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Simard SG, Greenfield CJ, Khoury AN. ACL Repair with Suture Tape Augmentation of Proximal Tears and Early ACL Reconstruction with Suture Tape Augmentation Result in Comparable Clinical Outcomes to ACL Reconstruction at 2-year Follow-up. Arthroscopy 2024:S0749-8063(24)00518-8. [PMID: 39069021 DOI: 10.1016/j.arthro.2024.07.021] [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: 02/21/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE The purpose of this study is to compare the post-operative side-to-side laxity and short-term clinical outcomes of patients who received primary ACL repair with suturetape augmentation, acute ACL reconstruction with suture tape augmentation performed within 8 weeks of injury (ACLRacute), or ACL reconstruction (ACLR) beyond 8 weeks of injury. METHODS Following IRB approval, 100 patients were enrolled in this prospective trial: n=34 primary ACL repair with suture tape augmentation, n=33 ACL reconstruction performed within 8 weeks of injury (ACLRacute), and n=33 ACL Reconstruction (ACLR). Patients were allocated to ACL repair if a proximal avulsion was present with good tissue quality (Sherman type 1), confirmed by intraoperative diagnostic arthroscopy. Preoperative side-to-side AP knee laxity was assessed with KT-1000 arthrometer and patient-reported outcomes (PROs) including visual analog scale (VAS), Marx activity scale, Veterans RAND 12-item health survey (VR-12 physical & mental), Single Assessment Numeric Evaluation (SANE), Knee Injury and Osteoarthritis Outcome Score (KOOS) survey subscales, and range of motion (ROM) were collected. These objective and subjective measures were repeated at regular intervals post-operatively through 2 years. Minimal clinically important differences (MCID) calculations were performed assessing post-operative PRO changes at 2 years compared to preoperative. RESULTS The average time from injury to surgery was 5.03±1.2 weeks for the ACL repair group, 5.09±0.74 weeks for the ACLRacute, and 43.22±33.5 weeks for the ACLR group. Postoperatively, the KT-1000 side-to-side laxity difference for 30lbs was determined to be 0.1±0.37, 95% CI: [-0.7,0.8] for ACL repair vs ACLR (p<0.0001), -0.8±0.35, 95% CI: [-1.5,-0.1] for ACLRacute vs ACLR (p<0.0001), and 0.8±0.40, 95% CI: [0.0,1.6] for ACL repair vs ACLRacute (p<0.0001). The data reveals ACL repair and ACLRacute are non-inferior to ACLR at 2-year follow-up. The post-operative difference from baseline for all PROs demonstrated improvement for all PROs. MRI at 1-year revealed tissue healing for the three ACL injury treatment groups. CONCLUSION Patients who underwent ACL repair of proximal tears with suture tape augmentation or ACL reconstruction within 8 weeks from injury resulted in non-inferior side-to-side knee laxity, comparable PROs, and similar range of motion at 2-year follow-up, compared to ACL reconstruction.
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Johns WL, Martinazzi BJ, Miltenberg B, Nam HH, Hammoud S. ChatGPT Provides Unsatisfactory Responses to Frequently Asked Questions Regarding Anterior Cruciate Ligament Reconstruction. Arthroscopy 2024; 40:2067-2079.e1. [PMID: 38311261 DOI: 10.1016/j.arthro.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/01/2024] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To determine whether the free online artificial intelligence platform ChatGPT could accurately, adequately, and appropriately answer questions regarding anterior cruciate ligament (ACL) reconstruction surgery. METHODS A list of 10 questions about ACL surgery was created based on a review of frequently asked questions that appeared on websites of various orthopaedic institutions. Each question was separately entered into ChatGPT (version 3.5), and responses were recorded, scored, and graded independently by 3 authors. The reading level of the ChatGPT response was calculated using the WordCalc software package, and readability was assessed using the Flesch-Kincaid grade level, Simple Measure of Gobbledygook index, Coleman-Liau index, Gunning fog index, and automated readability index. RESULTS Of the 10 frequently asked questions entered into ChatGPT, 6 were deemed as unsatisfactory and requiring substantial clarification; 1, as adequate and requiring moderate clarification; 1, as adequate and requiring minor clarification; and 2, as satisfactory and requiring minimal clarification. The mean DISCERN score was 41 (inter-rater reliability, 0.721), indicating the responses to the questions were average. According to the readability assessments, a full understanding of the ChatGPT responses required 13.4 years of education, which corresponds to the reading level of a college sophomore. CONCLUSIONS Most of the ChatGPT-generated responses were outdated and failed to provide an adequate foundation for patients' understanding regarding their injury and treatment options. The reading level required to understand the responses was too advanced for some patients, leading to potential misunderstanding and misinterpretation of information. ChatGPT lacks the ability to differentiate and prioritize information that is presented to patients. CLINICAL RELEVANCE Recognizing the shortcomings in artificial intelligence platforms may equip surgeons to better set expectations and provide support for patients considering and preparing for ACL reconstruction.
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Affiliation(s)
- William L Johns
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Brandon J Martinazzi
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A..
| | - Benjamin Miltenberg
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Hannah H Nam
- Penn State College of Medicine, Hershey, Pennsylvania, U.S.A
| | - Sommer Hammoud
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
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Chen M, Raji Y, Sivasundaram L, Voos JE. Risk Factors of Emergency Department Utilization After Outpatient Surgery for Sports-Related Injuries. J Am Acad Orthop Surg 2024; 32:611-626. [PMID: 38147678 DOI: 10.5435/jaaos-d-22-00715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 11/02/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION The purpose of this study was to identify the most common reasons for and risk factors associated with postoperative emergency department (ED) utilization after orthopaedic procedures for sports-related injuries. METHODS Using the 2014 to 2016 New York and Florida State Databases from the Healthcare Cost and Utilization Project, outpatient procedures for sports-related injuries were identified. Patient records were tracked across care settings within each state to determine the rate and reasons of postoperative ED utilization within 90 days after the index surgery. Multiple logistic regression models were used to identify risk factors associated with ED visits at 0 to 7 days, 8 to 30 days, 31 to 90 days postoperatively. RESULTS A total of 28,192 surgery visits for sports-related injuries were identified, with knee arthroscopy with partial meniscectomy (18.48%) and arthroscopic anterior cruciate ligament reconstruction (17.04%) as the two most common procedures treating sports injuries. The overall postoperative ED utilization rates were 1.6% (0 to 7 days postoperative), 1.3% (8 to 30 days) and 2.1% (31 to 90 days). The main cause of ED visits was markedly different during each postoperative period: mainly musculoskeletal pain (36.3%) during 0 to 7 days, either musculoskeletal pain (17%) or injury (16.6%) during 8 to 30 days, and injury (24.2%) during 31 to 90 days. Sports with the highest ED utilization in descending order were basketball, football, ice/snow sports, walking/running, cycling, and soccer. Relative to open procedures, arthroscopic procedures were 0.71 times as likely to result in a postoperative ED visit. Independent predictors of ED utilization up to 90 days postoperatively included renal failure, chronic pulmonary disease, psychosis, diabetes, and alcohol abuse. DISCUSSION Rate of ED utilization after outpatient surgery for sports-related injuries is low (<2.2%), with postoperative musculoskeletal pain and reinjury as the two most common causes, highlighting the importance of postoperative pain management and injury prevention. Arthroscopic procedures showed markedly lower ED utilization compared with open surgery, although not indicative of overall superiority. LEVEL OF EVIDENCE III, Retrospective Cohort Study.
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Affiliation(s)
- Mingda Chen
- From the Case Western Reserve University School of Medicine, Cleveland, OH (Chen, and Voos), the Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH (Raji and Voos), and the Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL (Sivasundaram)
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Heifner JJ, Kilgore JE, Nichols JA, Reb CW. Syndesmosis Injury Contributes a Large Negative Effect on Clinical Outcomes: A Systematic Review. Foot Ankle Spec 2024; 17:284-294. [PMID: 35048741 DOI: 10.1177/19386400211067865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The literature largely addresses questions of diagnostic accuracy and therapeutic accuracy. However, the magnitude of the clinical impact of syndesmosis injury is commonly described in intuitive yet qualitative terms. This systematic review aimed to quantify the impact of syndesmosis injury. METHODS Published clinical outcomes data were used to compute an effect size reflecting the impact of syndesmosis injury. This was done within the clinical contexts of isolated syndesmosis injury and syndesmosis injury with concomitant ankle fracture. Clinical outcomes data included Olerud-Molander (OM) and American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analog scale for pain, and days missed from sport competition. Parametric data were compared with Student t tests. Effect size was computed using Cohen's d. RESULTS In ankle fracture patients, syndesmosis injury demonstrated a large effect size for OM (d = 0.96) and AOFAS (d = 0.83) scores. In athletic populations without concomitant ankle fracture, syndesmosis injury demonstrated a large effect size on days missed from competition (d = 2.32). DISCUSSION These findings confirm the magnitude of the negative impact of syndesmosis injury in athletic populations with isolated injury and in ankle fracture patients. In ankle fracture patients, this large negative effect remains despite surgery. Thus, syndesmosis repair may not fully mitigate the impact of the injury. LEVELS OF EVIDENCE Level III: Systematic review.
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Affiliation(s)
- John J Heifner
- School of Medicine, St. George's University, Great River, New York
| | - Jack E Kilgore
- College of Medicine, University of Florida, Gainesville, Florida
| | - Jennifer A Nichols
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Christopher W Reb
- Division of Foot and Ankle, Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida
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Kara ÖS, Torgutalp SS, Turhan E, Dönmez G, Korkusuz F. Operative treatment in non-emergency sports injuries: a sports medicine clinic experience. PHYSICIAN SPORTSMED 2023; 51:596-602. [PMID: 36416053 DOI: 10.1080/00913847.2022.2151325] [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: 09/24/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To elucidate referrals from sports medicine clinic (SMC) to orthopedics, consensus rates among physicians and surgeons on surgical need in these patients, and reasoning of the patients who refused to have surgery despite the recommendations by both groups in non-emergency sports injury patients. METHODS We conducted a retrospective cohort analysis by using the administrative and referral records of a sports medicine clinic for the 15 months between October 2017 and January 2019. Gender, age, diagnosis, and type of sport were compared between two groups (patients referred to orthopedics vs patients treated in SMC). Agreement between orthopedics and SMC on surgical need in those patients who were referred to orthopedics was evaluated. We additionally screened the hospital archive for surgery reports of patients recommended surgery, and, if a patient did not have a surgery record, we investigated the reasons by telephone interview and categorized these reasons. RESULTS Surgical evaluation needed for 4.7% (n = 155) of the patients. Patients referred to orthopedics were younger (median: 22.0 years), mostly male (n = 119, 76.8%), and involved in contact sports (n = 108, 69.7%) (p < 0.001 for all) compared to patients treated conservatively. Majority of the consultations were made owing to certain diagnoses such as cruciate/collateral ligament sprain (n = 70, 45.2%), meniscal tear (n = 21, 13.5%), and cartilage injuries (n = 15, 9.7%). Most of the patients diagnosed with Achilles tendon rupture (n = 2, 100%) and patellar instability (n = 13, 81.3%) were referred to surgery. Orthopedics agreed with the sports medicine physicians' opinions in most cases (n = 110, 71.0%). Thirty-four patients (30.9%) recommended surgery by the surgeon postponed/refused the treatment for various reasons or had surgery in another hospital. CONCLUSION Most non-emergency sports injuries can be treated conservatively. Young and male patients participating in contact sports are more likely to need surgical treatment. Non-surgeon musculoskeletal health-care providers may consider referring patients to orthopedics considering the data demonstrated in this study. Nevertheless, patient's motivation to undergo an operation should be considered before referring to orthopedics.
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Affiliation(s)
- Ömer Serkan Kara
- Department of Sports Medicine, Hacettepe University Medical Faculty, 06230, Ankara, Turkey
- Department of Sports Medicine, Health Sciences, University Gülhane Medical Faculty, 06010, Ankara, Turkey
| | - Serife Seyma Torgutalp
- Department of Sports Medicine, Hacettepe University Medical Faculty, 06230, Ankara, Turkey
| | - Egemen Turhan
- Department of Orthopedic and Traumatology, Hacettepe University Medical Faculty, 06230, Ankara, Turkey
| | - Gürhan Dönmez
- Department of Sports Medicine, Hacettepe University Medical Faculty, 06230, Ankara, Turkey
| | - Feza Korkusuz
- Department of Sports Medicine, Hacettepe University Medical Faculty, 06230, Ankara, Turkey
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Morphometric characteristics of the knee are associated with the injury of the meniscus. J Orthop Surg Res 2022; 17:498. [PMCID: PMC9675146 DOI: 10.1186/s13018-022-03380-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background To assess the geometrical risk factors for meniscal injuries. We hypothesized that the narrowness of the intercondylar notch and the smaller tibial spine could increase the risk of meniscal injuries. Methods We retrospectively studied two hundred and seven patients examined for knee magnetic resonance images. Two experienced orthopedists evaluated the severity of meniscal injuries. The notch width, bicondylar notch width, notch width index, condyle width of the femur, tibial spine height, and intercondylar angle were measured in magnetic resonance image slides by two blinded orthopedists.
Results A total of 112 patients with a meniscus injury and 95 patients were as healthy control in all two hundred and seven patients. The NWI (P = 0.027) in patients with meniscus injuries was significantly different from the control group. A 1 SD (0.04 mm) increase in NWI was associated with a 0.4-fold increase in the risk of meniscal injury. A 1 SD (0.04 mm) increase in NWI was associated with a 0.64-fold increase in the risk of grade 3 meniscal injury. Furthermore, NWI and medial spine height are decreased significantly in grade 2 (P < 0.05) meniscal injury than in other grades. The medial spine height was significantly decreased in the meniscal injury group (P = 0.025), and the decrease in medial spine height would increase the risk of meniscal injury (OR = 0.77) and grade 3 meniscal injury (OR = 0.8). Conclusions The stenosis of the femoral intercondylar notch and small medial tibial spine is risk factors of meniscal injury. The decreased NWI and the medial tibial spine height were also associated with the severity of the meniscal injury. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03380-2.
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Wong AYY, Man GCW, Wu YM, Wong HW, Ong MTY, Yung PSH. Risk of surgery and epidemiological profile of athletes presenting to a single sports injury clinic in Hong Kong. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221082314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Although participation in sports and exercise is promoted widely due to its health benefits, sports-related injuries can also be a detriment to an individual's health and a burden for the healthcare system. Herein, the aim of this study is to provide a comprehensive review on the epidemiological profile and the risk for surgery of athletes presented to a sports injuries clinic in Hong Kong. Methods A total of 566 patients attending the sports injuries clinic at a local hospital between October 2017 and September 2018 were reviewed. Only 271 patients sustaining injuries from sports activities were included. These patients attended a survey-based data collection session, which recorded their demographic, injury site, events leading to injury, exercise details (type, level-of-play, frequency, experience), and functional score according to the injury site. Results The highest proportion of injuries was observed in amateur athletes (45.4%) than in recreational (28.8%) and professional (25.8%). Those patients aged between 18–29 years old (50.2%) had the most injuries. Both soccer (25.1%) and basketball (25.1%) were the two most common sports to incurred injuries. Whereas, the lower extremities being the most common injured sites. Based on our logistic model, athletes with less experience were more prone to required surgeries with injuries in the lower extremities. Conclusion Preventive measures should be targeted at less experience athletes, focusing on strengthening the knee region, to reduce sports-related injuries and surgeries. Importantly, this study demonstrates the need to further identify factors to develop effective sports injury prevention programmes for tailoring athletes at different levels-of-play.
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Affiliation(s)
- Ashley Ying-Ying Wong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Gene Chi-Wai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yuen-Man Wu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Hiu-Wun Wong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Lu J, Wu Z, Adams R, Han J, Cai B. Sex differences in the relationship of hip strength and functional performance to chronic ankle instability scores. J Orthop Surg Res 2022; 17:173. [PMID: 35313904 PMCID: PMC8935730 DOI: 10.1186/s13018-022-03061-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/09/2022] [Indexed: 12/26/2022] Open
Abstract
Background While decreased hip abductor strength, functional performance, and self-reported instability scores have all been shown in association with CAI, any sex difference in the relationship between these indicators is unclear. This study was to determine whether sex differences are present in the relationship between these indicators in individuals with CAI. Methods Thirty-two women and twenty-nine men with unilateral CAI took part. Hip abductor strength and functional performance were respectively assessed using a hand-held dynamometer and the figure-8-hop test. All 61 participants scored the Cumberland Ankle Instability Tool (CAIT) for self-reported ankle instability. Independent sample t-tests and correlation analysis were conducted. Results Normalized hip abductor strength and functional performance measures for females were lower than for males. The self-reported ankle instability CAIT score, where higher values represent less instability, was significantly and positively correlated with both normalized hip abductor strength (p = 0.003) and functional performance (p = 0.001) on the affected side in females, but not in males (p = 0.361 and p = 0.192 respectively). Conclusions Sex differences were observed in that there were significant relationships between normalized hip abductor strength, functional performance, and CAIT scores in female CAI participants, but not males, suggesting that CAI evaluation and rehabilitation strategies should be sex-specific. Highlights In females with CAI, hip abductor strength and functional performance showed significant relationships with self-reported instability scores. Correspondingly, in clinical practice with individuals with CAI, evaluation criteria may be formulated according to these observed sex differences. Sex differences should be factored into the evaluation and treatment of CAI individuals. Hip strength assessment should be employed with CAI individuals. Hip strengthening and functional hopping may be recommended for the rehabilitation of CAI, especially in female patients.
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Affiliation(s)
- Junlan Lu
- Children's Rehabilitation Center, Division of Pediatric Healthcare, Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhigang Wu
- Department of Rehabilitation Medicine, Hainan Western Central Hospital, Danzhou, Hainan, China
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, Bruce, ACT, Australia
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, 279 Zhouzhu Highway,Pudong New Area, Shanghai, 201318, China. .,Research Institute for Sport and Exercise, University of Canberra, Bruce, ACT, Australia.
| | - Bin Cai
- Department of Rehabilitation Medicine, Hainan Western Central Hospital, Danzhou, Hainan, China. .,Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
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Feng SM, Chen J, Ma C, Migliorini F, Oliva F, Maffulli N. Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Broström ligament repair. J Orthop Surg Res 2022; 17:69. [PMID: 35115041 PMCID: PMC8811990 DOI: 10.1186/s13018-022-02968-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background The arthroscopic modified Broström procedure, with repair of the anterior talofibular ligament and extensor retinaculum, produces good functional outcomes in patients with chronic lateral ankle instability (CLAI). CLAI can be associated with osteochondral lesions of the talus (OLTs). It remains unclear whether associated limited OLTs affect clinical outcomes in such patients. Methods This retrospective cohort study included 92 CLAI patients with and without OLTs undergoing an all-inside arthroscopic modified Broström procedure from June 2016 to May 2019. The patients were divided into non-lesion group (n = 32) and lesion group (n = 60) according to whether CLAI was associated or not with OLTs. All the osteochondral lesions less than 15 mm in diameter were managed with bone marrow stimulation techniques (arthroscopic microfracture) at the time of the arthroscopic modified Broström procedure. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups. Results Increase in all the functional scores (VAS, AOFAS, KAFS, ATT, and AJPS) in both groups was, respectively, recorded 1 year and 2 years after surgery. At the 1-year and 2-year follow-up, there was no significant difference in the VAS, AOFAS, KAFS, ATT, and AJPS scores between the non-lesion and lesion groups. Conclusion In patients with CLAI who underwent an arthroscopic modified Broström procedure, the presence of limited OLTs (less than 15 mm in diameter), which required arthroscopic microfracture, did not exert any influence on outcome. Level of Evidence Level III, a retrospective comparative study.
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Affiliation(s)
- Shi-Ming Feng
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, People's Republic of China.
| | - Jie Chen
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, People's Republic of China
| | - Chao Ma
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, People's Republic of China
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire, ST4 7QB, England.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
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Gatto JD, Park HY, Hwang R, Aderibigbe T, McClintick DJ, Shahinyan RH, Sekimura TK, Subhash A, Bernthal NM, Petrigliano FA. Analysis of Medical Malpractice Outcomes for Sports Orthopedic Procedures. Orthopedics 2022; 45:e47-e52. [PMID: 34734778 DOI: 10.3928/01477447-20211101-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Orthopedic sports medicine surgeons are especially vulnerable to litigation, largely because of high patient expectations in the setting of complex surgeries. Understanding the factors associated with litigation may reduce physician risk as well as optimize patient satisfaction and outcomes. We used a national medicolegal database to search for medical malpractice verdicts and out-of-court settlements involving common sports injuries and their surgical management between January 1, 2000, and January 1, 2018. Univariate analysis was performed to identify predictors of case outcome and monetary awards. We identified 777 cases, but only 328 met the inclusion criteria. Of the 328 cases included in our study, 231 (70.4%) resulted in a defendant verdict, 75 (22.9%) resulted in a plaintiff verdict, and 22 (6.7%) resulted in a settlement. The most common reason for litigation was intraoperative error (183 cases, 55.8%). No statistically significant difference was found between monetary awards for plaintiff verdicts vs settlements (mean award of $1.29 million and $0.72 million, respectively, P=.07). Cases in which the plaintiff claimed neurovascular injury were significantly more likely to result in a higher monetary award (mean award of $2.37 million, P=.02). Cases involving an incorrect surgical site were significantly less likely to result in a defendant outcome, with 7 of 12 cases (58.3%) leading to a plaintiff outcome (P=.047). With more than two-thirds of cases resulting in a defendant verdict, many suits result in a favorable outcome for practitioners. Intraoperative error is the most common reason for litigation, and neurovascular injury resulted in the highest monetary payouts. Vigilance to avoid these events may improve patient outcomes and decrease liability to practitioners. [Orthopedics. 2022;45(1):e47-e52.].
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Goulart Neto AM, Maffulli N, Migliorini F, de Menezes FS, Okubo R. Validation of Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in individuals with chronic ankle instability: a cross-sectional observational study. J Orthop Surg Res 2022; 17:38. [PMID: 35062990 PMCID: PMC8781557 DOI: 10.1186/s13018-022-02925-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/06/2022] [Indexed: 12/26/2022] Open
Abstract
Abstract
Background
Ankle sprain is the most common lower limb injury in physically active individuals. Loss of function, decreased postural control (PC), strength deficit, and reduced range of motion (ROM) are common after acute lateral ankle sprains. Some patients experienced long lasting symptoms, with recurrent sprains, and episodes of giving-way: a condition known as chronic ankle instability (CAI). Evaluating the function in patients with CAI in the clinical environment is important to identify the severity of the condition, in addition to allowing to assess the effectiveness of a given treatment. The aim of this study was to investigate the validation of the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in terms of muscle strength, PC and ROM in adults with CAI.
Methods
This is a cross-sectional study. Individuals with CAI aged between 18 and 45 years were eligible. Individuals with CAI were identified using the Identification of Functional Ankle Instability (IdFAI). All patients filled in the FAAM and FAOS scores. Muscle strength was assessed by manual dynamometry, ROM by the Lunge test, PC by computerized posturography, modified Star Excursion Balance Test (mSEBT) and modified Balance Error Score System (mBESS).
Results
50 participants were enrolled in the present study. The mean age of the patients was 27.2 ± 6.3 years, and the mean body mass index was 26.4 ± 4.8 kg/m2. 58% (29 of 50) were men and 42% (21 of 50) women. 18 individuals had unilateral (36%) and 32 bilateral (64%) CAI. The results of FAAM were associated with MCT, mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, and external hip rotator muscles strength (P < 0.05). The results of FAOS were associated with mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, evertor muscles strength, and external hip rotator muscles strength, and mBEES (P < 0.05).
Conclusion
Both the FAAM and FAOS demonstrated validity to evaluate postural control and muscle strength in patients with CAI, while no association was found in relation to ankle dorsiflexion.
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Sood M, Sachdeva J, Ghai A, Sud A, Chauhan M, Singh S. Pattern of anterior cruciate ligament injuries in armed forces. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_38_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The Majority of Complaints About Orthopedic Sports Surgeons on Yelp Are Nonclinical. Arthrosc Sports Med Rehabil 2021; 3:e1465-e1472. [PMID: 34746847 PMCID: PMC8551418 DOI: 10.1016/j.asmr.2021.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose To examine and characterize extremely negative Yelp reviews of orthopedic sports surgeons in the United States. Methods A search for reviews was performed using the keywords “Orthopedic Sports Medicine” on Yelp.com for 8 major metropolitan areas. Single-star reviews were isolated for analysis, and individual complaints were then categorized as clinical or nonclinical. The reviews were classified as surgical or nonsurgical. Results A total of 11,033 reviews were surveyed. Of these, 1,045 (9.5%) were identified as 1-star, and 289 were ultimately included in the study. These reviews encompassed 566 total complaints, 133 (23%) of which were clinical, and 433 (77%) of which were nonclinical in nature. The most common clinical complaints concerned complications (32 complaints; 6%), misdiagnosis (29 complaints; 5%), and uncontrolled pain (21 complaints; 4%). The most common nonclinical complaints concerned physicians’ bedside manner (120 complaints; 21%), unprofessional staff (98 complaints; 17%), and finances (78 complaints; 14%). Patients who had undergone surgery wrote 47 reviews that resulted in 114 complaints (20.5% of total complaints), whereas nonsurgical patients were responsible for 242 reviews and a total of 452 complaints (81.3% of total complaints). The difference in the number of complaints by patients after surgery and patients without surgery was statistically significant (P < 0.05) for all categories except for uncontrolled pain, delay in care, bedside manner of midlevel staff, and facilities. Conclusion Our study of extremely negative Yelp reviews found that 77% of negative complaints were nonclinical in nature. The most common clinical complaints were complications, misdiagnoses and uncontrolled pain. Only 16% of 1-star reviews were from surgical patients. Clinical Relevance Patients use online review platforms when choosing surgeons. A comprehensive understanding of factors affecting patient satisfaction and dissatisfaction is needed. The results of our study could be used to guide future quality-improvement measures and to assist surgeons in maintaining favorable online reputations.
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Schwarz I, Houck DA, Belk JW, Hop J, Bravman JT, McCarty E. The Quality and Content of Internet-Based Information on Orthopaedic Sports Medicine Requires Improvement: A Systematic Review. Arthrosc Sports Med Rehabil 2021; 3:e1547-e1555. [PMID: 34712992 PMCID: PMC8527260 DOI: 10.1016/j.asmr.2021.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/29/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose To evaluate the quality and content of internet-based information available for some of the most common orthopaedic sports medicine terms. Methods A search of the PubMed, Embase, and Cochrane databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines was performed. All English-language literature published from 2010 to 2020 discussing information quality pertaining to orthopaedic sports medicine terms was included. Outcomes included the search engines used, number and type of websites evaluated, platform, and quality scoring metrics. Descriptive statistics are presented. Results This review includes 21 studies. Of these, 3 evaluated both the upper and lower extremity. Twelve focused on either the upper or lower extremity, most commonly rotator cuff tears (3 of 12) and/or anterior cruciate ligament pathologies (7 of 12). The most common engines were Google (18 of 21), Bing (16 of 21), Yahoo (16 of 21), YouTube (3 of 21), Ask (3 of 21), and AOL (2 of 21). The average number of media files assessed per study was 87 ± 55. Website quality was assessed with DISCERN (7 of 21), Flesch-Kincaid (9 of 21), Health on the Net (7 of 21), and/or Journal of the American Medical Association Benchmark (7 of 21) scores. YouTube was evaluated with Journal of the American Medical Association Benchmark scores (1.74 ± 1.00). Image quality was reported in 2 studies and varied with search terminology. Conclusions The results of this systematic review suggest that physicians should improve the quality of online information and encourage patients to access credible sources when conducting their own research. Clinical Relevance Doctors can and should play an active role in closing the gap between the level of health literacy of their patients and that of most common online resources.
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Affiliation(s)
- Ilona Schwarz
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Darby A Houck
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - John W Belk
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Jack Hop
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Jonathan T Bravman
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Eric McCarty
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
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Telemedicine as a Therapeutic Option in Sports Medicine: Results of a Nationwide Cross-Sectional Study among Physicians and Patients in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137110. [PMID: 34281045 PMCID: PMC8297228 DOI: 10.3390/ijerph18137110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/05/2022]
Abstract
Background: Worldwide, the number of treatments in the field of sports medicine is increasing. However, the COVID-19 pandemic has changed everyday life. Many consultations had to be cancelled, postponed, or converted to a virtual format. Telemedicine in sports medicine could support physicians. This study analyzes the use and perception of telemedicine applications among physicians and patients in the field of sports medicine in Germany. Methods: This prospective cross-sectional study was based on a survey of sports medicine physicians and patients in Germany during the COVID-19 pandemic. Descriptive statistics were calculated. Results: We analyzed the responses of 729 patients and 702 sports medicine physicians. Most believed that telemedicine is useful. Both physicians and patients rated their knowledge of telemedicine as unsatisfactory. The majority of respondents said they do not currently use telemedicine but would like to do so. Patients and physicians reported that their attitude had changed positively towards telemedicine and that their usage had increased due to COVID-19. The majority in both groups agreed on implementing virtual visits in stable disease conditions. Telemedicine was considered helpful for follow-up monitoring and prevention by both groups. Conclusion: Telemedicine in sports medicine has seen limited use but is highly accepted among physicians and patients alike. The absence of a structured framework is an obstacle to effective implementation. Training courses should be introduced to improve the limited knowledge regarding the use of telemedicine. More research in telemedicine in sports medicine is needed. This includes large-scale randomized controlled trials, economic analyses and explorations of user preferences.
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Editorial Commentary: Preoperative Patient-Reported Outcomes Measurement Information System Scores Predict Which Patients Will Benefit From Arthroscopic Meniscectomy: To Scope or Not to Scope? Arthroscopy 2021; 37:972-975. [PMID: 33673975 DOI: 10.1016/j.arthro.2020.12.217] [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: 12/13/2020] [Accepted: 12/16/2020] [Indexed: 02/02/2023]
Abstract
Despite its widespread use and low complication rates, arthroscopic meniscectomy has not been uniformly successful in all patients, especially in those with concurrent osteoarthritis. The Patient-Reported Outcomes Measurement Information System (PROMIS) is an initiative funded by the National Institutes of Health to develop and validate patient-reported outcomes for clinical research and practice. PROMIS has shown the ability to enhance and standardize measurement of a variety of health domains affecting musculoskeletal function and in discriminating between various orthopaedic procedures through the use of computer adaptive testing. Preoperative PROMIS scores are valid predictors of postoperative minimal clinically important difference in patients undergoing arthroscopic meniscectomy based on preoperative decreased physical function and increased pain interference. PROMIS score cutoffs may be used by arthroscopic surgeons to counsel patients considering arthroscopic meniscectomy.
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Feng SM, Maffulli N, Ma C, Oliva F. All-inside arthroscopic modified Broström-Gould procedure for chronic lateral ankle instability with and without anterior talofibular ligament remnant repair produced similar functional results. Knee Surg Sports Traumatol Arthrosc 2021; 29:2453-2461. [PMID: 33206208 PMCID: PMC8298351 DOI: 10.1007/s00167-020-06361-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/30/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The Broström-Gould procedure, with the repair of the anterior talofibular ligament (ATFL) combined with the transfer of the extensor retinaculum, is considered the gold standard procedure for the management of chronic lateral ankle instability (CLAI). Lateral ligament reconstruction is considered if the ATFL remnant quality is poor or the ATFL has been damaged beyond the ability to suture it. It remains unclear whether not repairing the ATFL remnant produces comparable functional outcomes to the classical Broström-Gould procedure. METHODS This retrospective cohort study included 84 patients with CLAI undergoing either repair or non-repair of the ATFL remnant using an all-inside arthroscopic Broström-Gould procedure from 2015 to 2018. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups. RESULTS All the functional scores (VAS, AOFAS, KAFS, ATT, AJPS) significantly improved in both groups at 1 and 2 years after surgery. At all the follow-up time points, the VAS, AOFAS, KAFS, ATT, AJPS, and the rate of return to sport scores were comparable between the repair and non-repair group. CONCLUSION There are no statistically significant differences in postoperative outcomes between ATFL remnant repair and non-repair for the management of CLAI using the all-inside arthroscopic Broström-Gould procedure. From the clinical viewpoint, the present study shows that the potential differences in clinical outcomes between ATFL remnant repair and non-repair are likely not relevant when performing an all-inside arthroscopic Broström-Gould procedure for CLAI. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Shi-Ming Feng
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, People's Republic of China. .,Orthopaedic Department, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009, Jiangsu, People's Republic of China.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy. .,Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, ST4 7QB, Staffordshire, UK. .,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK.
| | - Chao Ma
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, No. 199, the Jiefang South Road, Xuzhou, 221009 Jiangsu People’s Republic of China ,Orthopaedic Department, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009 Jiangsu People’s Republic of China
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
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Maffulli N, Aicale R, D'Addona A, Young DA, Kader DF, Oliva F. Combined medial patellofemoral and patellotibial reconstruction with soft tissue fixation in recurrent patellar dislocation. Injury 2020; 51:1867-1873. [PMID: 32580890 DOI: 10.1016/j.injury.2020.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The medial patellofemoral and patellotibial ligaments (MPFL and MPTL) are the main passive restraints to lateral patellar translation. When nonoperative management of patellofemoral dislocations fails, surgical options can be considered to restore patellofemoral stability. Several reconstruction procedures of the MPFL with semitendinosus, gracilis, quadriceps tendon, and synthetic grafts have been described. No clear superiority of one surgical technique over another is evident. MATERIALS AND METHODS Patients who suffered at least two documented episodes of unilateral patellar dislocation, confirmed radiographically and at clinical examination, underwent combined MPFL and MPTL reconstruction. Patients were regularly followed-up postoperatively at 2, 4, 8, 12, and 24 weeks, and then annually for a minimum of 2.5 years. Clinical and functional evaluations were performed using the modified Cincinnati rating system and the Kujala score, while anthropometry values including thigh volume and cross-sectional area of the thigh were measured before the operation and at the latest follow-up bilaterally. RESULTS There were 7 males and 27 females with a mean age of 26.5 ± 10.7 years (range, 13-39 years). The mean follow-up was 3.1 years (range, 2.5-4 years). The mean modified Cincinnati score Increased from 51 ± 22 preoperatively to 90 ± 19 (P = .001). The mean Kujala scores increased from 47 ± 17 preoperatively to 82 ± 17 (P = .02), with no significant differences between patients with or without osteochondral lesions (P ≥ .05), and between male and female patients (P ≥ .08). The Insall-Salvati index was 1.1 preoperatively and remained within normal range (P = .05) at the latest follow-up. CONCLUSION Combined reconstruction of MPFL and MPTL using an ipsilateral autologous gracilis tendon is satisfactory and effective and can be considered as suitable management option to treat recurrent dislocation of the patella. However, randomized studies are needed to compare different techniques. STUDY DESIGN Case series.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, UK; Keele University, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England, UK.
| | - Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy
| | - Alessio D'Addona
- Department of Public Health, Section of Orthopaedics and Trauma Surgery, A.O.U. Federico II School of Medicine, Surgery and Dentistry, "Federico II" University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - David A Young
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor VIC 3181, Australia
| | - Deiary F Kader
- Academic Unit, South West London Elective Orthopaedic Centre, Epsom, Surrey, UK
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy
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Schwarz I, Smith JRH, Houck DA, Frank RM, Bravman JT, McCarty EC. Use of the Patient-Reported Outcomes Measurement Information System (PROMIS) for Operative Shoulder Outcomes. Orthop J Sports Med 2020; 8:2325967120924345. [PMID: 32596406 PMCID: PMC7298433 DOI: 10.1177/2325967120924345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Few studies have investigated the relationship between the Patient-Reported
Outcomes Measurement Information System (PROMIS) and legacy patient-reported
outcome (PRO) measurements. Purpose: To compare patient-reported outcomes from the PROMIS physical function (PF)
and upper extremity (UE) platforms against one another and against legacy
PRO measurements to assess the potential strengths and weaknesses of the
National Institutes of Health PROMIS initiative and expand on the use of PRO
measurements in clinical orthopaedic practice. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of the PubMed, Embase, and Cochrane Library databases was
conducted following PRISMA (Preferred Reporting Items for Systematic
Meta-Analyses) guidelines. All English-language studies published between
2017 and 2019 using PROMIS to evaluate patients for shoulder surgery were
analyzed. PROs were compared based on survey administered and the shoulder
condition being investigated. Study quality was evaluated using the Modified
Coleman Methodology Score and the Methodological Index for Non-Randomized
Studies score. Results: We included 9 studies (5 studies were level 2; 3 studies were level 3; 1
study was level 4) encompassing a total of 1130 patients (60.2% male; mean
age, 52.6 ± 16.5 years; mean BMI, 29.8 ± 2.8 kg/m2). Of these, 6
studies administered the PROMIS PF, and 6 studies administered the PROMIS
UE. The strongest correlation was between PROMIS PF computer adaptive test
and the 36-Item Short Form Health Survey Global Health (SF-36 GH)
(r = 0.75). The highest overall correlation with the
PROMIS UE was found with the American Shoulder and Elbow Surgeons (ASES)
Shoulder Score (r = 0.70). The lowest correlations were
found between PROMIS PF and the Marx Shoulder Activity Scale
(r = 0.08) and the PROMIS UE and the Marx Shoulder
Activity Scale (r = 0.18). Conclusion: From available data, the PROMIS PF and PROMIS UE were most closely correlated
with outcomes measured by the SF-36 GH. The PROMIS UE alone was most
correlated with ASES Shoulder Score. Thus, either PROMIS PF or UE may
provide a possible alternative to legacy PRO measurements but with a lower
overall number of questions and higher generalizability. Future research
should compare the time and question burden of the various PROMIS platforms
with a more consistent evaluation of standard PRO measurements.
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Affiliation(s)
- Ilona Schwarz
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, Aurora, Colorado, USA
| | - John-Rudolph H Smith
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, Aurora, Colorado, USA
| | - Darby A Houck
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, Aurora, Colorado, USA
| | - Rachel M Frank
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, Aurora, Colorado, USA
| | - Jonathan T Bravman
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, Aurora, Colorado, USA
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, Aurora, Colorado, USA
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Kakavas G, Malliaropoulos N, Pruna R, Traster D, Bikos G, Maffulli N. Neuroplasticity and Anterior Cruciate Ligament Injury. Indian J Orthop 2020; 54:275-280. [PMID: 32399146 PMCID: PMC7205971 DOI: 10.1007/s43465-020-00045-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/13/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) tears are common, with a seemingly constant increase in their number, and potentially serious consequences for sports participation and long-term general and musculoskeletal health. AREAS OF AGREEMENT Most players are able to return to cutting sport after ACL reconstruction, but some sustain further knee problems needing different approach to their rehabilitation. GROWING POINTS Neurocognitive tasks, measuring reaction time, processing speed, visual memory and verbal memory, allow indirect assessment of cerebral performance. Situational awareness, arousal, and attentional resources may influence neurocognitive function, affecting the complex integration of vestibular, visual, and somatosensory information needed for neuromuscular control. AREAS OF CONTROVERSY The underlying reasons for uncoordinated, high-velocity movements observed during non-contact injuries of the knee producing an ACL tear are not well understood. Fundamental neuropsychological characteristics are responsible for situational awareness, sensory integration, motor planning, and coordination, all of which control joint stiffness. There is a strong link between acquisition of motor skills and neuronal plasticity at cortical and subcortical levels in the central nervous system; these links may evolve over time and engage different spatially distributed interconnected brain regions. A cascade of neurophysiological alterations occurs after ACL injury. AREAS TIMELY FOR DEVELOPING RESEARCH Training can improve function; hence, rehabilitation programmes which include perturbation training, agility training, vision training and sport-specific skill training are essential after ACL injuries and for injury prevention, and to optimize return to play.
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Affiliation(s)
| | - Nikolaos Malliaropoulos
- Thessaloniki MSK Sports Medicine Clinic, Thessaloniki, Greece ,Queen Mary University of London, Centre for Sports and Exercise Medicine, London, UK
| | - Ricard Pruna
- FC Barcelona, FIFA Medical Center of Excellence, St Joan Despi, Barcelona, Spain
| | - David Traster
- Carrick Institute of Neurology, Cape Canaveral, FL USA
| | - Georgios Bikos
- Euromedica Arogi Rehabilitation Center, Thessaloniki, Greece
| | - Nicola Maffulli
- Queen Mary University of London, Centre for Sports and Exercise Medicine, London, UK ,Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy ,School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB England, UK
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