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Floyd SB, Oostdyk A, Cozad M, Brooks JM, Siffri P, Burnikel B. Assessing the Patient-Perceived Monetary Value of Patient-Reported Outcome Improvement for Patients With Chronic Knee Conditions. J Patient Cent Res Rev 2021; 8:98-106. [PMID: 33898641 PMCID: PMC8060045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
PURPOSE The high cost of orthopaedic care has attracted criticism in the current value-based health care environment. The objective of this work was to assess the properties of a willingness to pay (WTP)-based approach to estimate the monetary value that patients place on health improvements in chronic knee conditions following orthopaedic treatment. METHODS A sample of patients with a chronic knee condition were surveyed between January and May of 2018 at a large orthopaedic practice. Each patient provided their WTP for restoration to ideal knee health and completed the Single Assessment Numerical Evaluation (SANE) to describe their baseline knee state. Average WTP was calculated for the total sample and stratified by income, age, and baseline SANE (for which 0 is the worst and 100 is the best) levels. The patient-perceived monetary value of each unit of SANE improvement was assessed. RESULTS The study sample included 86 patients seeking orthopaedic care for a chronic knee condition. Mean baseline SANE score was 45.5 (standard deviation: 25.0). Mean WTP to obtain ideal knee function from baseline was $18,704 (standard deviation: $18,040). For the full sample, patients valued a 1-unit improvement in SANE score at $291.1 (β: 291.1; P<0.05). The amount of money patients were willing to pay to achieve ideal knee function varied with age, income, and baseline knee state. CONCLUSIONS Patients appear to highly value improvement in chronic knee conditions. Willingness-to-pay survey results appear to track expected variation in patient outcome valuation by income and baseline knee condition and could be a valuable approach to assess value-based care in orthopaedics.
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Affiliation(s)
- Sarah B Floyd
- Department of Public Health Sciences, Clemson University, Clemson, SC
- Center for Effectiveness Research in Orthopaedics, Columbia, SC
| | - Alicia Oostdyk
- Center for Effectiveness Research in Orthopaedics, Columbia, SC
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC
| | - Melanie Cozad
- Center for Effectiveness Research in Orthopaedics, Columbia, SC
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC
| | - John M Brooks
- Center for Effectiveness Research in Orthopaedics, Columbia, SC
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC
| | - Paul Siffri
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC
| | - Brian Burnikel
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC
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Floyd SB, Oostdyk A, Cozad M, Brooks JM, Siffri P, Burnikel B. Assessing the Patient-Perceived Monetary Value of Patient-Reported Outcome Improvement for Patients With Chronic Knee Conditions. J Patient Cent Res Rev 2021. [DOI: 10.17294/2330-0698.1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Irrgang JJ, Tashman S, Patterson CG, Musahl V, West R, Oostdyk A, Galvin B, Poploski K, Fu FH.. Anatomic single vs. double-bundle ACL reconstruction: a randomized clinical trial-Part 1: clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2021; 29:2665-2675. [PMID: 33970295 PMCID: PMC8298248 DOI: 10.1007/s00167-021-06585-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/15/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Compare clinical outcomes of anatomic single-bundle (SB) to anatomic double-bundle (DB) anterior cruciate ligament reconstruction (ACLR). It was hypothesized that anatomic DB ACLR would result in better International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) scores and reduced anterior and rotatory laxity compared to SB ACLR. METHODS Active individuals between 14 and 50 years of age that presented within 12 months of injury were eligible to participate. Individuals with prior injury or surgery of either knee, greater than a grade 1 concomitant knee ligament injury, or ACL insertion sites less than 14 mm or greater than 18 mm were excluded. Subjects were randomized to undergo SB or DB ACLR with a 10 mm-wide quadriceps tendon autograft harvested with a patellar bone block and were followed for 24 months. The primary outcome measures included the IKDC-SKF and KT-1000 (side to side difference) and pivot shift tests. Other secondary outcomes included measures of sports activity and participation, range of motion (ROM) and re-injury. RESULTS Enrollment in the study was suspended due to patellar fractures related to harvest of the patellar bone plug. At that time, 57 subjects had been randomized (29 DB) and two-year follow-up was attained from 51 (89.5%). At 24-month follow-up there were no between-group differences detected for the primary outcomes. Twenty-one (77.8%) DB's and 20 (83.3%) SB's reported returning to pre-injury sports 2 years after surgery (n.s) Three subjects (2 DB's, 5.3% of total) sustained a graft rupture and 5 individuals (4 SB's, 8.8% of total) had a subsequent meniscus injury. CONCLUSIONS Due to the early termination of the study, there were no detectable differences in clinical outcome between anatomic SB and DB ACLR when performed with a quadriceps tendon autograft with a bone block in individuals with ACL insertion sites that range from 14 to 18 mm. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- James J. Irrgang
- grid.21925.3d0000 0004 1936 9000Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 210, Bridgeside Point 1, 100 Technology Drive, Pittsburgh, PA 15203 USA ,grid.21925.3d0000 0004 1936 9000Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Scott Tashman
- grid.419649.70000 0001 0367 5968Steadman Philippon Research Institute, Vail, CO USA
| | - Charity G. Patterson
- grid.21925.3d0000 0004 1936 9000Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 210, Bridgeside Point 1, 100 Technology Drive, Pittsburgh, PA 15203 USA
| | - Volker Musahl
- grid.21925.3d0000 0004 1936 9000Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA ,grid.412689.00000 0001 0650 7433UPMC Freddie Fu Sports Medicine, Center, Pittsburgh, PA USA
| | | | - Alicia Oostdyk
- grid.412689.00000 0001 0650 7433UPMC Freddie Fu Sports Medicine, Center, Pittsburgh, PA USA
| | - Bryan Galvin
- grid.412689.00000 0001 0650 7433UPMC Freddie Fu Sports Medicine, Center, Pittsburgh, PA USA
| | - Kathleen Poploski
- grid.21925.3d0000 0004 1936 9000Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 210, Bridgeside Point 1, 100 Technology Drive, Pittsburgh, PA 15203 USA
| | - Freddie H . Fu
- grid.21925.3d0000 0004 1936 9000Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA ,grid.412689.00000 0001 0650 7433UPMC Freddie Fu Sports Medicine, Center, Pittsburgh, PA USA
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Diermeier T, Meredith SJ, Irrgang JJ, Zaffagnini S, Kuroda R, Hochino Y, Samuelsson K, Smith CN, Popchak A, Musahl V, Sheean A, Burnham JM, Lian J, Smith C, Popchak A, Herbst E, Pfeiffer T, Araujo P, Oostdyk A, Guenther D, Ohashi B, Irrgang JJ, Fu FH, Nagamune K, Kurosaka M, Kuroda R, Hochino Y, Grassi A, Muccioli GMM, Lopomo N, Signorelli C, Raggi F, Zaffagnini S, Horvath A, Svantesson E, Senorski EH, Sundemo D, Bjoernsson H, Ahlden M, Desai N, Samuelsson K, Karlsson J. Patient-Reported and Quantitative Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autografts. Orthop J Sports Med 2020; 8:2325967120926159. [PMID: 32685564 PMCID: PMC7343370 DOI: 10.1177/2325967120926159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/19/2020] [Indexed: 01/17/2023] Open
Abstract
Background: The pivot-shift test has become more consistent and reliable and is a meaningful outcome measurement after anterior cruciate ligament reconstruction (ACLR). Purpose/Hypothesis: The purpose of this investigation was to assess patient-reported outcomes (PROs) and the quantitative pivot shift (QPS) preoperatively, at time zero immediately after anatomic ACLR, and after 24 months as well as the relationship between PROs and the QPS. It was hypothesized that anatomic ACLR would restore rotatory stability measured by the pivot-shift test and that QPS measurements would be positively correlated with PROs. Study Design: Cohort study; Level of evidence, 2. Methods: The ACL-injured and contralateral uninjured knees from 89 of 107 (83.2%) enrolled patients at 4 international centers were evaluated using a standardized pivot-shift test. Tibial acceleration was assessed with an inertial sensor, and lateral compartment translation was measured using an image analysis system preoperatively, at time zero immediately postoperatively, and at follow-up after 2 years. PROs were assessed at 12 and 24 months postoperatively with the International Knee Documentation Committee (IKDC) subjective knee form, Cincinnati Knee Rating System (CKRS), Marx activity rating scale, and activity of daily living score (ADLS). Results: The mean patient age at surgery was 27 years (range, 15-45 years). A positive pivot shift preoperatively (side-to-side difference in tibial acceleration, 2.6 ± 4.0 m/s2; side-to-side difference in anterior tibial translation, 2.0 ± 2.0 mm) was reduced at time zero postoperatively (side-to-side difference in tibial acceleration, –0.5 ± 1.3 m/s2; side-to-side difference in anterior tibial translation, –0.1 ± 1.0 mm). All PROs improved from preoperatively to final follow-up at 24 months: from 56.5 to 85.5 points for the IKDC (P = .0001), from 28.8 to 32.4 points for the CKRS (P = .04), from 11.2 to 7.9 points for the Marx (P < .0001), and from 75.7 to 91.6 points for the ADLS (P < .0001). Neither preoperative nor time zero postoperative rotatory laxity assessed by the pivot-shift test correlated with PROs at 24-month follow-up. A graft retear was observed in 4 patients (4.5%) within 2 years of follow-up. Conclusion: Anatomic ACLR resulted in significantly improved and acceptable PROs at 2-year follow-up and a low failure rate. Anatomic ACLR restored QPS measurements of anterior tibial translation and tibial acceleration to those of the contralateral knee immediately after surgery while still under anesthesia, but there was no correlation between the QPS preoperatively or at time zero after ACLR and PROs at 2-year follow-up.
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Affiliation(s)
- Theresa Diermeier
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sean J Meredith
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James J Irrgang
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stefano Zaffagnini
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ryosuke Kuroda
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yuichi Hochino
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kristian Samuelsson
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Clair Nicole Smith
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adam Popchak
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Andrew Sheean
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeremy M Burnham
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jayson Lian
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Clair Smith
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adam Popchak
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elmar Herbst
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas Pfeiffer
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paulo Araujo
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alicia Oostdyk
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel Guenther
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bruno Ohashi
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James J Irrgang
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kouki Nagamune
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Masahiro Kurosaka
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ryosuke Kuroda
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yuichi Hochino
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alberto Grassi
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Nicola Lopomo
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cecilia Signorelli
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Federico Raggi
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stefano Zaffagnini
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alexandra Horvath
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eleonor Svantesson
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eric Hamrin Senorski
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Sundemo
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Haukur Bjoernsson
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mattias Ahlden
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Neel Desai
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kristian Samuelsson
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jon Karlsson
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Zaffagnini S, Signorelli C, Grassi A, Hoshino Y, Kuroda R, de Sa D, Sundemo D, Samuelsson K, Musahl V, Karlsson J, Sheean A, Burnham JM, Lian J, Smith C, Popchak A, Herbst E, Pfeiffer T, Araujo P, Oostdyk A, Guenther D, Ohashi B, Irrgang JJ, Fu FH, Nagamune K, Kurosaka M, Marcheggiani Muccioli GM, Lopomo N, Raggi F, Svantesson E, Hamrin Senorski E, Bjoernsson H, Ahlden M, Desai N. Anatomic Anterior Cruciate Ligament Reconstruction Using Hamstring Tendons Restores Quantitative Pivot Shift. Orthop J Sports Med 2018; 6:2325967118812364. [PMID: 30574514 PMCID: PMC6299314 DOI: 10.1177/2325967118812364] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: It is still uncertain how surgical reconstruction of the anterior cruciate
ligament (ACL) is able to restore rotatory laxity of the involved joint. The
desired amount of restraint applied by the ACL graft, as compared with the
healthy knee, has not been fully clarified. Purpose: To quantify the ability of single-bundle anatomic ACL reconstruction using
hamstring tendons in reducing the pivot-shift phenomenon immediately after
surgery under anesthesia. Study Design: Case series; Level of evidence, 4. Methods: An inertial sensor and image analysis were used at 4 international centers to
measure tibial acceleration and lateral compartment translation of the knee,
respectively. The standardized pivot-shift test was quantified in terms of
the side-to-side difference in laxity both preoperatively and
postoperatively with the patient under anesthesia. The reduction in both
tibial acceleration and lateral compartment translation after surgery and
the side-to-side difference were evaluated using the Wilcoxon signed-rank
test. Alpha was set at P < .05. Results: A total of 107 patients were recruited for the study, and data were available
for 89 patients. There was a statistically significant reduction in
quantitative rotatory knee laxity between preoperatively (inertial sensor,
2.55 ± 4.00 m/s2; image analysis, 2.04 ± 2.02 mm) and
postoperatively (inertial sensor, –0.54 ± 1.25 m/s2; image
analysis, –0.10 ± 1.04 mm) between the involved and healthy joints, as
measured by the 2 devices (P < .001 for both).
Postoperatively, both devices detected a lower rotatory laxity value in the
involved joint compared with the healthy joint (inertial sensor, 2.45 ± 0.89
vs 2.99 ± 1.10 m/s2, respectively [P < .001];
image analysis, 0.99 ± 0.83 vs 1.09 ± 0.92 mm, respectively
[P = .38]). Conclusion: The data from this study indicated a significant reduction in the pivot shift
when compared side to side. Both the inertial sensor and image analysis used
for the quantitative assessment of the pivot-shift test could successfully
detect restoration of the pivot shift after anatomic single-bundle ACL
reconstruction. Future research will examine how pivot-shift control is
maintained over time and correlation of the pivot shift with return to full
activity in patients with an ACL injury.
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Affiliation(s)
- Stefano Zaffagnini
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cecilia Signorelli
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Yuichi Hoshino
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ryosuke Kuroda
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Darren de Sa
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - David Sundemo
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kristian Samuelsson
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Volker Musahl
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jon Karlsson
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrew Sheean
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jeremy M Burnham
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jayson Lian
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Clair Smith
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Adam Popchak
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elmar Herbst
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Thomas Pfeiffer
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paulo Araujo
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alicia Oostdyk
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Daniel Guenther
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Bruno Ohashi
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - James J Irrgang
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Freddie H Fu
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kouki Nagamune
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Masahiro Kurosaka
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Nicola Lopomo
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Raggi
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eleonor Svantesson
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Haukur Bjoernsson
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mattias Ahlden
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Neel Desai
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Irrgang JJ, Tashman S, Moore C, Musahl V, West RV, Oostdyk A, Galvin B, Fu FH. Comparison of Clinical Outcomes Following Anatomic Single vs. Double-Bundle ACL Reconstruction: A Randomized Clinical Trial. Orthop J Sports Med 2017. [PMCID: PMC5542330 DOI: 10.1177/2325967117s00248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: The shortcomings of anterior cruciate ligament reconstruction (ACL), including failure to restore normal structure and function of the knee, limited return to pre-injury level of sports participation and failure to prevent the development of post-traumatic knee osteoarthritis (OA) have recently been recognized. Anatomic methods to reconstruct the ACL, including anatomic single-bundle (SB) and double-bundle (DB) reconstruction, have been proposed to improve clinical outcomes after ACL reconstruction. We performed a double-blinded randomized clinical trial to compare clinical outcomes of anatomic SB to anatomic DB ACL reconstruction. We hypothesized that anatomic DB ACL reconstruction with a quadriceps tendon autograft with bone block would result in reduced knee laxity, better range of motion, patient-reported outcomes (PROs), return to sports and reduced risk of re-injury compared to anatomic SB ACL reconstruction. Methods: Individuals between 14 and 50 years of age participating in at least 100 hours of Level 1 or 2 sports activities that presented within 12 months of injury to both bundles of the ACL with or without injury to the medial or lateral meniscus were eligible to participate in this study. Individuals with prior injury or surgery of the ipsilateral or contralateral knee or greater than a grade 1 concomitant knee ligament injury were excluded. If the ACL insertion sites were between 14 and 18mm, as measured with an arthroscopic ruler at the time of arthroscopy, the subject was randomized to undergo SB or DB ACL reconstruction with a 10 mm quadriceps tendon autograft harvested with a patellar bone block. A single, anatomically placed femoral tunnel was used for all cases. For DB ACL reconstruction, the graft was split into to two arms and passed through two anatomically placed tibial tunnels. Subjects were followed at 3, 6, 12 and 24 months after randomization, with the primary endpoints occurring at 24 months. Outcome measures included the KT-1000 (side to side difference) and pivot shift tests, range of motion (ROM), IKDC Subjective Knee Form (IKDC-SKF) and return to pre-injury level of sports participation. Results: Fifty-seven subjects were randomized (29 DB) and two-year follow-up was attained from 51 (89.5%). There were no differences between groups in terms of age, proportion of males, body mass index (BMI), participation in competitive or recreational sports or concomitant meniscus procedures. At 24-month follow-up there were no between groups differences for the pivot shift and KT-1000 tests, ROM and IKDC-SKF scores (Table 1). Twenty-three (85.2%) DB’s and 24 (87.5%) SB’s reported returning to pre-injury level of sports 2 years after surgery (p=0.81). Three subjects (2 SB’s, 5.9% of total) suffered a graft rupture and 5 individuals (4 SB’s, 9.8% of total) had a subsequent meniscus injury. Conclusion: With the available sample size, we were unable to demonstrate significant differences in clinical outcome between anatomic SB and DB ACL reconstruction when performed with a quadriceps tendon autograft with a bone block in individuals with ACL insertion sites that ranged from 14 to 18 mm. Furthermore, both anatomic SB and DB ACL reconstruction lead to clinical outcomes that are comparable or superior to those reported for non-anatomical ACL reconstruction with minimal recurrent instability. [Table: see text]
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Affiliation(s)
| | | | | | - Volker Musahl
- UPMC Center for Sports Medicine, Pittsburgh, PA, USA
| | | | - Alicia Oostdyk
- UPMC Rooney Center for Sports Medicine, Pittsburgh, PA, USA
| | | | - Freddie H. Fu
- Department of Orthopaedic Surgery - University of Pittsburgh, Pittsburgh, PA, USA
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Schuchert MJ, Abbas G, Nason KS, Pennathur A, Awais O, Santana M, Pereira R, Oostdyk A, Luketich JD, Landreneau RJ. Impact of anastomotic leak on outcomes after transhiatal esophagectomy. Surgery 2010; 148:831-8; discussion 838-40. [PMID: 20800864 DOI: 10.1016/j.surg.2010.07.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 07/13/2010] [Indexed: 12/31/2022]
Abstract
BACKGROUND The development of anastomotic leaks and/or strictures can be associated with considerable morbidity and impairment of quality of life. In the current study, we evaluated the outcomes of patients who developed anastomotic complications after esophagectomy to elucidate the impact of these events on morbidity, mortality, and subsequent need for dilation. METHODS We analyzed retrospectively the clinical course of 235 patients who underwent transhiatal esophagectomy for cancer from 2001 to 2009. Patients with confirmed anastomotic leaks were identified and classified with the following scale: class 1: Radiographic leak only, no intervention; class 2: leak requiring opening of the wound, cervical and/or percutaneous drainage; class 3: disruption of anastomosis (10-50% circumference) with perianastomotic abscess requiring video-assisted thoracoscopic surgery or thoracotomy; and class 4: gastric tip necrosis with anastomotic separation (>50% circumference). RESULTS Anastomotic leaks were encountered in 30 patients (13%). Anastomotic leaks were associated with greater morbidity (70% vs 47%; P = .02) and stricture formation (57% vs 19%; P = .0001). Mortality was not different. Increasing leak class was associated with an increased need for postoperative anastomotic dilations (P = .016). CONCLUSION Anastomotic integrity after esophagectomy has a substantial impact on perioperative course and long-term swallowing. A more formal radiographic and endoscopic leak classification system seems justified.
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Affiliation(s)
- Matthew J Schuchert
- Division of Thoracic and Foregut Surgery, Heart, Lung and Esophageal Surgery Institute, UPMC Health System, Pittsburgh, PA 15232, USA.
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8
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Schuchert MJ, Pettiford BL, Abbas G, Oostdyk A, Landreneau JR, Kilic A, Landreneau JP, Luketich JD, Landreneau RJ. The use of esophageal transit and gastric emptying studies in the evaluation of patients undergoing laparoscopic fundoplication. Surg Endosc 2010; 24:3119-26. [DOI: 10.1007/s00464-010-1099-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 02/26/2010] [Indexed: 10/19/2022]
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9
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Kilic A, Schuchert MJ, Landreneau JR, Landreneau JP, Oostdyk A, Wilson DO, Luketich JD, Landreneau RJ. The impact of length of hospitalization following surgical resection of stage I non-small cell lung cancer on long-term survival. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7584 Background: The aim of this study was to evaluate the impact of length of hospital stay (LOS) following surgical resection of stage I non-small cell lung cancer (NSCLC) on long-term survival. Methods: We reviewed the records of patients undergoing surgical resection for stage I NSCLC at our institution between 1990–2003. Patients not surviving hospitalization related to their surgery were excluded from analysis. Multivariate analysis was utilized to evaluate the impact of age, gender, tumor histology, tumor stage, LOS, and type of operation (lobar or sublobar) on long-term (>5 year) survival. As a secondary analysis, Kaplan-Meier survival curves of patients stratified according to LOS were compared using the log-rank test. Two-tailed p-values less than 0.05 were considered statistically significant. Results: A total of 730 patients underwent lobectomy (n=518) or sublobar resection during the study time period. There were 18 (2.5%) operative or in-hospital mortalities. Median LOS was 6 (range 1–81) and 7 (range 1–46) days in the lobar and sublobar cohorts, respectively. Patients with a longer hospital stay (≥14 days) had significantly worse 5- and 10-year overall survival rates as compared to those with a shorter hospitalization (lobectomy: 5-year- 60.3% vs 33.8%; 10-year-27.3% vs 8.4%; p<0.001; sublobar: 5-year-44.3% vs 11.7%; 10-year-9.9% vs 0%; p=0.006). There were 171 patients with extended clinical follow-up who had survived at least 5 years (mean follow-up = 88.1 ± 2.0 months). Multivariate analysis demonstrated that LOS predicted long-term survival independent of patient age, gender, tumor histology, tumor stage, and type of operation (p=0.013). Conclusions: LOS following surgical resection of stage I NSCLC is an independent predictor of long-term survival. These survival differences related to hospital stay may be related to underlying medical co-morbidities important to the decision making regarding therapy of patients with otherwise resectable stage I lung cancer. Prospective assessment of medical co-morbidities may be an important initiative for future treatment planning of early stage lung cancer patients. No significant financial relationships to disclose.
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Affiliation(s)
- A. Kilic
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | | - A. Oostdyk
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - D. O. Wilson
- University of Pittsburgh Medical Center, Pittsburgh, PA
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