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Bisson LJ, Kluczynski MA, Wind WM, Fineberg MS, Bernas GA, Rauh MA, Marzo JM, Scrivens B, Connaughton A, Zhou Z, Zhao J. Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy: Analysis of Patient Outcomes and Degenerative Joint Disease at 5 Years in the Chondral Lesions And Meniscus Procedures (ChAMP) Randomized Controlled Trial. J Bone Joint Surg Am 2021; 103:1569-1577. [PMID: 34133394 DOI: 10.2106/jbjs.20.01582] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to examine the effect of debridement (CL-Deb) versus observation (CL-noDeb) of unstable chondral lesions on knee pain 5 years after arthroscopic partial meniscectomy (APM) in patients enrolled in the Chondral Lesions And Meniscus Procedures (ChAMP) Trial. Secondarily, other knee symptoms, function, general health, and the rate of additional surgery on the affected knee were examined. METHODS Patients aged ≥30 years who had an unstable Outerbridge grade-II, III, or IV chondral lesion when undergoing APM were randomly allocated to the CL-Deb (n = 98) or CL-noDeb (n = 92) group; ∼80% in each group completed a 5-year follow-up. Outcomes were measured preoperatively and at 5 years postoperatively, and included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Short Form-36 (SF-36), physical knee measurements, knee radiographs, and rate of additional knee surgery at 5 years. The primary outcome was the 5-year WOMAC pain score. Group comparisons were made using the t test for continuous outcomes and the Fisher exact test for categorical outcomes. RESULTS There were no significant differences between the groups with respect to the primary outcome, the WOMAC pain score (CL-Deb: 86.0 [95% confidence interval (CI): 82.9 to 89.1]) versus CL-noDeb: 88.3 [95% CI: 85.5 to 91.1]; p = 0.27), or secondary outcomes at 5 years. There were also no differences in radiographic measurements of joint-space narrowing in any compartment (medial or lateral tibiofemoral or medial, central, or lateral patellofemoral) as well as no difference in the rate of additional knee surgery within 5 years after APM between the CL-Deb and CL-noDeb groups. CONCLUSIONS Outcomes for the CL-Deb and CL-noDeb groups did not differ at 5 years postoperatively, suggesting that there is no long-term benefit of arthroscopic debridement of chondral lesions encountered during APM. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Leslie J Bisson
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Melissa A Kluczynski
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - William M Wind
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Marc S Fineberg
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Geoffery A Bernas
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Michael A Rauh
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - John M Marzo
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Brian Scrivens
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Alexander Connaughton
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Zehua Zhou
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York
| | - Jiwei Zhao
- Department of Biostatistics and Medical Informatics, University of Wisconsin Madison, Madison, Wisconsin
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Scrivens B, Kluczynski MA, Fineberg MS, Bisson LJ. Computed Tomography Imaging of BioComposite Interference Screw After ACL Reconstruction With Bone-Patellar Tendon-Bone Graft. Orthop J Sports Med 2021; 9:23259671211006477. [PMID: 33997082 PMCID: PMC8113922 DOI: 10.1177/23259671211006477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Bioabsorbable interference screws tend to have high resorption rates after
anterior cruciate ligament (ACL) reconstruction; however, no studies have
examined screws composed of 30% biphasic calcium phosphate and 70%
poly-d-lactide (30% BCP/70% PLDLA). Purpose: To evaluate femoral and tibial tunnel widening and resorption of 30% BCP/70%
PLDLA interference screws and replacement with bone at 2 to 5 years after
ACL reconstruction using bone–patellar tendon–bone (BTB) autograft. Study Design: Case series; Level of evidence, 4. Methods: Included were 20 patients who had undergone ACL reconstruction using BTB
autograft and were reevaluated 2 to 5 years after surgery using computed
tomography scans. Tunnel measurements were obtained from computed tomography
scans in the sagittal and coronal planes and were compared with known tunnel
measurements based on operative reports. These images and measurements were
used to assess tunnel widening, resorption of the 30% BCP/70% PLDLA screw,
its replacement with bone, and possible cyst formation. Paired
t tests were used to compare initial and final femoral
and tibial tunnel measurements. Results: The cross-sectional area of the femoral tunnel decreased at the aperture
(P = .03), middle (P = .0002), and
exit (P < .0001) of the tunnel compared with the initial
femoral tunnel size, and the tibial tunnel cross-sectional area decreased at
the aperture (P < .0001) and exit (P =
.01) of the tunnel compared with the initial tibial tunnel size. Bone
formation was observed in 100% of femoral tunnels and 94.7% of tibial
tunnels. Screw resorption was 100% in the femur and 94.7% in the tibia at
the final follow-up. Cysts were noted around the femoral tunnel in 2
patients (5.1%). Conclusion: The 30% BCP/70% PLDLA interference screws used for ACL reconstruction using
BTB autograft had high rates of resorption and replacement with bone, and
there were no increases in tunnel size at 2 to 5 years postoperatively. The
authors observed a low rate of cyst formation and no other adverse events
stemming from the use of this specific biointerference screw, suggesting
that this type of screw is a reasonable option for graft fixation with
minimal unfavorable events and a reliable resorption profile.
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Affiliation(s)
- Brian Scrivens
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Marc S Fineberg
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, The State University of New York at Buffalo, Buffalo, New York, USA
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Bisson LJ, Phillips P, Matthews J, Zhou Z, Zhou J, Wind WM, Fineberg MS, Bernas GA, Rauh MA, Marzo JM, Kluczynski MA. Association Between Bone Marrow Lesions, Chondral Lesions, and Pain in Patients Without Radiographic Evidence of Degenerative Joint Disease Who Underwent Arthroscopic Partial Meniscectomy. Orthop J Sports Med 2019; 7:2325967119830381. [PMID: 30886877 PMCID: PMC6415484 DOI: 10.1177/2325967119830381] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Bone marrow lesions (BMLs) have been found on magnetic resonance imaging in patients with meniscal tears. Purpose We sought to determine the prevalence and location of BMLs, the association between BMLs and chondral lesions, and the association between BMLs and pain in patients without radiographic evidence of degenerative joint disease who underwent arthroscopic partial meniscectomy (APM). Study Design Cohort study; Level of evidence, 2. Methods We performed a secondary analysis of the Chondral Lesions And Meniscus Procedures (ChAMP) randomized controlled trial. BMLs were assessed on preoperative magnetic resonance imaging, and chondral lesions were documented at the time of surgery. Pain was assessed preoperatively and at 1 year after APM using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee injury and Osteoarthritis Outcome Score (KOOS). The chi-square test was used to examine the association between BMLs and chondral lesions, and the F test was used to examine the association between BMLs and pain. Results Of 241 patients, 58.9% had ≥1 BMLs, and most were located on the medial tibial plateau (MTP; 74.6%) and/or medial femoral condyle (MFC; 28.9%). Most MTP BMLs were submeniscal (56%), and most MFC BMLs extended beyond the meniscus (73%). There were more MFC chondral lesions for patients with any MFC BMLs (P = .01) and submeniscal MFC BMLs (P = .02) versus those without BMLs, and there was no association between BMLs and chondral lesions on the MTP. There was also no association between BMLs and preoperative or postoperative pain scores. Conclusion In patients without radiographic evidence of degenerative joint disease who underwent APM, BMLs were found in 58.9% of knees and were primarily located in the medial compartment. There was a borderline statistically significant association between BMLs and chondral lesions for the MFC; however, BMLs were not associated with pain scores preoperatively or at 1 year after surgery.
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Affiliation(s)
- Leslie J. Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Paul Phillips
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - John Matthews
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Zehua Zhou
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jiwei Zhou
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - William M. Wind
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Marc S. Fineberg
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Geoffrey A. Bernas
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Michael A. Rauh
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - John M. Marzo
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Melissa A. Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Bisson LJ, Kluczynski MA, Wind WM, Fineberg MS, Bernas GA, Rauh MA, Marzo JM, Zhou Z, Zhao J. How Does the Presence of Unstable Chondral Lesions Affect Patient Outcomes After Partial Meniscectomy? The ChAMP Randomized Controlled Trial. Am J Sports Med 2018; 46:590-597. [PMID: 29281798 DOI: 10.1177/0363546517744212] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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 Chondral lesions are commonly encountered during arthroscopic partial meniscectomy (APM); however, it is unknown how these lesions affect postoperative outcomes. PURPOSE The authors compared postoperative outcomes among patients with and without unstable chondral lesions 1 year after APM. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors conducted a secondary analysis of data from the ChAMP (Chondral Lesions and Meniscus Procedures) randomized controlled trial. They compared the following outcomes for patients with unstable chondral lesions that were left in situ and observed (CL-noDeb) versus patients without unstable chondral lesions (NoCL) at 1 year after APM: Western Ontario and McMaster Universities Osteoarthritis Index, Knee injury and Osteoarthritis Outcome Score, visual analog scale for pain, the Short Form Health Survey, range of motion, quadriceps circumference, and effusion. Multivariate linear regression was used to obtain mean differences (MDs) with corresponding 95% CIs adjusted for age, body mass index, and preoperative score (for postoperative scores). RESULTS Compared with the CL-noDeb group, the NoCL group had greater improvement in Western Ontario and McMaster Universities Osteoarthritis Index for pain (MD, 7.9, 95% CI: 2.7-13.1), stiffness (MD, 9.1, 95% CI: 1.9-16.3), and physical function (MD, 4.6, 95% CI: 0.1-9.0) and Knee injury and Osteoarthritis Outcome Score for pain (MD, 8.4, 95% CI: 2.7-14.0), function in sport and recreation (MD, 11, 95% CI: 3.0-19.1), and quality of life (MD, 10.4, 95% CI: 2.3-18.5). The NoCL group was less likely than the CL-noDeb group to have an effusion ( P = .02) 1 year after surgery. CONCLUSION Patients undergoing APM without unstable chondral lesions had better outcomes than patients with unstable chondral lesions.
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Affiliation(s)
- Leslie J Bisson
- The Jacobs School of Medicine and Biomedical Sciences, University of New York at Buffalo, Buffalo, New York, USA
| | - Melissa A Kluczynski
- The Jacobs School of Medicine and Biomedical Sciences, University of New York at Buffalo, Buffalo, New York, USA
| | - William M Wind
- The Jacobs School of Medicine and Biomedical Sciences, University of New York at Buffalo, Buffalo, New York, USA
| | - Marc S Fineberg
- The Jacobs School of Medicine and Biomedical Sciences, University of New York at Buffalo, Buffalo, New York, USA
| | - Geoffrey A Bernas
- The Jacobs School of Medicine and Biomedical Sciences, University of New York at Buffalo, Buffalo, New York, USA
| | - Michael A Rauh
- The Jacobs School of Medicine and Biomedical Sciences, University of New York at Buffalo, Buffalo, New York, USA
| | - John M Marzo
- The Jacobs School of Medicine and Biomedical Sciences, University of New York at Buffalo, Buffalo, New York, USA
| | - Zehua Zhou
- The Jacobs School of Medicine and Biomedical Sciences, University of New York at Buffalo, Buffalo, New York, USA
| | - Jiwei Zhao
- The Jacobs School of Medicine and Biomedical Sciences, University of New York at Buffalo, Buffalo, New York, USA
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Bisson LJ, Kluczynski MA, Wind WM, Fineberg MS, Bernas GA, Rauh MA, Marzo JM, Zhou Z, Zhao J. Patient Outcomes After Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy: The Chondral Lesions And Meniscus Procedures (ChAMP) Randomized Controlled Trial. J Bone Joint Surg Am 2017; 99:1078-1085. [PMID: 28678120 PMCID: PMC5490330 DOI: 10.2106/jbjs.16.00855] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is unknown whether unstable chondral lesions observed during arthroscopic partial meniscectomy (APM) require treatment. We examined differences at 1 year with respect to knee pain and other outcomes between patients who had debridement (CL-Deb) and those who had observation (CL-noDeb) of unstable chondral lesions encountered during APM. METHODS Patients who were ≥30 years old and undergoing APM were randomized to receive debridement (CL-Deb group; n = 98) or observation (CL-noDeb; n = 92) of unstable Outerbridge grade-II, III, or IV chondral lesions. Outcomes were evaluated preoperatively and at 8 to 12 days, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) pain score, Short Form-36 (SF-36) health survey, range of motion, quadriceps circumference, and effusion. The primary outcome was the WOMAC pain score at 1 year. T tests were used to examine group differences in outcomes, and the means and standard deviations are reported. RESULTS There were no significant differences between the groups with respect to any of the 1-year outcome scores. Compared with the CL-Deb group, the CL-noDeb group had improvement in the KOOS quality-of-life (p = 0.04) and SF-36 physical functioning scores (p = 0.01) as well as increased quadriceps circumference at 8 to 12 days (p = 0.02); had improvement in the pain score on the WOMAC (p = 0.02) and KOOS (p = 0.04) at 6 weeks; had improvement in SF-36 physical functioning scores at 3 months (p = 0.01); and had increased quadriceps circumference at 6 months (p = 0.02). CONCLUSIONS Outcomes for the CL-Deb and CL-noDeb groups did not differ at 1 year postoperatively. This suggests that there is no benefit to arthroscopic debridement of unstable chondral lesions encountered during APM, and it is recommended that these lesions be left in situ. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Leslie J. Bisson
- The State University of New York at Buffalo, Buffalo, New York,E-mail address for L.J. Bisson:
| | | | - William M. Wind
- The State University of New York at Buffalo, Buffalo, New York
| | | | | | - Michael A. Rauh
- The State University of New York at Buffalo, Buffalo, New York
| | - John M. Marzo
- The State University of New York at Buffalo, Buffalo, New York
| | - Zehua Zhou
- The State University of New York at Buffalo, Buffalo, New York
| | - Jiwei Zhao
- The State University of New York at Buffalo, Buffalo, New York
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Bisson LJ, Komm JT, Bernas GA, Fineberg MS, Marzo JM, Rauh MA, Smolinski RJ, Wind WM. How Accurate Are Patients at Diagnosing the Cause of Their Knee Pain With the Help of a Web-based Symptom Checker? Orthop J Sports Med 2016; 4:2325967116630286. [PMID: 26962542 PMCID: PMC4765835 DOI: 10.1177/2325967116630286] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Researching medical information is the third most popular activity online, and there are a variety of web-based symptom checker programs available. Purpose: This study evaluated a patient’s ability to self-diagnose their knee pain from a list of possible diagnoses supplied by an accurate symptom checker. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: All patients older than 18 years who presented to the office of 7 different fellowship-trained sports medicine surgeons over an 8-month period with a complaint of knee pain were asked to participate. A web-based symptom checker for knee pain was used; the program has a reported accuracy of 89%. The symptom checker generates a list of potential diagnoses after patients enter symptoms and links each diagnosis to informative content. After exploring the informative content, patients selected all diagnoses they felt could explain their symptoms. Each patient was later examined by a physician who was blinded to the differential generated by the program as well as the patient-selected diagnoses. A blinded third party compared the diagnoses generated by the program with those selected by the patient as well as the diagnoses determined by the physician. The level of matching between the patient-selected diagnoses and the physician’s diagnoses determined the patient’s ability to correctly diagnose their knee pain. Results: There were 163 male and 165 female patients, with a mean age of 48 years (range, 18-76 years). The program generated a mean 6.6 diagnoses (range, 2-15) per patient. Each patient had a mean 1.7 physician diagnoses (range, 1-4). Patients selected a mean 2 diagnoses (range, 1-9). The patient-selected diagnosis matched the physician’s diagnosis 58% of the time. Conclusion: With the aid of an accurate symptom checker, patients were able to correctly identify the cause of their knee pain 58% of the time.
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Affiliation(s)
- Leslie J Bisson
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Jorden T Komm
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Geoffrey A Bernas
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Marc S Fineberg
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - John M Marzo
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Michael A Rauh
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Robert J Smolinski
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - William M Wind
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
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Bisson LJ, Kluczynski MA, Wind WM, Fineberg MS, Bernas GA, Rauh MA, Marzo JM, Smolinski RJ. Design of a randomized controlled trial to compare debridement to observation of chondral lesions encountered during partial meniscectomy: The ChAMP (Chondral Lesions And Meniscus Procedures) Trial. Contemp Clin Trials 2015; 45:281-286. [PMID: 26343744 DOI: 10.1016/j.cct.2015.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/27/2015] [Accepted: 08/30/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few studies have examined whether chondral lesions encountered in patients undergoing meniscectomy should be surgically treated. The primary aim of the ChAMP (Chondral Lesions And Meniscus Procedures) Trial is to determine whether there is a difference in knee pain between patients undergoing debridement versus observation of chondral lesions encountered during arthroscopic meniscectomy. This paper describes the rationale and study design for the ChAMP Trial. METHODS/DESIGN The ChAMP Trial is a randomized controlled trial of patients aged 30 and older undergoing partial meniscectomy and randomly allocated to debridement (CL-Deb, N=98) or observation (CL-Obs, N=92) of chondral lesions identified during surgery and deemed to be significant (Outerbridge Grade II-IV). Patients and data collectors were unaware of treatment allocation until completion of the study. Patients with surgically insignificant (Outerbridge Grade I) chondral lesions or no chondral lesions were included as a third non-randomized comparison group (NoCL, N=76). The primary outcome is the difference in knee pain assessed by WOMAC (Western Ontario and McMaster Universities Arthritis Index) between the CL-Deb and CL-Obs groups at 1-year after surgery. Secondary outcomes include 1-year differences in additional measures of knee pain, function, symptoms, activity, and quality of life assessed by the WOMAC, KOOS (Knee Injury and Osteoarthritis Outcome Score), visual analog pain scale, and physical exam; as well as general health assessed with the SF-36 (Short-form Health Survey). Increased intraoperative costs associated with the addition of chondral debridement will also be assessed. DISCUSSION This study will add to the scant literature regarding management of chondral lesions in patients undergoing meniscectomy and might provide treatment guidance for clinicians and their patients.
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Affiliation(s)
- Leslie J Bisson
- University at Buffalo, The State University of New York, Buffalo, NY, United States.
| | - Melissa A Kluczynski
- University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - William M Wind
- University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Marc S Fineberg
- University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Geoffrey A Bernas
- University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Michael A Rauh
- University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - John M Marzo
- University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Robert J Smolinski
- University at Buffalo, The State University of New York, Buffalo, NY, United States
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Bisson LJ, Komm JT, Bernas GA, Fineberg MS, Marzo JM, Rauh MA, Smolinski RJ, Wind WM. Accuracy of a computer-based diagnostic program for ambulatory patients with knee pain. Am J Sports Med 2014; 42:2371-6. [PMID: 25073597 DOI: 10.1177/0363546514541654] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Looking up information regarding a medical condition is the third most popular activity online, and there are a variety of web-based symptom-checking programs available to the patient. However, the authors are not aware of any that have been scientifically evaluated as an accurate measure for the cause of one's knee pain. PURPOSE/HYPOTHESIS The purpose of this study was to design and evaluate an Internet-based program that generates a differential diagnosis based on a history of knee pain entered by the patient. The hypothesis was that the program would accurately generate a differential diagnosis for patients presenting with knee pain. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS A web-based program was created to collect knee pain history and generate a differential diagnosis for ambulatory patients with knee pain. The program selected from 26 common knee diagnoses. A total of 527 consecutive patients aged ≥18 years, who presented with a knee complaint to 7 different board-certified orthopaedic surgeons during a 3-month period, were asked to complete the questionnaire in the program. Upon completion, patients were examined by a board-certified orthopaedic surgeon. Both the patient and physician were blinded to the differential diagnosis generated by the program. A third party was responsible for comparing the diagnosis(es) generated by the program with that determined by the physician. The level of matching between diagnoses determined the accuracy of the program. RESULTS A total of 272 male and 255 female patients, with an average age of 47 years (range, 18-84 years), participated in the study. The median number of diagnoses generated by the program was 4.8 (range, 1-10), with this list containing the physician's diagnosis(es) 89% of the time. The specificity was 27%. CONCLUSION Despite a low specificity, the results of this study show the program to be an accurate method for generating a differential diagnosis for knee pain.
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Affiliation(s)
- Leslie J Bisson
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Jorden T Komm
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Geoffrey A Bernas
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Marc S Fineberg
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - John M Marzo
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Michael A Rauh
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Robert J Smolinski
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - William M Wind
- School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
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Abstract
In 2006, a survey regarding anterior cruciate ligament (ACL) reconstruction was mailed to physician members of the American Orthopaedic Society for Sports Medicine. A total of 993 responses were received from 1747 possible respondents (57%). The number of ACL reconstructions per year ranged from 1 to 275 (mean=55). The most important factors in the timing of surgery were knee range of motion and effusion. Bone-patellar tendon-bone (BPTB) autograft was most commonly preferred (46%), followed by hamstring tendon autograft (32%) and allografts (22%). Five years earlier, BPTB grafts were more frequent and hamstring tendon and allografts were less frequent (63%, 25%, and 12%, respectively). A single-incision arthroscopic technique was used by 90%. Most allowed return to full activity at 5 to 6 months, with a trend toward earlier return for BPTB grafts; quadriceps strength was an important factor in the decision. There was limited experience (4%) with double-bundle and computer-assisted ACL reconstruction. Arthroscopic-assisted, single-incision reconstruction using a BPTB autograft fixed with metal interference screws remains the most common technique used for primary ACL reconstruction. In the past 5 years, the use of alternative graft sources and methods of fixation has increased. Consensus regarding the best graft type, fixation method, and postoperative protocol is still lacking.
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Affiliation(s)
- Thomas R Duquin
- Department of Orthopaedic Surgery, State University of New York at Buffalo, Buffalo, NY, USA
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Munjal S, Rauh MA, Carney K, Fineberg MS, Mihalko W. Fixation strength of tibial inlay graft with one versus two screws: a cadaveric study. Orthopedics 2008; 31:219. [PMID: 19292255 DOI: 10.3928/01477447-20080301-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Various modes of fixation have been advocated for posterior cruciate ligament reconstruction. This study compared pullout forces and modes of failure for 2 commonly used techniques. Ten Achilles tendon-bone plug grafts were fixed to tibial troughs using either one 6.5-mm or two 4-mm cancellous screws positioned anatomically and tested to failure. The constructs did not differ statistically in mean pullout forces (385.2 and 358.8 N for the 6.5-mm and 4-mm screw constructs, respectively). The 2-screw construct failed by pullout, whereas the single-screw fixation failed through fracture. This study provides insight into the fixation used for posterior cruciate ligament reconstruction.
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Abstract
PURPOSE This study was conducted to define what portion of the normal popliteus musculotendinous unit can be visualized during standard diagnostic arthroscopy. METHODS Knee arthroscopy was performed on 5 fresh-frozen cadaveric human knees by use of standard anterolateral and anteromedial portals. The most proximal and distal portions of the popliteus that could be visualized were tagged with arthroscopic sutures. The knees were subsequently dissected, and 4 measurements were made per specimen: the total length of the popliteus tendon; the length of the popliteus tendon that was able to be visualized; the extrasynovial segment at the femoral attachment, which was unable to be visualized; and the distance from the distal-most visible point of the tendon to the musculotendinous junction of the popliteus. RESULTS The mean total length of the popliteus tendon was 42.0 mm. The arthroscopically tagged portion of the popliteus tendon that was able to be visualized averaged 18.2 mm, or 43.8% of the tendon length. The mean distance from the musculotendinous junction to the visualized portion was 15.1 mm, or 35.8% of the total tendon length. The mean distance from the most proximal visualized portion of the tendon to the femoral attachment was 8.7 mm, or 20.4% of the total tendon length. The musculotendinous junction was not arthroscopically visible in any specimen. CONCLUSIONS On standard knee arthroscopy, less than half of the normal popliteus tendon is visible, and the femoral insertion and musculotendinous junction are not visualized. Because most reported popliteus injuries have occurred here, reliance on arthroscopic visualization alone is inadequate. CLINICAL RELEVANCE The limitations of arthroscopic visualization of the normal popliteus tendon have implications for the diagnosis and treatment of posterolateral corner injuries.
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Affiliation(s)
- Marc S Fineberg
- Department of Orthopaedic Surgery, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, USA.
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Abstract
The endoscopic method of anterior cruciate ligament (ACL) reconstruction using a patellar tendon graft that is secured with interference screws is a commonly performed procedure. It has many potential pitfalls, the majority of which are secondary to technical errors. Prevention of errors starts with a full knowledge of normal ACL anatomy and any discrepancies with the size and shape of the graft substitute. Accurate tibial and femoral tunnel placement is essential and involves using consistent intra-articular landmarks and achieving specific radiographic criteria. Accurate tunnel placement minimizes graft excursion and impingement against the roof of the intercondylar notch. This will result in maximum knee stability and motion. Much has been written about the principles of graft-tunnel mismatch and interference screw-bone plug divergence. The clinical implications of these potential sources of error remain somewhat controversial and are discussed in this article.
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Affiliation(s)
- M S Fineberg
- Sports Medicine Service, Department of Orthopaedic Surgery, The State University of New York at Buffalo, Buffalo, New York, USA
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