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Freshman RD, Zhang AL, Benjamin Ma C, Feeley BT, Ortiz S, Patel J, Dunn W, Wolf BR, Hettrich C, Lansdown D, Baumgarten KM, Bishop JY, Bollier MJ, Brophy RH, Bravman JT, Cox CL, Cvetanovich GL, Grant JA, Frank RM, Jones GL, Kuhn JE, Mair SD, Marx RG, McCarty EC, Miller BS, Seidl AJ, Smith MV, Wright RW. Factors Associated With Humeral Avulsion of Glenohumeral Ligament Lesions in Patients With Anterior Shoulder Instability: An Analysis of the MOON Shoulder Instability Cohort. Orthop J Sports Med 2023; 11:23259671231206757. [PMID: 37900861 PMCID: PMC10612462 DOI: 10.1177/23259671231206757] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/19/2023] [Indexed: 10/31/2023] Open
Abstract
Background Humeral avulsion of the glenohumeral ligament (HAGL) lesions are an uncommon cause of anterior glenohumeral instability and may occur in isolation or combination with other pathologies. As HAGL lesions are difficult to detect via magnetic resonance imaging (MRI) and arthroscopy, they can remain unrecognized and result in continued glenohumeral instability. Purpose To compare patients with anterior shoulder instability from a large multicenter cohort with and without a diagnosis of a HAGL lesion and identify preoperative physical examination findings, patient-reported outcomes, imaging findings, and surgical management trends associated with HAGL lesions. Study Design Cross-sectional study; Level of evidence, 3. Methods Patients with anterior glenohumeral instability who underwent surgical management between 2012 and 2020 at 11 orthopaedic centers were enrolled. Patients with HAGL lesions identified intraoperatively were compared with patients without HAGL lesions. Preoperative characteristics, physical examinations, imaging findings, intraoperative findings, and surgical procedures were collected. The Student t test, Kruskal-Wallis H test, Fisher exact test, and chi-square test were used to compare groups. Results A total of 21 HAGL lesions were identified in 915 (2.3%) patients; approximately one-third (28.6%) of all lesions were visualized intraoperatively but not identified on preoperative MRI. Baseline characteristics did not differ between study cohorts. Compared with non-HAGL patients, HAGL patients were less likely to have a Hill-Sachs lesion (54.7% vs 28.6%; P = .03) or an anterior labral tear (87.2% vs 66.7%; P = .01) on preoperative MRI and demonstrated increased external rotation when their affected arm was positioned at 90° of abduction (85° vs 90°; P = .03). Additionally, HAGL lesions were independently associated with an increased risk of undergoing an open stabilization surgery (odds ratio, 74.6 [95% CI, 25.2-221.1]; P < .001). Conclusion Approximately one-third of HAGL lesions were missed on preoperative MRI. HAGL patients were less likely to exhibit preoperative imaging findings associated with anterior shoulder instability, such as Hill-Sachs lesions or anterior labral pathology. These patients underwent open procedures more frequently than patients without HAGL lesions.
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Affiliation(s)
- Ryan D. Freshman
- Investigation performed at the University of California–San Francisco, San Francisco, California, USA
| | - Alan L. Zhang
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | - C. Benjamin Ma
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Brian T. Feeley
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | | | - Jhillika Patel
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Warren Dunn
- Fondren Orthopedic Group, Houston, Texas, USA
| | - Brian R. Wolf
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | | | - Drew Lansdown
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | | | | | - Julie Y. Bishop
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | | | | | - Charles L. Cox
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - John A. Grant
- MedSport, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachel M. Frank
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Grant L. Jones
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John E. Kuhn
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Eric C. McCarty
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Adam J. Seidl
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Rick W. Wright
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Jacobs CA, Ortiz SF, Baumgarten KM, Bishop JY, Bollier MJ, Bravman JT, Brophy RH, Cvetanovich GL, Feeley BT, Frank RM, Jones GL, Kuhn JE, Lansdown DA, Ma CB, Mair SD, Marx RG, McCarty EC, Seidl AJ, Wright RW, Zhang AL, Wolf BR, Hettrich CM. Development and Validation of a Short-Form Version of the Western Ontario Shoulder Instability Scale (Short-WOSI). Am J Sports Med 2023; 51:2850-2857. [PMID: 37584514 DOI: 10.1177/03635465231188975] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) have transitioned from primarily being used as research instruments to becoming increasingly used in the clinical setting to assess recovery and inform shared decision-making. However, there is a need to develop validated short-form PROM instruments to decrease patient burden and ease incorporation into clinical practice. PURPOSE To assess the validity and responsiveness of a shortened version of the Western Ontario Shoulder Instability Index (Short-WOSI) when compared with the full WOSI and other shoulder-related PROM instruments. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS This study was a secondary analysis of data collected as part of an institutional review board-approved, multicenter cohort of 1160 patients undergoing surgical stabilization for shoulder instability. The following PROMs were captured preoperatively and 2 years after surgery: WOSI, American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), and 36-Item Health Survey (RAND-36). The cohort was split into 2 data sets: a training set to be used in the development of the Short-WOSI (n = 580) and a test set to be used to assess the validity and responsiveness of the Short-WOSI relative to the full WOSI, ASES, SANE, and RAND-36. RESULTS The Short-WOSI demonstrated excellent internal consistency before surgery (Cronbach α = .83) and excellent internal consistency at the 2-year follow-up (Cronbach α = .93). The baseline, 2-year, and pre- to postoperative changes in Short-WOSI and WOSI were closely correlated (r > 0.90), with both demonstrating large effect sizes (Short-WOSI = 1.92, WOSI = 1.81). Neither the Short-WOSI nor the WOSI correlated well with the other PROM instruments before (r = 0.21-0.33) or after (r = 0.25-0.38) surgery. The Short-WOSI, WOSI, and SANE scores were more responsive than ASES and RAND-36 scores. CONCLUSION The 7-item Short-WOSI demonstrated excellent internal consistency and a lack of floor or ceiling effects. The Short-WOSI demonstrated excellent cross-sectional and longitudinal construct validity and was similarly responsive over time as the full WOSI. Neither the Short-WOSI nor WOSI correlated with more general shoulder PROMs, underscoring the advantage of using instability-specific instruments for this population.
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Affiliation(s)
- Cale A Jacobs
- Mass General Brigham Sports Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Shannon F Ortiz
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Julie Y Bishop
- The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Matthew J Bollier
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Robert H Brophy
- Department of Orthopedics, Washington University Saint Louis, St Louis, Missouri, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Gregory L Cvetanovich
- The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Grant L Jones
- The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - John E Kuhn
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Scott D Mair
- University of Kentucky Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Robert G Marx
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Adam J Seidl
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Rick W Wright
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Carolyn M Hettrich
- North Country Orthopaedics, Clayton, New York, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
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Lee MJ, Folan AM, Baker DM, Blackwell S, Wootton R, Robinson K, Sebastian S, Brown SR, Jones GL, Lobo AJ. A survey of patient informational preferences when choosing between medical and surgical therapy for ulcerative colitis: a sub-study from the DISCUSS project. Colorectal Dis 2023. [PMID: 37237447 DOI: 10.1111/codi.16625] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/31/2022] [Accepted: 04/01/2023] [Indexed: 05/28/2023]
Abstract
AIM People living with ulcerative colitis (UC) have two broad treatment avenues, namely medical or surgical therapy. The choice between these can depend on patient preference as well as the receipt of relevant information. The aim of this study was to define the informational needs of patients with UC. METHOD A postal survey was designed to capture respondent demographics, treatment experienced within the previous 12 months and informational preferences by rating a long list of items. It was delivered through two hospitals that provide tertiary inflammatory bowel disease services. Descriptive analyses were performed to describe demographics and experiences. Principal component analysis was carried out using a varimax rotation to investigate informational needs. RESULTS A total of 101 responses were returned (20.1% response rate). The median age of respondents was 45 years and the median time since diagnosis was 10 years. Control preferences skewed towards shared (42.6%) or patient-led but clinician-informed (35.6%). Decision regret was low for the population (median 12.5/100, range 0-100). Key informational needs related to medical therapy were benefits and risks of long-term therapy, burden of hospital attendance, reproductive health, need for steroid treatment and impact on personal life. For surgery, these were stoma information, effect on daily life, effect on sexual and reproductive health, risks and benefits and disruption of life due to surgery. CONCLUSION This study has identified key areas for discussion when counselling patients about treatment decisions around medical therapy and surgery for UC.
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Affiliation(s)
- M J Lee
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A M Folan
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - D M Baker
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - R Wootton
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - K Robinson
- Department of Gastroenterology, Hull and East Yorkshire Hospitals, Hull, UK
| | - S Sebastian
- Sheffield Inflammatory Bowel Disease Centre, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S R Brown
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - A J Lobo
- Department of Gastroenterology, Hull and East Yorkshire Hospitals, Hull, UK
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4
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Ulrich MN, Cvetanovich GL, Meeks BD, Jones GL. Return to Sport and Patient-Reported Outcomes After Subpectoral Biceps Tenodesis for SLAP Tear in Collegiate Gymnasts. Orthop J Sports Med 2023; 11:23259671231159354. [PMID: 37152551 PMCID: PMC10161309 DOI: 10.1177/23259671231159354] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/19/2023] [Indexed: 05/09/2023] Open
Abstract
Background The biceps superior labral complex is a known source of shoulder dysfunction in young, high-level athletes. Superior labral anterior-posterior (SLAP) repairs are often unsatisfactory for treating biceps-labral pathology in this demographic group, with high failure rates and poor return to sport (RTS). Minimal data have been published to demonstrate patient-reported outcomes (PROs) and RTS in gymnasts after treatment of SLAP pathologies. Hypothesis Gymnasts undergoing biceps tenodesis for SLAP pathologies would have satisfactory PROs and satisfactory RTS. Study Design Case series; Level of evidence, 4. Methods Gymnasts aged ≤25 years who underwent open subpectoral biceps tenodesis for SLAP tears with or without biceps tendon pathology between August 20, 2014, and August 20, 2019, and who had minimum 2-year follow-up data were included in this study. Tenodesis was performed using a subpectoral technique with bicortical button fixation. The following PROs were included: RTS, postoperative activity level, 10-point visual analog scale for pain (VAS-Pain), American Shoulder and Elbow Surgeons (ASES), and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results Of 16 shoulders in 14 gymnasts undergoing biceps tenodesis for SLAP tear during the study period, a follow-up was obtained for 13 of 16 shoulders (81%) at 4.3 ± 1.5 years. The mean age of patients at the time of surgery was 21.8 ± 2.2 years, with 12 (92%) male patients. Biceps tenodesis was performed as the primary procedure for the diagnosis of SLAP tear in 12 patients (92%) and for failed prior SLAP repair in 1 patient (8%). PROs were excellent at the follow-up, with VAS-Pain scores of 1.8 ± 1.7, ASES scores of 89.1 ± 9.1, and DASH scores of 2.4 ± 3.2. After surgery, 8 (62%) patients returned to their prior level of collegiate gymnastics. Three (60%) of 5 patients did not return to collegiate gymnastics because of the end of eligibility, and 2 (40%) patients did not return to collegiate gymnastics because of knee injuries. Significantly higher DASH scores were noted in the group that did not RTS (P = .04). No patients experienced postoperative complications or reoperation. Conclusion Biceps tenodesis was an effective primary operation for high-level gymnasts with SLAP tears, with a satisfactory rate of return to the same level of sport and excellent PROs.
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Affiliation(s)
- Marisa N. Ulrich
- The Ohio State University Sports Medicine Research Institute, Columbus, Ohio, USA
| | - Gregory L. Cvetanovich
- The Ohio State University Sports Medicine Research Institute, Columbus, Ohio, USA
- Gregory L. Cvetanovich, MD, Jameson-Crane Sports Medicine Institute, 2835 Fred Taylor Drive Columbus, OH 43202, USA ()
| | - Brett D. Meeks
- The Ohio State University Sports Medicine Research Institute, Columbus, Ohio, USA
- Northeast Georgia Physicians Group, Gainesville, Georgia, USA
| | - Grant L. Jones
- The Ohio State University Sports Medicine Research Institute, Columbus, Ohio, USA
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5
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Haeberle HS, Ramkumar PN, Frantz TL, Jones GL, Curriero FC, Corrigan A, Soloff L, Schickendantz MS, Frangiamore SJ. Pectoralis muscle injuries in Major and Minor League Baseball. J Shoulder Elbow Surg 2022; 31:e363-e368. [PMID: 35183743 DOI: 10.1016/j.jse.2022.01.134] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Although shoulder and elbow injuries in professional baseball players have been thoroughly studied, little is known about the frequency and impact of pectoralis muscle injuries in this population. The purpose of this study was to use the official league injury surveillance system to describe pectoralis muscle injuries in professional baseball players in Major League Baseball (MLB) and Minor League Baseball (MiLB). Specifically, (1) player demographic characteristics, (2) return to play (RTP), (3) injury mechanism, (4) throwing- and batting-side dominance, and (5) injury rate per athlete exposure (AE) were characterized to guide future injury prevention strategies. METHODS The MLB Health and Injury Tracking System database was used to compile all pectoralis muscle injuries in MLB and MiLB athletes in the 2011-2017 seasons. Injury-related data including diagnosis (tear or rupture vs. strain), player demographic characteristics, injury timing, need for surgical intervention, RTP, and mechanism of injury were recorded. Subanalyses of throwing- and batting-side dominance, as well as MLB vs. MiLB injury frequency, were performed. RESULTS A total of 138 pectoralis muscle injuries (32 MLB and 106 MiLB injuries) were reported in the study period (5 tears or ruptures and 133 strains), with 5 of these being recurrent injuries. Operative intervention was performed in 4 athletes (2.9%). Of the 138 injuries, 116 (84.1%) resulted in missed days of play, with a mean time to RTP of 19.5 days. Starting pitchers sustained the greatest proportion of pectoralis injuries (48.1%), with pitching being the most common activity at the time of injury (45.9%). A majority of injuries (86.5%) were sustained during non-contact play. Overall, 87.5% of injuries occurred on the player's dominant throwing side and 81.3% occurred on the player's dominant batting side. There was no significant difference in the rate of pectoralis injuries in the MLB regular season (0.584 per 10,000 AEs) vs. the MiLB regular season (0.425 per 10,000 AEs) (P = .1018). CONCLUSION Pectoralis muscle injuries are most frequently non-contact injuries, most commonly sustained by pitchers. An understanding of these injuries can guide athletic trainers and management in expectation management and decision making, in addition to directing future efforts at injury prevention.
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Affiliation(s)
| | | | - Travis L Frantz
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Grant L Jones
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Frank C Curriero
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Corrigan
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lonnie Soloff
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
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6
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Brophy RH, Dunn WR, Baumgarten KM, Bishop JY, Bollier MJ, Bravman JT, Feeley BT, Grant JA, Jones GL, Kuhn JE, Benjamin Ma C, Marx RG, McCarty EC, Ortiz SF, Smith MV, Wolf BR, Wright RW, Zhang AL, Hettrich CM. Factors Associated With Shoulder Activity Level at Time of Surgery and at 2-Year Follow-up in Patients Undergoing Shoulder Stabilization Surgery. Am J Sports Med 2022; 50:1503-1511. [PMID: 35442106 DOI: 10.1177/03635465221085978] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients undergoing shoulder stabilization surgery have been shown to have elevated activity levels. Factors associated with shoulder activity in this patient population at baseline and after surgery are unknown. HYPOTHESIS Patient-specific variables are associated with shoulder activity level at baseline and at 2-year follow-up in a cohort of patients undergoing shoulder stabilization surgery. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients undergoing shoulder stabilization surgery were prospectively enrolled. As part of the data collection process, patients completed a previously validated Shoulder Activity Scale. A regression analysis was performed to assess the association of patient characteristics with baseline and 2-year follow-up shoulder activity levels. RESULTS A total of 764 (n = 612 men, n = 152 women) out of 957 patients (80%) undergoing shoulder stabilization surgery with a median age of 25 years had baseline and 2-year follow-up data and were included in the current analysis. The baseline shoulder activity level was associated with race ( P < .0001) and preoperative duration of instability (P < .0001). At 2 years, 52% of the cohort had returned to the same or higher activity level after surgery. Predictors of higher shoulder activity level at 2-year follow-up included higher baseline activity level (P < .0001), male sex (P < .0001), younger age (P = .004), higher body mass index (BMI) (P = .03), more dislocations (P = .03), nonsmokers (P = .04), and race (P = .04). CONCLUSION A longer duration of preoperative symptoms was associated with a lower baseline activity in this cohort. High baseline preoperative shoulder activity, younger age, male sex, higher BMI, number of dislocations, and nonsmoking status predicted higher shoulder activity 2 years after shoulder stabilization surgery. REGISTRATION NCT02075775 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Robert H Brophy
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Warren R Dunn
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
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- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Keith M Baumgarten
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Julie Y Bishop
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Matthew J Bollier
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Jonathan T Bravman
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Brian T Feeley
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - John A Grant
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Grant L Jones
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - John E Kuhn
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - C Benjamin Ma
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Robert G Marx
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Eric C McCarty
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Shannon F Ortiz
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Matthew V Smith
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Brian R Wolf
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Rick W Wright
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Alan L Zhang
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
| | - Carolyn M Hettrich
- Investigation performed at the Washington University School of Medicine, Chesterfield, Missouri, USA
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7
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Giri A, Freeman TH, Kim P, Kuhn JE, Garriga GA, Khazzam M, Higgins LD, Matzkin E, Baumgarten KM, Bishop JY, Brophy RH, Carey JL, Dunn WR, Jones GL, Ma CB, Marx RG, McCarty EC, Poddar SK, Smith MV, Spencer EE, Vidal AF, Wolf BR, Wright RW, Jain NB. Obesity and sex influence fatty infiltration of the rotator cuff: the Rotator Cuff Outcomes Workgroup (ROW) and Multicenter Orthopaedic Outcomes Network (MOON) cohorts. J Shoulder Elbow Surg 2022; 31:726-735. [PMID: 35032677 PMCID: PMC8940702 DOI: 10.1016/j.jse.2021.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fatty infiltration (FI) is one of the most important prognostic factors for outcomes after rotator cuff surgery. Established risk factors include advancing age, larger tear size, and increased tear chronicity. A growing body of evidence suggests that sex and obesity are associated with FI; however, data are limited. METHODS We recruited 2 well-characterized multicenter cohorts of patients with rotator cuff tears (Multicenter Orthopaedic Outcomes Network [MOON] cohort [n = 80] and Rotator Cuff Outcomes Workgroup [ROW] cohort [n = 158]). We used multivariable logistic regression to evaluate the relationship between body mass index (BMI) and the presence of FI while adjusting for the participant's age at magnetic resonance imaging, sex, and duration of shoulder symptoms, as well as the cross-sectional area of the tear. We analyzed the 2 cohorts separately and performed a meta-analysis to combine estimates. RESULTS A total of 27 patients (33.8%) in the Multicenter Orthopaedic Outcomes Network (MOON) cohort and 57 patients (36.1%) in the Rotator Cuff Outcomes Workgroup (ROW) cohort had FI. When BMI < 25 kg/m2 was used as the reference category, being overweight was associated with a 2.37-fold (95% confidence interval [CI], 0.77-7.29) increased odds of FI and being obese was associated with a 3.28-fold (95% CI, 1.16-9.25) increased odds of FI. Women were 4.9 times (95% CI, 2.06-11.69) as likely to have FI as men. CONCLUSIONS Among patients with rotator cuff tears, obese patients had a substantially higher likelihood of FI. Further research is needed to assess whether modifying BMI can alter FI in patients with rotator cuff tears. This may have significant clinical implications for presurgical surgical management of rotator cuff tears. Sex was also significantly associated with FI, with women having higher odds of FI than men. Higher odds of FI in female patients may also explain previously reported early suboptimal outcomes of rotator cuff surgery and higher pain levels in female patients as compared with male patients.
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Affiliation(s)
- Ayush Giri
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas H Freeman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter Kim
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John E Kuhn
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gustavo A Garriga
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Khazzam
- Department of Orthopaedics, University of Texas Southwestern, Dallas, TX, USA
| | | | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Julie Y Bishop
- Departments of Orthopaedic Surgery and Sports Medicine, Ohio State University, Columbus, OH, USA
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - James L Carey
- Department of Orthopaedic Surgery, University of Pennsylvania and Perelman School of Medicine, Philadelphia, PA, USA
| | - Warren R Dunn
- Department of Clinical Research, Fondren Orthopedic Group, Houston, TX, USA
| | - Grant L Jones
- Departments of Orthopaedic Surgery and Sports Medicine, Ohio State University, Columbus, OH, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Robert G Marx
- Department of Orthopedic Surgery, Weill Medical College of Cornell University, New York, NY, USA
| | - Eric C McCarty
- Department of Orthopedic Sports Medicine, University of Colorado, Denver, CO, USA
| | - Sourav K Poddar
- Department of Orthopedic Sports Medicine, University of Colorado, Denver, CO, USA
| | - Matthew V Smith
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Edwin E Spencer
- Shoulder & Elbow Division, Knoxville Orthopaedic Clinic, Knoxville, TN, USA
| | - Armando F Vidal
- The Steadman Clinic and Steadman Philippon Research Institute, Vial, CO, USA
| | - Brian R Wolf
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nitin B Jain
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; Departments of Physical Medicine and Rehabilitation, Orthopaedics, and Population & Data Sciences, University of Texas Southwestern, Dallas, TX, USA.
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8
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Sridharan M, Ulrich M, Thacher R, Swinehart S, Baria MR, Jones GL, Bishop JY, Cvetanovich GL, Rauck RC. The Quality and Accuracy of Direct-to-Consumer Biologic Marketing for Shoulder Pathology is Poor. JSES Int 2022; 6:518-522. [PMID: 35572419 PMCID: PMC9091716 DOI: 10.1016/j.jseint.2021.12.013] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The growing role of biologic therapies as adjunct or standalone procedures in orthopedic practice has led to greater levels of direct-to-consumer biologic marketing. The present study aims to assess the quality, accuracy, and readability of online educational resources available to patients regarding biologic therapies for shoulder pathology. Methods Eight search terms relevant to shoulder biologic therapies (shoulder + BMAC, Bone Marrow Aspirate Concentrate, PRP, Platelet Rich Plasma, Lipogems, Adipose Tissue, Biologic therapy, and Stem cell therapy) were searched across three separate search engines. The first 25 websites of each search were recorded. Duplicate websites and those not specific to shoulder pathology were excluded. Three evaluators independently assessed quality using an author-derived scoring rubric for a total of 25 possible points and accuracy for a total of 12 possible points. The Flesch-Kincaid readability test was used to quantify reading levels. Websites were further characterized by authorship and the presence of commercial bias. Results Of the 600 results from the initial search, 59 met inclusion criteria. The mean quality of the websites was poor, with 7.97 ± 2.3 of 25 points (32%). The mean accuracy was low, with 8.47 ± 1.52 of 12 points (71%). The average reading level was 11.2 ± 1.93, with 32% of websites' reading at greater than 12th grade reading level. The search terms of “shoulder PRP” and “shoulder Platelet Rich Plasma” yielded the highest quality results (mean = 8.14 ± 2.63). “shoulder Lipogems” and “shoulder Adipose tissue” yielded the most accurate results (mean = 9.25 ± 0.96). “shoulder BMAC” and “shoulder bone marrow aspirate concentrate” were most difficult to read (mean = 12.54 ± 3.73). Sixty-four percent of websites were authored by physicians, hospitals, or medical groups. The accuracy of websites authored by health care professionals was significantly higher than the accuracy of those authored by other industry sources (P = .01). Fifteen percent of websites demonstrated commercial bias. Discussion The online resources available to patients seeking information about biologic therapies for the treatment of shoulder pathologies are of very poor quality, moderately poor accuracy, and advanced readability. Providers should caution patients about the reliability of direct-to-consumer biologic marketing for shoulder pathology. Conclusion The information available to patients online regarding the diagnosis, evaluation, and treatment of shoulder pathology with biologic therapies is of poor quality and accuracy and difficult readability.
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Affiliation(s)
- Mathangi Sridharan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Marisa Ulrich
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ryan Thacher
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Steven Swinehart
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael R. Baria
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Grant L. Jones
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie Y. Bishop
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Gregory L. Cvetanovich
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ryan C. Rauck
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Corresponding author: Ryan Rauck, MD, Assistant Professor, Department of Orthopaedic Surgery, Jameson Crane Sports Institute of The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA.
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9
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Miller TL, Jones GL, Hutchinson M, Vyas D, Borchers J. Evolving Expectations of the Orthopedic Team Physician: Managing the Sidelines and Landmines. Curr Sports Med Rep 2021; 20:553-561. [PMID: 34622821 DOI: 10.1249/jsr.0000000000000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT The role of orthopedic team physicians has evolved greatly over the past decade having been influenced by advances in sports science and performance, new surgical and biologic technologies, social media, medicolegal liability, marketing, and sexual misconduct cases by some team physicians. The great variety of events and sports that are covered from high school and collegiate to the Olympic and professional levels requires a myriad of skills outside of the traditional medical training curriculum. In the current climate of increasing media scrutiny from a 24-h news cycle it is imperative for orthopedic team physicians, whether operative or nonoperative, to continually adapt to the needs and expectations of athletes who also are patients. This is especially true in the wake of the COVID-19 pandemic. Orthopedic team physicians' responsibilities continue to evolve ensuring their relevance and necessity on the sidelines and in the training room as well as in the operative suite.
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Affiliation(s)
- Timothy L Miller
- Orthopaedics and Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Grant L Jones
- Orthopaedics and Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mark Hutchinson
- Orthopaedic Surgery and Sports Medicine, University of Illinois Chicago College of Medicine, Chicago, IL
| | - Dharmesh Vyas
- Orthopaedic Surgery and Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - James Borchers
- Family Medicine and Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
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10
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Randhawa AE, Tufte-Hewett AD, Weckesser AM, Jones GL, Hewett FG. Secondary School Girls' Experiences of Menstruation and Awareness of Endometriosis: A Cross-Sectional Study. J Pediatr Adolesc Gynecol 2021; 34:643-648. [PMID: 33548448 DOI: 10.1016/j.jpag.2021.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/10/2020] [Accepted: 01/29/2021] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVE To characterize typical menstrual characteristics in a large sample of secondary school girls, as well as knowledge of typical (ie, normal) menstruation, endometriosis awareness, and educational needs. To establish whether self-reported atypical period symptoms indicate menstrual characteristics suggesting the need for further clinical review for a specialist opinion. DESIGN Cross-sectional survey. SETTING Secondary schools in West Midlands, England. PARTICIPANTS A total of 442 girls, aged 15-19 years. INTERVENTIONS AND MAIN OUTCOME MEASURES The questionnaire determined demographic characteristics, age at menarche, menstrual cycle patterns and experiences, awareness of endometriosis, and preferences for learning about it. RESULTS Period pain was common (94%), with pain reported as moderate/severe (86%). Girls reported missing school due to their menstrual periods (23%), mainly because of pain. Most believed their period was typical (63%); however, 27% were unsure, and 30% did not know whether it was regular. Self-report of atypical periods was associated with symptoms suggesting need for clinical review and with consulting a doctor [χ²(2) = 36.272, P < .001)]. Only 8% could describe endometriosis, although 86% wanted to learn more about it. CONCLUSION Most secondary school girls report dysmenorrhea. Although most girls reporting atypical periods had seen a doctor, more than one-fourth did not know whether their period was typical or regular. The majority do not have knowledge of endometriosis, contrasting with adolescents' familiarity with other common chronic conditions such as diabetes and epilepsy. We suggest menstrual health education (MHE) to improve knowledge of typical menstruation and pain treatment, aiding earlier identification of problematic period symptoms that might indicate underlying pathology.
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Affiliation(s)
- A E Randhawa
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, UK
| | - A D Tufte-Hewett
- Department of Psychology, Birmingham City University, Birmingham, UK.
| | - A M Weckesser
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - F G Hewett
- Manor Practice, James Preston Health Centre, Sutton Coldfield, West Midlands, UK
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11
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Baron JE, Duchman KR, Hettrich CM, Glass NA, Ortiz SF, Baumgarten KM, Bishop JY, Bollier MJ, Bravman JT, Brophy RH, Carpenter JE, Cox CL, Feeley BT, Frank RM, Grant JA, Jones GL, Kuhn JE, Lansdown DA, Benjamin Ma C, Marx RG, McCarty EC, Miller BS, Neviaser AS, Seidl AJ, Smith MV, Wright RW, Zhang AL, Wolf BR. Beach Chair Versus Lateral Decubitus Position: Differences in Suture Anchor Position and Number During Arthroscopic Anterior Shoulder Stabilization. Am J Sports Med 2021; 49:2020-2026. [PMID: 34019439 DOI: 10.1177/03635465211013709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic shoulder capsulolabral repair using glenoid-based suture anchor fixation provides consistently favorable outcomes for patients with anterior glenohumeral instability. To optimize outcomes, inferior anchor position, especially at the 6-o'clock position, has been emphasized. Proponents of both the beach-chair (BC) and lateral decubitus (LD) positions advocate that this anchor location can be consistently achieved in both positions. HYPOTHESIS Patient positioning would be associated with the surgeon-reported labral tear length, total number of anchors used, number of anchors in the inferior glenoid, and placement of an anchor at the 6-o'clock position. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS This study was a cross-sectional analysis of a prospective multicenter cohort of patients undergoing primary arthroscopic anterior capsulolabral repair. Patient positioning in the BC versus LD position was determined by the operating surgeon and was not randomized. At the time of operative intervention, surgeon-reported labral tear length, total anchor number, anchor number in the inferior glenoid, and anchor placement at the 6-o'clock position were evaluated between BC and LD cohorts. Descriptive statistics and between-group differences (continuous: t test [normal distributions], Wilcoxon rank sum test [nonnormal distributions], and chi-square test [categorical]) were assessed. RESULTS In total, 714 patients underwent arthroscopic anterior capsulolabral repair (BC vs LD, 406 [56.9%] vs 308 [43.1%]). The surgeon-reported labral tear length was greater for patients having surgery in the LD position (BC vs LD [mean ± SD], 123.5°± 49° vs 132.3°± 44°; P = .012). The LD position was associated with more anchors placed in the inferior glenoid and more frequent placement of anchors at the 6-o'clock (BC vs LD, 22.4% vs 51.6%; P < .001). The LD position was more frequently associated with utilization of ≥4 total anchors (BC vs LD, 33.5% vs 46.1%; P < .001). CONCLUSION Surgeons utilizing the LD position for arthroscopic capsulolabral repair in patients with anterior shoulder instability more frequently placed anchors in the inferior glenoid and at the 6-o'clock position. Additionally, surgeon-reported labral tear length was longer when utilizing the LD position. These results suggest that patient positioning may influence the total number of anchors used, the number of anchors used in the inferior glenoid, and the frequency of anchor placement at the 6 o'clock position during arthroscopic capsulolabral repair for anterior shoulder instability. How these findings affect clinical outcomes warrants further study. REGISTRATION NCT02075775 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jacqueline E Baron
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Kyle R Duchman
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Carolyn M Hettrich
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Natalie A Glass
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Shannon F Ortiz
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
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- Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Julie Y Bishop
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Matthew J Bollier
- University of Iowa, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Jonathan T Bravman
- University of Colorado, Aurora, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Robert H Brophy
- Washington University, St. Louis, Missouri, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - James E Carpenter
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Brian T Feeley
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Rachel M Frank
- University of Colorado, Denver, Denver, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - John A Grant
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Grant L Jones
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - John E Kuhn
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Drew A Lansdown
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - C Benjamin Ma
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Eric C McCarty
- University of Colorado, Aurora, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Bruce S Miller
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Andres S Neviaser
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Adam J Seidl
- University of Colorado, Aurora, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Matthew V Smith
- Washington University, St. Louis, Missouri, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Alan L Zhang
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Brian R Wolf
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
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12
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Cronin KJ, Magnuson JA, Wolf BR, Hawk GS, Thompson KL, Jacobs CA, Hettrich CM, Bishop JY, Bollier MJ, Baumgarten KM, Bravman JT, Brophy RH, Cox CL, Feeley BT, Frank RM, Grant JA, Jones GL, Kuhn JE, Ma CB, Marx RG, McCarty EC, Miller BS, Neviaser AS, Seidl AJ, Smith MV, Wright RW, Zhang AL. Male Sex, Western Ontario Shoulder Instability Index Score, and Sport as Predictors of Large Labral Tears of the Shoulder: A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Cohort Study. Arthroscopy 2021; 37:1740-1744. [PMID: 33460709 DOI: 10.1016/j.arthro.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/31/2020] [Accepted: 01/03/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify factors predictive of a large labral tear at the time of shoulder instability surgery. METHODS As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, patients undergoing open or arthroscopic shoulder instability surgery for a labral tear were evaluated. Patients with >270° tears were defined as having large labral tears. To build a predictive logistic regression model for large tears, the Feasible Solutions Algorithm was used to add significant interaction effects. RESULTS After applying exclusion criteria, 1235 patients were available for analysis. There were 222 females (18.0%) and 1013 males (82.0%) in the cohort, with an average age of 24.7 years (range 12 to 66). The prevalence of large tears was 4.6% (n = 57), with the average tear size being 141.9°. Males accounted for significantly more of the large tears seen in the cohort (94.7%, P = .01). Racquet sports (P = .01), swimming (P = .02), softball (P = .05), skiing (P = .04), and golf (P = .04) were all associated with large labral tears, as was a higher Western Ontario Shoulder Instability Index (WOSI; P = .01). Age, race, history of dislocation, and injury during sport were not associated with having a larger tear. Using our predictive logistic regression model for large tears, patients with a larger body mass index (BMI) who played contact sports were also more likely to have large tears (P = .007). CONCLUSIONS Multiple factors were identified as being associated with large labral tears at the time of surgery, including male sex, preoperative WOSI score, and participation in certain sports including racquet sports, softball, skiing, swimming, and golf. LEVEL OF EVIDENCE I, prognostic study.
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Affiliation(s)
- Kevin J Cronin
- University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, U.S.A..
| | - Justin A Magnuson
- University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, U.S.A
| | - Brian R Wolf
- University of Iowa Department of Orthopaedics, Iowa City, Iowa, U.S.A
| | - Gregory S Hawk
- University of Kentucky Department of Statistics, Lexington, Kentucky, U.S.A
| | | | - Cale A Jacobs
- University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, U.S.A
| | | | | | - Julie Y Bishop
- The Ohio State University Sports Medicine Center, Columbus, OH
| | | | | | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Robert H Brophy
- Department of Orthopedics, Washington University Saint Louis, St. Louis, MO
| | - Charles L Cox
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - John A Grant
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Grant L Jones
- The Ohio State University Sports Medicine Center, Columbus, OH
| | - John E Kuhn
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - Robert G Marx
- Department of Sports Medicine, Hospital for Special Surgery, New York, NY
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Bruce S Miller
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | | | - Adam J Seidl
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Matthew V Smith
- Department of Orthopedics, Washington University Saint Louis, St. Louis, MO
| | - Rick W Wright
- Department of Orthopedics, Washington University Saint Louis, St. Louis, MO
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
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13
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Sridharan M, Samade R, J Kopechek K, Roebke AJ, Goyal KS, L Jones G, Y Bishop J, Cvetanovich GL. The Effect of Patient and Surgical Factors on Opioid Prescription Requests Following Arthroscopic Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2021; 3:e707-e713. [PMID: 34195635 PMCID: PMC8220602 DOI: 10.1016/j.asmr.2021.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/15/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose To determine whether differences in total morphine equivalent doses (MEDs) prescribed after arthroscopic rotator cuff repair (RCR) existed because of age younger than or older than 55 years and sex and to characterize potential risk factors for needing an opioid medication refill, visiting a provider other than the surgeon (either in the emergency department or ambulatory settings), and postoperative pain control requiring opioids approximately 6 weeks from the date of surgery. Methods A retrospective cohort study of 100 patients who underwent arthroscopic RCR between July 1, 2018, to November 30, 2018, in a single institution was performed. Data including demographics, perioperative treatments, and postoperative opioid prescriptions were recorded. Our primary hypotheses were evaluated with the Wilcoxon-Mann-Whitney test. Univariate and multivariate analyses assessed potential risk factors for the 3 outcomes of interest. Results were given in adjusted odds ratios (aORs), 95% confidence intervals (CIs), and P values. Results There was a difference (P = .038) in total MEDs used (in 5 mg oxycodone tablets) between males (median 56 tablets; interquartile range, 50-98 tablets) and females (median 78 tablets; interquartile range, 56-116 tablets). Age younger than 55 years was a risk factor for seeking an opioid refill (OR = 2.51; CI, 1.11-5.66; P = .026). A significant risk factor for visiting another provider was preoperative opiate use (OR = 15.0; CI, 1.79-125.8; P = .013). Age younger than than 55 years (aOR = 2.51; CI, 1.01-6.02; P = .047), body mass index (aOR = 1.08; CI, 1.01-1.17; P = .046), and shorter surgical duration (aOR = 0.97; CI, 0.95-0.99, P =.007) were independent predictive factors for requiring opioids for pain control 6 weeks after surgery. Conclusions After arthroscopic RCR, MED prescription is higher for females than males. The risk factors for requesting opioid prescription refill for pain control 6 weeks after surgery were age younger than 55 years and shorter surgical duration. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Mathangi Sridharan
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Richard Samade
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Kyle J Kopechek
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Austin J Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Kanu S Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Grant L Jones
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Julie Y Bishop
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Gregory L Cvetanovich
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
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14
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Frantz TL, Shacklett AG, Martin AS, Barlow JD, Jones GL, Neviaser AS, Cvetanovich GL. Biceps Tenodesis for Superior Labrum Anterior-Posterior Tear in the Overhead Athlete: A Systematic Review. Am J Sports Med 2021; 49:522-528. [PMID: 32579853 DOI: 10.1177/0363546520921177] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Superior labrum anterior-posterior (SLAP) lesion is a common shoulder injury, particularly in overhead athletes. While surgical management has traditionally consisted of SLAP repair, high rates of revision and complications have led to alternative techniques, such as biceps tenodesis (BT). While BT is commonly reserved for older nonoverhead athletes, indications for its use have expanded in recent years. PURPOSE To determine functional outcomes and return-to-sport rates among overhead athletes after BT for SLAP tear. STUDY DESIGN Systematic review. METHODS A systematic review was performed for any articles published before July 2019. The search phrase "labral tear" was used to capture maximum results, followed by keyword inclusion of "SLAP tear" and "biceps tenodesis." Inclusion criteria included outcome studies of BT for isolated SLAP tear in athletes participating in any overhead sports, not limited to throwing alone. Abstracts and manuscripts were independently reviewed to determine eligibility. When clearly delineated, outcome variables from multiple studies were combined. RESULTS After full review, 8 articles met inclusion criteria (99 athletes; mean age, 19.8-47 years), with baseball and softball players the most common among them (n = 62). Type II SLAP tear was the most common diagnosis, and 0% to 44% of athletes had a failed previous SLAP repair before undergoing BT. Only 1 study included patients with concomitant rotator cuff repair. Open subpectoral BT was most commonly used, and complication rates ranged from 0% to 14%, with wound erythema, traumatic biceps tendon rupture, brachial plexus neurapraxia, and adhesive capsulitis being reported. Combined reported postoperative functional scores were as follows: American Shoulder and Elbow Surgeons, 81.7 to 97; 12-Item Short Form Health Survey physical, 50 to 54; visual analog scale for pain, 0.8-1.5; Kerlan Jobe Orthopaedic Clinic, 66 to 79; and satisfaction, 80% to 87%. The overall return-to-sports rate for overhead athletes was 70% (60 of 86). For studies that clearly delineated outcomes based on level of play/athlete, the combined return-to-sports rate was 69% (11 of 16) for recreational overhead athletes, 80% (4 of 5) for competitive/collegiate athletes, and 60% (18 of 30) for professionals. CONCLUSION BT in the overhead athlete offers encouraging functional outcomes and return-to-sports rates, particularly in the recreational athlete. It can be successfully performed as an index operation rather than SLAP repair, as well as in a younger patient population. Careful consideration should be given to elite overhead athletes, particularly pitchers, who tend to experience poorer outcomes.
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Affiliation(s)
- Travis L Frantz
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Andrew G Shacklett
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | | | | | - Grant L Jones
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Andrew S Neviaser
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Gregory L Cvetanovich
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
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15
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Baker DM, Folan AM, Lee MJ, Jones GL, Brown SR, Lobo AJ. A systematic review and meta-analysis of outcomes after elective surgery for ulcerative colitis. Colorectal Dis 2021; 23:18-33. [PMID: 32777171 DOI: 10.1111/codi.15301] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/18/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
AIM Approximately 20%-30% of patients with ulcerative colitis (UC) will undergo surgery during their disease course, the vast majority being elective due to chronic refractory disease. The risks of elective surgery are reported variably. The aim of this systematic review and meta-analysis is to summarize the outcomes after elective surgery for UC. METHODS A systematic review was conducted that analysed studies reporting outcomes for elective surgery in the modern era (>2002). It was prospectively registered on the PROSPERO database (ref: CRD42018115513). Searches were performed of Embase and MEDLINE on 15 January 2019. Outcomes were split by operation performed. Primary outcome was quality of life; secondary outcomes were early, late and functional outcomes after surgery. Outcomes reported in five or more studies underwent a meta-analysis of incidence using random effects. Heterogeneity is reported with I2 , and publication bias was assessed using Doi plots and the Luis Furuya-Kanamori index. RESULTS A total of 34 studies were included (11 774 patients). Quality of life was reported in 12 studies, with variable and contrasting results. Thirteen outcomes (eight early surgical complications, five functional outcomes) were included in the formal meta-analysis, all of which were outcomes for ileal pouch-anal anastomosis (IPAA). A further 71 outcomes were reported (50 IPAA, 21 end ileostomy). Only 14 of 84 outcomes received formal definitions, with high inter-study variation of definitions. CONCLUSION Outcomes after elective surgery for UC are variably defined. This systematic review and meta-analysis highlights the range of reported incidences and provides practical information that facilitates shared decision making in clinical practice.
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Affiliation(s)
- D M Baker
- Academic Foundation Doctor, Sheffield Teaching Hospitals, Sheffield, UK
| | - A-M Folan
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - M J Lee
- Academic Directorate Sheffield Teaching Hospitals, Sheffield, UK.,Department of Oncology and Metabolism, Sheffield Medical School, Sheffield, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - S R Brown
- Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - A J Lobo
- Gastroenterology Unit, P Floor, Royal Hallamshire Hospital, Sheffield, UK
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16
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Abstract
AIM Approximately 20%-30% of patients with ulcerative colitis (UC) will undergo surgery during their disease course, the vast majority being elective due to chronic refractory disease. The risks of elective surgery are reported variably. The aim of this systematic review and meta-analysis is to summarize the outcomes after elective surgery for UC. METHODS A systematic review was conducted that analysed studies reporting outcomes for elective surgery in the modern era (>2002). It was prospectively registered on the PROSPERO database (ref: CRD42018115513). Searches were performed of Embase and MEDLINE on 15 January 2019. Outcomes were split by operation performed. Primary outcome was quality of life; secondary outcomes were early, late and functional outcomes after surgery. Outcomes reported in five or more studies underwent a meta-analysis of incidence using random effects. Heterogeneity is reported with I2 , and publication bias was assessed using Doi plots and the Luis Furuya-Kanamori index. RESULTS A total of 34 studies were included (11 774 patients). Quality of life was reported in 12 studies, with variable and contrasting results. Thirteen outcomes (eight early surgical complications, five functional outcomes) were included in the formal meta-analysis, all of which were outcomes for ileal pouch-anal anastomosis (IPAA). A further 71 outcomes were reported (50 IPAA, 21 end ileostomy). Only 14 of 84 outcomes received formal definitions, with high inter-study variation of definitions. CONCLUSION Outcomes after elective surgery for UC are variably defined. This systematic review and meta-analysis highlights the range of reported incidences and provides practical information that facilitates shared decision making in clinical practice.
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Affiliation(s)
- D M Baker
- Academic Foundation Doctor, Sheffield Teaching Hospitals, Sheffield, UK
| | - A-M Folan
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - M J Lee
- Academic Directorate Sheffield Teaching Hospitals, Sheffield, UK.,Department of Oncology and Metabolism, Sheffield Medical School, Sheffield, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - S R Brown
- Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - A J Lobo
- Gastroenterology Unit, P Floor, Royal Hallamshire Hospital, Sheffield, UK
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17
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Malik AT, Sridharan M, Bishop JY, Khan SN, Jones GL, Neviaser AS, Cvetanovich GL. Health Care Utilization and Costs in the Year Prior to Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2020; 8:2325967120937016. [PMID: 32782903 PMCID: PMC7383668 DOI: 10.1177/2325967120937016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/17/2020] [Accepted: 03/03/2020] [Indexed: 01/14/2023] Open
Abstract
Background: A majority of cost-control strategies in arthroscopic rotator cuff repair (RCR) have been concentrated on the perioperative and post–acute care periods, with the preoperative health care period being largely overlooked. Purpose: To report the distribution of costs associated with health care utilization within the year prior to arthroscopic RCR. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: The 2007 through 2015 (third quarter) Humana Administrative Claims database was queried using Current Procedural Terminology code 29827 to identify patients undergoing arthroscopic RCR for only degenerative rotator cuff tears. The study cohort was divided into 2 distinct groups based on insurance plan: commercial or Medicare Advantage (MA). Total 1-year costs, per-patient average reimbursements (PPARs), and trends in utilization for the following preoperative health care resource categories were studied: office visits, radiographs, magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, steroid injections, hyaluronic acid (HA) injections, physical therapy, and pain medications (opioids + nonopioids). Results: A total of 18,457 MA and 6530 commercial beneficiaries undergoing arthroscopic RCR over the study period were included. Total 1-year preoperative costs (in US$) amounted to $16,923,595 ($916/patient) and $8,397,291 ($1285/patient) for MA and commercial beneficiaries, respectively. The largest proportion of total 1-year costs for both MA and commercial beneficiaries was accounted for by MRI scans (36% and 56%, respectively). PPARs for each health care resource category were as follows: office visits (MA, $240; commercial, $249), radiographs (MA, $60; commercial, $93), MRI scans (MA, $385; commercial, $813), CT scans (MA, $223; commercial, $562), steroid injections (MA, $97; commercial, $137), HA injections (MA, $422; commercial, $602), physical therapy (MA, $473; commercial, $551), and pain medications (MA, $208; commercial, $136). High health care utilization within the past 3 months before surgery was noted for radiographs, physical therapy, opioids, steroid injections, and office visits, with up to 40% to 90% of 1-year PPARs being accounted for within this time period alone. Conclusion: Approximately $900 to $1300 per patient was spent in rotator cuff–related health care resource use in the year prior to undergoing arthroscopic RCR. As we begin to implement value in shoulder surgery, judicious use of nonoperative treatment modalities among patients who would not benefit from nonoperative care will be an effective way of reducing costs.
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Affiliation(s)
- Azeem Tariq Malik
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mathangi Sridharan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Julie Y Bishop
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Safdar N Khan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Grant L Jones
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Andrew S Neviaser
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Gregory L Cvetanovich
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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18
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Lee MJ, Marshall JH, Jones GL, Lobo AJ, Brown SR. The informational and decisional preferences of patients undergoing surgery for Crohn's anal fistula: a qualitative study. Colorectal Dis 2020; 22:703-712. [PMID: 31868981 DOI: 10.1111/codi.14936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/08/2019] [Indexed: 12/17/2022]
Abstract
AIM One in three patients with Crohn's disease will develop a perianal fistula, but only a few achieve long-term healing. Treatment is both medical and surgical. Since there is no 'best' surgical procedure, patient preference is important in selecting the appropriate treatment for this condition. The aim of this study was to investigate the informational and decisional preferences of patients when surgical treatment is being considered. METHOD Patients who had undergone surgery for Crohn's anal fistula underwent face-to-face semi-structured interviews. These explored the experience of treatments for fistula, of receiving information and of participation in decision-making. Transcripts were analysed by two investigators through inductive thematic analysis. Saturation was assessed for at 12 interviews and then after each subsequent interview. RESULTS Seventeen patients completed interviews, and saturation was achieved. Five themes were identified, of which two (desired information and decision-making) were relevant to this study. Other themes included experience of Crohn's disease, experience of receiving information and procedure-specific comments. Participants wanted to have information on any risks, high-level outcomes (e.g. success), impact on day-to-day life and aftercare. Participants felt they did not always receive the information they needed to select the best treatment option. Participants felt uninvolved in treatment decisions and would have liked to trade off operations to reach their treatment goal. CONCLUSION Information provided to patients about surgical treatment of Crohn's perianal fistula does not meet their needs. Clinicians should address aftercare, impact on quality of life and the risks and benefits of the any proposed procedure.
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Affiliation(s)
- M J Lee
- Academic Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
| | - J H Marshall
- The Medical School, University of Sheffield, Sheffield, UK
| | - G L Jones
- Department of Psychology, Leeds Beckett University, Leeds, UK
| | - A J Lobo
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S R Brown
- Academic Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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19
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Lansdown DA, Cvetanovich GL, Zhang AL, Feeley BT, Wolf BR, Hettrich CM, Baumgarten KM, Bishop JY, Bollier MJ, Bravman JT, Brophy RH, Cox CL, Frank RM, Grant JA, Jones GL, Kuhn JE, Marx RG, McCarty EC, Miller BS, Ortiz SF, Smith MV, Wright RW, Ma CB. Risk Factors for Intra-articular Bone and Cartilage Lesions in Patients Undergoing Surgical Treatment for Posterior Instability. Am J Sports Med 2020; 48:1207-1212. [PMID: 32150443 DOI: 10.1177/0363546520907916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with posterior shoulder instability may have bone and cartilage lesions (BCLs) in addition to capsulolabral injuries, although the risk factors for these intra-articular lesions are unclear. HYPOTHESIS We hypothesized that patients with posterior instability who had a greater number of instability events would have a higher rate of BCLs compared with patients who had fewer instability episodes. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Data from the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group instability patient cohort were analyzed. Patients aged 12 to 99 years undergoing primary surgical treatment for shoulder instability were included. The glenohumeral joint was evaluated by the treating surgeon at the time of surgery, and patients were classified as having a BCL if they had any grade 3 or 4 glenoid or humeral cartilage lesion, reverse Hill-Sachs lesion, bony Bankart lesion, or glenoid bone loss. The effects of the number of instability events on the presence of BCLs was investigated by use of Fisher exact tests. Logistic regression modeling was performed to investigate the independent contributions of demographic variables and injury-specific variables to the likelihood of having a BCL. Significance was defined as P < .05. RESULTS We identified 271 patients (223 male) for analysis. Bone and cartilage lesions were identified in 54 patients (19.9%) at the time of surgical treatment. A glenoid cartilage injury was most common and was identified in 28 patients (10.3%). A significant difference was noted between the number of instability events and the presence of BCLs (P = .025), with the highest rate observed in patients with 2 to 5 instability events (32.3%). Multivariate logistic regression modeling indicated that increasing age (P = .019) and 2 to 5 reported instability events (P = .001) were significant independent predictors of the presence of BCLs. For bone lesions alone, the number of instability events was the only significant independent predictor; increased risk of bone lesion was present for patients with 1 instability event (OR, 6.1; P = .012), patients with 2 to 5 instability events (OR, 4.2; P = .033), and patients with more than 5 instability events (OR, 6.0; P = .011). CONCLUSION Bone and cartilage lesions are seen significantly more frequently with increasing patient age and in patients with 2 to 5 instability events. Early surgical stabilization for posterior instability may be considered to potentially limit the extent of associated intra-articular injury. The group of patients with more than 5 instability events may represent a different pathological condition, as this group showed a decrease in the likelihood of cartilage injury, although not bony injury.
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Affiliation(s)
- Drew A Lansdown
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Gregory L Cvetanovich
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Brian R Wolf
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Carolyn M Hettrich
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | -
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Keith M Baumgarten
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Julie Y Bishop
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Matthew J Bollier
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Jonathan T Bravman
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Robert H Brophy
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Charles L Cox
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Rachel M Frank
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - John A Grant
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Grant L Jones
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - John E Kuhn
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Robert G Marx
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Eric C McCarty
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Bruce S Miller
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Shannon F Ortiz
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Matthew V Smith
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Rick W Wright
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
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20
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Frantz TL, Everhart JS, Cvetanovich GL, Neviaser A, Jones GL, Hettrich CM, Wolf BR, Baumgarten KM, Bollier MJ, Bravman JT, Kuhn JE, Ma CB, Marx RG, McCarty EC, Ortiz SF, Zhang AL, Bishop JY. Are Patients Who Undergo the Latarjet Procedure Ready to Return to Play at 6 Months? A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group Cohort Study. Am J Sports Med 2020; 48:923-930. [PMID: 32045268 DOI: 10.1177/0363546520901538] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Latarjet procedure is growing in popularity for treating athletes with recurrent anterior shoulder instability, largely because of the high recurrence rate of arthroscopic stabilization, particularly among contact athletes with bone loss. PURPOSE (1) To evaluate return of strength and range of motion (ROM) 6 months after the Latarjet procedure and (2) to determine risk factors for failure to achieve return-to-play (RTP) criteria at 6 months. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 65 athletes (83% contact sports, 37% overhead sports; mean ± SD age, 24.5 ± 8.2 years; 59 male, 6 female) who enrolled in a prospective multicenter study underwent the Latarjet procedure for anterior instability (29% as primary procedure for instability, 71% for failed prior stabilization procedure). Strength and ROM were assessed preoperatively and 6 months after surgery. RTP criteria were defined as return to baseline strength and <20° side-to-side ROM deficits in all planes. The independent likelihood of achieving strength and motion RTP criteria at 6 months was assessed through multivariate logistic regression modeling with adjustment as needed for age, sex, subscapularis split versus tenotomy, preoperative strength/motion, percentage bone loss, number of prior dislocations, preoperative subjective shoulder function (American Shoulder and Elbow Surgeons and Western Ontario Shoulder Instability Index percentage), and participation in contact versus overhead sports. RESULTS Of the patients, 55% failed to meet ≥1 RTP criteria: 6% failed for persistent weakness and 51% for ≥20° side-to-side loss of motion. There was no difference in failure to achieve RTP criteria at 6 months between subscapularis split (57%) versus tenotomy (47%) (P = .49). Independent risk factors for failure to achieve either strength or ROM criteria were preoperative American Shoulder and Elbow Surgeons scores (per 10-point decrease: adjusted odds ratio [aOR], 1.61; 95% CI, 1.14-2.43; P = .006), Western Ontario Shoulder Instability Index percentage (per 10% decrease: aOR, 0.61; 95% CI, 0.38-0.92; P = .01), and a preoperative side-to-side ROM deficit ≥20° in any plane (aOR, 5.01; 95% CI, 1.42-21.5; P = .01) or deficits in external rotation at 90° of abduction (per 10° increased deficit: aOR, 1.64; 95% CI, 1.06-2.88; P = .02). CONCLUSION A large percentage of athletes fail to achieve full strength and ROM 6 months after the Latarjet procedure. Greater preoperative stiffness and subjective disability are risk factors for failure to meet ROM or strength RTP criteria.
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Affiliation(s)
- Travis L Frantz
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Joshua S Everhart
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Gregory L Cvetanovich
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Andrew Neviaser
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Grant L Jones
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Carolyn M Hettrich
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Brian R Wolf
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | -
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Keith M Baumgarten
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Matthew J Bollier
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Jonathan T Bravman
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - John E Kuhn
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - C Benjamin Ma
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Robert G Marx
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Eric C McCarty
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Shannon F Ortiz
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Alan L Zhang
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Julie Y Bishop
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
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21
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Cronin KJ, Wolf BR, Magnuson JA, Jacobs CA, Ortiz S, Bishop JY, Bollier MJ, Baumgarten KM, Bravman JT, Brophy RH, Cox CL, Feeley BT, Grant JA, Jones GL, Kuhn JE, Benjamin Ma C, Marx RG, McCarty EC, Miller BS, Seidl AJ, Smith MV, Wright RW, Zhang AL, Hettrich CM. The Prevalence and Clinical Implications of Comorbid Back Pain in Shoulder Instability: A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Cohort Study. Orthop J Sports Med 2020; 8:2325967119894738. [PMID: 32110679 PMCID: PMC7000858 DOI: 10.1177/2325967119894738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/21/2019] [Accepted: 10/10/2019] [Indexed: 01/28/2023] Open
Abstract
Background: Understanding predictors of pain is critical, as recent literature shows that
comorbid back pain is an independent risk factor for worse functional and
patient-reported outcomes (PROs) as well as increased opioid dependence
after total joint arthroplasty. Purpose/Hypothesis: The purpose of this study was to evaluate whether comorbid back pain would be
predictive of pain or self-reported instability symptoms at the time of
stabilization surgery. We hypothesized that comorbid back pain will
correlate with increased pain at the time of surgery as well as with worse
scores on shoulder-related PRO measures. Study Design: Cross-sectional study; Level of evidence, 3. Methods: As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder
Instability cohort, patients consented to participate in pre- and
intraoperative data collection. Demographic characteristics, injury history,
preoperative PRO scores, and radiologic and intraoperative findings were
recorded for patients undergoing surgical shoulder stabilization. Patients
were also asked, whether they had any back pain. Results: The study cohort consisted of 1001 patients (81% male; mean age, 24.1 years).
Patients with comorbid back pain (158 patients; 15.8%) were significantly
older (28.1 vs 23.4 years; P < .001) and were more
likely to be female (25.3% vs 17.4%; P = .02) but did not
differ in terms of either preoperative imaging or intraoperative findings.
Patients with self-reported back pain had significantly worse preoperative
pain and shoulder-related PRO scores (American Shoulder and Elbow Surgeons
score, Western Ontario Shoulder Instability Index) (P <
.001), more frequent depression (22.2% vs 8.3%; P <
.001), poorer mental health status (worse scores for the RAND 36-Item Health
Survey Mental Component Score, Iowa Quick Screen, and Personality Assessment
Screener) (P < .01), and worse preoperative expectations
(P < .01). Conclusion: Despite having similar physical findings, patients with comorbid back pain
had more severe preoperative pain and self-reported symptoms of instability
as well as more frequent depression and lower mental health scores. The
combination of disproportionate shoulder pain, comorbid back pain and mental
health conditions, and inferior preoperative expectations may affect not
only the patient’s preoperative state but also postoperative pain control
and/or postoperative outcomes.
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Affiliation(s)
- Kevin J Cronin
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Brian R Wolf
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Justin A Magnuson
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Cale A Jacobs
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Shannon Ortiz
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | | | - Julie Y Bishop
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Matthew J Bollier
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Keith M Baumgarten
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Jonathan T Bravman
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Robert H Brophy
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Charles L Cox
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Brian T Feeley
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - John A Grant
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Grant L Jones
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - John E Kuhn
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - C Benjamin Ma
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Robert G Marx
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Eric C McCarty
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Bruce S Miller
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Adam J Seidl
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Matthew V Smith
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Rick W Wright
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Alan L Zhang
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
| | - Carolyn M Hettrich
- Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA
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22
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Frantz TL, Everhart JS, Cvetanovich GL, Neviaser A, Jones GL, Hettrich CM, Wolf BR, Bishop J, Miller B, Brophy RH, Ma CB, Cox CL, Baumgarten KM, Feeley BT, Zhang AL, McCarty EC, Kuhn JE. What Are the Effects of Remplissage on 6-Month Strength and Range of Motion After Arthroscopic Bankart Repair? A Multicenter Cohort Study. Orthop J Sports Med 2020; 8:2325967120903283. [PMID: 33283013 PMCID: PMC7686606 DOI: 10.1177/2325967120903283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/30/2019] [Accepted: 11/06/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients who have undergone shoulder instability surgery are often allowed to return to sports, work, and high-level activity based largely on a time-based criterion of 6 months postoperatively. However, some believe that advancing activity after surgery should be dependent on the return of strength and range of motion (ROM). HYPOTHESIS There will be a significant loss of strength or ROM at 6 months after arthroscopic Bankart repair with remplissage compared with Bankart repair alone. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 38 patients in a prospective multicenter study underwent arthroscopic Bankart repair with remplissage (33 males, 5 females; mean age, 27.0 ± 10.2 years; 82% with ≥2 dislocation events in the past year). Strength and ROM were assessed preoperatively and at 6 months after surgery. Results were compared with 104 matched patients who had undergone Bankart repair without remplissage, although all had radiographic evidence of a Hill-Sachs defect. RESULTS At 6 months, there were no patients in the remplissage group with anterior apprehension on physical examination. However, 26% had a ≥20° external rotation (ER) deficit with the elbow at the side, 42% had a ≥20° ER deficit with the elbow at 90° of abduction, and 5% had persistent weakness. Compared with matched patients who underwent only arthroscopic Bankart repair, the remplissage group had greater humeral bone loss and had a greater likelihood of a ≥20° ER deficit with the elbow at 90° of abduction (P = .004). Risk factors for a ≥20° ER deficit with the elbow at 90° of abduction were preoperative stiffness in the same plane (P = .02), while risk factors for a ≥20° ER deficit with the elbow at the side were increased number of inferior quadrant glenoid anchors (P = .003), increased patient age (P = .02), and preoperative side-to-side deficits in ER (P = .04). The only risk factor for postoperative ER weakness was preoperative ER weakness (P = .04), with no association with remplissage (P = .26). CONCLUSION Arthroscopic Bankart repair with remplissage did not result in significant strength deficits but increased the risk of ER stiffness in abduction compared with Bankart repair without remplissage at short-term follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Julie Bishop
- Investigation performed at The Ohio State University Wexner Medical Center,
Department of Orthopaedics, Columbus, Ohio, USA
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23
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Jones GL. Full-Thickness Rotator-Cuff Tears: Nonoperative Treatment Is Good, But Surgery May Be Better: Commentary on an article by Austin J. Ramme, MD, PhD, et al.: "Surgical Versus Nonsurgical Management of Rotator Cuff Tears. A Matched-Pair Analysis". J Bone Joint Surg Am 2019; 101:e105. [PMID: 31577690 DOI: 10.2106/jbjs.19.00810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Grant L Jones
- Department of Orthopaedics, Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
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24
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Beason AM, Koehler RJ, Sanders RA, Rode BE, Menge TJ, McCullough KA, Glass NA, Hettrich CM, Cox CL, Bollier MJ, Wolf BR, Spencer EE, Grant JA, Bishop JY, Jones GL, Barlow JD, Baumgarten KM, Kelly JD, Sennett BJ, Zgonis M, Abboud JA, Namdari S, Allen C, Kuhn JE, Sullivan JP, Wright RW, Brophy RH, Smith MV, Dunn WR. Surgeon Agreement on the Presence of Pathologic Anterior Instability on Shoulder Imaging Studies. Orthop J Sports Med 2019; 7:2325967119862501. [PMID: 31448299 PMCID: PMC6689926 DOI: 10.1177/2325967119862501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/16/2022] Open
Abstract
Background In the setting of anterior shoulder instability, it is important to assess the reliability of orthopaedic surgeons to diagnose pathologic characteristics on the 2 most common imaging modalities used in clinical practice: standard plain radiographs and magnetic resonance imaging (MRI). Purpose To assess the intra- and interrater reliability of diagnosing pathologic characteristics associated with anterior shoulder instability using standard plain radiographs and MRI. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods Patient charts at a single academic institution were reviewed for anterior shoulder instability injuries. The study included 40 sets of images (20 radiograph sets, 20 MRI series). The images, along with standardized evaluation forms, were distributed to 22 shoulder/sports medicine fellowship-trained orthopaedic surgeons over 2 points in time. Kappa values for inter- and intrarater reliability were calculated. Results The overall response rate was 91%. For shoulder radiographs, interrater agreement was fair to moderate for the presence of glenoid lesions (κ = 0.49), estimate of glenoid lesion surface area (κ = 0.59), presence of a Hill-Sachs lesion (κ = 0.35), and estimate of Hill-Sachs surface area (κ = 0.50). Intrarater agreement was moderate for radiographs (κ = 0.48-0.57). For shoulder MRI, interrater agreement was fair to moderate for the presence of glenoid lesions (κ = 0.44), glenoid lesion surface area (κ = 0.35), Hill-Sachs lesion (κ = 0.33), Hill-Sachs surface area (κ = 0.28), humeral head edema (κ = 0.41), and presence of a capsulolabral injury (κ = 0.36). Fair agreement was found for specific type of capsulolabral injury (κ = 0.21). Intrarater agreement for shoulder MRI was moderate for the presence of glenoid lesion (κ = 0.59), presence of a Hill-Sachs lesion (κ = 0.52), estimate of Hill-Sachs surface area (κ = 0.50), humeral head edema (κ = 0.51), and presence of a capsulolabral injury (κ = 0.53), and agreement was substantial for glenoid lesion surface area (κ = 0.63). Intrarater agreement was fair for determining the specific type of capsulolabral injury (κ = 0.38). Conclusion Fair to moderate agreement by surgeons was found when evaluating imaging studies for anterior shoulder instability. Agreement was similar for identifying pathologic characteristics on radiographs and MRI. There was a trend toward better agreement for the presence of glenoid-sided injury. The lowest agreement was observed for specific capsulolabral injuries.
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Affiliation(s)
- Austin M Beason
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan J Koehler
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rosemary A Sanders
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brooke E Rode
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Travis J Menge
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kirk A McCullough
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natalie A Glass
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carolyn M Hettrich
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Charles L Cox
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew J Bollier
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian R Wolf
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Edwin E Spencer
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John A Grant
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Julie Y Bishop
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Grant L Jones
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan D Barlow
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith M Baumgarten
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John D Kelly
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian J Sennett
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Milt Zgonis
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joseph A Abboud
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Surena Namdari
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christina Allen
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John E Kuhn
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jaron P Sullivan
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rick W Wright
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert H Brophy
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew V Smith
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Warren R Dunn
- Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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25
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Abstract
CASE A 66-year-old man presented with 2 years of atraumatic right shoulder pain and difficulty with overhead activities. Radiographs and magnetic resonance imaging demonstrated Hamada stage I changes and a massive irreparable rotator cuff tear involving the supraspinatus and infraspinatus. He underwent superior capsular reconstruction with acellular human dermal matrix (SCR with ADM) allograft. Diagnostic arthroscopy and humeral avulsion of the glenohumeral ligament repair 1 year postoperatively showed that the SCR appeared intact and vascularized. CONCLUSIONS This is the first study to confirm visually that SCR with ADM allograft is well-vascularized and intact 1 year post-operatively.
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Affiliation(s)
- Richard Samade
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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26
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Bishop JY, Hidden KA, Jones GL, Hettrich CM, Wolf BR, Bollier M, Bravman J, McCarty EC, Brophy RH, Smith MV, Wright RW, Cox C, Kuhn J, Feely B, Ma CB, Zhang A, Grant J, Miller B, Marx RG. Factors Influencing Surgeon's Choice of Procedure for Anterior Shoulder Instability: A Multicenter Prospective Cohort Study. Arthroscopy 2019; 35:2014-2025. [PMID: 31208919 DOI: 10.1016/j.arthro.2019.02.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/15/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate preoperative factors associated with selection of surgical treatment for anterior shoulder instability. METHODS Patient demographics, initial physical examinations, and patient-oriented outcome questionnaires were collected prospectively from 26 shoulder surgeons at 10 sites. Symptom duration, number of dislocations, sport, history of prior stabilization procedure, Hill-Sachs/glenoid bone loss, pain level, and failure of conservative treatment were recorded. Statistical analysis was performed with Fisher's exact test and logistic regression analysis. RESULTS A total of 564 patients who underwent surgical treatment for anterior shoulder instability from November 2012 to June 2017 were enrolled. Of these, 426 shoulders underwent arthroscopic stabilization alone, 38 underwent arthroscopic stabilization with remplissage, 28 underwent open Bankart repair, and 72 underwent a Latarjet procedure. Predictors for undergoing Latarjet (P < .003) were symptom duration (75% had symptoms for >1 year), number of dislocations (47% had >5 dislocations), revision surgery (69%), Hill-Sachs lesion size (45% had a lesion between 11% and 20% of the humeral head), and glenoid bone loss (75% of Latarjet patients had 11% to 30% loss). Predictors for undergoing open Bankart repair (P < .001) were number of dislocations (32% had >5 dislocations), revision surgeries (54%), and glenoid bone loss (11% of open Bankart patients had 11% to 20% loss). History of prior shoulder surgery was the only significant predictor of open versus arthroscopic Bankart procedure. Prediction models showed athletes involved in high-risk sports were 2.61 times more likely to have a Latarjet (P < .01). CONCLUSIONS Indications for the Latarjet were: humeral and glenoid bone loss, duration of symptoms, number of dislocations, and revision stabilizations. Athletes involved in high-risk sports were more likely to undergo the Latarjet procedure, even if other predictive factors were not present. The open Bankart procedure was the least common procedure performed, with a history of prior shoulder surgery being the only predictor for use when treating recurrent instability. LEVEL OF EVIDENCE Level II, prospective prognostic cohort investigation.
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Affiliation(s)
- Julie Y Bishop
- The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A..
| | - Krystin A Hidden
- The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Grant L Jones
- The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
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27
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Trinh TQ, Naimark MB, Bedi A, Carpenter JE, Robbins CB, Grant JA, Miller BS, Ortiz S, Bollier MJ, Kuhn JE, Cox CL, Ma CB, Feeley BT, Zhang AL, McCarty EC, Bravman JT, Bishop JY, Jones GL, Brophy RH, Wright RW, Smith MV, Marx RG, Baumgarten KM, Wolf BR, Hettrich CM, Miller BS. Clinical Outcomes After Anterior Shoulder Stabilization in Overhead Athletes: An Analysis of the MOON Shoulder Instability Consortium. Am J Sports Med 2019; 47:1404-1410. [PMID: 31042440 DOI: 10.1177/0363546519837666] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traumatic anterior shoulder instability is a common condition affecting sports participation among young athletes. Clinical outcomes after surgical management may vary according to patient activity level and sport involvement. Overhead athletes may experience a higher rate of recurrent instability and difficulty returning to sport postoperatively with limited previous literature to guide treatment. PURPOSE To report the clinical outcomes of patients undergoing primary arthroscopic anterior shoulder stabilization within the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Consortium and to identify prognostic factors associated with successful return to sport at 2 years postoperatively. STUDY DESIGN Case series; Level of evidence, 4. METHODS Overhead athletes undergoing primary arthroscopic anterior shoulder stabilization as part of the MOON Shoulder Instability Consortium were identified for analysis. Primary outcomes included the rate of recurrent instability, defined as any patient reporting recurrent dislocation or reoperation attributed to persistent instability, and return to sport at 2 years postoperatively. Secondary outcomes included the Western Ontario Shoulder Instability Index and Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow questionnaire score. Univariate regression analysis was performed to identify patient and surgical factors predictive of return to sport at short-term follow-up. RESULTS A total of 49 athletes were identified for inclusion. At 2-year follow-up, 31 (63%) athletes reported returning to sport. Of those returning to sport, 22 athletes (45% of the study population) were able to return to their previous levels of competition (nonrefereed, refereed, or professional) in at least 1 overhead sport. Two patients (4.1%) underwent revision stabilization, although 14 (28.6%) reported subjective apprehension or looseness. Age ( P = .87), sex ( P = .82), and baseline level of competition ( P = .37) were not predictive of return to sport. No difference in range of motion in all planes ( P > .05) and Western Ontario Shoulder Instability Index scores (78.0 vs 80.1, P = .73) was noted between those who reported returning to sport and those who did not. CONCLUSION Primary arthroscopic anterior shoulder stabilization in overhead athletes is associated with a low rate of recurrent stabilization surgery. Return to overhead athletics at short-term follow-up is lower than that previously reported for the general athletic population.
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Affiliation(s)
- Thai Q Trinh
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Micah B Naimark
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Asheesh Bedi
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - James E Carpenter
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
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- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - John A Grant
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Bruce S Miller
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Shannon Ortiz
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew J Bollier
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - John E Kuhn
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Charlie L Cox
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - C Benjamin Ma
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Brain T Feeley
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Alan L Zhang
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Eric C McCarty
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan T Bravman
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Julie Y Bishop
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Grant L Jones
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Robert H Brophy
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Rick W Wright
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew V Smith
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Robert G Marx
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Keith M Baumgarten
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Brian R Wolf
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Carolyn M Hettrich
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
| | - Bruce S Miller
- Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
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28
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Lee MJ, Morgan J, Watson AJM, Jones GL, Brown SR. A validated severity score for haemorrhoids as an essential prerequisite for future haemorrhoid trials. Tech Coloproctol 2019; 23:33-41. [PMID: 30725242 PMCID: PMC6394714 DOI: 10.1007/s10151-019-01936-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is a lack of standardised outcomes for haemorrhoidal disease making comparison between trials difficult. A need for a very well validated severity score is essential to facilitate meta-analysis of comparative studies, enabling evidence-based clinical practice. METHODS The Hubble trial provides a large cohort of patients with haemorrhoidal disease randomised to rubber band ligation (RBL) or haemorrhoidal artery ligation. The haemorrhoid severity score (HSS) was collected on each patient at baseline, 6 weeks and 1 year after intervention. This allows for the responsiveness of the HSS instrument to be examined and compared with a more specific instrument, the Vaizey incontinence score (also collected). Responsiveness was tested using four methods (effect size, standardised response means (SRM), significance of change, and responsiveness statistic). RESULTS The four tests of responsiveness demonstrated that the HSS was more responsive to changes in the patient's health status following both of the interventions compared to the Vaizey questionnaire. For example, between baseline and 6 weeks, the RBL intervention effect size scores and SRM calculations indicated a non-significant small amount of change (0.20 and 0.16 respectively). However, using the HSS, the effect size and SRM demonstrated a large magnitude of change (1.12 and 1.01, respectively) which was significant. Similar results were observed at 1 year. Significance of change scores and the index of responsiveness were also higher for the HSS questionnaire than the Vaizey across both treatment modalities. CONCLUSIONS The HSS is a highly responsive tool for the detection of changes in haemorrhoid symptoms. It should form an essential patient-reported outcome tool for future studies on haemorrhoidal disease.
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Affiliation(s)
- M J Lee
- Department of Surgery, Sheffield Teaching Hospitals, Northern General Hospital, Sheffield, UK
| | - J Morgan
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - A J M Watson
- Department of Colorectal Surgery, Raigmore Hospital, Inverness, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - S R Brown
- Department of Surgery, Sheffield Teaching Hospitals, Northern General Hospital, Sheffield, UK.
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29
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Jones GL. Reporting of Near-Infrared Spectroscopy Did Not Reduce Risk for Cerebral Desaturation Events in Patients Having Arthroscopic Shoulder Surgery in the Beach Chair Position. J Bone Joint Surg Am 2018; 100:1983. [PMID: 30480603 DOI: 10.2106/jbjs.18.00918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Grant L Jones
- Department of Orthopaedic Surgery, Ohio State University, Columbus, Ohio
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Mahmoodi N, Bekker HL, King NV, Hughes J, Jones GL. Are publicly available internet resources enabling women to make informed fertility preservation decisions before starting cancer treatment: an environmental scan? BMC Med Inform Decis Mak 2018; 18:104. [PMID: 30453942 PMCID: PMC6245564 DOI: 10.1186/s12911-018-0698-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/26/2018] [Indexed: 12/02/2022] Open
Abstract
Background To identify publicly available internet resources and assess their likelihood to support women making informed decisions about, and between, fertility preservation procedures before starting their cancer treatment. Methods A survey of publically available internet resources utilising an environmental scan method. Inclusion criteria were applied to hits from searches of three data sources (November 2015; repeated June 2017): Google (Chrome) for patient resources; repositories for clinical guidelines and projects; distribution email lists to contact patient decision aid experts. The Data Extraction Sheet applied to eligible resources elicited: resource characteristics; informed and shared decision making components; engagement health services. Results Four thousand eight hundred fifty one records were identified; 24 patient resources and 0 clinical guidelines met scan inclusion criteria. Most resources aimed to inform women with cancer about fertility preservation procedures and infertility treatment options, but not decision making between options. There was a lack of consistency about how health conditions, decision problems and treatment options were described, and resources were difficult to understand. Conclusions Unless developed as part of a patient decision aid project, resources did not include components to support proactively women’s fertility preservation decisions. Current guidelines help people deliver information relevant to treatment options within a single disease pathway; we identified five additional components for patient decision aid checklists to support more effectively people’s treatment decision making across health pathways, linking current with future health problems. Electronic supplementary material The online version of this article (10.1186/s12911-018-0698-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Mahmoodi
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, LS1 3HE, UK.
| | - H L Bekker
- Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
| | - N V King
- Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
| | - J Hughes
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, LS1 3HE, UK
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31
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Ravindra A, Barlow JD, Jones GL, Bishop JY. A prospective evaluation of predictors of pain after arthroscopic rotator cuff repair: psychosocial factors have a stronger association than structural factors. J Shoulder Elbow Surg 2018; 27:1824-1829. [PMID: 30122405 DOI: 10.1016/j.jse.2018.06.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We evaluated the correlation of preoperative factors with pain after arthroscopic rotator cuff repair (ARCR). We hypothesized that nonstructural factors, including metrics of psychological well-being and preoperative narcotic use, would correlate with higher pain levels postoperatively and that structural factors, such as tear size, would not be predictive. METHODS Ninety-three patients were prospectively enrolled and evenly distributed by tear size. Patient sex, age, occupation, smoking status, tear mechanism, tear characteristics on magnetic resonance imaging, visual analog scale (VAS) pain scores, narcotic usage, range of motion (ROM) by goniometry, and functional and psychological assessments through the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, Simple Shoulder Test, Western Ontario Rotator Cuff Index (WORC), and RAND 36-item Short Form Survey questionnaires were obtained preoperatively. VAS scores and ROM were collected postoperatively at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year. The ASES, SST, WORC, and RAND 36-item Short Form Survey questionnaires were repeated 1 year postoperatively. RESULTS The patients (54% men) were a mean age of 56.4 years. There were 68% traumatic tears, 11% smokers, and 13% used narcotics preoperatively. ROM, VAS, ASES, and WORC scores improved significantly from the preoperative to 1-year postoperative assessment. Correlating with increased pain scores at 1 year were preoperative narcotic use, higher preoperative VAS, and lower scores on the WORC index and emotion sections. CONCLUSION Our data show that the factors most predictive of persistent pain after ARCR are psychosocial characteristics, including poor performance on validated measures of emotional well-being. Demographic and tear-specific structural factors did not correlate with postoperative pain scores.
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Affiliation(s)
- Amy Ravindra
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
| | | | - Grant L Jones
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
| | - Julie Y Bishop
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA.
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32
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Marshall JH, Baker DM, Lee MJ, Jones GL, Lobo AJ, Brown SR. The assessment of online health videos for surgery in Crohn's disease. Colorectal Dis 2018; 20:606-613. [PMID: 29427466 DOI: 10.1111/codi.14045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 01/29/2018] [Indexed: 02/08/2023]
Abstract
AIM YouTube™ is an open-access, nonpeer-reviewed video-hosting site and is used as a source of publicly available healthcare information. This study aimed to assess the thematic content of the most viewed videos relating to surgery and Crohn's disease and to explore the viewer interactions with these videos. METHOD A search of YouTube™ was carried out using one search string. The 50 most viewed videos were identified and categorized by source and content themes and assessed for viewer interactions. Video comments were used to describe the usefulness of the video content to viewers. RESULTS The majority of videos were uploaded by patients (n = 21).The remainder were uploaded by individual healthcare professionals (n = 9), hospital/speciality associations (n = 18) and industry (n = 2). The median number of likes for patient videos was significantly higher than for hospital/speciality association videos (P < 0.001). Patient videos received more comments praising the video content (n = 27) and more comments asking for further information (n = 14). The median number of likes for 'experience of surgery' (P < 0.001) and 'experience of disease' (P = 0.0015) themed videos were significantly higher than for 'disease management' themed videos. CONCLUSION Crohn's disease patients use YouTube™ as a surgical information source. The content of patient-sourced videos focused on surgical and disease experience, suggesting that these themes are important to patients. Current patient developed videos provide limited information, as reflected by viewers requesting further information. Storytelling patient-centred videos combined with clinical evidence may be a good model for future videos.
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Affiliation(s)
- J H Marshall
- University of Sheffield Medical School, Sheffield, UK
| | - D M Baker
- University of Sheffield Medical School, Sheffield, UK
| | - M J Lee
- University of Sheffield Medical School, Sheffield, UK.,Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - G L Jones
- Department of Psychology, Leeds Beckett University, Leeds, UK
| | - A J Lobo
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - S R Brown
- Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
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Kraeutler MJ, McCarty EC, Belk JW, Wolf BR, Hettrich CM, Ortiz SF, Bravman JT, Baumgarten KM, Bishop JY, Bollier MJ, Brophy RH, Carey JL, Carpenter JE, Cox CL, Feeley BT, Grant JA, Jones GL, Kuhn JE, Kelly JD, Ma CB, Marx RG, Miller BS, Sennett BJ, Smith MV, Wright RW, Zhang AL. Descriptive Epidemiology of the MOON Shoulder Instability Cohort. Am J Sports Med 2018; 46:1064-1069. [PMID: 29505730 DOI: 10.1177/0363546518755752] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder instability is a common diagnosis among patients undergoing shoulder surgery. PURPOSE To perform a descriptive analysis of patients undergoing surgery for shoulder instability through a large multicenter consortium. STUDY DESIGN Case series; Level of evidence, 4. METHODS All patients undergoing surgery for shoulder instability who were enrolled in the MOON Shoulder Instability Study were included. Baseline demographics included age, sex, body mass index, and race. Baseline patient-reported outcomes (PROs) included the American Shoulder and Elbow Surgeons (ASES) score, Shoulder Activity Score, Western Ontario Shoulder Instability Index (WOSI), 36-Item Health Survey (RAND-36), and Single Assessment Numeric Evaluation (SANE). The preoperative physician examination included active range of motion (ROM) and strength testing. Preoperative imaging assessments with plain radiography, magnetic resonance imaging (MRI), and computed tomography were also included and analyzed. RESULTS Twenty-six surgeons had enrolled 863 patients (709 male, 154 female) across 10 clinical sites. The mean age for the cohort was 24 years (range, 12-63 years). Male patients represented 82% of the cohort. The primary direction of instability was anterior for both male (74%) and female (73%) patients. Football (24%) and basketball (13%) were the most common sports in which the primary shoulder injury occurred. No clinically significant differences were found in preoperative ROM between the affected and unaffected sides for any measurement taken. Preoperative MRI scans were obtained in 798 patients (92%). An anterior labral tear was the most common injury found on preoperative MRI, seen in 66% of patients, followed by a Hill-Sachs lesion in 41%. Poor PRO scores were recorded preoperatively (mean: ASES, 72.4; WOSI, 43.3; SANE, 46.6). CONCLUSION The MOON Shoulder Instability Study has enrolled the largest cohort of patients undergoing shoulder stabilization to date. Anterior instability is most common among shoulder instability patients, and most patients undergoing shoulder stabilization are in their early 20s or younger. The results of this study provide important epidemiological information for patients undergoing shoulder stabilization surgery.
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Affiliation(s)
- Matthew J Kraeutler
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Eric C McCarty
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - John W Belk
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Brian R Wolf
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Carolyn M Hettrich
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Shannon F Ortiz
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
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- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Jonathan T Bravman
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Keith M Baumgarten
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Julie Y Bishop
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Matthew J Bollier
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Robert H Brophy
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - James L Carey
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - James E Carpenter
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Charlie L Cox
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Brian T Feeley
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - John A Grant
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Grant L Jones
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - John E Kuhn
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - John D Kelly
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - C Benjamin Ma
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Robert G Marx
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Bruce S Miller
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Brian J Sennett
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Matthew V Smith
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Rick W Wright
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Alan L Zhang
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
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Affiliation(s)
- G L Jones
- Centre for Nephrology, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
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Darius G, Byron WA, DeAngelis CR, Hassan MT, Wietfeldt FE, Collett B, Jones GL, Dewey MS, Mendenhall MP, Nico JS, Park H, Komives A, Stephenson EJ. Measurement of the Electron-Antineutrino Angular Correlation in Neutron β Decay. Phys Rev Lett 2017; 119:042502. [PMID: 29341742 DOI: 10.1103/physrevlett.119.042502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Indexed: 06/07/2023]
Abstract
We report the first result for the electron-antineutrino angular correlation (a coefficient) in free neutron β decay from the aCORN experiment. aCORN uses a novel method in which the a coefficient is proportional to an asymmetry in proton time of flight for events where the β electron and recoil proton are detected in delayed coincidence. Data are presented from a 15 month run at the NIST Center for Neutron Research. We obtained a=-0.1090±0.0030(stat)±0.0028(sys), the most precise measurement of the neutron a coefficient reported to date.
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Affiliation(s)
- G Darius
- Tulane University, New Orleans, Louisiana 70118, USA
| | - W A Byron
- Tulane University, New Orleans, Louisiana 70118, USA
| | - C R DeAngelis
- Tulane University, New Orleans, Louisiana 70118, USA
| | - M T Hassan
- Tulane University, New Orleans, Louisiana 70118, USA
| | - F E Wietfeldt
- Tulane University, New Orleans, Louisiana 70118, USA
| | - B Collett
- Hamilton College, Clinton, New York 13323, USA
| | - G L Jones
- Hamilton College, Clinton, New York 13323, USA
| | - M S Dewey
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - M P Mendenhall
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - J S Nico
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - H Park
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - A Komives
- DePauw University, Greencastle, Indiana 46135, USA
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Jones GL, Hughes J, Mahmoodi N, Greenfield D, Brauten-Smith G, Skull J, Gath J, Yeomanson D, Baskind E, Snowden JA, Jacques RM, Velikova G, Collins K, Stark D, Phillips R, Lane S, Bekker HL. Observational study of the development and evaluation of a fertility preservation patient decision aid for teenage and adult women diagnosed with cancer: the Cancer, Fertility and Me research protocol. BMJ Open 2017; 7:e013219. [PMID: 28289046 PMCID: PMC5353284 DOI: 10.1136/bmjopen-2016-013219] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Women diagnosed with cancer and facing potentially sterilising cancer treatment have to make time-pressured decisions regarding fertility preservation with specialist fertility services while undergoing treatment of their cancer with oncology services. Oncologists identify a need for resources enabling them to support women's fertility preservation decisions more effectively; women report wanting more specialist information to make these decisions. The overall aim of the 'Cancer, Fertility and Me' study is to develop and evaluate a new evidence-based patient decision aid (PtDA) for women with any cancer considering fertility preservation to address this unmet need. METHODS AND ANALYSIS This is a prospective mixed-method observational study including women of reproductive age (16 years +) with a new diagnosis of any cancer across two regional cancer and fertility centres in Yorkshire, UK. The research involves three stages. In stage 1, the aim is to develop the PtDA using a systematic method of evidence synthesis and multidisciplinary expert review of current clinical practice and patient information. In stage 2, the aim is to assess the face validity of the PtDA. Feedback on its content and format will be ascertained using questionnaires and interviews with patients, user groups and key stakeholders. Finally, in stage 3 the acceptability of using this resource when integrated into usual cancer care pathways at the point of cancer diagnosis and treatment planning will be evaluated. This will involve a quantitative and qualitative evaluation of the PtDA in clinical practice. Measures chosen include using count data of the PtDAs administered in clinics and accessed online, decisional and patient-reported outcome measures and qualitative feedback. Quantitative data will be analysed using descriptive statistics, paired sample t-tests and CIs; interviews will be analysed using thematic analysis. ETHICS AND DISSEMINATION Research Ethics Committee approval (Ref: 16/EM/0122) and Health Research Authority approval (Ref: 194751) has been granted. Findings will be published in open access peer-reviewed journals, presented at conferences for academic and health professional audiences, with feedback to health professionals and program managers. The Cancer, Fertility and Me patient decision aid (PtDA) will be disseminated via a diverse range of open-access media, study and charity websites, professional organisations and academic sources. External endorsement will be sought from the International Patient Decision Aid Standards (IPDAS) Collaboration inventory of PtDAs and other relevant professional organisations, for example, the British Fertility Society. TRIAL REGISTRATION NUMBER NCT02753296; pre-results.
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Affiliation(s)
- G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, City Centre Campus, Leeds, UK
| | - J Hughes
- Department of Psychology, School of Social Sciences, Leeds Beckett University, City Centre Campus, Leeds, UK
| | - N Mahmoodi
- Department of Psychology, School of Social Sciences, Leeds Beckett University, City Centre Campus, Leeds, UK
| | - D Greenfield
- Department of Oncology, Sheffield Teaching NHS Hospitals Foundation Trust, Sheffield University, Sheffield, UK
| | | | - J Skull
- Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J Gath
- Independent Cancer Patients' Voice, London, UK
| | - D Yeomanson
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - E Baskind
- Seacroft Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - R M Jacques
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - G Velikova
- University of Leeds, St James Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - K Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - D Stark
- University of Leeds, St James Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - R Phillips
- Center for Review and Dissemination, University of York, Leeds General Infirmary, Leeds Teaching Hospitals, York, UK
| | - S Lane
- Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - H L Bekker
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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Hassan MT, Bateman F, Collett B, Darius G, DeAngelis C, Dewey MS, Jones GL, Komives A, Laptev A, Mendenhall MP, Nico JS, Noid G, Stephenson EJ, Stern I, Trull C, Wietfeldt FE. The aCORN Backscatter-Suppressed Beta Spectrometer. Nucl Instrum Methods Phys Res A 2017; 867:10.1016/j.nima.2017.05.029. [PMID: 31092963 PMCID: PMC6512858 DOI: 10.1016/j.nima.2017.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Backscatter of electrons from a beta spectrometer, with incomplete energy deposition, can lead to undesirable effects in many types of experiments. We present and discuss the design and operation of a backscatter-suppressed beta spectrometer that was developed as part of a program to measure the electronantineutrino correlation coefficient in neutron beta decay (aCORN). An array of backscatter veto detectors surrounds a plastic scintillator beta energy detector. The spectrometer contains an axial magnetic field gradient, so electrons are efficiently admitted but have a low probability for escaping back through the entrance after backscattering. The design, construction, calibration, and performance of the spectrometer are discussed.
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Affiliation(s)
- M T Hassan
- Department of Physics and Engineering Physics, Tulane University, New Orleans, LA 70118, USA
| | - F Bateman
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - B Collett
- Physics Department, Hamilton College, Clinton, NY 13323, USA
| | - G Darius
- Department of Physics and Engineering Physics, Tulane University, New Orleans, LA 70118, USA
| | - C DeAngelis
- Department of Physics and Engineering Physics, Tulane University, New Orleans, LA 70118, USA
| | - M S Dewey
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - G L Jones
- Physics Department, Hamilton College, Clinton, NY 13323, USA
| | - A Komives
- Department of Physics and Astronomy, DePauw University, Greencastle, IN 46135, USA
| | - A Laptev
- Department of Physics and Engineering Physics, Tulane University, New Orleans, LA 70118, USA
| | - M P Mendenhall
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - J S Nico
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - G Noid
- CEEM, Indiana University, Bloomington, IN 47408, USA
| | | | - I Stern
- Department of Physics and Engineering Physics, Tulane University, New Orleans, LA 70118, USA
| | - C Trull
- Department of Physics and Engineering Physics, Tulane University, New Orleans, LA 70118, USA
| | - F E Wietfeldt
- Department of Physics and Engineering Physics, Tulane University, New Orleans, LA 70118, USA
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Barlow JD, Bishop JY, Dunn WR, Kuhn JE, Brophy RH, Carey JL, Holloway BG, Jones GL, Ma CB, Marx RG, McCarty EC, Poddar SK, Smith MV, Spencer EE, Vidal AF, Wolf BR, Wright RW. What factors are predictors of emotional health in patients with full-thickness rotator cuff tears? J Shoulder Elbow Surg 2016; 25:1769-1773. [PMID: 27282735 DOI: 10.1016/j.jse.2016.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/16/2016] [Accepted: 04/05/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The importance of emotional and psychological factors in treatment of patients with rotator cuff disease has been recently emphasized. Our goal was to establish factors most predictive of poor emotional health in patients with full-thickness rotator cuff tears (FTRCTs). METHODS In 2007, we began to prospectively collect data on patients with symptomatic, atraumatic FTRCTs. All patients completed a questionnaire collecting data on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcomes (12-Item Short Form Health Survey, American Shoulder and Elbow Surgeons score, Western Ontario Rotator Cuff Index [WORC], Single Assessment Numeric Evaluation score, Shoulder Activity Scale). Physicians recorded physical examination and imaging data. To evaluate the predictors of lower WORC emotion scores, a linear multiple regression model was fit. RESULTS Baseline data for 452 patients were used for analysis. In patients with symptomatic FTRCTs, the factors most predictive of worse WORC emotion scores were higher levels of pain (interquartile range odds ratio, -18.9; 95% confidence interval, -20.2 to -11.6; P < .0001) and lower Single Assessment Numeric Evaluation scores (rating of percentage normal that patients perceive their shoulder to be; interquartile range odds ratio, 6.2; 95% confidence interval, 2.5-9.95; P = .0012). Higher education (P = .006) and unemployment status (P = .0025) were associated with higher WORC emotion scores. CONCLUSIONS Education level, employment status, pain levels, and patient perception of percentage of shoulder normalcy were most predictive of emotional health in patients with FTRCTs. Structural data, such astendon tear size, were not. Those with poor emotional health may perceive their shoulder to be worse than others and experience more pain. This may allow us to better optimize patient outcomes with nonoperative and operative treatment of rotator cuff tears.
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Affiliation(s)
- Jonathan D Barlow
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
| | - Julie Y Bishop
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA.
| | - Warren R Dunn
- Department of Orthopaedics, University of Wisconsin, Madison, WI, USA
| | - John E Kuhn
- Vanderbilt Orthopaedic Institute, Nashville, TN, USA
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Creasey T, Jones GL, Collin M. Granulocyte infusion: benefit beyond neutrophils? Transfus Med 2016; 26:390-392. [PMID: 27273103 DOI: 10.1111/tme.12319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/01/2016] [Indexed: 11/28/2022]
Affiliation(s)
- T Creasey
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - G L Jones
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - M Collin
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK.
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Bishop JY, Jones GL, Lewis B, Pedroza A, Kuhn J, Dunn W, Cox C, Wolf B, Hettrich C, Bollier M, Carey J, Kelly J, Sennett B, McCarty E, Vidal A, Bravman J, Poddar S, Spencer E, Holloway B, Ma B, Allen C, Feeley B, Marx R, Miller B, Carpenter J, Wright R, Brophy R, Smith M, Abboud J. Intra- and interobserver agreement in the classification and treatment of distal third clavicle fractures. Am J Sports Med 2015; 43:979-84. [PMID: 25587184 DOI: 10.1177/0363546514563281] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In treatment of distal third clavicle fractures, the Neer classification system, based on the location of the fracture in relation to the coracoclavicular ligaments, has traditionally been used to determine fracture pattern stability. PURPOSE To determine the intra- and interobserver reliability in the classification of distal third clavicle fractures via standard plain radiographs and the intra- and interobserver agreement in the preferred treatment of these fractures. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS Thirty radiographs of distal clavicle fractures were randomly selected from patients treated for distal clavicle fractures between 2006 and 2011. The radiographs were distributed to 22 shoulder/sports medicine fellowship-trained orthopaedic surgeons. Fourteen surgeons responded and took part in the study. The evaluators were asked to measure the size of the distal fragment, classify the fracture pattern as stable or unstable, assign the Neer classification, and recommend operative versus nonoperative treatment. The radiographs were reordered and redistributed 3 months later. Inter- and intrarater agreement was determined for the distal fragment size, stability of the fracture, Neer classification, and decision to operate. Single variable logistic regression was performed to determine what factors could most accurately predict the decision for surgery. RESULTS Interrater agreement was fair for distal fragment size, moderate for stability, fair for Neer classification, slight for type IIB and III fractures, and moderate for treatment approach. Intrarater agreement was moderate for distal fragment size categories (κ = 0.50, P < .001) and Neer classification (κ = 0.42, P < .001) and substantial for stable fracture (κ = 0.65, P < .001) and decision to operate (κ = 0.65, P < .001). Fracture stability was the best predictor of treatment, with 89% accuracy (P < .001). CONCLUSION Fracture stability determination and the decision to operate had the highest interobserver agreement. Fracture stability was the key determinant of treatment, rather than the Neer classification system or the size of the distal fragment.
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Affiliation(s)
- Julie Y Bishop
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Grant L Jones
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Brian Lewis
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Angela Pedroza
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
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Abstract
INTRODUCTION We describe the presentation, exam findings, surgical repair techniques, and short-term outcomes in a series of patients with isolated inferior labral tears. MATERIALS AND METHODS A retrospective chart review was performed at a large academic medical center. Isolated inferior labral tears were defined as between the 4 o'clock and 8 o'clock position of the glenoid as determined by direct arthroscopic visualization. Tears that were smaller were also included but were required to cross the 6 o'clock point, having anterior and posterior components. Patients were excluded if they had any other pathology or treatment of the shoulder. 1-year follow-up was required. RESULTS Of the 17 patients who met inclusion criteria for review, 12 were available for a minimum 1-year follow-up. Average total follow-up for patients to complete the phone interview/Oxford Shoulder Instability Score (OSIS) was an average of 37.7 months (range: 16-79 months). Postoperatively, all reported symptom improvement or resolution since surgery. The mean preoperative pain on a scale of 0-10 was 6.3 (range: 0-10). Mean postoperative pain on a scale of 0-10 was 2.25 (range: 0-5). Eleven of 12 patients (91.7%) had returned to the level of activity desired. The mean OSIS was 41.4 (median: 43; range: 27-47). Eleven of 12 patients (91.7%) had good or excellent scores. Ten of 12 patients (83.3%) had a feeling of stability in the shoulder. All 12 patients reached were satisfied with the procedure and would undergo surgery again in a similar situation. CONCLUSIONS We have presented our series of patients with isolated inferior labral injury, and have shown that when surgically treated, outcomes of this uncommon injury are good to excellent and a full return to sports can be expected.
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Affiliation(s)
- Val Irion
- Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Cheah
- Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Grant L Jones
- Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie Y Bishop
- Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Unruh KP, Kuhn JE, Sanders R, An Q, Baumgarten KM, Bishop JY, Brophy RH, Carey JL, Holloway BG, Jones GL, Ma BC, Marx RG, McCarty EC, Poddar SK, Smith MV, Spencer EE, Vidal AF, Wolf BR, Wright RW, Dunn WR. The duration of symptoms does not correlate with rotator cuff tear severity or other patient-related features: a cross-sectional study of patients with atraumatic, full-thickness rotator cuff tears. J Shoulder Elbow Surg 2014; 23:1052-8. [PMID: 24411924 PMCID: PMC4058396 DOI: 10.1016/j.jse.2013.10.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 10/02/2013] [Accepted: 10/11/2013] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of this cross-sectional study is to determine whether the duration of symptoms influences the features seen in patients with atraumatic, full-thickness rotator cuff tears. Our hypothesis is that an increasing duration of symptoms will correlate with more advanced findings of rotator cuff tear severity on magnetic resonance imaging, worse shoulder outcome scores, more pain, decreased range of motion, and less strength. METHODS We enrolled 450 patients with full-thickness rotator cuff tears in a prospective cohort study to assess the effectiveness of nonoperative treatment and factors predictive of success. The duration of patient symptoms was divided into 4 groups: 3 months or less, 4 to 6 months, 7 to 12 months, and greater than 12 months. Data collected at patient entry into the study included (1) demographic data, (2) history and physical examination data, (3) radiographic imaging data, and (4) validated patient-reported measures of shoulder status. Statistical analysis included a univariate analysis with the Kruskal-Wallis test and Pearson test to identify statistically significant differences in these features for different durations of symptoms. RESULTS A longer duration of symptoms does not correlate with more severe rotator cuff disease. The duration of symptoms was not related to weakness, limited range of motion, tear size, fatty atrophy, or validated patient-reported outcome measures. CONCLUSIONS There is only a weak relationship between the duration of symptoms and features associated with rotator cuff disease.
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Dunn WR, Kuhn JE, Sanders R, An Q, Baumgarten KM, Bishop JY, Brophy RH, Carey JL, Holloway GB, Jones GL, Ma CB, Marx RG, McCarty EC, Poddar SK, Smith MV, Spencer EE, Vidal AF, Wolf BR, Wright RW. Symptoms of pain do not correlate with rotator cuff tear severity: a cross-sectional study of 393 patients with a symptomatic atraumatic full-thickness rotator cuff tear. J Bone Joint Surg Am 2014; 96:793-800. [PMID: 24875019 PMCID: PMC4018774 DOI: 10.2106/jbjs.l.01304] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND For many orthopaedic disorders, symptoms correlate with disease severity. The objective of this study was to determine if pain level is related to the severity of rotator cuff disorders. METHODS A cohort of 393 subjects with an atraumatic symptomatic full-thickness rotator-cuff tear treated with physical therapy was studied. Baseline pretreatment data were used to examine the relationship between the severity of rotator cuff disease and pain. Disease severity was determined by evaluating tear size, retraction, superior humeral head migration, and rotator cuff muscle atrophy. Pain was measured on the 10-point visual analog scale (VAS) in the patient-reported American Shoulder and Elbow Surgeons (ASES) score. A linear multiple regression model was constructed with use of the continuous VAS score as the dependent variable and measures of rotator cuff tear severity and other nonanatomic patient factors as the independent variables. Forty-eight percent of the patients were female, and the median age was sixty-one years. The dominant shoulder was involved in 69% of the patients. The duration of symptoms was less than one month for 8% of the patients, one to three months for 22%, four to six months for 20%, seven to twelve months for 15%, and more than a year for 36%. The tear involved only the supraspinatus in 72% of the patients; the supraspinatus and infraspinatus, with or without the teres minor, in 21%; and only the subscapularis in 7%. Humeral head migration was noted in 16%. Tendon retraction was minimal in 48%, midhumeral in 34%, glenohumeral in 13%, and to the glenoid in 5%. The median baseline VAS pain score was 4.4. RESULTS Multivariable modeling, controlling for other baseline factors, identified increased comorbidities (p = 0.002), lower education level (p = 0.004), and race (p = 0.041) as the only significant factors associated with pain on presentation. No measure of rotator cuff tear severity correlated with pain (p > 0.25). CONCLUSIONS Anatomic features defining the severity of atraumatic rotator cuff tears are not associated with the pain level. Factors associated with pain are comorbidities, lower education level, and race. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Warren R. Dunn
- University of Wisconsin, Research Park Clinic Sports Medicine Clinic, 621 Science Drive, Madison, WI 53711
| | - John E. Kuhn
- Vanderbilt University Medical Center, 4200 MCE South Tower, 1215 21st Avenue South, Nashville, TN 37232. E-mail address for J.E. Kuhn:
| | - Rosemary Sanders
- Vanderbilt University Medical Center, 4200 MCE South Tower, 1215 21st Avenue South, Nashville, TN 37232. E-mail address for J.E. Kuhn:
| | - Qi An
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 723, Memphis, TN 38105-3768
| | - Keith M. Baumgarten
- Sports Medicine & Shoulder Surgery Orthopedic Institute, 810 East 23rd Street, Sioux Falls, SD 57117
| | - Julie Y. Bishop
- OSU Sports Medicine Center, 2050 Kenny Road, Suite 3300, Columbus, OH 43221-3502
| | - Robert H. Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, 14532 South Outer Forty Drive, Chesterfield, MO 63017
| | - James L. Carey
- PENN Orthopaedics, Hospital of the University of Pennsylvania, Weightman Hall, 33rd and Spruce Streets, Philadelphia, PA 19104
| | - G. Brian Holloway
- Shoulder and Elbow Institute Knoxville Orthopaedic Clinic, 260 Fort Sanders West Boulevard, Knoxville, TN 37922
| | - Grant L. Jones
- OSU Sports Medicine Center, 2050 Kenny Road, Suite 3300, Columbus, OH 43221-3502
| | - C. Benjamin Ma
- UCSF Sports Medicine, 1500 Owens Street, San Francisco, CA 94158
| | - Robert G. Marx
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | | | - Sourav K. Poddar
- CU Sports Medicine, 2000 South Colorado Boulevard, Colorado Center Tower One, Suite 4500, Denver, CO 80222
| | - Matthew V. Smith
- Department of Orthopaedic Surgery, Washington University School of Medicine, 14532 South Outer Forty Drive, Chesterfield, MO 63017
| | - Edwin E. Spencer
- Shoulder and Elbow Institute Knoxville Orthopaedic Clinic, 260 Fort Sanders West Boulevard, Knoxville, TN 37922
| | - Armando F. Vidal
- CU Sports Medicine, 2000 South Colorado Boulevard, Colorado Center Tower One, Suite 4500, Denver, CO 80222
| | - Brian R. Wolf
- University of Iowa, 2701 Prairie Meadow Drive, Iowa City, IA 52242-1088
| | - Rick W. Wright
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St. Louis, MO 63110
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Abstract
BACKGROUND With the recent emphasis on performing open reduction and internal fixation on midshaft clavicle fractures with complete displacement, comminution, and >2 cm of shortening, it is important to determine the reliability of orthopaedic surgeons to assess these variables on standard plain radiographs and to determine the agreement among orthopaedic surgeons in choosing the treatment. PURPOSE To determine the intra- and interobserver reliability in the classification of midshaft clavicle fractures via standard plain radiographs and to determine the intra- and interobserver agreement in the treatment of these fractures. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Charts of patients seen by the 2 senior authors from 2006 to 2011 were reviewed to identify patients treated for clavicle fractures (CPT codes 23500 and 23515). Anteroposterior and 30° cephalad radiographs were selected, representing midshaft clavicle fractures treated both operatively and nonoperatively. Thirty pairs of radiographs were included in the investigation. The radiographs were standardized for size to allow accurate measurements within a non-PACS (picture archiving and communications system) program, and a PDF document was created with all representative radiographs. Clinical scenarios were created for each set of radiographs, and the evaluators were asked to (1) measure the degree of shortening in millimeters, (2) determine the percentage displacement, (3) determine whether the fracture was comminuted, and (4) state whether they would treat the fracture operatively or nonoperatively. The radiographs, along with instructions on how to use the measuring tool with Adobe Reader, were distributed to 22 shoulder/sports medicine fellowship-trained orthopaedic surgeons, then reordered and redistributed approximately 3 months later. Sixteen surgeons completed 1 round of surveys, and 13 surgeons completed both rounds. RESULTS Interrater agreement was moderate for displacement of 0%-49% (κ = 0.71, P < .001) and >100% (κ = 0.73, P < .001), with minimal agreement for displacement of 50%-100% (κ = 0.39, P < .001). There was moderate interrater agreement for the presence/absence of comminution (κ = 0.75, P < .001). Interrater agreement was weak for shortening of 0-5.0 mm (κ = 0.58, P < .001) and >30.0 mm (κ = 0.51, P < .001), with minimal agreement for shortening of 5.1-10.0 mm (κ = 0.22, P < .001) and no agreement for the other 4 categories. Interrater analysis showed weak agreement on whether surgical treatment was recommended (κ = 0.40, P < .001). Intrarater agreement was strong for comminution (κ = 0.80, P < .0001), moderate for both displacement (κ = 0.76, P < .001) and operative treatment (κ = 0.64, P < .001), and minimal for shortening (κ = 0.38, P < .001). The following variables statistically predicted whether surgery was recommended (P < .001): (1) the odds of surgery were 2.26 if comminution was noted, holding displacement and the interaction between displacement and shortening constant, and (2) the odds of surgery were 3.37 if there is displacement of >100% compared with displacement of 0%-49%, holding comminution and shortening constant. CONCLUSION Standard plain unilateral radiographs of the clavicle are insufficient to reliably determine the degree of shortening of clavicle fractures and the need for surgery among shoulder/sports medicine fellowship-trained orthopaedic surgeons. Consideration should be made to not use shortening as the sole determinant for whether to proceed with surgical intervention or to use other radiographic modalities to determine the amount of shortening.
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Affiliation(s)
- Grant L Jones
- Grant L. Jones, OSU Sports Medicine Center, 2050 Kenny Road, Columbus, OH 43221, USA.
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Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA, Ramsey ML, Karli DC, Rettig AC. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med 2014; 42:463-71. [PMID: 23825183 DOI: 10.1177/0363546513494359] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Elbow tenderness and pain with resisted wrist extension are common manifestations of lateral epicondylar tendinopathy, also known as tennis elbow. Previous studies have suggested platelet-rich plasma (PRP) to be a safe and effective therapy for tennis elbow. PURPOSE To evaluate the clinical value of tendon needling with PRP in patients with chronic tennis elbow compared with an active control group. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS A total of 230 patients with chronic lateral epicondylar tendinopathy were treated at 12 centers over 5 years. All patients had at least 3 months of symptoms and had failed conventional therapy. There were no differences in patients randomized to receive PRP (n = 116) or active controls (n = 114). The PRP was prepared from venous whole blood at the point of care and contained both concentrated platelets and leukocytes. After receiving a local anesthetic, all patients had their extensor tendons needled with or without PRP. Patients and investigators remained blinded to the treatment group throughout the study. A successful outcome was defined as 25% or greater improvement on the visual analog scale for pain. RESULTS Patient outcomes were followed for up to 24 weeks. At 12 weeks (n = 192), the PRP-treated patients reported an improvement of 55.1% in their pain scores compared with 47.4% in the active control group (P = .163). At 24 weeks (n = 119), the PRP-treated patients reported an improvement of 71.5% in their pain scores compared with 56.1% in the control group (P = .019). The percentage of patients reporting significant elbow tenderness at 12 weeks was 37.4% in the PRP group versus 48.4% in the control group (P = .143). Success rates for patients at 12 weeks were 75.2% in the PRP group versus 65.9% in the control group (P = .104). At 24 weeks, 29.1% of the PRP-treated patients reported significant elbow tenderness versus 54.0% in the control group (P = .009). Success rates for patients with 24 weeks of follow-up were 83.9% in the PRP group compared with 68.3% in the control group (P = .037). No significant complications occurred in either group. CONCLUSION No significant differences were found at 12 weeks in this study. At 24 weeks, however, clinically meaningful improvements were found in patients treated with leukocyte-enriched PRP compared with an active control group.
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Affiliation(s)
- Allan K Mishra
- Allan K. Mishra, Department of Orthopedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, 1300 Crane Street, Menlo Park, CA 94025.
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Kuhn JE, Dunn WR, Sanders R, An Q, Baumgarten KM, Bishop JY, Brophy RH, Carey JL, Holloway BG, Jones GL, Ma CB, Marx RG, McCarty EC, Poddar SK, Smith MV, Spencer EE, Vidal AF, Wolf BR, Wright RW. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg 2013; 22:1371-9. [PMID: 23540577 PMCID: PMC3748251 DOI: 10.1016/j.jse.2013.01.026] [Citation(s) in RCA: 207] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 01/21/2013] [Accepted: 01/30/2013] [Indexed: 02/01/2023]
Abstract
PURPOSE To assess the effectiveness of a specific nonoperative physical therapy program in treating atraumatic full-thickness rotator cuff tears using a multicenter prospective cohort study design. MATERIALS AND METHODS Patients with atraumatic full-thickness rotator cuff tears who consented to enroll provided data via questionnaire on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcome assessments (Short Form 12 score, American Shoulder and Elbow Surgeons score, Western Ontario Rotator Cuff score, Single Assessment Numeric Evaluation score, and Shoulder Activity Scale). Physicians recorded physical examination and imaging data. Patients began a physical therapy program developed from a systematic review of the literature and returned for evaluation at 6 and 12 weeks. At those visits, patients could choose 1 of 3 courses: (1) cured (no formal follow-up scheduled), (2) improved (continue therapy with scheduled reassessment in 6 weeks), or (3) no better (surgery offered). Patients were contacted by telephone at 1 and 2 years to determine whether they had undergone surgery since their last visit. A Wilcoxon signed rank test with continuity correction was used to compare initial, 6-week, and 12-week outcome scores. RESULTS The cohort consists of 452 patients. Patient-reported outcomes improved significantly at 6 and 12 weeks. Patients elected to undergo surgery less than 25% of the time. Patients who decided to have surgery generally did so between 6 and 12 weeks, and few had surgery between 3 and 24 months. CONCLUSION Nonoperative treatment using this physical therapy protocol is effective for treating atraumatic full-thickness rotator cuff tears in approximately 75% of patients followed up for 2 years.
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Angell JW, Jones GL, Voigt K, Grove-White DH. Successful correction of D-lactic acid neurotoxicity (drunken lamb syndrome) by bolus administration of oral sodium bicarbonate. Vet Rec 2013; 173:193. [PMID: 23812111 DOI: 10.1136/vr.101536] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Drunken lamb syndrome (DLS) has recently been described as lamb D-lactic acidosis syndrome (LDLAS). In 2012, 18 lambs aged between 7 days and 28 days with LDLAS were identified. Biochemically, each lamb had a metabolic acidosis characterised by D-lactic acidosis and exhibited clinical signs including: not hyperthermic, no evidence of dehydration, demonstrating an ataxic gait tending to recumbency (DLS) and possibly somnolence. These lambs received 50 mmol of sodium bicarbonate as an 8.4 per cent solution given orally, together with parenteral long-acting amoxicillin. All 18 cases made a full clinical recovery. This study demonstrates a novel effective treatment for a disease that is usually fatal, and also demonstrates a strong correlation between venous plasma bicarbonate concentrations and venous plasma D-lactate concentrations (R(2)=0.49).
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Affiliation(s)
- J W Angell
- Wern Veterinary Surgeons, Greenfield Road, Ruthin, UK.
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Jadav AM, Wadhawan H, Jones GL, Wheldon LW, Radley SC, Brown SR. Does sacral nerve stimulation improve global pelvic function in women? Colorectal Dis 2013; 15:848-57. [PMID: 23451900 DOI: 10.1111/codi.12181] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 10/19/2012] [Indexed: 12/16/2022]
Abstract
AIM Many women undergoing sacral neuromodulation for faecal incontinence have coexisting pelvic floor dysfunction. We used a global pelvic-floor assessment questionnaire to evaluate the effect of sacral neuromodulation on non-bowel related symptomatology. METHOD The electronic Personnel Assessment Questionnaire - Pelvic Floor (ePAQ-PF) is a validated Web-based electronic pelvic floor questionnaire. Women with faecal incontinence underwent assessment using the ePAQ. Pre- and poststimulator data were analysed over a 4.5-year period. RESULTS Forty-three women (mean age 56.5 years; median follow up 6.8 months) were included. All (100%) had urinary symptoms, 81.4% had vaginal symptoms and 85.7% described some sexual dysfunction. There was a significant improvement in faecal incontinence and in bowel-related quality of life (P < 0.005) as well as in irritable bowel syndrome (IBS)-related symptoms (P < 0.01) and in bowel-related sexual heath (P < 0.01). Symptoms of vaginal prolapse significantly improved (P = 0.05). There was also improvement in symptoms of overactive bladder (P = 0.005) and in urinary-related quality of life (P < 0.05). A global health improvement was reported in 58.1%, mainly in bowel evacuation (P < 0.01) and in vaginal pain and sensation (P < 0.05). In sexually active female patients, significant improvements in vaginal and bowel-related sexual health were seen (P < 0.005). Improvement in general sex life following stimulation was reported in 53.3%. CONCLUSION A Web-based electronic pelvic-floor assessment questionnaire has demonstrated global improvement in pelvic floor function in bowel, urinary, vaginal and sexual dimensions in women following sacral neuromodulation for faecal incontinence.
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Affiliation(s)
- A M Jadav
- Northern General Hospital, Sheffield, UK
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Sadgrove NJ, Jones GL. A possible role of partially pyrolysed essential oils in Australian Aboriginal traditional ceremonial and medicinal smoking applications of Eremophila longifolia (R. Br.) F. Muell (Scrophulariaceae). J Ethnopharmacol 2013; 147:638-644. [PMID: 23563055 DOI: 10.1016/j.jep.2013.03.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/22/2013] [Accepted: 03/22/2013] [Indexed: 06/02/2023]
Abstract
ETHNOPHARMACOLOGICAL SIGNIFICANCE Eremophila longifolia is one of the most respected of the traditional medicines used by Australian Aboriginal people. Customary use involves smoldering the leaves over hot embers of a fire to produce an acrid smoke, believed to have therapeutic effects broadly consistent with antimicrobial, antifungal and anti-inflammatory capacity. AIM OF THE STUDY The current study aims to examine the contribution of partially pyrolysed and non-pyrolysed essential oils in traditional usage of Eremophila longifolia. MATERIALS AND METHODS Non-pyrolysed and partially pyrolysed essential oils were produced by hydrodistillation and part-wet/part-dry distillation, respectively. All samples were tested for antimicrobial activity by broth dilution. Some of these samples were further treated to an incrementally stepped temperature profile in a novel procedure employing a commercial thermocycler in an attempt to mimic the effect of temperature gradients produced during smoking ceremonies. Components from the pyrodistilled oils were compared with the non-pyrodistilled oils, using GC-MS, GC-FID and HPLC-PAD. The 2,2-diphenyl-1-picrylhydrazyl method, was used to compare free radical scavenging ability. RESULTS Partially pyrolysed oils had approximately three or more times greater antimicrobial activity, enhanced in cultures warmed incrementally to 60°C and held for 30s and further enhanced if held for 2 min. Partially pyrolysed oils showed a radical scavenging capacity 30-700 times greater than the corresponding non-pyrolysed oils. HPLC-PAD revealed the presence of additional constituents not present in the fresh essential oil. CONCLUSION These results, by showing enhanced antimicrobial and antioxidant activities, provide the first known Western scientific justification for the smoking ceremonies involving leaves of Eremophila longifolia. During customary use, both partially pyrolysed as well as non-pyrolysed essential oils may contribute significantly to the overall intended medicinal effect.
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Affiliation(s)
- N J Sadgrove
- University of New England, Pharmaceuticals, Nutraceuticals Group for Bioactive Discovery in Health and Ageing Science and Technology Armidale, Armidale, NSW 2351, Australia.
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