=4p-DtZgUHOA&t=354s) for a video that explains the highlights of the paper in practical terms.
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Affiliation(s)
- Minji K. Lee
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Isabella Zaniletti
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Dirk R. Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Georgopoulos V, Smith S, McWilliams DF, Steultjens MPM, Williams A, Price A, Valdes AM, Vincent TL, Watt FE, Walsh DA. Harmonising knee pain patient-reported outcomes: a systematic literature review and meta-analysis of Patient Acceptable Symptom State (PASS) and individual participant data (IPD). Osteoarthritis Cartilage 2023; 31:83-95. [PMID: 36089231 DOI: 10.1016/j.joca.2022.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In order to facilitate data pooling between studies, we explored harmonisation of patient-reported outcome measures (PROMs) in people with knee pain due to osteoarthritis or knee trauma, using the Patient Acceptable Symptom State scores (PASS) as a criterion. METHODS We undertook a systematic literature review (SLR) of PASS scores, and performed individual participant data (IPD) analysis of score distributions from concurrently completed PROM pairs. Numerical rating scales (NRS), visual analogue scales, KOOS and WOMAC pain questionnaires were standardised to 0 to 100 (worst) scales. Meta-regression explored associations of PASS. Bland Altman plots compared PROM scores within individuals using IPD from WebEx, KICK, MenTOR and NEKO studies. RESULTS SLR identified 18 studies reporting PASS in people with knee pain. Pooled standardised PASS was 27 (95% CI: 21 to 35; n = 6,339). PASS was statistically similar for each standardised PROM. Lower PASS was associated with lower baseline pain (β = 0.49, P = 0.01) and longer time from treatment initiation (Q = 6.35, P = 0.04). PASS scores were lowest in ligament rupture (12, 95% CI: 11 to 13), but similar between knee osteoarthritis (31, 95% CI: 26 to 36) and meniscal tear (27, 95% CI: 20 to 35). In IPD, standardised PROMs each revealed similar group mean scores, but scores within individuals diverged between PROMs (LoA between -7 to -38 and +25 to 52). CONCLUSION Different standardised PROMs give similar PASS thresholds in group data. PASS thresholds may be affected more by patient and treatment characteristics than between PROMs. However, different PROMs give divergent scores within individuals, possibly reflecting different experiences of pain.
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Affiliation(s)
- V Georgopoulos
- Academic Rheumatology, Pain Centre Versus Arthritis and NIHR Nottingham BRC, School of Medicine, University of Nottingham, UK.
| | - S Smith
- Academic Rheumatology, Pain Centre Versus Arthritis and NIHR Nottingham BRC, School of Medicine, University of Nottingham, UK.
| | - D F McWilliams
- Academic Rheumatology, Pain Centre Versus Arthritis and NIHR Nottingham BRC, School of Medicine, University of Nottingham, UK.
| | - M P M Steultjens
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, UK.
| | - A Williams
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, University of Oxford, UK; Fortius Clinic, London, UK.
| | - A Price
- Department of Immunology and Inflammation, Imperial College London, UK; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
| | - A M Valdes
- Academic Rheumatology, Pain Centre Versus Arthritis and NIHR Nottingham BRC, School of Medicine, University of Nottingham, UK.
| | - T L Vincent
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, University of Oxford, UK; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
| | - F E Watt
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, UK; Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, University of Oxford, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK.
| | - D A Walsh
- Academic Rheumatology, Pain Centre Versus Arthritis and NIHR Nottingham BRC, School of Medicine, University of Nottingham, UK.
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Sports Participation and Performance 5 Years After Arthroscopic Partial Meniscectomy: A Retrospective Cohort Study of 288 Patients. J Orthop Sports Phys Ther 2022; 52:224-232. [PMID: 35442751 DOI: 10.2519/jospt.2022.10785] [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: 02/07/2023]
Abstract
OBJECTIVE To investigate return to sport (RTS) approximately 5 years after arthroscopic partial meniscectomy (APM). DESIGN Retrospective cohort study. METHODS Knee Arthroscopy Cohort Southern Denmark patients were asked about RTS and reasons for non-RTS approximately 5 years (range, 4-6 years) after APM using online questionnaires. Patients engaged in their sport at the pre-injury level at follow-up were classified as "RTS" (or "returned to sport") and as being engaged in their sport with (1) full participation and performance, (2) reduced performance, or (3) both reduced participation and performance. Self-reported knee function was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS We included 288 patients (mean ± SD age, 49 ± 12 years; 44% women). Of these, 172 patients (60%; 95% confidence interval, 54%-65%) were classified as returned to sport, but only 42% (72/172) reported full participation and performance. Persistent problems with the operated knee were reported by 60% of the patients as the main reason for reduced participation or performance and by 70% of the patients as the main reason for not returning to pre-injury levels of their sport. Patients who had returned to sport, on average, improved by 10.1 points (95% confidence interval, 5.7-14.4) more in KOOS4 scores from baseline to 5 years than non-RTS patients. CONCLUSION At approximately 5 years after APM, 6 in every 10 patients had returned to their sport at pre-injury levels, but only 1 in every 4 returned with full participation and performance, mainly due to persistent knee problems. Greater improvements in KOOS scores were observed in patients who were classified as returned to sport. J Orthop Sports Phys Ther 2022;52(4):224-232. doi:10.2519/jospt.2022.10785.
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Wang L, Lin Q, Qi X, Chen D, Xia C, Song X. Predictive Factors Associated With Short-Term Clinical Outcomes and Time to Return to Activity After Arthroscopic Partial Meniscectomy in Nonathletes. Orthop J Sports Med 2022; 10:23259671221080787. [PMID: 35309234 PMCID: PMC8928400 DOI: 10.1177/23259671221080787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/08/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Although arthroscopic partial meniscectomy is a widely implemented surgical procedure, studies investigating the time to return to activity (RTA) are rare. Purpose: To explore which factors are associated with the RTA times after arthroscopic partial meniscectomy and to investigate whether those factors can also improve short-term patient-reported outcomes. Study Design: Case-control study; Level of evidence, 3. Methods: The authors reviewed the records of patients who underwent isolated partial meniscectomy in their institution from January 2017 to December 2019. Patient and injury characteristics were documented, and time to RTA was obtained via phone interview in January 2021. Pre- and postoperative outcomes were assessed with the Lysholm score and International Knee Documentation Committee (IKDC) score. The chi-square test and independent-samples t test were used to evaluate differences in outcome scores and time to RTA according to the patient and injury characteristics, and risk factors with a P value <.1 in the univariate analysis were used in the binary regression. Results: Included were 215 patients (87 men and 128 women; mean age, 33.7 years [range, 24-75 years]). Of these patients, 204 provided information on time to RTA (mean, 3.3 months). By 3 months postoperatively, 49.5% (101/204) of patients could perform activities without knee-related restriction; this improved to 69.6% (142/204) at 6 months and 90.2% (184/204) at 12 months. On multivariate logistic regression analysis, age (OR, 0.39; 95% CI, 0.21-1.19; P = .044) and injury duration (OR, 0.20; 95% CI, 0.19-1.07; P = .032) were significantly associated with the time to RTA. IKDC scores improved significantly from 41.2 preoperatively to 76.7 postoperatively, and in the multivariate logistic regression model, female sex (OR, 2.67; 95% CI, 1.10-6.47; P = .030), body mass index (BMI) ≥27 kg/m2 (OR, 2.96; 95% CI, 1.02-8.66; P = .047), and medial meniscal tear (OR, 0.20; 95% CI, 0.04-1.00; P = .050) were associated with inferior outcome scores. Conclusion: Patients aged 40 years and younger who underwent partial meniscectomy surgery within 6 months after a meniscal tear were more likely to have a shorter time to RTA, and female patients with obesity (BMI ≥27 kg/m2), especially those with medial meniscal tears, tended to have inferior clinical outcomes.
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Affiliation(s)
- Lipeng Wang
- Department of Anaesthesia, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, People’s Republic of China
| | - Qingxi Lin
- Department of Orthopedics, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People’s Republic of China
| | - Xinsheng Qi
- Department of Orthopedics, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People’s Republic of China
| | - Dongyang Chen
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People’s Republic of China
| | - Caiwei Xia
- Department of Orthopedics, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People’s Republic of China
| | - Xiaoxiao Song
- Department of Orthopedics, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People’s Republic of China
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Erickson BJ, Chalmers PN, D'Angelo J, Ma K, Rowe D, Ciccotti MG, Dugas JR. Performance and Return to Sports After Meniscectomy in Professional Baseball Players. Am J Sports Med 2022; 50:1006-1012. [PMID: 35148211 DOI: 10.1177/03635465221074021] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal injuries are common in athletes across many sports. How professional baseball players respond to partial meniscectomy is not well documented. PURPOSE/HYPOTHESIS The purpose was to determine the performance and return-to-sports (RTS) rate in professional baseball players after arthroscopic partial knee meniscectomy and compare the results of partial medial meniscectomy versus partial lateral meniscectomy. The hypothesis was that there would be a high RTS rate in professional baseball players after partial meniscectomy with no difference in the RTS rate or timing of RTS between players who underwent partial medial meniscectomy versus partial lateral meniscectomy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All professional baseball players who underwent arthroscopic partial meniscectomy between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Demographic and performance data (before and after injury) for each player were recorded. The RTS rate and timing of RTS were then compared between players who underwent partial medial meniscectomy versus partial lateral meniscectomy. RESULTS A total of 168 knees (168 players) underwent arthroscopic partial meniscectomy (mean age, 25 ± 5 years; 46% medial meniscectomy, 45% lateral meniscectomy, and 9% both medial and lateral meniscectomy). The most common mechanism of injury was fielding in the infield on natural grass. Injuries were spread evenly across positions: 18% catchers, 24% infielders, 20% outfielders, and 38% pitchers. The overall RTS rate was 80% (76% returned to the same or a higher level, and 4% returned to a lower level). For performance, pitchers saw significant decreases in usage but significant improvements in performance using the advanced statistics of fielding independent pitching (P < .001) and wins above replacement (P = .011). Hitters saw significant decreases in usage but increases in efficiency as seen by improvements in wins above replacement (P = .003). Of the 79 athletes who returned during the same season, the median time to return to play was 42 days. CONCLUSION The RTS rate after meniscectomy in professional baseball players was 80%. Player efficiency improved after surgery in pitchers and position players. No difference in the RTS rate or timing of RTS existed between players who underwent partial medial meniscectomy versus partial lateral meniscectomy.
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Affiliation(s)
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - John D'Angelo
- Major League Baseball Commissioner's Office, New York, New York, USA
| | - Kevin Ma
- Major League Baseball Commissioner's Office, New York, New York, USA
| | - Dana Rowe
- Major League Baseball Commissioner's Office, New York, New York, USA
| | | | - Jeffrey R Dugas
- Andrews Sports Medicine & Orthopaedic Center, Birmingham, Alabama, USA
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Van Doninck J, Van Doninck D, Sprenghers L, Peeters E, Du Bois M. Impact of job characteristics on return-to-work interval following arthroscopic partial meniscectomy. Acta Orthop Belg 2022; 88:95-101. [PMID: 35512159 DOI: 10.52628/88.1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this paper was to investigate whether job characteristics are associated with time interval for return to former professional activity (return to work, RTW) after arthroscopic partial meniscectomy (APM). A retrospective study was carried out in a sample of 63 patients in working age who underwent an APM between July 2018 and July 2020. The following preoperative characteristics were assessed: age at surgery, meniscal side, sex, physical job demands (white versus blue collar worker), telework and work status (salaried versus self- employed). A linear regression analysis was used to study the association between job characteristics and RTW interval adjusted for socio-demographic and medical (meniscal side) factors. Telework was most strongly associated with interval for RTW (p <0,001, adjusted R Square: 20,8). The results suggested that telework supports early RTW independently of sociodemographic and medical factors. This study supported the need for a tailormade approach in the prescription of sick leave.
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Lu Y, Forlenza E, Wilbur RR, Lavoie-Gagne O, Fu MC, Yanke AB, Cole BJ, Verma N, Forsythe B. Machine-learning model successfully predicts patients at risk for prolonged postoperative opioid use following elective knee arthroscopy. Knee Surg Sports Traumatol Arthrosc 2022; 30:762-772. [PMID: 33420807 DOI: 10.1007/s00167-020-06421-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/14/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Recovery following elective knee arthroscopy can be compromised by prolonged postoperative opioid utilization, yet an effective and validated risk calculator for this outcome remains elusive. The purpose of this study is to develop and validate a machine-learning algorithm that can reliably and effectively predict prolonged opioid consumption in patients following elective knee arthroscopy. METHODS A retrospective review of an institutional outcome database was performed at a tertiary academic medical centre to identify adult patients who underwent knee arthroscopy between 2016 and 2018. Extended postoperative opioid consumption was defined as opioid consumption at least 150 days following surgery. Five machine-learning algorithms were assessed for the ability to predict this outcome. Performances of the algorithms were assessed through discrimination, calibration, and decision curve analysis. RESULTS Overall, of the 381 patients included, 60 (20.3%) demonstrated sustained postoperative opioid consumption. The factors determined for prediction of prolonged postoperative opioid prescriptions were reduced preoperative scores on the following patient-reported outcomes: the IKDC, KOOS ADL, VR12 MCS, KOOS pain, and KOOS Sport and Activities. The ensemble model achieved the best performance based on discrimination (AUC = 0.74), calibration, and decision curve analysis. This model was integrated into a web-based open-access application able to provide both predictions and explanations. CONCLUSION Following appropriate external validation, the algorithm developed presently could augment timely identification of patients who are at risk of extended opioid use. Reduced scores on preoperative patient-reported outcomes, symptom duration and perioperative oral morphine equivalents were identified as novel predictors of prolonged postoperative opioid use. The predictive model can be easily deployed in the clinical setting to identify at risk patients thus allowing providers to optimize modifiable risk factors and appropriately counsel patients preoperatively. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yining Lu
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Enrico Forlenza
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ryan R Wilbur
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ophelie Lavoie-Gagne
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael C Fu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Adam B Yanke
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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12
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Lavoie-Gagne OZ, Korrapati A, Retzky J, Bernstein DN, Diaz CC, Berlinberg EJ, Forlenza EM, Fury MS, Mehta N, O'Donnell EA, Forsythe B. Return to Play and Player Performance After Meniscal Tear Among Elite-Level European Soccer Players: A Matched Cohort Analysis of Injuries From 2006 to 2016. Orthop J Sports Med 2022; 10:23259671211059541. [PMID: 35047646 PMCID: PMC8761888 DOI: 10.1177/23259671211059541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Meniscal injuries are extremely common in soccer athletes, and little is known about postrecovery performance. Purpose: To (1) identify characteristics associated with return to play (RTP) to the same league level and (2) evaluate long-term effects that injury and management approach may have on player performance. Study Design: Cohort study; Level of evidence, 3. Methods: Using publicly available records, we identified athletes who sustained meniscal tears across the 5 major European soccer leagues (English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A) between 2006 and 2016. Injured athletes were matched to controls 1:2 by demographics and performance. Investigations included rate of RTP to the same league level, reinjury, player characteristics associated with RTP within 2 seasons, long-term availability, field time, and performance metrics standardized to 90 minutes of play during the next 4 seasons. Results: A total of 250 players sustaining meniscal tears were included, of which 106 (42%) received surgical management. Median absence was 57.5 days (interquartile range [IQR], 35-92) or 7 games (IQR, 4-12). Rate of RTP was 70%, and the reinjury rate 5% if a player could RTP. Age greater than 30 years was a negative predictor for RTP (odds ratio [OR], 0.62; P = .002), whereas higher preinjury goals per game (OR, 2.80; P = .04) and surgical management (OR, 1.38; P = .002) were positive predictors for RTP. Surgical management was associated with higher long-term availability (P < .01). As compared with the control, there were no significant differences in field time or performance metrics after RTP, either overall or by player position. As compared with nonoperative management, defenders undergoing surgery demonstrated decreased field time. Attackers and midfielders demonstrated similar field time and performance regardless of management. Conclusion: RTP of elite soccer athletes sustaining meniscal tear is contingent on age, preinjury performance, and management approach. Those who RTP to the same league level can be expected to demonstrate equivalent field time, performance, and long-term availability as noninjured athletes.
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Affiliation(s)
- Ophelie Z Lavoie-Gagne
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Avinaash Korrapati
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Julia Retzky
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, New York, USA
| | - David N Bernstein
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Connor C Diaz
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Elyse J Berlinberg
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Enrico M Forlenza
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Matthew S Fury
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nabil Mehta
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Evan A O'Donnell
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brian Forsythe
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
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13
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Zhou ML, Haley CC. The Team Physician: Return to Play Considerations and Outcomes. Sports Med Arthrosc Rev 2021; 29:e65-e70. [PMID: 34730118 DOI: 10.1097/jsa.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Successful rehabilitation of sports-related orthopedic injuries remains a challenge for both orthopedic surgeons and their patients. Team physicians are tasked with the complex problem of minimizing time away from competition, while simultaneously mitigating the risk of reinjury. Varying levels of expectation and demand between recreational and competitive athletes coupled with the already complex nature of sports-related injuries present a multifactorial challenge for the even the most experienced physicians. In the realm of sports medicine, timing of return to sport has become a controversial yet ubiquitous criterion by which treatment outcomes are measured. While accelerated rehabilitation may be desired in many cases, surgeons must also recognize the identifiable risk factors for potential reinjury. With these principles in mind, we present a summary of the available literature on data pertaining to return to sport, with coverage of injuries commonly seen within an orthopedic sports medicine practice.
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Affiliation(s)
- Maj Liang Zhou
- Keller Army Hospital, United States Military Academy, West Point, NY
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