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Baumgarten KM, Sandhurst ES, Sun H. Can Human Growth Hormone Accelerate Tendon and Ligament Injury Recovery? Sports Health 2024:19417381241245938. [PMID: 38618948 DOI: 10.1177/19417381241245938] [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] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Studies involving human fibroblasts and use of human growth hormone (HGH) administration for injury recovery are limited. It is plausible that if the administration of HGH to human cells increased cellular proliferation and differentiation, then HGH might be able to assist in accelerating recovery from injury. HYPOTHESIS HGH will increase proliferation and differentiation of human tendon and ligament fibroblasts in vitro based on both a single-dose and a sustained-dose model of HGH administration. STUDY DESIGN Basic science cellular study. METHODS Human tendon and ligament tissue were harvested from 24 patients. Tissue samples were digested with type I collagenase to isolate the target cell types. HGH was administered directly to isolated cells at doses ranging from 100 pg/mL to 10 µg/mL, either in a single-dose or a sustained-dose model. Proliferation was analyzed at days 4 and 7. Differentiation of ligament and tendon fibroblasts was assessed at day 14. RESULTS Administration of a single-dose of HGH to both cell types demonstrated similar or inferior cellular proliferation compared with controls after 7 days. For the sustained-dosing model of ligament fibroblasts, only the 100 ng/mL concentration demonstrated at least statistically similar or improved proliferation compared with controls. When examining the 100 ng/mL HGH concentration with larger sample sizes, cellular proliferation was not improved over controls for any cell type for the single- or sustained-dosing models. Proliferation for tendon fibroblasts was either similar or inferior to the control group at all concentrations of HGH. There was no clear dose-response relationship demonstrating enhanced collagen production with administration of HGH to suggest it enhances injury recovery. CONCLUSION HGH administered to human tendon and ligament fibroblasts does not appear to positively affect cellular proliferation and differentiation. CLINICAL RELEVANCE This study does not support the use of HGH for accelerating recovery from injury.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota
- Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
| | - Eric S Sandhurst
- University of South Dakota GEAR Center, Sioux Falls, South Dakota
| | - Hongli Sun
- University of South Dakota GEAR Center, Sioux Falls, South Dakota
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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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Baumgarten KM. Patients who have intraoperative deviations in their preoperative plan have inferior clinical and radiographic outcomes after anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:e451-e463. [PMID: 36868298 DOI: 10.1016/j.jse.2023.01.035] [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: 11/07/2022] [Revised: 01/08/2023] [Accepted: 01/22/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Three-dimensional computed tomography preoperative planning has become adopted among shoulder arthroplasty surgeons. Prior studies have not examined outcomes in patients in whom the surgeon implanted prostheses that deviated from the preoperative plan compared with patients in whom the surgeon followed the preoperative plan. The hypothesis of this study was that clinical and radiographic outcomes would be equivalent between patients undergoing anatomic total shoulder arthroplasty that had a deviation in the components predicted in the preoperative plan and patients who did not have a change in the components predicted in the preoperative plan. METHODS A retrospective review of patients who had preoperative planning for anatomic total shoulder arthroplasty from March 2017 through October 2022 was performed. Patients were stratified into 2 groups: patients in whom the surgeon used components that deviated from those anticipated by the preoperative plan (changed group), and patients in whom the surgeon used all of the components anticipated by the preoperative plan (planned group). Patient-determined outcomes including the Western Ontario Osteoarthritis Index, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test (SST), and Shoulder Activity Level were recorded preoperatively, at 1 year, and at 2 years. Preoperative and 1-year postoperative range of motion was recorded. Radiographic parameters to assess restoration of proximal humeral anatomy included humeral head height, humeral neck angle, humeral centering on the glenoid, and postoperative restoration of the anatomic center of rotation. RESULTS A total of 159 patients had intraoperative changes to their preoperative plan, and 136 patients underwent arthroplasty without changes to their preoperative plan. The planned group had higher scores than the group that had a deviation in the preoperative plan for every patient-determined outcome metric at every postoperative time point with statistically significant improvements found in the SST and Single Assessment Numeric Evaluation at 1-year and the SST and American Shoulder and Elbow Surgeons score at 2-year follow-up. No differences were found in range of motion metrics between the groups. Patients who did not have a deviation in their preoperative plan had more optimal restoration of their postoperative radiographic center of rotation than patients who did have a deviation in their preoperative plan. CONCLUSIONS Patients who have intraoperative changes to their preoperative plan have (1) inferior postoperative patient-determined outcome scores at 1 and 2 years after surgery and (2) a larger deviation in the postoperative radiographic restoration of the humeral center of rotation than patients who did not have intraoperative changes from the initial plan.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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5
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Hettrich CM, Magnuson JA, Baumgarten KM, Brophy RH, Kattan M, Bishop JY, Bollier MJ, Bravman JT, Cvetanovich GL, Dunn WR, Feeley BT, Frank RM, Kuhn JE, Lansdown DA, Benjamin Ma C, Marx RG, McCarty EC, Neviaser AS, Ortiz SF, Seidl AJ, Smith MV, Wright RW, Zhang AL, Cronin KJ, Wolf BR. Predictors of Bone Loss in Anterior Glenohumeral Instability. Am J Sports Med 2023; 51:1286-1294. [PMID: 36939180 DOI: 10.1177/03635465231160286] [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: 03/21/2023]
Abstract
BACKGROUND Anterior shoulder instability can result in bone loss of both the anterior glenoid and the posterior humerus. Bone loss has been shown to lead to increased failure postoperatively and may necessitate more complex surgical procedures, resulting in worse clinical outcomes and posttraumatic arthritis. HYPOTHESIS/PURPOSE The purpose of this study was to investigate predictors of glenoid and humeral head bone loss in patients undergoing surgery for anterior shoulder instability. It was hypothesized that male sex, contact sport participation, traumatic dislocation, and higher number of instability events would be associated with greater bone loss. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 892 patients with anterior shoulder instability were prospectively enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort. The presence and amount of anterior glenoid bone loss and accompanying Hill-Sachs lesions were quantified. Descriptive information and injury history were used to construct proportional odds models for the presence of any bone defect, for defects >10% of the anterior glenoid or humeral head, and for combined bony defects. RESULTS Anterior glenoid bone loss and Hill-Sachs lesions were present in 185 (20.7%) and 470 (52.7%) patients, respectively. Having an increased number of dislocations was associated with bone loss in all models. Increasing age, male sex, and non-White race were associated with anterior glenoid bone defects and Hill-Sachs lesions. Contact sport participation was associated with anterior glenoid bone loss, and Shoulder Actitvity Scale with glenoid bone loss >10%. A positive apprehension test was associated with Hill-Sachs lesions. Combined lesions were present in 19.4% of patients, and for every additional shoulder dislocation, the odds of having a combined lesion was 95% higher. CONCLUSION An increasing number of preoperative shoulder dislocations is the factor most strongly associated with glenoid bone loss, Hill-Sachs lesions, and combined lesions. Early surgical stabilization before recurrence of instability may be the most effective method for preventing progression to clinically significant bone loss. Patients should be made aware of the expected course of shoulder instability, especially in athletes at high risk for recurrence and osseous defects, which may complicate care and worsen outcomes. REGISTRATION NCT02075775 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Carolyn M Hettrich
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Robert H Brophy
- Department of Orthopedics, Washington University Saint Louis, St. Louis, Missouri, USA
| | - Michael Kattan
- Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio, USA
| | | | - Julie Y Bishop
- The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
| | | | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Warren R Dunn
- Fondren Orthopedic Group, Orthopedic Surgery, Houston, Texas, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John E Kuhn
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert G Marx
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Shannon F Ortiz
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Adam J Seidl
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew V Smith
- Department of Orthopedics, Washington University Saint Louis, St. Louis, Missouri, USA
| | - Rick W Wright
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | | | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Investigation performed at multicenter facilities and the primary site is at University of Iowa, Iowa City, Iowa, USA
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Wright RW, Huston LJ, Haas AK, Pennings JS, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study. Am J Sports Med 2023; 51:605-614. [PMID: 36734487 PMCID: PMC10338044 DOI: 10.1177/03635465231151389] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/04/2023]
Abstract
BACKGROUND Meniscal and chondral damage is common in the patient undergoing revision anterior cruciate ligament (ACL) reconstruction. PURPOSE To determine if meniscal and/or articular cartilage pathology at the time of revision ACL surgery significantly influences a patient's outcome at 6-year follow-up. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients undergoing revision ACL reconstruction were prospectively enrolled between 2006 and 2011. Data collection included baseline demographics, surgical technique, pathology, treatment, and scores from 4 validated patient-reported outcome instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx Activity Rating Scale. Patients were followed up at 6 years and asked to complete the identical set of outcome instruments. Regression analysis assessed the meniscal and articular cartilage pathology risk factors for clinical outcomes 6 years after revision ACL reconstruction. RESULTS An overall 1234 patients were enrolled (716 males, 58%; median age, 26 years). Surgeons reported the pathology at the time of revision surgery in the medial meniscus (45%), lateral meniscus (36%), medial femoral condyle (43%), lateral femoral condyle (29%), medial tibial plateau (11%), lateral tibial plateau (17%), patella (30%), and trochlea (21%). Six-year follow-up was obtained on 79% of the sample (980/1234). Meniscal pathology and articular cartilage pathology (medial femoral condyle, lateral femoral condyle, lateral tibial plateau, trochlea, and patella) were significant drivers of poorer patient-reported outcomes at 6 years (IKDC, KOOS, WOMAC, and Marx). The most consistent factors driving outcomes were having a medial meniscal excision (either before or at the time of revision surgery) and patellofemoral articular cartilage pathology. Six-year Marx activity levels were negatively affected by having either a repair/excision of the medial meniscus (odds ratio range, 1.45-1.72; P≤ .04) or grade 3-4 patellar chondrosis (odds ratio, 1.72; P = .04). Meniscal pathology occurring before the index revision surgery negatively affected scores on all KOOS subscales except for sports/recreation (P < .05). Articular cartilage pathology significantly impaired all KOOS subscale scores (P < .05). Lower baseline outcome scores, higher body mass index, being a smoker, and incurring subsequent surgery all significantly increased the odds of reporting poorer clinical outcomes at 6 years. CONCLUSION Meniscal and chondral pathology at the time of revision ACL reconstruction has continued significant detrimental effects on patient-reported outcomes at 6 years after revision surgery.
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Affiliation(s)
| | | | - Amanda K Haas
- Washington University in St Louis, St Louis, Missouri, USA
| | | | | | | | | | | | | | | | | | - John P Albright
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | | | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | | | - Arthur R Bartolozzi
- 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | | | | | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA
| | | | | | | | | | - J Brad Butler
- Orthopedic and Fracture Clinic, Portland, Oregon, USA
| | - John D Campbell
- Bridger Orthopedic and Sports Medicine, Bozeman, Montana, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | | | | | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA
| | | | - Robert W Frederick
- The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | - Sharon L Hame
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | | | - C Benjamin Ma
- University of California, San Francisco, California, USA
| | - G Peter Maiers
- Methodist Sports Medicine Center, Indianapolis, Indiana, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | - Eric C McCarty
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada
| | | | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | | | - Brett D Owens
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | | | | | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA
| | | | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Ltc Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA
| | - Armando F Vidal
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
| | | | | | | | | | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA
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7
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Baumgarten KM. Is stemless total shoulder arthroplasty indicated in elderly patients? J Shoulder Elbow Surg 2023; 32:260-268. [PMID: 36162630 DOI: 10.1016/j.jse.2022.08.003] [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: 05/10/2022] [Revised: 07/24/2022] [Accepted: 08/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Stemmed anatomic total shoulder arthroplasty has represented the gold standard for the treatment of glenohumeral osteoarthritis with an intact rotator cuff for decades. To the author's knowledge, no study has specifically examined the outcomes of stemless, modular total shoulder arthroplasty in elderly patients. The hypothesis of this study was that stemless anatomic total shoulder arthroplasty in elderly patients (age ≥70 years) would have equivalent clinical and radiographic outcomes compared with a younger population (age <70 years). MATERIALS AND METHODS A prospectively collected database of patients undergoing primary, modular, stemless anatomic total shoulder arthroplasty for osteoarthritis was retrospectively reviewed. Patient-determined outcomes including the Western Ontario Osteoarthritis Index (WOOS) score, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Simple Shoulder Test score, and Shoulder Activity Level score were recorded preoperatively and postoperatively at 1 year and 2 years. Preoperative and 1-year postoperative range of motion was recorded. Postoperative radiographs were examined to assess for radiographic evidence of complications. RESULTS Stemless arthroplasty was planned in 116 patients. Seven patients underwent conversion intraoperatively to a stemmed prosthesis. There was no difference between patients aged <70 yr and those aged ≥70 years who required intraoperative deviation from the preoperative plan to a stemmed prosthesis (5.8% vs 6.4%, P = .90). At the time of stemless arthroplasty, 64 patients were aged <70 yr and 44 patients were aged ≥70 years. Between the 2 groups, there were no clinically or statistically significant differences in WOOS, ASES, and SANE scores at baseline, 1-year follow-up, or 2-year follow-up. The changes in all scores from baseline to 2 years were similar between the group aged <70 yr and the group aged ≥70 years. There was no difference in the percentage of patients achieving the minimal clinically important difference or substantial clinical benefit in either group after shoulder arthroplasty at 2-year follow-up. There was no difference between the 2 groups in terms of final postoperative range of motion or change in range of motion for any metric examined. There was no evidence of radiographic complications in either group. CONCLUSIONS Age ≥70 years does not appear to be a contraindication to stemless anatomic total shoulder arthroplasty. Postoperative improvements in patient-determined outcome scores, the percentage of patients achieving clinically important outcomes for the ASES, SANE, and WOOS scores, and postoperative range of motion were similar between patients aged <70 yr and those aged ≥70 years. There was no difference between the groups regarding the patients who required intraoperative deviation from the preoperatively planned stemless prosthesis to a stemmed prosthesis. Neither age group demonstrated a radiographically apparent complication.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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8
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Baumgarten KM. Can the Single Assessment Numeric Evaluation be used as a stand-alone subjective outcome instrument in patients undergoing rotator cuff repair? J Shoulder Elbow Surg 2022; 31:2542-2553. [PMID: 35750155 DOI: 10.1016/j.jse.2022.05.017] [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] [Received: 03/20/2022] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND/HYPOTHESIS There is no consensus to which patient-determined shoulder outcome scores should be considered when analyzing patient outcomes. Use of multiple patient-determined outcomes may be redundant and cause increased responder burden. The Single Assessment Numeric (SANE) has not been widely accepted as a stand-alone shoulder-specific outcome measure. The hypothesis was that SANE will correlate with and be comparable in responsiveness to other subjective outcome measures that have been used in a stand-alone fashion in patients undergoing rotator cuff repair (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], Western Ontario Rotator Cuff Index [WORC], and the Simple Shoulder Test [SST]). In addition, the SANE will be more relevant to each patient compared to the ASES, further supporting its use as a stand-alone shoulder-specific outcomes measure. METHODS A retrospective review of a database of patients undergoing rotator cuff repair was reviewed where the SANE was recorded with the ASES, WORC, and/or SST. Correlations were determined using the Pearson coefficient. Subgroup analysis was performed to determine if correlations differed in (1) preoperative and (2) postoperative outcome determinations. Responsiveness was determined by calculating the standardized response mean (SRM) and the effect size (ES) of all scores. Relevance and precision of the SANE and ASES were examined using 150 consecutive patients to determine the number of questions in each score that were not answered. RESULTS Correlation was excellent for the SANE and the ASES (n = 1838, r = 0.81, P < .0001), the WORC (n = 1793, r = 0.82, P < .0001), and the SST (n = 1836, r = 0.76, P < .0001). Correlation of preoperative scores was moderate and postoperative scores were excellent when comparing the SANE with all 3 scores. All scores were highly responsive, with the SRM of the SANE = 2.1, ASES = 2.2, WORC = 2.4, and the SST = 1.8. The ES of the SANE = 2.4, ASES = 2.7, WORC = 3.0, and the SST = 2.1. One hundred percent of the SANE scores were answered completely compared with 57% (P < .0001) of the ASES, with significant variability found in the answers to the "work" and "score" questions. CONCLUSION In patients undergoing rotator cuff repair, the SANE highly correlated and has equivalent responsiveness with the WORC, ASES, and SST, which have been used as stand-alone shoulder-specific outcomes measures. The SANE may provide the same information as the WORC, ASES, and SST regarding outcome with significant reduction in responder burden. This study supports that the SANE can be used as a subjective, stand-alone instrument for patients undergoing rotator cuff repair.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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9
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Baumgarten KM. Can the Single Assessment Numeric Evaluation (SANE) be used as a stand-alone outcome instrument in patients undergoing total shoulder arthroplasty? J Shoulder Elbow Surg 2022; 31:e426-e435. [PMID: 35413432 DOI: 10.1016/j.jse.2022.02.036] [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] [Received: 11/20/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS There is no consensus as to which patient-determined shoulder outcome scores should be considered when analyzing patient outcomes for either clinical or research purposes. Use of multiple patient-determined outcomes may be redundant and cause increased responder burden. To date, the Single Assessment Numeric Evaluation (SANE) has not been widely accepted as a stand-alone shoulder-specific outcome measure. The hypothesis of this study was that the SANE would correlate with and be equal or superior in responsiveness to other outcome measures that have been used in a stand-alone fashion in patients undergoing total shoulder arthroplasty (American Shoulder and Elbow Surgeons [ASES], Western Ontario Osteoarthritis of the Shoulder [WOOS], and Simple Shoulder Test [SST] scores). In addition, it was hypothesized that the SANE would be more relevant to each patient than the ASES assessment, further supporting the use of the SANE as a stand-alone shoulder-specific outcome measure. METHODS A retrospective review of a database of patients undergoing total shoulder arthroplasty was performed, in which the SANE score was recorded simultaneously with the ASES, WOOS, and/or SST score. Correlations were determined using the Pearson coefficient. Subgroup analysis was performed to determine whether correlations differed in (1) preoperative outcome and (2) postoperative outcome determinations. Responsiveness was determined by calculating the standardized response mean and the effect size of all scores. The relevance of the SANE and ASES assessments was examined using the scores of 150 consecutive patients to determine the number of questions on each assessment that were not answered. RESULTS Correlation was excellent for the SANE score and the ASES score (n = 1447, r = 0.82, P < .0001), WOOS score (n = 1514, r = 0.83, P < .0001), and SST score (n = 1095, r = 0.81, P < .0001). The correlation of preoperative scores was moderate and that of postoperative scores was strong-moderate when the SANE score was compared with all 3 other scores. All scores were highly responsive, with standardized response mean values of 2.2 for the SANE score, 2.3 for the ASES score, 1.4 for the WOOS score, and 1.6 for the SST score. The effect size of the SANE score was 2.9; ASES score, 2.9; WOOS score, 2.9; and SST score, 2.3. One hundred percent of the SANE questions were answered completely compared with 61% of the ASES questions (P < .0001). CONCLUSION In patients undergoing total shoulder arthroplasty, the SANE score highly correlated with the WOOS, ASES, and SST scores, which have been used as stand-alone shoulder-specific outcome measures. The SANE score may provide the same information as the WOOS, ASES, and SST score regarding outcomes with a significant reduction in responder burden. It is logical that the SANE can be used as a stand-alone instrument for patients undergoing total shoulder arthroplasty.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA.
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10
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DeFroda SF, Owens BD, Wright RW, Huston LJ, Pennings JS, Haas AK, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting. Am J Sports Med 2022; 50:2397-2409. [PMID: 35833922 DOI: 10.1177/03635465221104470] [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 Lytic or malpositioned tunnels may require bone grafting during revision anterior cruciate ligament reconstruction (rACLR) surgery. Patient characteristics and effects of grafting on outcomes after rACLR are not well described. PURPOSE To describe preoperative characteristics, intraoperative findings, and 2-year outcomes for patients with rACLR undergoing bone grafting procedures compared with patients with rACLR without grafting. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 1234 patients who underwent rACLR were prospectively enrolled between 2006 and 2011. Baseline revision and 2-year characteristics, surgical technique, pathology, treatment, and patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale [Marx]) were collected, as well as subsequent surgery information, if applicable. The chi-square and analysis of variance tests were used to compare group characteristics. RESULTS A total of 159 patients (13%) underwent tunnel grafting-64 (5%) patients underwent 1-stage and 95 (8%) underwent 2-stage grafting. Grafting was isolated to the femur in 31 (2.5%) patients, the tibia in 40 (3%) patients, and combined in 88 patients (7%). Baseline KOOS Quality of Life (QoL) and Marx activity scores were significantly lower in the 2-stage group compared with the no bone grafting group (P≤ .001). Patients who required 2-stage grafting had more previous ACLRs (P < .001) and were less likely to have received a bone-patellar tendon-bone or a soft tissue autograft at primary ACLR procedure (P≤ .021) compared with the no bone grafting group. For current rACLR, patients undergoing either 1-stage or 2-stage bone grafting were more likely to receive a bone-patellar tendon-bone allograft (P≤ .008) and less likely to receive a soft tissue autograft (P≤ .003) compared with the no bone grafting group. At 2-year follow-up of 1052 (85%) patients, we found inferior outcomes in the 2-stage bone grafting group (IKDC score = 68; KOOS QoL score = 44; KOOS Sport/Recreation score = 65; and Marx activity score = 3) compared with the no bone grafting group (IKDC score = 77; KOOS QoL score = 63; KOOS Sport/Recreation score = 75; and Marx activity score = 7) (P≤ .01). The 1-stage bone graft group did not significantly differ compared with the no bone grafting group. CONCLUSION Tunnel bone grafting was performed in 13% of our rACLR cohort, with 8% undergoing 2-stage surgery. Patients treated with 2-stage grafting had inferior baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting. Patients treated with 1-stage grafting had similar baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting.
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Affiliation(s)
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- Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Steven F DeFroda
- University of Missouri, Columbia, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brett D Owens
- Brown Alpert Medical School, Providence, Rhode Island, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Laura J Huston
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jacquelyn S Pennings
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Amanda K Haas
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christina R Allen
- Yale University, New Haven, Connecticut, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Daniel E Cooper
- W.B. Carrell Memorial Clinic, Dallas, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Thomas M DeBerardino
- The San Antonio Orthopaedic Group, San Antonio, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Warren R Dunn
- Texas Orthopedic Hospital, Houston, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brett Brick A Lantz
- Slocum Research & Education Foundation, Eugene, Oregon, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Kurt P Spindler
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Michael J Stuart
- Mayo Clinic, Rochester, Minnesota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - John P Albright
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Annunziato Ned Amendola
- Duke University, Durham, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher C Annunziata
- Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Bernard R Bach
- Rush University Medical Center, Chicago, Illinois, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Champ L Baker
- The Hughston Clinic, Columbus, Georgia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Arthur R Bartolozzi
- 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffery R Bechler
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Geoffrey A Bernas
- State University of New York at Buffalo, Buffalo, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Stephen F Brockmeier
- University of Virginia, Charlottesville, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert H Brophy
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Charles A Bush-Joseph
- Rush University Medical Center, Chicago, Illinois, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - J Brad Butler
- Orthopedic and Fracture Clinic, Portland, Oregon, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James E Carpenter
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brian J Cole
- Rush University Medical Center, Chicago, IL USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jonathan M Cooper
- HealthPartners Specialty Center, St Paul, Minnesota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - R Alexander Creighton
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - David C Flanigan
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert W Frederick
- Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Elizabeth A Garofoli
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Sharon L Hame
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher D Harner
- University of Texas Health Center, Houston, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Norman Lindsay Harris
- Grand River Health-Rifle, Rifle, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Keith S Hechtman
- UHZ Sports Medicine Institute, Coral Gables, Florida, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Elliott B Hershman
- Lenox Hill Hospital, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Rudolf G Hoellrich
- Slocum Research & Education Foundation, Eugene, Oregon, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - David C Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Timothy S Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Morgan H Jones
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher C Kaeding
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Thomas E Klootwyk
- Methodist Sports Medicine, Indianapolis, Indiana, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Bruce A Levy
- Mayo Clinic Rochester, Rochester, Minnesota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - C Benjamin Ma
- University of California, San Francisco, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - G Peter Maiers
- Methodist Sports Medicine Center, Indianapolis, Indiana, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Matthew J Matava
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Gregory M Mathien
- Knoxville Orthopaedic Clinic, Knoxville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - David R McAllister
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Eric C McCarty
- University of Colorado Denver School of Medicine, Denver, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Bruce S Miller
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Daniel F O'Neill
- Littleton Regional Healthcare, Littleton, New Hampshire, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Richard D Parker
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Mark L Purnell
- Aspen Orthopedic Associates, Aspen, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Arthur C Rettig
- Methodist Sports Medicine, Indianapolis, Indiana, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Kevin G Shea
- Intermountain Orthopaedics, Boise, Idaho, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Orrin H Sherman
- NYU Hospital for Joint Diseases, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James R Slauterbeck
- University of South Alabama, Mobile, Alabama, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Matthew V Smith
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Joachim J Tenuta
- Albany Medical Center, Albany, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Armando F Vidal
- University of Colorado Denver School of Medicine, Denver, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Darius G Viskontas
- Royal Columbian Hospital, New Westminster, British Columbia, Canada.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Richard A White
- Fitzgibbon's Hospital, Marshall, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James S Williams
- Cleveland Clinic, Euclid, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Michelle L Wolcott
- University of Colorado Denver School of Medicine, Denver, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
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11
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Bigouette JP, Owen EC, Lantz BBA, Hoellrich RG, Wright RW, Huston LJ, Haas AK, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Spindler KP, Stuart MJ, Albright JP, Amendola A(N, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Robert Giffin J, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LTCSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ, York JJ. Returning to Activity After Anterior Cruciate Ligament Revision Surgery: An Analysis of the Multicenter Anterior Cruciate Ligament Revision Study (MARS) Cohort at 2 Years Postoperative. Am J Sports Med 2022; 50:1788-1797. [PMID: 35648628 PMCID: PMC9756873 DOI: 10.1177/03635465221094621] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with anterior cruciate ligament (ACL) revision report lower outcome scores on validated knee questionnaires postoperatively compared to cohorts with primary ACL reconstruction. In a previously active population, it is unclear if patient-reported outcomes (PROs) are associated with a return to activity (RTA) or vary by sports participation level (higher level vs. recreational athletes). HYPOTHESES Individual RTA would be associated with improved outcomes (ie, decreased knee symptoms, pain, function) as measured using validated PROs. Recreational participants would report lower PROs compared with higher level athletes and be less likely to RTA. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS There were 862 patients who underwent a revision ACL reconstruction (rACLR) and self-reported physical activity at any level preoperatively. Those who did not RTA reported no activity 2 years after revision. Baseline data included patient characteristics, surgical history and characteristics, and PROs: International Knee Documentation Committee questionnaire, Marx Activity Rating Scale, Knee injury and Osteoarthritis Outcome Score, and the Western Ontario and McMaster Universities Osteoarthritis Index. A binary indicator was used to identify patients with same/better PROs versus worse outcomes compared with baseline, quantifying the magnitude of change in each direction, respectively. Multivariable regression models were used to evaluate risk factors for not returning to activity, the association of 2-year PROs after rACLR surgery by RTA status, and whether each PRO and RTA status differed by participation level. RESULTS At 2 years postoperatively, approximately 15% did not RTA, with current smokers (adjusted odds ratio [aOR] = 3.3; P = .001), female patients (aOR = 2.9; P < .001), recreational participants (aOR = 2.0; P = .016), and those with a previous medial meniscal excision (aOR = 1.9; P = .013) having higher odds of not returning. In multivariate models, not returning to activity was significantly associated with having worse PROs at 2 years; however, no clinically meaningful differences in PROs at 2 years were seen between participation levels. CONCLUSION Recreational-level participants were twice as likely to not RTA compared with those participating at higher levels. Within a previously active cohort, no RTA was a significant predictor of lower PROs after rACLR. However, among patients who did RTA after rACLR, approximately 20% reported lower outcome scores. Most patients with rACLR who were active at baseline improved over time; however, patients who reported worse outcomes at 2 years had a clinically meaningful decline across all PROs.
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Affiliation(s)
| | - Erin C. Owen
- Slocum Research & Education Foundation, Eugene, OR USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tal S. David
- Synergy Specialists Medical Group, San Diego, CA USA
| | | | | | | | | | | | | | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London Ontario, Canada
| | - Sharon L. Hame
- David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | | | | | | | | | | | | | | | | | | | - Ganesh V. Kamath
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | | | | | | | | | | | | | | | - Eric C. McCarty
- University of Colorado Denver School of Medicine, Denver, CO USA
| | - Robert G. McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada
| | | | | | | | - Brett D. Owens
- Warren Alpert Medical School, Brown University, Providence, RI USA
| | | | | | | | | | | | | | | | | | | | | | - Jeffrey T. Spang
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Timothy N. Taft
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Edwin M. Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA USA
| | - Armando F. Vidal
- University of Colorado Denver School of Medicine, Denver, CO USA
| | | | | | | | | | - Brian R. Wolf
- University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - James J. York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, MD
| | - James J York
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
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12
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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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13
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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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14
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Baumgarten KM, Barthman BJ, Chang PS. The American Shoulder and Elbow Score Is Highly Correlated With the Western Ontario Rotator Cuff Index and Has Less Responder and Administrator Burden. Arthrosc Sports Med Rehabil 2021; 3:e1637-e1643. [PMID: 34977615 PMCID: PMC8689201 DOI: 10.1016/j.asmr.2021.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/12/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To compare the correlation, responsiveness, and responder and administrator burdens of the American Shoulder and Elbow Score (ASES) with the Western Ontario Rotator Cuff Index (WORC) for patients undergoing arthroscopic rotator cuff repair to determine whether one score is superior to the other to limit the use of multiple scoring measures when tracking patient outcomes. Methods A retrospective review of a database of patients undergoing arthroscopic rotator cuff repair was reviewed where the ASES was simultaneously recorded with the WORC. Correlations were determined using the Pearson coefficient. Subgroup analysis was performed to determine if correlations differed in (1) preoperative outcome and (2) postoperative outcome determinations. Responsiveness was determined by calculating the standardized response mean and the effect size of both scores. Responder and administrator burden was examined using 50 consecutively scored WORC and ASES scores by determining the number of questions accurately answered and the length of time taken to score each questionnaire. Results Correlation was excellent for the ASES and WORC (r = 0.90). The correlation of preoperative scores was strong-moderate (r = 0.69), and the correlation of postoperative scores was excellent (r = 0.86). The standardized response mean WORC = 2.3; ASES = 2.2) and the effect size (WORC = 2.9; ASES = 2.8) demonstrated comparable responsiveness. In total, 71.5% of the WORC questions were able to be scored compared with 93.3% for the ASES (P < .0001). The mean time to score the WORC was significantly greater than the ASES (154 vs 23 seconds; P < .0001). Conclusions There is excellent correlation and comparable responsiveness between the ASES and WORC. Since there is greater responder and administrative burden for the WORC score, the authors recommend using the ASES over the WORC in patients undergoing rotator cuff repair. Level of Evidence Level IV, diagnostic series.
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Affiliation(s)
- Keith M. Baumgarten
- Orthopedic Institute
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
- Address correspondence to Keith M. Baumgarten, M.D., Orthopedic Institute, 810 E 23rd St., Sioux Falls, SD 57117.
| | | | - Peter S. Chang
- Washington University Department of Orthopaedics, St. Louis, Missouri, U.S.A
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15
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Baumgarten KM. The American Shoulder and Elbow Surgeons score has excellent correlation with the Western Ontario Osteoarthritis score. J Shoulder Elbow Surg 2021; 30:2604-2610. [PMID: 33895303 DOI: 10.1016/j.jse.2021.04.011] [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] [Received: 01/25/2021] [Accepted: 04/04/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND/HYPOTHESIS The purpose of this study was to compare the correlation, responsiveness, and responder and administrator burden of the American Shoulder and Elbow Surgeons (ASES) score with the Western Ontario Osteoarthritis of the Shoulder (WOOS) score for patients undergoing total shoulder arthroplasty. The goal was to determine whether one score was superior to the other to limit the use of multiple scoring measures when tracking patient outcomes. The hypothesis of this study was that for patients undergoing total shoulder arthroplasty, the WOOS score would have (1) a high level of correlation with the ASES score, (2) comparable responsiveness to the ASES score, and (3) a higher responder and administrator burden than the ASES score. METHODS We performed a retrospective review of a database of patients undergoing total shoulder arthroplasty in which the ASES score was recorded with the WOOS score. Correlations were determined using the Pearson coefficient. Subgroup analysis was performed to determine whether correlations differed in (1) preoperative outcome and (2) postoperative outcome determinations and by type of arthroplasty (anatomic vs. reverse). Responsiveness was determined by calculating the standardized response mean and the effect size of both scores. Responder and administrator burden was examined using 50 consecutive preoperative patients to determine the number of incorrectly completed WOOS and ASES scores. RESULTS The correlation of the ASES and WOOS scores for all patients was excellent (n = 1218, r = 0.88, P < .0001). The correlation of the ASES and WOOS scores was excellent for patients undergoing anatomic total shoulder arthroplasty (n = 695, r = 0.71, P < .0001) and reverse total shoulder arthroplasty (n = 523, r = 0.88, P < .0001). The correlation of preoperative scores was strong-moderate (n = 606, r = 0.62, P < .0001), and that of postoperative scores was strong-moderate (n = 612, r = 0.69, P < .0001). The standardized response mean (WOOS score, 2.1; ASES score, 2.1) and the effect size (WOOS score, 3.0; ASES score, 3.0) demonstrated comparable responsiveness. Twenty-six percent of the WOOS scores were completed incorrectly and were invalid compared with 0% of the ASES scores (P < .0001). CONCLUSION There is excellent correlation and comparable responsiveness between the ASES score and WOOS score. Including these scores simultaneously when tracking patient-determined outcomes appears to be redundant and therefore unnecessary. Because there is higher responder and administrative burden for the WOOS score, we recommend use of the ASES score over the WOOS score in patients undergoing total shoulder arthroplasty.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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16
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Wright RW, Huston LJ, Haas AK, Pennings JS, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Brad Butler V J, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Association Between Graft Choice and 6-Year Outcomes of Revision Anterior Cruciate Ligament Reconstruction in the MARS Cohort. Am J Sports Med 2021; 49:2589-2598. [PMID: 34260326 PMCID: PMC9236596 DOI: 10.1177/03635465211027170] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although graft choice may be limited in the revision setting based on previously used grafts, most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome. HYPOTHESIS In the ACL revision setting, there would be no difference between autograft and allograft in rerupture rate and patient-reported outcomes (PROs) at 6-year follow-up. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients who had revision surgery were identified and prospectively enrolled in this cohort study by 83 surgeons over 52 sites. Data collected included baseline characteristics, surgical technique and pathology, and a series of validated PRO measures. Patients were followed up at 6 years and asked to complete the identical set of PRO instruments. Incidence of additional surgery and reoperation because of graft failure were also recorded. Multivariable regression models were used to determine the predictors (risk factors) of PROs, graft rerupture, and reoperation at 6 years after revision surgery. RESULTS A total of 1234 patients including 716 (58%) men were enrolled. A total of 325 (26%) underwent revision using a bone-patellar tendon-bone (BTB) autograft; 251 (20%), soft tissue autograft; 289 (23%), BTB allograft; 302 (25%), soft tissue allograft; and 67 (5%), other graft. Questionnaires and telephone follow-up for subsequent surgery information were obtained for 809 (66%) patients, while telephone follow-up was only obtained for an additional 128 patients for the total follow-up on 949 (77%) patients. Graft choice was a significant predictor of 6-year Marx Activity Rating Scale scores (P = .024). Specifically, patients who received a BTB autograft for revision reconstruction had higher activity levels than did patients who received a BTB allograft (odds ratio [OR], 1.92; 95% CI, 1.25-2.94). Graft rerupture was reported in 5.8% (55/949) of patients by their 6-year follow-up: 3.5% (16/455) of patients with autografts and 8.4% (37/441) of patients with allografts. Use of a BTB autograft for revision resulted in patients being 4.2 times less likely to sustain a subsequent graft rupture than if a BTB allograft were utilized (P = .011; 95% CI, 1.56-11.27). No significant differences were found in graft rerupture rates between BTB autograft and soft tissue autografts (P = .87) or between BTB autografts and soft tissue allografts (P = .36). Use of an autograft was found to be a significant predictor of having fewer reoperations within 6 years compared with using an allograft (P = .010; OR, 0.56; 95% CI, 0.36-0.87). CONCLUSION BTB and soft tissue autografts had a decreased risk in graft rerupture compared with BTB allografts. BTB autografts were associated with higher activity level than were BTB allografts at 6 years after revision reconstruction. Surgeons and patients should consider this information when choosing a graft for revision ACL reconstruction.
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Affiliation(s)
- Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura J Huston
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amanda K Haas
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacquelyn S Pennings
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christina R Allen
- Yale University, New Haven, Connecticut, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel E Cooper
- W.B. Carrell Memorial Clinic, Dallas, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas M DeBerardino
- The San Antonio Orthopaedic Group, San Antonio, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Warren R Dunn
- Texas Orthopedic Hospital, Houston, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brett Brick A Lantz
- Slocum Research and Education Foundation, Eugene, Oregon, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kurt P Spindler
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Stuart
- Mayo Clinic, Rochester, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John P Albright
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annunziato Ned Amendola
- Duke University, Durham, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jack T Andrish
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher C Annunziata
- Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bernard R Bach
- Rush University Medical Center, Chicago, Illinois, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Champ L Baker
- The Hughston Clinic, Columbus, Georgia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arthur R Bartolozzi
- 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffery R Bechler
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Geoffrey A Bernas
- State University of New York at Buffalo, Buffalo, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen F Brockmeier
- University of Virginia, Charlottesville, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert H Brophy
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles A Bush-Joseph
- Rush University Medical Center, Chicago, Illinois, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - J Brad Butler V
- Orthopedic and Fracture Clinic, Portland, Oregon, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John D Campbell
- Bridger Orthopedic and Sports Medicine, Bozeman, Montana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James E Carpenter
- University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan M Cooper
- HealthPartners Specialty Center, Saint Paul, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - R Alexander Creighton
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Diane L Dahm
- Mayo Clinic, Rochester, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David C Flanigan
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert W Frederick
- The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth A Garofoli
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sharon L Hame
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher D Harner
- University of Texas Health Center, Houston, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Norman Lindsay Harris
- Grand River Health, Rifle, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith S Hechtman
- UHZ Sports Medicine Institute, Coral Gables, Florida, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elliott B Hershman
- Lenox Hill Hospital, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rudolf G Hoellrich
- Slocum Research and Education Foundation, Eugene, Oregon, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David C Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy S Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Morgan H Jones
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher C Kaeding
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas E Klootwyk
- Methodist Sports Medicine, Indianapolis, Indiana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce A Levy
- Mayo Clinic, Rochester, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - C Benjamin Ma
- University of California, San Francisco, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - G Peter Maiers
- Methodist Sports Medicine Center, Indianapolis, Indiana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew J Matava
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gregory M Mathien
- Knoxville Orthopaedic Clinic, Knoxville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David R McAllister
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric C McCarty
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, New Westminster, British Columbia, Canada
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce S Miller
- University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel F O'Neill
- Littleton Regional Healthcare, Littleton, New Hampshire, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brett D Owens
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard D Parker
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark L Purnell
- Aspen Orthopedic Associates, Aspen, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arthur C Rettig
- Methodist Sports Medicine, Indianapolis, Indiana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin G Shea
- Intermountain Orthopaedics, Boise, Idaho, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Orrin H Sherman
- NYU Hospital for Joint Diseases, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James R Slauterbeck
- University of South Alabama, Mobile, Alabama, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew V Smith
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ltc Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joachim J Tenuta
- Albany Medical Center, Albany, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Armando F Vidal
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Darius G Viskontas
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard A White
- Fitzgibbon's Hospital, Marshall, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James S Williams
- Cleveland Clinic, Euclid, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michelle L Wolcott
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasadena, Maryland, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
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17
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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
| | -
- 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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18
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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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19
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Lindner TD, Scholten SD, Halverson JM, Baumgarten KM, Birger CB, Nowotny BG. The Acute Effects of Ischemic Preconditioning on Power and Sprint Performance. S D Med 2021; 74:210-219. [PMID: 34437779 PMCID: PMC9272512] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Ischemic preconditioning (IPC) has been shown to induce positive effects on skeletal muscle resulting in enhanced physical performance. Data display that IPC positively impacts both aerobic and anaerobic performance. However, there is inconclusive data exemplifying IPC's effects on power and sprint performance. We hypothesized 15 minutes of bilateral lower limb IPC, applied 25-45 minutes prior to power and sprint activity, would enhance power and sprint performance. METHODS Using a randomized crossover design, 14 NCAA Division II athletes received IPC (100 percent occlusion) and sham (50 mmHg) treatments followed by either a 0 minute or a 20 minute rest. A Delfi Personalized Tourniquet System (PTS) for blood flow restriction with an internal doppler radar was used to occlude blood flow to the lower extremities. Followed by IPC treatment, power and sprint performance was assessed using a vertical jump, reactive strength index (RSI), broad jump, flying 10m dash, and pro-agility. Each of the fourteen subjects in the experimental group received all four protocols. RESULTS Using an ANOVA, no statistical significance was found between the type of treatment (i.e., sham 0 min, sham 20 min, IPC 0 min, IPC 20 min) and the performance tests: vertical jump (p=0.97), RSI (p=0.73), broad jump (p=0.98), flying 10m dash (p=0.99), and pro-agility (p=0.90). In addition, no statistical significance was found between the order of treatments and the performance tests (p=0.97). CONCLUSION Despite previous research suggesting IPC enhances anaerobic and anaerobic performance, the current results indicate IPC doesn't significantly enhance power and sprint performance in highly trained athletes.
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Affiliation(s)
- Tiegen D Lindner
- Department of Exercise and Sport Sciences, Augustana University, Sioux Falls, South Dakota
| | - Shane D Scholten
- Department of Exercise and Sport Sciences, Augustana University, Sioux Falls, South Dakota
| | | | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
- The John Hopkins School of Medicine, Baltimore, Maryland
| | | | - Brett G Nowotny
- Sanford POWER Sports Physical Therapy, Sioux Falls, South Dakota
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20
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Baumgarten KM, Pfiefle BK, Chang KC. The 'Bench Rite' Orthosis Decreases Cervical Muscle Activation During the Bench Press. S D Med 2021; 74:154-157. [PMID: 34432961] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND There is little data available that examines the activation of the cervical paraspinal muscles that occurs during the bench press. It is intuitive that activation of these muscles may lead to increased loads across the cervical spine and may increase the risk of injury to the intervertebral disks of the cervical spine. HYPOTHESIS The hypothesis of this study is that by supporting the cervical spine with the "Bench Rite" cervical spine orthosis, there will be less muscular activation of the cervical paraspinal muscles as determined by electromyography when performing the bench press. STUDY DESIGN Comparative electromyographic study - Level of evidence III (case-control study). METHODS Fifteen healthy subjects performed two sets (with and without the cervical orthosis) of five repetitions of a 60 percent maximum repetition on the bench press for each muscle group tested (pectoralis major, deltoid, C5 paraspinal, trapezius). Electromyography was used to determine the maximum isometric contraction and concentric contraction of each muscle with and without the cervical orthosis. The concentric contraction of each muscle group was reported as a percentage of maximum voluntary isometric contraction. RESULTS The use of the "Bench Rite" cervical spine orthosis resulted in a statistically significant decrease in muscle activation in the C5 paraspinal (37 percent; p=0.0001) and deltoid muscles (9.8 percent; p=0.001) and a significant increase in trapezius muscle activation (9.3 percent; p=0.03). No differences were found in muscle activation of the pectoralis major with or without the use of the cervical spine orthosis (0.8 percent; p=0.90). CONCLUSIONS Weightlifters may consider utilizing the "Bench Rite" cervical orthosis while performing the bench press to decrease cervical paraspinal muscle activation without impacting the muscle activation of the pectoralis major.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | | | - K C Chang
- Orthopedic Institute, Sioux Falls, South Dakota
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21
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Grusky AZ, Song A, Kim P, Ayers GD, Higgins LD, Kuhn JE, Baumgarten KM, Matzkin E, Jain NB. Factors Associated With Symptomatic Rotator Cuff Tears: The Rotator Cuff Outcomes Workgroup Cohort Study. Am J Phys Med Rehabil 2021; 100:331-336. [PMID: 33443862 PMCID: PMC7969413 DOI: 10.1097/phm.0000000000001684] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although rotator cuff tear is one of the most common musculoskeletal disorders, its etiology is poorly understood. We assessed factors associated with the presence of rotator cuff tears in a cohort of patients with shoulder pain. DESIGN From February 2011 to July 2016, a longitudinal cohort of patients with shoulder pain was recruited. Patients completed a detailed questionnaire in addition to a magnetic resonance imaging scan and a clinical shoulder evaluation. The association of multiple factors associated with rotator cuff tears was assessed using multivariate logistic regression. RESULTS In our cohort of 266 patients, 61.3% of patients had a rotator cuff tear. Older age (per 1 yr: odds ratio = 1.03, 95% confidence interval = 1.02-1.07), involvement of the dominant shoulder (odds ratio = 2.02, 95% confidence interval = 1.16-3.52), and a higher body mass index (per 1 kg/m2: odds ratio = 1.06, 95% confidence interval = 1.03-1.12) were independently associated with rotator cuff tears. Sex, depression, smoking status, shoulder use at work, hypertension, and diabetes were not significantly associated with rotator cuff tear. CONCLUSIONS In a cohort of patients with shoulder pain, we identified older age, involvement of the dominant shoulder, and a higher body mass index to be independently associated with rotator cuff tear. The mechanism of how these factors possibly lead to rotator cuff tears needs further research. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Identify factors associated with an increased risk of developing rotator cuff tears in adults; (2) Describe the current epidemiological trends of rotator cuff tears in the United States; and (3) Discuss the pathophysiological role of aging in the development of nontraumatic rotator cuff tears. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
| | - Amos Song
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | | | - Gregory D. Ayers
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | | | - John E. Kuhn
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | | | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Nitin B. Jain
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
- Departments of Physical Medicine and Rehabilitation, Orthopaedics, and Population & Data Sciences, University of Texas Southwestern
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22
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Brophy RH, Wright RW, Huston LJ, Haas AK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Bush-Joseph CA, Butler JBV, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Alexander Creighton R, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Benjamin Ma C, Peter Maiers G, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Li X, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Rate of infection following revision anterior cruciate ligament reconstruction and associated patient- and surgeon-dependent risk factors: Retrospective results from MOON and MARS data collected from 2002 to 2011. J Orthop Res 2021; 39:274-280. [PMID: 33002248 PMCID: PMC7854959 DOI: 10.1002/jor.24871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/23/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 02/04/2023]
Abstract
Infection is a rare occurrence after revision anterior cruciate ligament reconstruction (rACLR). Because of the low rates of infection, it has been difficult to identify risk factors for infection in this patient population. The purpose of this study was to report the rate of infection following rACLR and assess whether infection is associated with patient- and surgeon-dependent risk factors. We reviewed two large prospective cohorts to identify patients with postoperative infections following rACLR. Age, sex, body mass index (BMI), smoking status, history of diabetes, and graft choice were recorded for each patient. The association of these factors with postoperative infection following rACLR was assessed. There were 1423 rACLR cases in the combined cohort, with 9 (0.6%) reporting postoperative infections. Allografts had a higher risk of infection than autografts (odds ratio, 6.8; 95% CI, 0.9-54.5; p = .045). Diabetes (odds ratio, 28.6; 95% CI, 5.5-149.9; p = .004) was a risk factor for infection. Patient age, sex, BMI, and smoking status were not associated with risk of infection after rACLR.
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Affiliation(s)
- Robert H Brophy
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | | | - Amanda K Haas
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Christina R Allen
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | | | - Arthur R Bartolozzi
- Bat Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | | | | | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA
| | | | | | | | | | - John D Campbell
- Bridger Orthopedic and Sports Medicine, Bozeman, Montana, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | | | | | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA
| | | | - Robert W Frederick
- The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | - Sharon L Hame
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | | | | | - Timothy M Hosea
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
| | | | | | | | | | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | | | | | | | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | - Eric C McCarty
- School of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada
| | | | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | | | - Brett D Owens
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | | | | | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA
| | | | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Xulei Li
- Vanderbilt University, Nashville, Tennessee, USA
| | - James R Slauterbeck
- Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Matthew V Smith
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Ltc Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA, USA
| | - Armando F Vidal
- School of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | | | | | | | - Michelle L Wolcott
- School of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa, Iowa, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA
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23
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Baumgarten KM, Chang PS, Schweinle WE. Does the Presence of Chondral Lesions Negatively Affect Patient-Determined Outcomes After Arthroscopic Rotator Cuff Repair? Orthop J Sports Med 2020; 8:2325967120957993. [PMID: 33173799 PMCID: PMC7588774 DOI: 10.1177/2325967120957993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/07/2020] [Indexed: 11/30/2022] Open
Abstract
Background: There are limited data available to guide patients to their prognosis when
glenohumeral chondral lesions are found during arthroscopic rotator cuff
repair. Hypothesis: The primary hypothesis was that patients with glenohumeral chondral lesions
will have inferior outcomes after arthroscopic rotator cuff repair compared
with patients without chondral lesions. The secondary hypothesis was that
patients with concomitant chondral lesions will have more severe
preoperative symptoms compared with those without chondral lesions. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis was performed of patients who underwent arthroscopic
rotator cuff repair between 2008 and 2012. We examined the effects of
chondral lesions on patient-determined outcomes, which included the Western
Ontario Rotator Cuff Index (WORC), American Shoulder and Elbow Surgeons
(ASES) score, Simple Shoulder Test (SST), Single Assessment Numeric
Evaluation (SANE), and the Shoulder Activity Level (SAL). Shoulders without
chondral lesions were compared with shoulders with chondral lesions to
determine whether differences in severity of preoperative symptoms as well
as postoperative improvements were statistically significant. Results: A total of 281 shoulders were included from 273 patients, with a mean
follow-up of 3.7 years. In total, 90 shoulders (32%) had concomitant
chondral lesions in the glenohumeral joint. The presence and degree of
chondral damage were not associated with the severity of preoperative
symptoms or the amount of improvement after arthroscopic rotator cuff
repair, as determined by patient outcome scores. Shoulders with bipolar
chondral lesions had less postoperative improvement in their outcome scores
compared with shoulders with unipolar lesions, with significant differences
found in the SST (P = .0005), the SANE (P
= .005), and the SAL (P = .04). Regardless of this, the
majority of shoulders with bipolar chondral lesions (80%-92%) had
postoperative improvements that superseded the minimal clinically important
difference of the ASES, WORC, and SANE. Conclusion: At a mean 3.7-year follow-up, the presence of chondral damage did not appear
to negatively affect the improvement in patient-determined outcomes after
arthroscopic rotator cuff repair. However, improvement in outcomes was
negatively affected by the presence of bipolar chondral lesions.
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Affiliation(s)
- Keith M. Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA
- University of South Dakota Sanford School of Medicine, Sioux Falls,
South Dakota, USA
- Keith M. Baumgarten, MD, Orthopedic Institute, 810 E 23rd
Street, Sioux Falls, SD 57117, USA ()
(Twitter: @DrBaumgarten)
| | - Peter S. Chang
- Washington University School of Medicine, St. Louis, Missouri,
USA
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24
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Baumgarten KM. Patient-Determined Outcomes After Arthroscopic Margin Convergence Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2020; 2:e517-e522. [PMID: 33134989 PMCID: PMC7588634 DOI: 10.1016/j.asmr.2020.05.017] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/29/2020] [Indexed: 10/28/2022] Open
Abstract
Purpose To determine whether patients who require margin convergence would have equivalent postsurgical patient-determined scores compared with patients with standard rotator cuff repair. The secondary purpose of this study was to determine whether the short-term results found for patients with margin convergence repairs would be durable through medium-term follow-up. Methods A retrospective analysis of patients undergoing arthroscopic rotator cuff repair was performed to examine the effects of marginal convergence on patient-determined outcomes (Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, Single Assessment Numeric Evaluation, and Shoulder Activity Level). Patient-determined outcomes in patients who had margin convergence repairs were compared with patients who had standard rotator cuff repair. Prospective follow-up of patients that had margin convergence repairs was performed to determine whether patient-determined outcomes deteriorated over time. Results Two-hundred-seventy-two patients had standard rotator cuff repairs and 9 patients had margin convergence rotator cuff repair (3.2%). All patients had significant improvements in their Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and Single Assessment Numeric Evaluation. Patients requiring margin convergence rotator cuff repair had similar preoperative and postoperative scores compared with patients with a standard rotator cuff repair. At a mean follow-up of 7.5 years, there was no change in outcome scores compared with the early follow-up time point (mean 3.3 years) for patients undergoing margin convergence. Conclusions Arthroscopic margin convergence repair techniques along with the treatment of concomitant pathologies result in similar patient-determined outcomes compared with standard rotator cuff repair techniques. These results appear to be durable and do not deteriorate from short-term to medium-term follow-up. Level of evidence III: Retrospective comparative study.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute; and University of South Dakota Sanford School of Medicine. Sioux Falls, South Dakota, U.S.A
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25
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Wright RW, Huston LJ, Haas AK, Nwosu SK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Pennings JS, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Steven J Svoboda L, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: Results From the MARS Cohort. Am J Sports Med 2020; 48:2978-2985. [PMID: 32822238 PMCID: PMC8171059 DOI: 10.1177/0363546520948850] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal preservation has been demonstrated to contribute to long-term knee health. This has been a successful intervention in patients with isolated tears and tears associated with anterior cruciate ligament (ACL) reconstruction. However, the results of meniscal repair in the setting of revision ACL reconstruction have not been documented. PURPOSE To examine the prevalence and 2-year operative success rate of meniscal repairs in the revision ACL setting. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS All cases of revision ACL reconstruction with concomitant meniscal repair from a multicenter group between 2006 and 2011 were selected. Two-year follow-up was obtained by phone and email to determine whether any subsequent surgery had occurred to either knee since the initial revision ACL reconstruction. If so, operative reports were obtained, whenever possible, to verify the pathologic condition and subsequent treatment. RESULTS In total, 218 patients (18%) from 1205 revision ACL reconstructions underwent concurrent meniscal repairs. There were 235 repairs performed: 153 medial, 48 lateral, and 17 medial and lateral. The majority of these repairs (n = 178; 76%) were performed with all-inside techniques. Two-year surgical follow-up was obtained on 90% (197/218) of the cohort. Overall, the meniscal repair failure rate was 8.6% (17/197) at 2 years. Of the 17 failures, 15 were medial (13 all-inside, 2 inside-out) and 2 were lateral (both all-inside). Four medial failures were treated in conjunction with a subsequent repeat revision ACL reconstruction. CONCLUSION Meniscal repair in the revision ACL reconstruction setting does not have a high failure rate at 2-year follow-up. Failure rates for medial and lateral repairs were both <10% and consistent with success rates of primary ACL reconstruction meniscal repair. Medial tears underwent reoperation for failure at a significantly higher rate than lateral tears.
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26
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Baumgarten KM, Schweinle WE, Chang PS. Do patients who smoke tobacco have success with primary arthroscopic rotator cuff repair? A comparison with nonsmokers. J Shoulder Elbow Surg 2020; 29:1650-1655. [PMID: 32245726 DOI: 10.1016/j.jse.2019.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 10/29/2019] [Revised: 12/18/2019] [Accepted: 12/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is recommended that patients cease smoking before rotator cuff repair. However, not all patients want to or are able to successfully cease smoking. This raises the question if these patients should be advised to pursue surgical intervention or if surgery should be contraindicated until patients successfully cease smoking. METHODS A retrospective analysis of patients undergoing rotator cuff repair was performed to examine the effects of smoking tobacco on patient-determined outcomes (Western Ontario Rotator Cuff Index [WORC], American Shoulder and Elbow Surgeons score [ASES], Simple Shoulder Test [SST], and Single Assessment Numeric Evaluation [SANE]). Patients who smoked tobacco at the time of surgery were compared with patients who were not smoking to determine if differences in (1) severity of preoperative and postoperative symptoms and (2) the postoperative improvements were statistically significant. RESULTS Thirty-one patients were smokers and 205 were nonsmokers. Preoperative scores were worse for smokers compared with nonsmokers: WORC (32 vs. 43; P = .0002), ASES (32 vs. 43; P = .001), SST (3.5 vs. 4.6; P = .04), and SANE (34 vs. 38; P = .35). Postoperative scores were worse for smokers compared with nonsmokers: WORC (79 vs. 89; P = .001), ASES (82 vs. 89; P = .04), SST (9.0 vs. 10.2; P = .02), and SANE (84 vs. 89; P = .09). There were no significant differences in change in scores over time or percentage of patients achieving the minimal clinically important difference of the score between groups. CONCLUSIONS From examining the patients' subjective patient-determined outcome scores, it does not appear that rotator cuff repair should be strictly contraindicated in active smokers. Postoperative improvements in smokers were similar to nonsmokers. Smokers have lower baseline preoperative and postoperative outcome scores compared with nonsmokers.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
| | | | - Peter S Chang
- Department of Orthopaedics, Washington University, St. Louis, MO, USA
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27
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Song A, DeClercq J, Ayers GD, Higgins LD, Kuhn JE, Baumgarten KM, Matzkin E, Jain NB. Comparative Time to Improvement in Nonoperative and Operative Treatment of Rotator Cuff Tears. J Bone Joint Surg Am 2020; 102:1142-1150. [PMID: 32618921 PMCID: PMC7508291 DOI: 10.2106/jbjs.19.01112] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Comparative time to recovery after operative and nonoperative treatment for rotator cuff tears is an important consideration for patients. Hence, we compared the time to achieve clinically meaningful reduction in shoulder pain and function after treatment. METHODS From February 2011 to June 2015, a multicenter cohort of patients with rotator cuff tears undergoing operative or nonoperative treatment was recruited. After propensity score weighting, the Kaplan-Meier method was used to estimate the time to achieve a minimal clinically important difference (MCID), >30% reduction, and >50% reduction in the Shoulder Pain and Disability Index (SPADI) and the American Shoulder and Elbow Surgeons (ASES) scores. (In our analysis, both ASES and SPADI were coded such that a lower number corresponded to a better outcome; thus, the word "reduction" was used to indicate improvement in both ASES and SPADI scores.) A 2-stage test was conducted to detect a difference between the 2 groups. RESULTS In this cohort, 96 patients underwent nonoperative treatment and 73 patients underwent a surgical procedure. The surgical treatment group and the nonoperative treatment group were significantly different with respect to SPADI and ASES scores (p < 0.05). The maximum difference between groups in achievement of the MCID for the SPADI scores was at 3.25 months, favoring the nonoperative treatment group. The probability to achieve the MCID was 0.06 (95% confidence interval [CI], 0.00 to 0.12) for the surgical treatment group compared with 0.40 (95% CI, 0.29 to 0.50) for the nonoperative treatment group. The surgical treatment group had a greater probability of achieving >50% reduction in SPADI scores at 15.49 months (0.20 [95% CI, 0.12 to 0.29] for the surgical treatment group compared with 0.04 [95% CI, 0.00 to 0.09] for the nonoperative treatment group). The surgical treatment group had a greater probability of achieving >50% reduction in ASES scores at 24.74 months (0.96 [95% CI, 0.84 to 0.99] for the surgical treatment group compared with 0.66 [95% CI, 0.53 to 0.75] for the nonoperative treatment group). The differences for >30% reduction in SPADI and ASES scores and the MCID for ASES scores were not significant. CONCLUSIONS Patients undergoing nonoperative treatment had significantly better outcomes in the initial follow-up period compared with patients undergoing a surgical procedure, but this trend reversed in the longer term. These data can be used to inform expectations for nonoperative and operative treatments for rotator cuff tears. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Amos Song
- Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joshua DeClercq
- Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory D. Ayers
- Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - John E. Kuhn
- Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nitin B. Jain
- Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee,Email address for N.B. Jain:
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28
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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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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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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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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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Jain NB, Ayers GD, Fan R, Kuhn JE, Warner JJ, Baumgarten KM, Matzkin E, Higgins LD. Comparative Effectiveness of Operative Versus Nonoperative Treatment for Rotator Cuff Tears: A Propensity Score Analysis From the ROW Cohort. Am J Sports Med 2019; 47:3065-3072. [PMID: 31518155 PMCID: PMC7325686 DOI: 10.1177/0363546519873840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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 The evidence to support operative versus nonoperative treatment for rotator cuff tears is sparse and inconclusive. PURPOSE To assess pain and functional outcomes in patients undergoing operative and nonoperative treatments for rotator cuff tears. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS From March 2011 to February 2015, a multicenter cohort of patients with rotator cuff tears undergoing operative and nonoperative treatments was recruited. Patients completed a detailed history questionnaire, the Shoulder Pain and Disability Index (SPADI), and the American Shoulder and Elbow Surgeons (ASES) standardized form and underwent magnetic resonance imaging. In addition to baseline assessments, patients received follow-up questionnaires at 3, 6, 12, and 18 months. Propensity score weighting was used to balance differences in characteristics of the operative and nonoperative groups. RESULTS Adjusted for propensity scores, the operative (n = 50) and nonoperative (n = 77) groups had similar characteristics, as evidenced by the small standardized mean differences between the groups. Adjusted mean differences in the SPADI and ASES scores between the operative and nonoperative groups were -22.0 points (95% CI, -32.1 to -11.8) and -22.2 points (95% CI, -32.8 to -11.6) at 18 months, respectively. The operative group had a significantly higher proportion of patients who showed ≥30% (P = .002) and ≥50% (P < .0001) improvement in SPADI and ASES scores as compared with the nonoperative group. CONCLUSION In this prospective cohort study, patients undergoing operative treatment had significantly better pain and functional outcomes as compared with patients undergoing nonoperative treatment for rotator cuff tears. Differences between the 2 groups in SPADI and ASES scores at the 6- to 18-month time points met the minimal clinically important difference (depending on the threshold used). A large randomized controlled trial is needed to answer this question more definitively.
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Affiliation(s)
- Nitin B. Jain
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Gregory D. Ayers
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Run Fan
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - John E. Kuhn
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Jon J.P. Warner
- Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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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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Dabija DI, Pennings JS, Archer KR, Ayers GD, Higgins LD, Kuhn JE, Baumgarten KM, Matzkin E, Jain NB. Which Is the Best Outcome Measure for Rotator Cuff Tears? Clin Orthop Relat Res 2019; 477:1869-1878. [PMID: 31335605 PMCID: PMC7000030 DOI: 10.1097/corr.0000000000000800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 04/11/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The American Shoulder and Elbow Surgeons Standardized Shoulder Form (ASES), the Shoulder Pain and Disability Index (SPADI), and the shortened Disability of the Arm, Shoulder, and Hand (quickDASH) are patient-reported upper extremity-specific outcome scales currently used to evaluate patients with rotator cuff tears. This heterogeneity does not allow for a uniform metric for research and patient care. QUESTIONS/PURPOSES Our objective was to determine psychometric properties (reliability, convergent and discriminant validity, and responsiveness) of five commonly used outcome instruments (the ASES, the SPADI, the quickDASH, the SF-12, and the EuroQol-5D) in a longitudinal study of patients undergoing treatment for rotator cuff tears. METHODS From February 2011 through June 2015, 120 patients completed a standardized history, the five outcome scales under study, a physical examination, and an MRI. Of these, 47 (39%) were lost to followup before 18 months, and another 24 (20%) were accounted for at 18 months but had missing data at one or more of the earlier prespecified followup intervals (3, 6, or 12 months). Reliability (the reproducibility of an outcome instrument between subjects; tested by Cronbach's alpha), convergent and discriminant validity (determining which outcome measures correlate most strongly with others; tested by Spearman's correlation coefficients), and responsiveness (the change in outcome scales over time based on percent improvement in shoulder functionality using the minimal clinically important difference [MCID] and the subjective shoulder value) were calculated. RESULTS All outcomes measures had a Cronbach's alpha above 0.70 (range, 0.74-0.94) and therefore were considered reliable. Convergent validity was demonstrated as the upper extremity-specific measures (SPADI, ASES, and quickDASH) were more strongly correlated with each other (rho = 0.74-0.81; p < 0.001) than with any of the other measures. Discriminant validity was demonstrated because the Spearman's correlation coefficients were stronger for the relationships between upper extremity measures compared with the correlations between upper extremity measures and general health measures for 53 of the 54 correlations that were compared. Both internal and external responsiveness of the measures was supported. Patients who achieved the MCID and at least a 30% change on the subjective shoulder value had more positive change in scores over time compared with those who did not. Mixed model linear regressions revealed that all three upper extremity-specific measures had a group by time interaction for the MCID, indicating that patients who achieved the MCID had greater change over time compared with those who did not achieve the MCID. Results showed that the measure with the best discrimination between groups, or best internal responsiveness, was the ASES (beta = -8.26, 95% confidence interval [CI], -11.39 to -5.14; p < 0.001; η = 0.089) followed by the SPADI (beta = 6.88, 95% CI, 3.78-9.97; p < 0.001; η = 0.088) then the quickDASH (beta = 3.43, 95% CI, 0.86-6.01; p = 0.009, η = 0.027). Measures with the best external responsiveness followed the same pattern of results. CONCLUSIONS All the upper extremity-specific scales had acceptable psychometric properties. Correlations were high and thus only one upper extremity-specific instrument is needed for outcome assessment. Given the overall psychometric assessment, we recommend SPADI be the shoulder-specific instrument used to assess outcomes in patients with rotator cuff tears. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Dominique I Dabija
- D. I. Dabija, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA J. S. Pennings, K. R. Archer, J. E. Kuhn, N. B. Jain, Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA K. R. Archer, N. B. Jain, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA G. D. Ayers, Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA L. D. Higgins, E. Matzkin, Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA K. M. Baumgarten, Orthopedic Institute, Sioux Falls, SD, USA
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Wright RW, Huston LJ, Haas AK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Nwosu SK, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Brad Butler V J, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Predictors of Patient-Reported Outcomes at 2 Years After Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:2394-2401. [PMID: 31318611 PMCID: PMC7335592 DOI: 10.1177/0363546519862279] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are a valid measure of results after revision anterior cruciate ligament (ACL) reconstruction. Revision ACL reconstruction has been documented to have worse outcomes when compared with primary ACL reconstruction. Understanding positive and negative predictors of PROs will allow surgeons to modify and potentially improve outcome for patients. PURPOSE/HYPOTHESIS The purpose was to describe PROs after revision ACL reconstruction and test the hypothesis that patient- and technique-specific variables are associated with these outcomes. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons over 52 sites. Data included baseline demographics, surgical technique and pathology, and a series of validated PRO instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale. Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Multivariate regression models were used to control for a variety of demographic and surgical factors to determine the positive and negative predictors of PRO scores at 2 years after revision surgery. RESULTS A total of 1205 patients met the inclusion criteria and were successfully enrolled: 697 (58%) were male, with a median cohort age of 26 years. The median time since their most recent previous ACL reconstruction was 3.4 years. Two-year questionnaire follow-up was obtained from 989 patients (82%). The most significant positive predictors of 2-year IKDC scores were a high baseline IKDC score, high baseline Marx activity level, male sex, and having a longer time since the most recent previous ACL reconstruction, while negative predictors included having a lateral meniscectomy before the revision ACL reconstruction or having grade 3/4 chondrosis in either the trochlear groove or the medial tibial plateau at the time of the revision surgery. For KOOS, having a high baseline score and having a longer time between the most recent previous ACL reconstruction and revision surgery were significant positive predictors for having a better (ie, higher) 2-year KOOS, while having a lateral meniscectomy before the revision ACL reconstruction was a consistent predictor for having a significantly worse (ie, lower) 2-year KOOS. Statistically significant positive predictors for 2-year Marx activity levels included higher baseline Marx activity levels, younger age, male sex, and being a nonsmoker. Negative 2-year activity level predictors included having an allograft or a biologic enhancement at the time of revision surgery. CONCLUSION PROs after revision ACL reconstruction are associated with a variety of patient- and surgeon-related variables. Understanding positive and negative predictors of PROs will allow surgeons to guide patient expectations as well as potentially improve outcomes.
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Bigouette JP, Owen EC, Lantz B(BA, Hoellrich RG, Huston LJ, Haas AK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Mann B, Spindler KP, Stuart MJ, Wright RW, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Relationship Between Sports Participation After Revision Anterior Cruciate Ligament Reconstruction and 2-Year Patient-Reported Outcome Measures. Am J Sports Med 2019; 47:2056-2066. [PMID: 31225999 PMCID: PMC6939628 DOI: 10.1177/0363546519856348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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 Anterior cruciate ligament (ACL) revision cohorts continually report lower outcome scores on validated knee questionnaires than primary ACL cohorts at similar time points after surgery. It is unclear how these outcomes are associated with physical activity after physician clearance for return to recreational or competitive sports after ACL revision surgery. HYPOTHESES Participants who return to either multiple sports or a singular sport after revision ACL surgery will report decreased knee symptoms, increased activity level, and improved knee function as measured by validated patient-reported outcome measures (PROMs) and compared with no sports participation. Multisport participation as compared with singular sport participation will result in similar increased PROMs and activity level. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 1205 patients who underwent revision ACL reconstruction were enrolled by 83 surgeons at 52 clinical sites. At the time of revision, baseline data collected included the following: demographics, surgical characteristics, previous knee treatment and PROMs, the International Knee Documentation Committee (IKDC) questionnaire, Marx activity score, Knee injury and Osteoarthritis Outcome Score (KOOS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A series of multivariate regression models were used to evaluate the association of IKDC, KOOS, WOMAC, and Marx Activity Rating Scale scores at 2 years after revision surgery by sports participation category, controlling for known significant covariates. RESULTS Two-year follow-up was obtained on 82% (986 of 1205) of the original cohort. Patients who reported not participating in sports after revision surgery had lower median PROMs both at baseline and at 2 years as compared with patients who participated in either a single sport or multiple sports. Significant differences were found in the change of scores among groups on the IKDC (P < .0001), KOOS-Symptoms (P = .01), KOOS-Sports and Recreation (P = .04), and KOOS-Quality of Life (P < .0001). Patients with no sports participation were 2.0 to 5.7 times more likely than multiple-sport participants to report significantly lower PROMs, depending on the specific outcome measure assessed, and 1.8 to 3.8 times more likely than single-sport participants (except for WOMAC-Stiffness, P = .18), after controlling for known covariates. CONCLUSION Participation in either a single sport or multiple sports in the 2 years after ACL revision surgery was found to be significantly associated with higher PROMs across multiple validated self-reported assessment tools. During follow-up appointments, surgeons should continue to expect that patients who report returning to physical activity after surgery will self-report better functional outcomes, regardless of baseline activity levels.
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Affiliation(s)
| | - John P. Bigouette
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Erin C. Owen
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Brett (Brick) A. Lantz
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Rudolf G. Hoellrich
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Laura J. Huston
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Amanda K. Haas
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Christina R. Allen
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Allen F. Anderson
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Daniel E. Cooper
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Thomas M. DeBerardino
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Warren R. Dunn
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Barton Mann
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Kurt P. Spindler
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Michael J. Stuart
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Rick W. Wright
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - John P. Albright
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | | | - Jack T. Andrish
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | | | - Robert A. Arciero
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Bernard R. Bach
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Champ L. Baker
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Arthur R. Bartolozzi
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Keith M. Baumgarten
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jeffery R. Bechler
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jeffrey H. Berg
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Geoffrey A. Bernas
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Stephen F. Brockmeier
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Robert H. Brophy
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Charles A. Bush-Joseph
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - J. Brad Butler
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - John D. Campbell
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James L. Carey
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James E. Carpenter
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Brian J. Cole
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jonathan M. Cooper
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Charles L. Cox
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - R. Alexander Creighton
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Diane L. Dahm
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Tal S. David
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - David C. Flanigan
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Robert W. Frederick
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Theodore J. Ganley
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Elizabeth A. Garofoli
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Charles J. Gatt
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Steven R. Gecha
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James Robert Giffin
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Sharon L. Hame
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jo A. Hannafin
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Christopher D. Harner
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Norman Lindsay Harris
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Keith S. Hechtman
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Elliott B. Hershman
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Timothy M. Hosea
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - David C. Johnson
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Timothy S. Johnson
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Morgan H. Jones
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Christopher C. Kaeding
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Ganesh V. Kamath
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Thomas E. Klootwyk
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Bruce A. Levy
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - C. Benjamin Ma
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - G. Peter Maiers
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Robert G. Marx
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Matthew J. Matava
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Gregory M. Mathien
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - David R. McAllister
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Eric C. McCarty
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Robert G. McCormack
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Bruce S. Miller
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Carl W. Nissen
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Daniel F. O’Neill
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Brett D. Owens
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Richard D. Parker
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Mark L. Purnell
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Arun J. Ramappa
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Michael A. Rauh
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Arthur C. Rettig
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jon K. Sekiya
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Kevin G. Shea
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Orrin H. Sherman
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James R. Slauterbeck
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Matthew V. Smith
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jeffrey T. Spang
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Steven J. Svoboda
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Timothy N. Taft
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Joachim J. Tenuta
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Edwin M. Tingstad
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Armando F. Vidal
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Darius G. Viskontas
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Richard A. White
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James S. Williams
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Michelle L. Wolcott
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Brian R. Wolf
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James J. York
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
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Baumgarten KM, Chang PS, Foley EK. Patient-determined outcomes after arthroscopic rotator cuff repair with and without biceps tenodesis utilizing the PITT technique. J Shoulder Elbow Surg 2019; 28:1049-1055. [PMID: 30981549 DOI: 10.1016/j.jse.2019.01.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/04/2018] [Revised: 01/20/2019] [Accepted: 01/27/2019] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND BACKGROUND The percutaneous intra-articular transtendon technique (PITT) is a simple, rapid, and low-cost method of performing a biceps tenodesis. Few studies exist that examine the patient-determined outcomes of this technique in general or in patients undergoing arthroscopic rotator cuff repair (RCR) with and without biceps tenodesis. We hypothesized that patients undergoing an isolated arthroscopic RCR would have equivalent outcomes to those undergoing RCRs with PITT biceps tenodesis. METHODS We compared preoperative, patient-determined outcomes scores on patients undergoing primary arthroscopic RCR with and without a PITT biceps tenodesis with postoperative scores at a minimum of 2 years. These scores included the Western Ontario Rotator Cuff score (WORC), American Shoulder and Elbow Surgeons score (ASES), Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test (SST), and Shoulder Activity Level (SAL). Indication for a concomitant biceps tenodesis was a partial long head biceps tendon tear or biceps instability/subluxation. RESULTS A total of 153 patients underwent an isolated RCR and 131 patients underwent RCR with biceps tenodesis (RCRBT). Both groups had improvements in WORC, ASES, SANE, and SST (P < .0001) and deteriorations in the SAL (P ≤ .005). There was no difference in the change in outcome scores between the groups (RCRBT vs. RCR, respectively) for WORC (46 vs. 47; P = .85), ASES (46 vs. 47; P = .82), SANE (53 vs. 51; P = .35), SST (5.8 vs. 5.8; P = .93), and SAL (-0.9 vs. -1.4; P = .46). There was no difference between the groups in complications that required revision surgery (1.5% vs. 1.3%; P = .91). CONCLUSIONS Arthroscopic PITT RCRBT is safe and effective with equivalent patient-determined outcomes compared with patients undergoing RCR without biceps tenodesis.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Vermillion, SD, USA.
| | - Peter S Chang
- University of South Dakota Sanford School of Medicine, Vermillion, SD, USA
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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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Dickinson RN, Ayers GD, Archer KR, Fan R, Page C, Higgins LD, Kuhn JE, Baumgarten KM, Matzkin E, Jain NB. Physical therapy versus natural history in outcomes of rotator cuff tears: the Rotator Cuff Outcomes Workgroup (ROW) cohort study. J Shoulder Elbow Surg 2019; 28:833-838. [PMID: 30553798 PMCID: PMC9186215 DOI: 10.1016/j.jse.2018.10.001] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND We compared the outcomes of patients who performed physical therapy versus those who did not in a longitudinal cohort of patients undergoing nonoperative treatment of rotator cuff tears. We also assessed whether there was a dose effect in which the pain and functional outcomes in patients performing physical therapy plateaued. METHODS From February 2011 to June 2015, a multicenter cohort of patients with rotator cuff tears undergoing nonoperative treatment completed a detailed health and demographic questionnaire and the Shoulder Pain and Disability Index (SPADI) at baseline and 3, 6, 12, and 18 months. Longitudinal mixed models were used to assess whether physical therapy in the first 3 months predicted SPADI scores and dose effect. RESULTS Among the 55 patients in our cohort, the performance of physical therapy within the first 3 months predicted better SPADI scores versus nonperformance of physical therapy at 3 months (P = .02). Scores were similar between groups at 6, 12, and 18 months. A threshold of 16 physical therapy sessions was observed for pain and functional improvement during follow-up, after which significant improvement was not seen. CONCLUSIONS Patients who performed physical therapy within the first 3 months had statistically significant improvements in pain and function as measured by the SPADI score at 3 months compared with patients who did not report performing physical therapy. Depending on the minimal clinically important difference used for the SPADI score, our results could be interpreted as meeting the minimal clinically important difference threshold or not. Improvement in outcomes was observed up to 16 sessions of physical therapy, after which outcomes plateaued.
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Affiliation(s)
- Rebecca N. Dickinson
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gregory D. Ayers
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kristin R. Archer
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Run Fan
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Cristina Page
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Laurence D. Higgins
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - John E. Kuhn
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Nitin B. Jain
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA,Reprint requests: Nitin B. Jain, MD, MSPH, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 Children’s Way, Ste 1318, Nashville, TN 37212, USA. (N.B. Jain)
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Abboud JA, Jamgochian GC, Romeo AA, Nagda S, Edwards TB, Baumgarten KM, Pinto M, Cordasco FA, Beach W, Bushnell BD, Schlegel T. A prospective study assessing the political advocacy of American Shoulder and Elbow Surgeons members. J Shoulder Elbow Surg 2019; 28:802-807. [PMID: 30553797 DOI: 10.1016/j.jse.2018.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/04/2018] [Revised: 09/17/2018] [Accepted: 09/22/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study assessed the current political standings and active political engagement of American Shoulder and Elbow Surgeons (ASES) members along with the political process as it relates to health care policy. METHODS This survey study involved 552 ASES members. The survey was open for 2 weeks. Responses were received from 254 of the 552 members (46%), and their answers were analyzed. RESULTS Six (2%) of the responding members were solo practitioners, 100 (39%) belonged to a private practice, 106 (42%) were providers at academic institutions or residency training programs, 25 (10%) were employed by a hospital, and 17 (7%) categorized themselves as other. Email was the preferred method of communication. Of all responding members, 110 (43%) stated they had contributed to the American Academy of Orthopaedic Surgery Political Advocacy Committee in the last 12 months. Four (10%) of the responding members have a relationship with an elected official, and 220 (87%) would be willing to become a key contact and reach out to a legislator. CONCLUSION Moving forward, this survey can be used to better shape the political advocacy efforts of the ASES and potentially other subspecialty societies. The response that "a high percentage of members would like to be more involved" suggests the need for a program to help further educate and facilitate the membership on political advocacy.
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Baumgarten KM, Chang PS, Dannenbring TM, Foley EK. Does arthroscopic rotator cuff repair improve patients' activity levels? J Shoulder Elbow Surg 2018; 27:2167-2174. [PMID: 29880446 DOI: 10.1016/j.jse.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/05/2018] [Revised: 04/09/2018] [Accepted: 04/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff repair decreases pain, improves range of motion, and increases strength. Whether these improvements translate to an improvement in a patient's activity level postoperatively remains unknown. The Shoulder Activity Level is a valid and reliable outcomes survey that can be used to measure a patient's shoulder-specific activity level. Currently, there are no studies that examine the effect of rotator cuff repair on shoulder activity level. METHODS Preoperative patient-determined outcomes scores collected prospectively on patients undergoing rotator cuff repair were compared with postoperative scores at a minimum of 2 years. These scores included the Shoulder Activity Level, Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Single Assessment Numeric Evaluation, and simple shoulder test. Inclusion criteria were patients undergoing arthroscopic rotator cuff repair. RESULTS Included were 281 shoulders from 273 patients with a mean follow-up of 3.7 years. The postoperative median Western Ontario Rotator Cuff Index (42 vs. 94), American Shoulder and Elbow Surgeons (41 vs. 95), Single Assessment Numeric Evaluation (30 vs. 95), and simple shoulder test (4 vs. 11) scores were statistically significantly improved compared with preoperative scores (P < .0001). The postoperative median Shoulder Activity Level score decreased compared with the preoperative score (12 vs. 11; P < .0001). CONCLUSIONS Patients reported a statistically significant deterioration of their Shoulder Activity Level score after rotator cuff repair compared with their preoperative scores, although disease-specific and joint-specific quality of life scores all had statistically significantly improvement. This study suggests that patients generally have (1) significant improvements in their quality of life and (2) small deteriorations in activity level after arthroscopic rotator cuff repair.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
| | - Peter S Chang
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
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Baumgarten KM, Chang PS, Dannenbring TM, Foley EK. Does total shoulder arthroplasty improve patients' activity levels? J Shoulder Elbow Surg 2018; 27:1987-1995. [PMID: 29804913 DOI: 10.1016/j.jse.2018.03.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Received: 01/05/2018] [Revised: 03/23/2018] [Accepted: 03/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) decreases pain, improves range of motion, and increases strength. Whether these improvements translate to improvements in activity levels postoperatively remains unknown. The Shoulder Activity Level (SAL) is a valid and reliable outcomes survey that measures the patient's activity level. Currently, no studies have specifically examined the effect of TSA on SAL. METHODS A prospective collection of preoperative, patient-determined outcomes on patients undergoing TSA was compared with postoperative scores at a minimum of 2 years. These scores included the SAL, Western Ontario Osteoarthritis of the Shoulder Index (WOOS), American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment, Single Assessment Numeric Evaluation (SANE), and the Simple Shoulder Test (SST). Inclusion criteria were patients undergoing primary anatomic TSA or reverse TSA. RESULTS A mean follow-up of 3.7 years was available for 80 anatomic and 42 reverse TSAs. Anatomic TSAs had improvements from median preoperative scores to median postoperative scores for WOOS (34 to 89; P < .0001), ASES (30 to 87; P < .0001), SST (2 to 9; P < .0001), and SANE scores (23 to 90; P < .0001). The SAL improved from 7 to 8 but did not quite reach statistical significance (P = .07). Reverse TSAs had improvements from median preoperative scores to median postoperative scores for WOOS (31 to 83; P < .0001), ASES (29 to 82; P < .0001), SST (2 to 7; P < .0001), and SANE scores (20 to 85; P < .0001). The SAL improved from 4.5 to 6, but this did not reach statistical significance (P = .38). However, when anatomic and reverse TSAs were analyzed together, a statistically significant improvement was found postoperatively in the SAL (from 6 to 8; P = .006). CONCLUSIONS Anatomic TSA and reverse TSA improved activity levels. In addition, disease-specific and joint-specific quality of life scores all had statistically significant improvements. This study suggests that after shoulder arthroplasty patients in general have (1) significant improvements in their quality of life and (2) have small improvements in activity level. This study shows that most patients do not have to decrease their activity levels to diminish symptoms to an acceptable range.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
| | - Peter S Chang
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
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Cooper DE, Dunn WR, Huston LJ, Haas AK, Spindler KP, Allen CR, Anderson AF, DeBerardino TM, Lantz B(BA, Mann B, Stuart MJ, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ, Wright RW. Physiologic Preoperative Knee Hyperextension Is a Predictor of Failure in an Anterior Cruciate Ligament Revision Cohort: A Report From the MARS Group. Am J Sports Med 2018; 46:2836-2841. [PMID: 29882693 PMCID: PMC6170681 DOI: 10.1177/0363546518777732] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 01/31/2023]
Abstract
BACKGROUND The occurrence of physiologic knee hyperextension (HE) in the revision anterior cruciate ligament reconstruction (ACLR) population and its effect on outcomes have yet to be reported. Hypothesis/Purpose: The prevalence of knee HE in revision ACLR and its effect on 2-year outcome were studied with the hypothesis that preoperative physiologic knee HE ≥5° is a risk factor for anterior cruciate ligament (ACL) graft rupture. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients undergoing revision ACLR were identified and prospectively enrolled between 2006 and 2011. Study inclusion criteria were patients undergoing single-bundle graft reconstructions. Patients were followed up at 2 years and asked to complete an identical set of outcome instruments (International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, WOMAC, and Marx Activity Rating Scale) as well as provide information regarding revision ACL graft failure. A regression model with graft failure as the dependent variable included age, sex, graft type at the time of the revision ACL surgery, and physiologic preoperative passive HE ≥5° (yes/no) to assess these as potential risk factors for clinical outcomes 2 years after revision ACLR. RESULTS Analyses included 1145 patients, for whom 2-year follow-up was attained for 91%. The median age was 26 years, with age being a continuous variable. Those below the median were grouped as "younger" and those above as "older" (age: interquartile range = 20, 35 years), and 42% of patients were female. There were 50% autografts, 48% allografts, and 2% that had a combination of autograft plus allograft. Passive knee HE ≥5° was present in 374 (33%) patients in the revision cohort, with 52% being female. Graft rupture at 2-year follow-up occurred in 34 cases in the entire cohort, of which 12 were in the HE ≥5° group (3.2% failure rate) and 22 in the non-HE group (2.9% failure rate). The median age of patients who failed was 19 years, as opposed to 26 years for those with intact grafts. Three variables in the regression model were significant predictors of graft failure: younger age (odds ratio [OR] = 3.6; 95% CI, 1.6-7.9; P = .002), use of allograft (OR = 3.3; 95% CI, 1.5-7.4; P = .003), and HE ≥5° (OR = 2.12; 95% CI, 1.1-4.7; P = .03). CONCLUSION This study revealed that preoperative physiologic passive knee HE ≥5° is present in one-third of patients who undergo revision ACLR. HE ≥5° was an independent significant predictor of graft failure after revision ACLR with a >2-fold OR of subsequent graft rupture in revision ACL surgery. Registration: NCT00625885 ( ClinicalTrials.gov identifier).
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Affiliation(s)
| | - Daniel E. Cooper
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Warren R. Dunn
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Laura J. Huston
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Amanda K. Haas
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Kurt P. Spindler
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Christina R. Allen
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Allen F. Anderson
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Thomas M. DeBerardino
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Brett (Brick) A. Lantz
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Barton Mann
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Michael J. Stuart
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - John P. Albright
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Annunziato (Ned) Amendola
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jack T. Andrish
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Christopher C. Annunziata
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert A. Arciero
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Bernard R. Bach
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Champ L. Baker
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Arthur R. Bartolozzi
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Keith M. Baumgarten
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jeffery R. Bechler
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jeffrey H. Berg
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Geoffrey A. Bernas
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Stephen F. Brockmeier
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert H. Brophy
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Charles A. Bush-Joseph
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - J. Brad Butler V
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - John D. Campbell
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James L. Carey
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James E. Carpenter
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Brian J. Cole
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jonathan M. Cooper
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Charles L. Cox
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - R. Alexander Creighton
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Diane L. Dahm
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Tal S. David
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - David C. Flanigan
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert W. Frederick
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Theodore J. Ganley
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Elizabeth A. Garofoli
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Charles J. Gatt
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Steven R. Gecha
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James Robert Giffin
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Sharon L. Hame
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jo A. Hannafin
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Christopher D. Harner
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Norman Lindsay Harris
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Keith S. Hechtman
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Elliott B. Hershman
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Rudolf G. Hoellrich
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Timothy M. Hosea
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - David C. Johnson
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Timothy S. Johnson
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Morgan H. Jones
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Christopher C. Kaeding
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Ganesh V. Kamath
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Thomas E. Klootwyk
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Bruce A. Levy
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - C. Benjamin Ma
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - G. Peter Maiers
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert G. Marx
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Matthew J. Matava
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Gregory M. Mathien
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - David R. McAllister
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Eric C. McCarty
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert G. McCormack
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Bruce S. Miller
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Carl W. Nissen
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Daniel F. O’Neill
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Brett D. Owens
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Richard D. Parker
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Mark L. Purnell
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Arun J. Ramappa
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Michael A. Rauh
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Arthur C. Rettig
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jon K. Sekiya
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Kevin G. Shea
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Orrin H. Sherman
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James R. Slauterbeck
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Matthew V. Smith
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jeffrey T. Spang
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Steven J. Svoboda
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Timothy N. Taft
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Joachim J. Tenuta
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Edwin M. Tingstad
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Armando F. Vidal
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Darius G. Viskontas
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Richard A. White
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James S. Williams
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Michelle L. Wolcott
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Brian R. Wolf
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James J. York
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Rick W. Wright
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
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Wolf BR, Uribe B, Hettrich CM, Gao Y, Johnson M, Kuhn JE, Cox CL, Feely BT, Bishop J, Jones G, Brophy RH, Smith MV, Baumgarten KM, Spencer EE. Shoulder Instability: Interobserver and Intraobserver Agreement in the Assessment of Labral Tears. Orthop J Sports Med 2018; 6:2325967118793372. [PMID: 30202768 PMCID: PMC6128077 DOI: 10.1177/2325967118793372] [Citation(s) in RCA: 5] [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] [Indexed: 12/04/2022] Open
Abstract
Background: The glenohumeral joint combines large range of motion and insufficient bony stabilization, making it susceptible to instability and dislocations. Arthroscopic surgery is routinely used as a diagnostic tool and has been considered the gold standard for the diagnosis of shoulder lesions. However, several studies have demonstrated variability in intraobserver and interobserver agreement. Purpose: To evaluate interobserver and intraobserver agreement in the assessment of intra-articular lesions associated with shoulder instability among fellowship-trained shoulder surgeons. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 24 arthroscopic videos from patients treated for recurrent shoulder instability were shown to a group of 10 fellowship-trained shoulder surgeons who are members of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group. They were presented to the surgeons on 2 different occasions at least 2 months apart. They were asked to classify labral tears by their position, type, extension, other intra-articular abnormality, and preferred treatment. No patient history or physical examination data were provided. The primary outcome was the median overall percentage of agreement for the surgeons performing a video review, measured for each variable evaluated. Intraclass correlation coefficients were used to evaluate continuous variables, and kappa values were used for categorical items. Results: Interobserver agreement was good for anterior labral lesions; good for Hill-Sachs lesions; and moderate for lesions of the superior labrum, posterior labrum, anterior sublabral foramen, and position and extension of the tear. Intraobserver agreement was either good or very good for all variables evaluated, except for being poor for inferior labral lesions and moderate for lesions of the meniscoid superior labrum. Conclusion: Interobserver and intraobserver reliability for the arthroscopic assessment of labral tears in patients with recurrent shoulder instability were good to moderate for the majority of anatomic structures assessed. There was relatively good agreement between shoulder instability surgeons on assessing and documenting shoulder instability–associated abnormalities. These findings are important when interpreting collaborative clinical cohort studies with numerous surgeons involved in the research.
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Affiliation(s)
- Brian R Wolf
- Investigation performed at the University of Iowa, Iowa City, Iowa, USA
| | - Bastian Uribe
- Investigation performed at the University of Iowa, Iowa City, Iowa, USA
| | | | - Yubo Gao
- Investigation performed at the University of Iowa, Iowa City, Iowa, USA
| | - Morgan Johnson
- Investigation performed at the University of Iowa, Iowa City, Iowa, USA
| | | | - John E Kuhn
- Investigation performed at the University of Iowa, Iowa City, Iowa, USA
| | - Charles L Cox
- Investigation performed at the University of Iowa, Iowa City, Iowa, USA
| | - Brian T Feely
- Investigation performed at the University of Iowa, Iowa City, Iowa, USA
| | - Julie Bishop
- Investigation performed at the University of Iowa, Iowa City, Iowa, USA
| | - Grant Jones
- Investigation performed at the University of Iowa, Iowa City, Iowa, USA
| | - Robert H Brophy
- Investigation performed at the University of Iowa, Iowa City, Iowa, USA
| | - Matthew V Smith
- Investigation performed at the University of Iowa, Iowa City, Iowa, USA
| | | | - Edwin E Spencer
- Investigation performed at the University of Iowa, Iowa City, Iowa, USA
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Jain NB, Ayers GD, Fan R, Kuhn JE, Baumgarten KM, Matzkin E, Higgins LD. Predictors of pain and functional outcomes after operative treatment for rotator cuff tears. J Shoulder Elbow Surg 2018; 27:1393-1400. [PMID: 30016692 PMCID: PMC6085102 DOI: 10.1016/j.jse.2018.04.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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] [Received: 12/14/2017] [Revised: 04/18/2018] [Accepted: 04/27/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Optimal patient selection is key to success of operative treatment for cuff tears. We assessed predictors of pain and functional outcomes in a longitudinal cohort of patients undergoing operative treatment. METHODS From March 2011 to January 2015, a cohort of patients with rotator cuff tears undergoing rotator cuff surgery was recruited. Patients completed a detailed health and demographic questionnaire, standardized shoulder questionnaires, including the Shoulder Pain and Disability Index (SPADI), and underwent a magnetic resonance imaging scan. Patients received follow-up questionnaires at 3, 6, 12, and 18 months. We assessed longitudinal predictors of SPADI using longitudinal mixed models. Interactions with follow-up duration after surgery were also assessed. RESULTS In our analysis (n = 50), a lower Fear-Avoidance Beliefs Questionnaire physical activity score (P = .001) predicted a lower SPADI score (better shoulder pain and function). Those consuming alcohol 1 to 2 times per week or more had lower SPADI scores than those consuming alcohol 2 to 3 times per month or less (P = .017). Both of these variables had a significant interaction with duration of follow-up. Variables that were not significant predictors of SPADI included sociodemographic characteristics, magnetic resonance imaging characteristics, such as tear size and muscle quality, shoulder strength, and variations in surgical techniques/performance of adjuvant surgical procedures. CONCLUSIONS Those with higher fear avoidance behavior and alcohol use of 1 to 2 times per week had worse shoulder pain and function at 18 months of follow-up. These data can be used to select optimal candidates for operative treatment of rotator cuff tears and assist with patient education and expectations before treatment.
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Affiliation(s)
- Nitin B. Jain
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gregory D. Ayers
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Run Fan
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - John E. Kuhn
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women ‘s Hospital and Harvard Medical School, Boston, MA, USA
| | - Laurence D. Higgins
- Department of Orthopaedic Surgery, Brigham and Women ‘s Hospital and Harvard Medical School, Boston, MA, USA
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Baumgarten KM, Osborn R, Schweinle WE, Zens MJ, Helsper EA. SCAPULAR SUBSTITUTION AFTER ROTATOR CUFF REPAIR CORRELATES WITH POSTOPERATIVE PATIENT OUTCOME. Int J Sports Phys Ther 2018; 13:687-699. [PMID: 30140562 PMCID: PMC6088123] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Scapular substitution is an alteration of scapulohumeral kinematics that may occur when patients have shoulder pain or dysfunction. These abnormal scapular kinematic patterns have been recognized in patients with rotator cuff tears. It remains unknown if 1) normal scapular kinematics can be restored with rehabilitation after rotator cuff repair surgery and 2) abnormal scapular kinematics are associated with inferior patient-determined outcome scores, range of motion, or strength. PURPOSE The purpose of this study was to determine 1) if scapular substitution can be decreased or improved with rehabilitation after rotator cuff repair surgery and 2) if the presence or amount of scapular substitution was correlated with patient-determined outcome scores, range of motion, or strength after rotator cuff repair surgery. STUDY DESIGN Retrospective review of prospectively collected data (LOE IV). METHODS Forty-eight patients who underwent post-operative rehabilitation after an arthroscopic rotator cuff repair were reviewed for this study. The outcomes measures of interest included: patient-determined outcome scores (WORC, Simple Shoulder Test, the ASES Score, the Shoulder Activity Score, and the SANE rating), identification and quantification of scapular substitution, active range of motion, and strength. Outcomes were prospectively collected up to 12 months after surgery and assessed retrospectively. RESULTS As patients progress through their first year of rehabilitation from a rotator cuff repair, the amount of scapular substitution decreases but remains statistically significantly greater than the contralateral, asymptomatic side. At all post-operative time points, patients with scapular substitution, (determined subjectively by a physical therapist), had 1) inferior WORC, ASES, SANE, and SST scores, 2) inferior flexion, abduction, and external rotation range of motion, and 3) inferior scaption strength compared to those patients without subjective scapular substitution. CONCLUSIONS Rehabilitation decreases but does not normalize the amount of scapular substitution up to one year after rotator cuff repair. Subjective identification of scapular substitution is associated with inferior patient-determined outcome scores, range of motion, and strength. LEVEL OF EVIDENCE 4 - Prognosis study.
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Affiliation(s)
| | - Roy Osborn
- University of South Dakota, Vermillion, South Dakota
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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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Magnussen RA, Borchers JR, Pedroza AD, Huston LJ, Haas AK, Spindler KP, Wright RW, Kaeding CC, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BA, Mann B, Stuart MJ, Albright JP, Amendola A, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Risk Factors and Predictors of Significant Chondral Surface Change From Primary to Revision Anterior Cruciate Ligament Reconstruction: A MOON and MARS Cohort Study. Am J Sports Med 2018; 46:557-564. [PMID: 29244532 PMCID: PMC7004295 DOI: 10.1177/0363546517741484] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Articular cartilage health is an important issue following anterior cruciate ligament (ACL) injury and primary ACL reconstruction. Factors present at the time of primary ACL reconstruction may influence the subsequent progression of articular cartilage damage. HYPOTHESIS Larger meniscus resection at primary ACL reconstruction, increased patient age, and increased body mass index (BMI) are associated with increased odds of worsened articular cartilage damage at the time of revision ACL reconstruction. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Subjects who had primary and revision data in the databases of the Multicenter Orthopaedics Outcomes Network (MOON) and Multicenter ACL Revision Study (MARS) were included. Reviewed data included chondral surface status at the time of primary and revision surgery, meniscus status at the time of primary reconstruction, primary reconstruction graft type, time from primary to revision ACL surgery, as well as demographics and Marx activity score at the time of revision. Significant progression of articular cartilage damage was defined in each compartment according to progression on the modified Outerbridge scale (increase ≥1 grade) or >25% enlargement in any area of damage. Logistic regression identified predictors of significant chondral surface change in each compartment from primary to revision surgery. RESULTS A total of 134 patients were included, with a median age of 19.5 years at revision surgery. Progression of articular cartilage damage was noted in 34 patients (25.4%) in the lateral compartment, 32 (23.9%) in the medial compartment, and 31 (23.1%) in the patellofemoral compartment. For the lateral compartment, patients who had >33% of the lateral meniscus excised at primary reconstruction had 16.9-times greater odds of progression of articular cartilage injury than those with an intact lateral meniscus ( P < .001). For the medial compartment, patients who had <33% of the medial meniscus excised at the time of the primary reconstruction had 4.8-times greater odds of progression of articular cartilage injury than those with an intact medial meniscus ( P = .02). Odds of significant chondral surface change increased by 5% in the lateral compartment and 6% in the medial compartment for each increased year of age ( P ≤ .02). For the patellofemoral compartment, the use of allograft in primary reconstruction was associated with a 15-fold increased odds of progression of articular cartilage damage relative to a patellar tendon autograft ( P < .001). Each 1-unit increase in BMI at the time of revision surgery was associated with a 10% increase in the odds of progression of articular cartilage damage ( P = .046) in the patellofemoral compartment. CONCLUSION Excision of the medial and lateral meniscus at primary ACL reconstruction increases the odds of articular cartilage damage in the corresponding compartment at the time of revision ACL reconstruction. Increased age is a risk factor for deterioration of articular cartilage in both tibiofemoral compartments, while increased BMI and the use of allograft for primary ACL reconstruction are associated with an increased risk of progression in the patellofemoral compartment.
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Affiliation(s)
| | - Robert A. Magnussen
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James R. Borchers
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Angela D. Pedroza
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Laura J. Huston
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Amanda K. Haas
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kurt P. Spindler
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rick W. Wright
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher C. Kaeding
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christina R. Allen
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Allen F. Anderson
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel E. Cooper
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas M. DeBerardino
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Warren R. Dunn
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brett A. Lantz
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Barton Mann
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael J. Stuart
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John P. Albright
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Annunziato Amendola
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jack T. Andrish
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Robert A. Arciero
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bernard R. Bach
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Champ L. Baker
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arthur R. Bartolozzi
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Keith M. Baumgarten
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffery R. Bechler
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffrey H. Berg
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Geoffrey A. Bernas
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephen F. Brockmeier
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert H. Brophy
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles A. Bush-Joseph
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - J. Brad Butler
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D. Campbell
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James L. Carey
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James E. Carpenter
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brian J. Cole
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jonathan M. Cooper
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles L. Cox
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - R. Alexander Creighton
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Diane L. Dahm
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tal S. David
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David C. Flanigan
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert W. Frederick
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Theodore J. Ganley
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Elizabeth A. Garofoli
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles J. Gatt
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven R. Gecha
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James Robert Giffin
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sharon L. Hame
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jo A. Hannafin
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher D. Harner
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Norman Lindsay Harris
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Keith S. Hechtman
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Elliott B. Hershman
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rudolf G. Hoellrich
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Timothy M. Hosea
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David C. Johnson
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Timothy S. Johnson
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Morgan H. Jones
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ganesh V. Kamath
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas E. Klootwyk
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bruce A. Levy
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - C. Benjamin Ma
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - G. Peter Maiers
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert G. Marx
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew J. Matava
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Gregory M. Mathien
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David R. McAllister
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Eric C. McCarty
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert G. McCormack
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bruce S. Miller
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Carl W. Nissen
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel F. O’Neill
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brett D. Owens
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard D. Parker
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mark L. Purnell
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arun J. Ramappa
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael A. Rauh
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arthur C. Rettig
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jon K. Sekiya
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kevin G. Shea
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Orrin H. Sherman
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James R. Slauterbeck
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew V. Smith
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffrey T. Spang
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven J. Svoboda
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Timothy N. Taft
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Joachim J. Tenuta
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Edwin M. Tingstad
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Armando F. Vidal
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Darius G. Viskontas
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard A. White
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James S. Williams
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michelle L. Wolcott
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brian R. Wolf
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James J. York
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Baumgarten KM, Osborn R, Schweinle WE, Zens MJ. The influence of anatomic total shoulder arthroplasty using a subscapularis tenotomy on shoulder strength. J Shoulder Elbow Surg 2018; 27:82-89. [PMID: 28843506 DOI: 10.1016/j.jse.2017.06.043] [Citation(s) in RCA: 15] [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: 03/27/2017] [Revised: 06/19/2017] [Accepted: 06/29/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS There is limited evidence describing the influence of total shoulder arthroplasty on strength. The hypothesis was that after total shoulder arthroplasty, strength would improve compared with the preoperative state but remain inferior to that of the nonoperative shoulder. An additional aim was to determine whether strength improvement was associated with improvements in outcome scores and motion. MATERIALS AND METHODS Thirty-six patients underwent total shoulder arthroplasty, with 31 patients (86%) having 1 year of follow-up for all outcomes. Patient-determined outcomes (Western Ontario Osteoarthritis of the Shoulder score; Disabilities of the Arm, Shoulder and Hand score; Single Assessment Numeric Evaluation rating; and shoulder activity level), range of motion, and strength were assessed. Isometric strength was determined for scaption and external rotation, as well as the liftoff test, belly-press test, and bear-hug test. RESULTS All strength measures improved, with significant increases in external rotation, the liftoff test, and the bear-hug test, but remained inferior to the nonoperative-side strength. Improved strength in the belly-press test was associated with greater improvement in Single Assessment Numeric Evaluation scores. Improvements in scaption and belly-press testing were associated with improvements in active flexion. Strength improvements in the liftoff test were associated with improved internal rotation in 90° of abduction. Patients with improvements in strength had improvements in their shoulder activity level from baseline to final follow-up, whereas patients without improved strength test findings did not have improved shoulder activity levels. CONCLUSIONS Total shoulder arthroplasty improved external rotation, liftoff, and bear-hug strength testing. Operative shoulder strength remained inferior to strength of the nonoperative shoulder. Patients with improvements in strength were more likely to have greater improvements in outcome scores and range of motion. Improvements in the shoulder activity level after anatomic total shoulder arthroplasty may be dependent on improvements in strength.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota, Vermillion, SD, USA.
| | - Roy Osborn
- University of South Dakota, Vermillion, SD, USA
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50
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Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Haas AK, Huston LJ, Lantz B(BA, Mann B, Nwosu SK, Spindler KP, Stuart MJ, Wright RW, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LTCSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Surgical Predictors of Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2017; 45:2586-2594. [PMID: 28696164 PMCID: PMC5675127 DOI: 10.1177/0363546517712952] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Revision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes compared with primary ACL reconstruction. HYPOTHESIS Certain factors under the control of the surgeon at the time of revision surgery can both negatively and positively affect outcomes. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients undergoing revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, intraoperative surgical technique and joint disorders, and a series of validated patient-reported outcome instruments (International Knee Documentation Committee [IKDC] subjective form, Knee Injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Marx activity rating scale) completed before surgery. Patients were followed up for 2 years and asked to complete an identical set of outcome instruments. Regression analysis was used to control for age, sex, body mass index (BMI), activity level, baseline outcome scores, revision number, time since last ACL reconstruction, and a variety of previous and current surgical variables to assess the surgical risk factors for clinical outcomes 2 years after revision ACL reconstruction. RESULTS A total of 1205 patients (697 male [58%]) met the inclusion criteria and were successfully enrolled. The median age was 26 years, and the median time since their last ACL reconstruction was 3.4 years. Two-year follow-up was obtained on 82% (989/1205). Both previous and current surgical factors were found to be significant contributors toward poorer clinical outcomes at 2 years. Having undergone previous arthrotomy (nonarthroscopic open approach) for ACL reconstruction compared with the 1-incision technique resulted in significantly poorer outcomes for the 2-year IKDC ( P = .037; odds ratio [OR], 2.43; 95% CI, 1.05-5.88) and KOOS pain, sports/recreation, and quality of life (QOL) subscales ( P ≤ .05; OR range, 2.38-4.35; 95% CI, 1.03-10.00). The use of a metal interference screw for current femoral fixation resulted in significantly better outcomes for the 2-year KOOS symptoms, pain, and QOL subscales ( P ≤ .05; OR range, 1.70-1.96; 95% CI, 1.00-3.33) as well as WOMAC stiffness subscale ( P = .041; OR, 1.75; 95% CI, 1.02-3.03). Not performing notchplasty at revision significantly improved 2-year outcomes for the IKDC ( P = .013; OR, 1.47; 95% CI, 1.08-1.99), KOOS activities of daily living (ADL) and QOL subscales ( P ≤ .04; OR range, 1.40-1.41; 95% CI, 1.03-1.93), and WOMAC stiffness and ADL subscales ( P ≤ .04; OR range, 1.41-1.49; 95% CI, 1.03-2.05). Factors before revision ACL reconstruction that increased the risk of poorer clinical outcomes at 2 years included lower baseline outcome scores, a lower Marx activity score at the time of revision, a higher BMI, female sex, and a shorter time since the patient's last ACL reconstruction. Prior femoral fixation, prior femoral tunnel aperture position, and knee flexion angle at the time of revision graft fixation were not found to affect 2-year outcomes in this revision cohort. CONCLUSION There are certain surgical variables that the physician can control at the time of revision ACL reconstruction that can modify clinical outcomes at 2 years. Whenever possible, opting for an anteromedial portal or transtibial surgical exposure, choosing a metal interference screw for femoral fixation, and not performing notchplasty are associated with significantly better 2-year clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tal S. David
- Synergy Specialists Medical Group, San Diego, CA USA
| | | | | | | | | | | | | | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London Ontario, Canada
| | - Sharon L. Hame
- David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | | | | | | | | | | | | | | | | | | | | | | | - Ganesh V. Kamath
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | | | | | | | | | | | | | | | - Eric C. McCarty
- University of Colorado Denver School of Medicine, Denver, CO USA
| | | | | | | | | | - Brett D. Owens
- Warren Alpert Medical School, Brown University, Providence, RI USA
| | | | | | | | | | | | | | | | | | | | | | - Jeffrey T. Spang
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Timothy N. Taft
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Edwin M. Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA USA
| | - Armando F. Vidal
- University of Colorado Denver School of Medicine, Denver, CO USA
| | | | | | | | | | - Brian R. Wolf
- University of Iowa Hospitals and Clinics, Iowa City, IA USA
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