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Jones MH, Gottreich JR, Jin Y, Kattan MW, Spindler KP, Farrow LD, Frangiamore SJ, Gilot GJ, Hampton RJ, Leo BM, Nickodem RJ, Parker RD, Rosneck JT, Saluan PM, Scarcella MJ, Serna A, Stearns KL. Surgeon Performance as a Predictor for Patient-Reported Outcomes After Arthroscopic Partial Meniscectomy. Orthop J Sports Med 2024; 12:23259671231204014. [PMID: 38646604 PMCID: PMC11032050 DOI: 10.1177/23259671231204014] [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: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 04/23/2024] Open
Abstract
Background Surgeon performance has been investigated as a factor affecting patient outcomes after orthopaedic procedures to improve transparency between patients and providers. Purpose/Hypothesis The purpose of this study was to identify whether surgeon performance influenced patient-reported outcomes (PROMs) 1 year after arthroscopic partial meniscectomy (APM). It was hypothesized that there would be no significant difference in PROMs between patients who underwent APM from various surgeons. Study Design Case-control study; Level of evidence, 3. Methods A prospective cohort of 794 patients who underwent APM between 2018 and 2019 were included in the analysis. A total of 34 surgeons from a large multicenter health care center were included. Three multivariable models were built to determine whether the surgeon-among demographic and meniscal pathology factors-was a significant variable for predicting the Knee injury and Osteoarthritis Outcome Score (KOOS)-Pain subscale, the Patient Acceptable Symptom State (PASS), and a 10-point improvement in the KOOS-Pain at 1 year after APM. Likelihood ratio (LR) tests were used to determine the significance of the surgeon variable in the models. Results The 794 patients were identified from the multicenter hospital system. The baseline KOOS-Pain score was a significant predictor of outcome in the 1-year KOOS-Pain model (odds ratio [OR], 2.1 [95% CI, 1.77-2.48]; P < .001), the KOOS-Pain 10-point improvement model (OR, 0.57 [95% CI, 0.44-0.73), and the 1-year PASS model (OR, 1.42 [95% CI, 1.15-1.76]; P = .002) among articular cartilage pathology (bipolar medial cartilage) and patient-factor variables, including body mass index, Veterans RAND 12-Item Health Survey-Mental Component Score, and Area Deprivation Index. The individual surgeon significantly impacted outcomes in the 1-year KOOS-Pain mixed model in the LR test (P = .004). Conclusion Patient factors and characteristics are better predictors for patient outcomes 1 year after APM than surgeon characteristics, specifically baseline KOOS-Pain, although an individual surgeon influenced the 1-Year KOOS-Pain mixed model in the LR test. This finding has key clinical implications; surgeons who wish to improve patient outcomes after APM should focus on improving patient selection rather than improving the surgical technique. Future research is needed to determine whether surgeon variability has an impact on longer-term patient outcomes.
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Affiliation(s)
- Morgan H. Jones
- Orthopaedic and Arthritis Center for Outcomes Research and Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Julia R. Gottreich
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Yuxuan Jin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Michael W. Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | - Kurt P. Spindler
- Department of Orthopaedic Surgery, Sports Medicine, Cleveland Clinic, Florida, Weston, Florida
| | - Lutul D. Farrow
- Department of Orthopaedic Surgery, Sports Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Gregory J. Gilot
- Department of Orthopaedic Surgery, Sports Medicine, Cleveland Clinic, Florida, Weston, Florida
| | - Robert J. Hampton
- Department of Orthopaedic Surgery, Sports Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Brian M. Leo
- Department of Orthopaedic Surgery, Sports Medicine, Cleveland Clinic, Florida, Weston, Florida
| | - Robert J. Nickodem
- Department of Orthopaedic Surgery, Sports Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Richard D. Parker
- Department of Orthopaedic Surgery, Sports Medicine, Cleveland Clinic, Cleveland, Ohio
| | - James T. Rosneck
- Department of Orthopaedic Surgery, Sports Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Paul M. Saluan
- Department of Orthopaedic Surgery, Sports Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Michael J. Scarcella
- Department of Orthopaedic Surgery, Sports Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Alfred Serna
- Department of Orthopaedic Surgery, Sports Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Kim L. Stearns
- Department of Orthopaedic Surgery, Sports Medicine, Cleveland Clinic, Cleveland, Ohio
- Investigation Performed at the Cleveland Clinic, Cleveland, Ohio, USA
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Gottreich JR, Katz JN, Jones MH. Preoperative Synovial Tissue and Synovial Fluid Biomarkers as Predictors for Outcomes After Knee Arthroscopy and ACL Reconstruction: A Narrative Review. Orthop J Sports Med 2024; 12:23259671231193370. [PMID: 38496336 PMCID: PMC10943742 DOI: 10.1177/23259671231193370] [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: 04/10/2023] [Accepted: 05/03/2023] [Indexed: 03/19/2024] Open
Abstract
Background Biomarkers collected in synovial tissue and fluid have been identified as potential predictors of outcomes after arthroscopy. Purpose To provide a narrative review of the current literature that assesses the associations between preoperative biomarkers in the synovial fluid or synovial tissue and patient outcomes after knee arthroscopy. Study Design Narrative review. Methods We searched the PubMed database with keywords, "biomarkers AND arthroscopy," "biomarkers AND anterior cruciate ligament reconstruction," and "biomarkers AND meniscectomy." To be included, studies must have collected synovial fluid or synovial tissue from patients before or during arthroscopic knee surgery and analyzed the relationship of biomarkers to postoperative patient outcomes. Biomarkers were classified into 4 main categories: metabolism of aggrecan in cartilage, metabolism of collagen in cartilage (type II collagen), noncollagenous proteins in the knee, and other. When biomarker levels and outcomes were expressed with continuous variables, we abstracted the Pearson or Spearman correlation coefficients as the effect measure. If the biomarker values were continuous and the outcomes binary, we abstracted the mean or median biomarker values in those with favorable versus unfavorable outcomes. We calculated effect sizes as the difference between means of both groups divided by the standard deviation from the mean in the group with better outcomes. Results Eight studies were included in the review. Each study reported different patient outcomes. Biomarkers associated with metabolism of aggrecan, type II collagen metabolism, and noncollagenous proteins as well as inflammatory biomarkers had statistically significant associations with a range of patient outcomes after knee arthroscopy. Difference across studies in sample size and outcome measures precluded choosing a single biomarker that best predicted patient outcomes. Conclusion The findings suggest that biomarkers associated with metabolism of aggrecan, type II collagen metabolism, noncollagenous proteins, as well as inflammatory biomarkers may help surgeons and their patients anticipate surgical outcomes.
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Affiliation(s)
- Julia R. Gottreich
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - Morgan H. Jones
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Waddell LM, Musbahi O, Collins JE, Jones MH, Selzer F, Losina E, Katz JN. Responsiveness of Subjective and Objective Measures of Pain and Function Following Operative Interventions for Musculoskeletal Conditions: A Narrative Review. Arthritis Care Res (Hoboken) 2024. [PMID: 38221714 DOI: 10.1002/acr.25298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/16/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Musculoskeletal (MSK) disorders affect ~50% of US adults and 75% of those over the age of 65, representing a sizable economic and disability burden. Outcome measures, both objective and subjective, help clinicians and investigators determine whether interventions to treat MSK conditions are effective. This narrative review qualitatively compared the responsiveness of different types of outcome measures, a key measurement characteristic that assesses an outcome measure's ability to detect change in patient status. METHODS We evaluated elective orthopedic interventions as a model for assessing responsiveness because the great majority of patients improves following surgery. We searched for articles reporting responsiveness (quantified as effect size [ES]) of subjective and objective outcome measures after orthopedic surgery and included 16 articles reporting 17 interventions in this review. RESULTS In 14 of 17 interventions, subjective function measures had an ES 10% greater than that of objective function measures. Two reported a difference in ES of <10%. The sole intervention that demonstrated higher ES of objective function used a composite measure. Sixteen interventions reported measures of subjective pain and/or mixed measures and subjective function. In nine interventions, subjective pain had a higher ES than subjective function by >10%, in three, subjective function had a higher ES than subjective pain by >10%, and in the remaining four, the difference between pain and function was <10%. CONCLUSION These findings reinforce the clinical observation that subjective pain generally changes more than function following elective orthopedic surgery. They also suggest that subjective function measures are more responsive than objective function measures, and composite scores may be more responsive than individual performance tests.
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Affiliation(s)
- Lily M Waddell
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Omar Musbahi
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- MSk Lab, Imperial College London, London, UK
| | - Jamie E Collins
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Morgan H Jones
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Faith Selzer
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elena Losina
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Jeffrey N Katz
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Inflammation and Immunity Brigham and Women's Hospital, Boston, Massachusetts
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Grun LK, Maurmann RM, Scholl JN, Fogaça ME, Schmitz CRR, Dias CK, Gasparotto J, Padoin AV, Mottin CC, Klamt F, Figueiró F, Jones MH, Filippi-Chiela EC, Guma FCR, Barbé-Tuana FM. Obesity drives adipose-derived stem cells into a senescent and dysfunctional phenotype associated with P38MAPK/NF-KB axis. Immun Ageing 2023; 20:51. [PMID: 37821967 PMCID: PMC10566105 DOI: 10.1186/s12979-023-00378-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Adipose-derived stem cells (ADSC) are multipotent cells implicated in tissue homeostasis. Obesity represents a chronic inflammatory disease associated with metabolic dysfunction and age-related mechanisms, with progressive accumulation of senescent cells and compromised ADSC function. In this study, we aimed to explore mechanisms associated with the inflammatory environment present in obesity in modulating ADSC to a senescent phenotype. We evaluated phenotypic and functional alterations through 18 days of treatment. ADSC were cultivated with a conditioned medium supplemented with a pool of plasma from eutrophic individuals (PE, n = 15) or with obesity (PO, n = 14), and compared to the control. RESULTS Our results showed that PO-treated ADSC exhibited decreased proliferative capacity with G2/M cycle arrest and CDKN1A (p21WAF1/Cip1) up-regulation. We also observed increased senescence-associated β-galactosidase (SA-β-gal) activity, which was positively correlated with TRF1 protein expression. After 18 days, ADSC treated with PO showed augmented CDKN2A (p16INK4A) expression, which was accompanied by a cumulative nuclear enlargement. After 10 days, ADSC treated with PO showed an increase in NF-κB phosphorylation, while PE and PO showed an increase in p38MAPK activation. PE and PO treatment also induced an increase in senescence-associated secretory phenotype (SASP) cytokines IL-6 and IL-8. PO-treated cells exhibited decreased metabolic activity, reduced oxygen consumption related to basal respiration, increased mitochondrial depolarization and biomass, and mitochondrial network remodeling, with no superoxide overproduction. Finally, we observed an accumulation of lipid droplets in PO-treated ADSC, implying an adaptive cellular mechanism induced by the obesogenic stimuli. CONCLUSIONS Taken together, our data suggest that the inflammatory environment observed in obesity induces a senescent phenotype associated with p38MAPK/NF-κB axis, which stimulates and amplifies the SASP and is associated with impaired mitochondrial homeostasis.
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Affiliation(s)
- L K Grun
- Graduate Program in Pediatrics and Child Health, School of Medicine, Pontifical Catholic University at Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
- Group of Inflammation and Cellular Senescence, Immunobiology Laboratory, School of Health Sciences and Life, Pontifical Catholic University at Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
| | - R M Maurmann
- Graduate Program in Cellular and Molecular Biology, School of Health, Sciences, and Life, Pontifical Catholic University at Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Group of Inflammation and Cellular Senescence, Immunobiology Laboratory, School of Health Sciences and Life, Pontifical Catholic University at Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - J N Scholl
- Graduate Program in Biological Sciences: Biochemistry, Federal University at Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - M E Fogaça
- Group of Inflammation and Cellular Senescence, Immunobiology Laboratory, School of Health Sciences and Life, Pontifical Catholic University at Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - C R R Schmitz
- Group of Inflammation and Cellular Senescence, Immunobiology Laboratory, School of Health Sciences and Life, Pontifical Catholic University at Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Graduate Program in Biological Sciences: Biochemistry, Federal University at Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - C K Dias
- Graduate Program in Biological Sciences: Biochemistry, Federal University at Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - J Gasparotto
- Institute of Biomedical Sciences, Federal University at Alfenas, Alfenas, Brazil
| | - A V Padoin
- Graduate Program in Medicine and Health Sciences, Pontifical Catholic University at Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - C C Mottin
- Graduate Program in Medicine and Health Sciences, Pontifical Catholic University at Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - F Klamt
- Graduate Program in Biological Sciences: Biochemistry, Federal University at Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - F Figueiró
- Graduate Program in Biological Sciences: Biochemistry, Federal University at Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - M H Jones
- Graduate Program in Pediatrics and Child Health, School of Medicine, Pontifical Catholic University at Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - E C Filippi-Chiela
- Institute of Basic Health Sciences, Department of Morphological Sciences, Federal University at Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Center for Biotechnology, Federal University at Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - F C R Guma
- Graduate Program in Biological Sciences: Biochemistry, Federal University at Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - F M Barbé-Tuana
- Graduate Program in Pediatrics and Child Health, School of Medicine, Pontifical Catholic University at Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Graduate Program in Cellular and Molecular Biology, School of Health, Sciences, and Life, Pontifical Catholic University at Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Group of Inflammation and Cellular Senescence, Immunobiology Laboratory, School of Health Sciences and Life, Pontifical Catholic University at Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Katz JN, Collins JE, Brophy RH, Cole BJ, Cox CL, Guermazi A, Jones MH, Levy BA, MacFarlane LA, Mandl LA, Marx RG, Selzer F, Spindler KP, Wright RW, Losina E, Chang Y. Radiographic Changes Five Years After Treatment of Meniscal Tear and Osteoarthritic Changes. Arthritis Care Res (Hoboken) 2023:10.1002/acr.25197. [PMID: 37474452 PMCID: PMC10799184 DOI: 10.1002/acr.25197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Meniscal tear in persons aged ≥45 years is typically managed with physical therapy (PT), and arthroscopic partial meniscectomy (APM) is offered to those who do not respond. Prior studies suggest APM may be associated with greater progression of radiographic changes. METHODS We assessed changes between baseline and 60 months in the Kellgren-Lawrence (KL) grade and OARSI radiographic score (including subscores for joint space narrowing and osteophytes) in subjects aged 45-85 years enrolled into a seven-center randomized trial comparing outcomes of APM with PT for meniscal tear, osteoarthritis changes, and knee pain. The primary analysis classified subjects according to treatment received. To balance APM and PT groups, we developed a propensity score and used inverse probability weighting (IPW). We imputed a 60-month change in the OARSI score for subjects who underwent total knee replacement (TKR). In a sensitivity analysis, we classified subjects by randomization group. RESULTS We analyzed data from 142 subjects (100 APM, 42 PT). The mean ± SD weighted baseline OARSI radiographic score was 3.8 ± 3.5 in the APM group and 4.0 ± 4.9 in the PT group. OARSI scores increased by a mean of 4.1 (95% confidence interval [95% CI] 3.5-4.7) in the APM group and 2.4 (95% CI 1.7-3.2) in the PT group (P < 0.001) due to changes in the osteophyte component. We did not observe statistically significant differences in the KL grade. Sensitivity analyses yielded similar findings to the primary analysis. CONCLUSION Subjects treated with APM had greater progression in the OARSI score because of osteophyte progression but not in the KL grade. The clinical implications of these findings require investigation.
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Affiliation(s)
- Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jamie E Collins
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert H Brophy
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Ali Guermazi
- Boston Veteran's Medical Center and Boston University Medical Center, Boston, Massachusetts
| | - Morgan H Jones
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Lisa A Mandl
- Hospital for Special Surgery, New York, New York
| | | | - Faith Selzer
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Elena Losina
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yuchiao Chang
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Sheean AJ, Jin Y, Huston LJ, Brophy RH, Cox CL, Flanigan DC, Jones MH, Kaeding CC, Magnussen RA, Marx RG, Matava MJ, McCarty EC, Parker RD, Wolcott ML, Wolf BR, Wright RW, Spindler KP. Predictors of Return to Activity at 2 Years After Anterior Cruciate Ligament Reconstruction Among Patients With High Preinjury Marx Activity Scores: A MOON Prospective Cohort Study. Am J Sports Med 2023; 51:2313-2323. [PMID: 37724692 DOI: 10.1177/03635465231172769] [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: 09/21/2023]
Abstract
BACKGROUND Predictors of return to activity after anterior cruciate ligament reconstruction (ACLR) among patients with relatively high preinjury activity levels remain poorly understood. PURPOSE/HYPOTHESIS The purpose of this study was to identify predictors of return to preinjury levels of activity after ACLR, defined as achieving a Marx activity score within 2 points of the preinjury value, among patients with Marx activity scores of 12 to 16 who had been prospectively enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) cohort. We hypothesized that age, sex, preinjury activity level, meniscal injuries and/or procedures, and concurrent articular cartilage injuries would predict return to preinjury activity levels at 2 years after ACLR. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS All unilateral ACLR procedures from 2002 to 2008 performed in patients enrolled in the MOON, with preinjury Marx activity scores ranging from 12 to 16, were evaluated with a specific focus on return to preinjury activity levels at 2 years postoperatively. Return to activity was defined as a Marx activity score within 2 points of the preinjury value. The proportion of patients able to return to preinjury activity levels was calculated, and multivariable modeling was performed to identify risk factors for patients' inability to return to preinjury activity levels. RESULTS A total of 1188 patients were included in the final analysis. The median preinjury Marx activity score was 16 (interquartile range, 12-16). Overall, 466 patients (39.2%) were able to return to preinjury levels of activity, and 722 patients (60.8%) were not able to return to preinjury levels of activity. Female sex, smoking at the time of ACLR, fewer years of education, lower 36-Item Short Form Health Survey Mental Component Summary scores, and higher preinjury Marx activity scores were predictive of patients' inability to return to preinjury activity levels. Graft type, revision ACLR, the presence of medial and/or lateral meniscal injuries, a history of meniscal surgery, the presence of articular cartilage injuries, a history of articular cartilage treatment, and the presence of high-grade knee laxity were not predictive of a patient's ability to return to preinjury activity level. CONCLUSION At 2 years after ACLR, most patients with high preinjury Marx activity scores did not return to their preinjury level of activity. The higher the preinjury Marx activity score that a patient reported at the time of enrollment, the less likely he/she was able to return to preinjury activity level. Smoking and lower mental health at the time of ACLR were the only modifiable risk factors in this cohort that predicted an inability to return to preinjury activity levels. Continued effort and investigation are required to maximize functional recovery after ACLR in patients with high preinjury levels of activity.
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Affiliation(s)
- Andrew J Sheean
- San Antonio Military Medical Center, San Antonio, Texas, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Yuxuan Jin
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura J Huston
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert H Brophy
- Washington University in St Louis, St Louis, Missouri, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - David C Flanigan
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Morgan H Jones
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher C Kaeding
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert A Magnussen
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew J Matava
- Washington University in St Louis, St Louis, Missouri, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric C McCarty
- University of Colorado, Denver, Colorado, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard D Parker
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Michelle L Wolcott
- University of Colorado, Denver, Colorado, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian R Wolf
- University of Iowa, Iowa City, Iowa, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
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7
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Sullivan JK, Gottreich JR, Imrey PB, Winalski CS, Li X, Spindler KP, Tomko PM, Cox CL, Wright RW, Jones MH. The Corticosteroid Meniscectomy Trial of Extended-Release Triamcinolone Injection After Arthroscopic Partial Meniscectomy: Protocol for a Double-Blind Randomized Controlled Trial. Orthop J Sports Med 2023; 11:23259671231150812. [PMID: 37113139 PMCID: PMC10126624 DOI: 10.1177/23259671231150812] [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: 09/22/2022] [Accepted: 10/21/2022] [Indexed: 04/29/2023] Open
Abstract
Background Meniscal tear in older adults often accompanies knee osteoarthritis and is commonly treated with arthroscopic partial meniscectomy (APM) when patients have persistent pain after a trial of physical therapy. Cross-sectional evidence suggests that synovitis is associated with baseline pain in this patient population, but little is known about the relationship between synovitis and postoperative recovery or progression of knee osteoarthritis. Purpose/Hypothesis Intra-articular extended-release triamcinolone may reduce inflammation and thereby improve outcomes and slow disease progression. This article presents the rationale behind the Corticosteroid Meniscectomy Trial (CoMeT) and describes its study design and implementation strategies. Study Design Randomized controlled trial. Methods CoMeT is a 2-arm, 3-center, randomized placebo-controlled trial designed to establish the clinical efficacy of extended-release triamcinolone administered via intra-articular injection immediately after APM. The primary outcome is change in Knee injury and Osteoarthritis Outcome Score Pain subscore at 3-month follow-up. Synovial biopsy, joint fluid aspirate, and urine and blood sample analyses will examine the associations between various objective measures of baseline inflammation and pre- and postoperative outcome measures and clinical responses to triamcinolone intervention. Quantitative 3-T magnetic resonance imaging will evaluate cartilage and meniscal composition and 3-dimensional bone shape to detect early joint degeneration. Results We discuss methodologic innovations and challenges. Conclusion To our knowledge, this is the first randomized double-blind clinical trial that will analyze the effect of extended-release triamcinolone acetonide on pain, magnetic resonance imaging measures of structural change and effusion/synovitis, soluble biomarkers, and synovial tissue transcriptomics after APM.
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Affiliation(s)
- James K. Sullivan
- Cleveland Clinic Lerner College of
Medicine of Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Julia R. Gottreich
- Orthopaedic and Arthritis Center for
Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Peter B. Imrey
- Cleveland Clinic Lerner College of
Medicine of Case Western Reserve School of Medicine, Cleveland, Ohio, USA
- Department of Quantitative Health
Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Xiaojuan Li
- Imaging Institute, Cleveland Clinic,
Cleveland, Ohio, USA
- Department of Biomedical Engineering,
Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P. Spindler
- Department of Orthopaedic Surgery,
Sports Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick M. Tomko
- Department of Orthopaedic Surgery,
Sports Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Charles L. Cox
- Department of Orthopaedic Surgery,
Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rick W. Wright
- Department of Orthopaedic Surgery,
Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Morgan H. Jones
- Orthopaedic and Arthritis Center for
Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery,
Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Morgan H. Jones, MD, MPH,
Department of Orthopedic Surgery, Brigham and Women’s Hospital, 75 Francis St,
Hale 5016, Boston, MA 02115, USA (
)
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8
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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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9
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Xie D, Murray J, Lartey R, Gaj S, Kim J, Li M, Eck BL, Winalski CS, Altahawi F, Jones MH, Obuchowski NA, Huston LJ, Harkins KD, Friel HT, Damon BM, Knopp MV, Kaeding CC, Spindler KP, Li X. Multi-vendor multi-site quantitative MRI analysis of cartilage degeneration 10 Years after anterior cruciate ligament reconstruction: MOON-MRI protocol and preliminary results. Osteoarthritis Cartilage 2022; 30:1647-1657. [PMID: 36049665 PMCID: PMC9671830 DOI: 10.1016/j.joca.2022.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 01/08/2022] [Revised: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the protocol of a multi-vendor, multi-site quantitative MRI study for knee post-traumatic osteoarthritis (PTOA), and to present preliminary results of cartilage degeneration using MR T1ρ and T2 imaging 10 years after anterior cruciate ligament reconstruction (ACLR). DESIGN This study involves three sites and two MR platforms. The patients are from a nested cohort (termed as Onsite cohort) within the Multicenter Orthopaedic Outcomes Network (MOON) cohort 10 years after ACLR. Phantoms and controls were scanned for evaluating reproducibility. Cartilage was automatically segmented, and T1ρ and T2 were compared between operated, contralateral, and control knees. RESULTS Sixty-eight ACL-reconstructed patients and 20 healthy controls were included. In phantoms, the intra-site coefficients of variation (CVs) of repeated scans ranged 1.8-2.1% for T1ρ and 1.3-1.7% for T2. The inter-site CVs ranged 1.6-2.1% for T1ρ and 1.1-1.4% for T2. In human subjects, the intra-site scan/rescan CVs ranged 2.2-3.5% for T1ρ and 2.6-4.9% for T2 for the six major compartments. In patients, operated knees showed significantly higher T1ρ and T2 values mainly in medial femoral condyle, medial tibia and trochlear cartilage compared with contralateral knees, and showed significantly higer T1ρ and T2 values in all six compartments compared to healthy control knees. The patient contralateral knees showed higher T1ρ and T2 values mainly in the lateral femoral condyle, lateral tibia, trochlear, and patellar cartilage compared to healthy control knees. CONCLUSION A platform and workflow with rigorous quality control has been established for a multi-vendor multi-site quantitative MRI study in evaluating PTOA 10 years after ACLR. Our preliminary report suggests significant cartilage matrix changes in both operated and contralateral knees compared with healthy control knees.
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Affiliation(s)
- D Xie
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - J Murray
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - R Lartey
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - S Gaj
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - J Kim
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - M Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - B L Eck
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - C S Winalski
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - F Altahawi
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - M H Jones
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - N A Obuchowski
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - L J Huston
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - K D Harkins
- Departments of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - H T Friel
- MR Clinical Science, Philips Healthcare, Highland Heights, OH, USA.
| | - B M Damon
- Departments of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - M V Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University, Columbus, OH, USA.
| | - C C Kaeding
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA.
| | - K P Spindler
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - X Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
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10
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Byrd JM, Colak C, Yalcin S, Winalski C, Briskin I, Farrow LD, Jones MH, Miniaci AA, Parker RD, Rosneck JT, Saluan PM, Strnad GJ, Spindler KP. Posteromedial Tibial Bone Bruise After Anterior Cruciate Ligament Injury: An MRI Study of Bone Bruise Patterns in 208 Patients. Orthop J Sports Med 2022; 10:23259671221120636. [PMID: 36276425 PMCID: PMC9580091 DOI: 10.1177/23259671221120636] [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: 04/19/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Bone bruise patterns after anterior cruciate ligament (ACL) rupture may predict the presence of intra-articular pathology and help explain the mechanism of injury. Lateral femoral condyle (LFC) and lateral tibial plateau (LTP) bone bruises are pathognomic to ACL rupture. There is a lack of information regarding medial tibial plateau (MTP) and medial femoral condyle (MFC) bone bruises. Purpose: To summarize the prevalence and location of MTP bone bruises with acute ACL rupture and to determine the predictors of MTP bone bruises. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Inclusion criteria were patients who underwent ACL reconstruction between February 2015 and November 2017, magnetic resonance imaging (MRI) within 90 days of injury, and participation in the database. Exclusion criteria included previous ipsilateral surgery, multiligamentous injuries, and incomplete imaging. Due to the large number of cases remaining (n = 600), 150 patients were selected randomly from each year included in the study, for a total of 300 patients. Two readers independently reviewed injury MRI scans using the Costa-Paz bone bruise grading system. Logistic regression was used to identify factors associated with MTP bone bruises. Results: Included were 208 patients (mean age, 23.8 years; mean body mass index, 25.6). The mechanism of injury was noncontact in 59% of injuries, with over half from soccer, basketball, and football. The median time from injury to MRI scan was 12 days. Of the 208 patients, 98% (203/208) had a bone bruise, 79% (164/208) had an MTP bone bruise, and 83% (172/208) had bruises in both medial and lateral compartments. The most common pattern, representing 46.6% of patients (97/208), was a bruise in all 4 locations (MFC, LFC, MTP, and LTP). Of the 164 MTP bruises, 160 (98%) involved the posterior third of the plateau, and 161 were grade 1. The presence of an MFC bruise was the only independent risk factor for an MTP bruise (odds ratio, 3.71). The resulting nomogram demonstrated MFC bruise, sport, and mechanism of injury were the most important predictors of an MTP bruise. Conclusion: MTP bruise after acute ACL rupture was as prevalent as lateral bruises. The presence of a posterior MTP bruise suggested anterior tibial translation at the time of injury and could portend more medial compartment pathology at the time of injury than previously recognized.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kurt P. Spindler
- Kurt P. Spindler, MD, Department of Orthopaedic Surgery, Cleveland Clinic Florida Region, 3250 Meridian Pkwy, Krupa Building, Weston, FL 33331, USA (; )
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11
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MacFarlane LA, Arant KR, Kostic AM, Mass H, Jones MH, Collins JE, Losina E, Katz JN. Identifying Inflammation in Knee Osteoarthritis: Relationship of Synovial Fluid White Blood Cell Count to Effusion-Synovitis on Magnetic Resonance Imaging. Arthritis Care Res (Hoboken) 2022. [PMID: 36250414 DOI: 10.1002/acr.25040] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/15/2022] [Accepted: 10/11/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Inflammation is a potential pain generator and treatment target in knee osteoarthritis (OA). Inflammation can be detected on magnetic resonance imaging (MRI) and by synovial fluid white blood cell count (WBC). However, the performance characteristics of synovial fluid WBC for the detection of synovitis have not been established. This study was undertaken to determine the sensitivity and specificity of synovial fluid WBC in identifying inflammation in knee OA using MRI effusion-synovitis as the gold standard. METHODS We identified records of patients seen at an academic center with a diagnosis code for knee OA, a procedural code for knee aspiration, and a laboratory order for synovial fluid WBC in the same encounter, as well as an MRI within 12 months of the aspiration. MRIs were read for effusion-synovitis using the MRI OA Knee Score (MOAKS). We dichotomized effusion-synovitis as 1) none or small, or 2) medium or large. We calculated the sensitivity and specificity of synovial fluid WBC using MRI effusion-synovitis (medium/large) as the gold standard. We used the Youden index to identify the best cut point. RESULTS We included 75 patients. Mean ± SD age was 63 ± 12 years, and 69% were female. The synovial fluid WBC was higher in the medium/large effusion-synovitis group (median 335 [interquartile range (IQR) 312]) than in the none/small group (median 194 [IQR 272]). The optimal cut point was 242, yielding a sensitivity of 71% (95% confidence interval [95% CI] 56-83%) and specificity of 63% (95% CI 41-81%). CONCLUSION The sensitivity and specificity of synovial fluid WBC in identifying effusion-synovitis on MRI were limited. Further research is needed to better understand the association between MRI and effusion-synovitis measured by synovial fluid and to determine which measure more strongly relates to synovial histopathology and patient outcomes.
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Affiliation(s)
| | | | | | - Hanna Mass
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Morgan H Jones
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jamie E Collins
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elena Losina
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey N Katz
- Brigham and Women's Hospital, Harvard Medical School, and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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12
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Farrow LD, Scarcella MJ, Wentt CL, Jones MH, Spindler KP, Briskin I, Leo BM, McCoy BW, Miniaci AA, Parker RD, Rosneck JT, Sabo FM, Saluan PM, Serna A, Stearns KL, Strnad GJ, Williams JS. Evaluation of Health Care Disparities in Patients With Anterior Cruciate Ligament Injury: Does Race and Insurance Matter? Orthop J Sports Med 2022; 10:23259671221117486. [PMID: 36199832 PMCID: PMC9528024 DOI: 10.1177/23259671221117486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background: It is unknown whether race- or insurance-based disparities in health care exist regarding baseline knee pain, knee function, complete meniscal tear, or articular cartilage damage in patients who undergo anterior cruciate ligament reconstruction (ACLR). Hypothesis: Black patients and patients with Medicaid evaluated for ACLR would have worse baseline knee pain, worse knee function, and greater odds of having a complete meniscal tear. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A cohort of patients (N = 1463; 81% White, 14% Black, 5% Other race; median age, 22 years) who underwent ACLR between February 2015 and December 2018 was selected from an institutional database. Patients who underwent concomitant procedures and patients of undisclosed race or self-pay status were excluded. The associations of race with preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) Pain subscale, KOOS Function subscale, and intraoperatively assessed complete meniscal tear (tear that extended through both the superior and the inferior meniscal surfaces) were determined via multivariate modeling with adjustment for age, sex, insurance status, years of education, smoking status, body mass index (BMI), meniscal tear location, and Veterans RAND 12-Item Health Survey Mental Component Score (VR-12 MCS). Results: The 3 factors most strongly associated with worse KOOS Pain and KOOS Function were lower VR-12 MCS score, increased BMI, and increased age. Except for age, the other two factors had an unequal distribution between Black and White patients. Univariate analysis demonstrated equal baseline median KOOS Pain scores (Black, 72.2; White, 72.2) and KOOS Function scores (Black, 68.2; White, 68.2). After adjusting for confounding variables, there was no significant difference between Black and White patients in KOOS Pain, KOOS Function, or complete meniscal tears. Insurance status was not a significant predictor of KOOS Pain, KOOS Function, or complete meniscal tear. Conclusion: There were clinically significant differences between Black and White patients evaluated for ACLR. After accounting for confounding factors, no difference was observed between Black and White patients in knee pain, knee function, or complete meniscal tear. Insurance was not a clinically significant predictor of knee pain, knee function, or complete meniscal tear.
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Affiliation(s)
- Lutul D. Farrow
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Christa L. Wentt
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Morgan H. Jones
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P. Spindler
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Isaac Briskin
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian M. Leo
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Brett W. McCoy
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - James T. Rosneck
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Frank M. Sabo
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul M. Saluan
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Alfred Serna
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Kim L. Stearns
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
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13
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Yalcin S, McCoy B, Farrow LD, Johnson C, Jones MH, Kolczun M, Leo B, Miniaci A, Nickodem R, Parker R, Serna A, Stearns K, Strnad G, Williams J, Yuxuan J, Spindler KP. Do Patellar Tendon Repairs Have Better Outcomes than Quadriceps Tendon Repairs? A Prospective Cohort Analysis. J Knee Surg 2022. [PMID: 35798347 DOI: 10.1055/s-0042-1750060] [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: 02/07/2023]
Abstract
Patellar tendon (PT) and quadriceps tendon (QT) ruptures represent significant injuries and warrant surgical intervention in most patients. Outcome data are predominantly retrospective analyses with low sample sizes. There are also minimal data comparing QT and PT repairs and the variables impacting patient outcomes. The level of evidence of the study is level II (prognosis). From the prospective OME cohort, 189 PT or QT repairs were performed between February 2015 and October 2019. Of these, 178 were successfully enrolled (94.2%) with 1-year follow-up on 141 (79.2%). Baseline demographic data included age, sex, race, BMI, years of education, smoking status, and baseline VR-12 MCS score. Surgical and follow-up data included surgeon volume, fixation technique, baseline, and 1-year Knee Injury and Osteoarthritis Outcome Score-Pain (KOOS-Pain), Knee Injury and Osteoarthritis Outcome Score-Physical Function (KOOS-PS), and 1-year Patient Acceptable Symptom State (PASS) scores and complications. Multivariable regression analysis was utilized to identify prognosis and significant risk factors for outcomes-specifically, whether KOOS-Pain or KOOS-PS were different between QT versus PT repairs. There were 59 patients in the PT cohort and 82 patients in QT cohort. Baseline demographic data demonstrated that PT cohort was younger (45.1 vs. 59.5 years, p <0.001), included significantly fewer patients of White race (51.7 vs. 80.0%, p = 0.001), lesser number of years of education (13.9 vs. 15.2 years, p = 0.020), a higher percentage of "high" surgeon volume (72.9% vs. 43.9%, p = 0.001) and 25.4% of PT repairs had supplemental fixation (QT had zero, p <0.001). Multivariable analysis identified gender (female-worse, p = 0.001), years of education (higher-better, p = 0.02), and baseline KOOS-Pain score (higher-better, p <0.001) as the risk factors that significantly predicted KOOS-Pain score. The risk factors that significantly predicted KOOS-PS were gender (female worse, p = 0.033), race (non-White-worse, p <0.001), baseline VR-12 MCS score (higher-better, p <0.001), and baseline KOOS-PS score (higher better, p = 0.029). KOOS-Pain and KOOS-PS scores improved after both QT and PT repairs. Patient reported pain and function at 1 year were similar between PT and QT repairs after adjusting for known risk factors. Multivariable analysis identified female gender and low baseline KOOS scores as predictors for worse outcomes.
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Affiliation(s)
- Sercan Yalcin
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
| | - Brett McCoy
- Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
| | - Lutul D Farrow
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
| | - Carrie Johnson
- Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
| | - Morgan H Jones
- Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
| | - Michael Kolczun
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
| | - Brian Leo
- Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
| | - Anthony Miniaci
- Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
| | - Robert Nickodem
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
| | - Richard Parker
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
| | - Alfred Serna
- Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
| | - Kim Stearns
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
| | - Greg Strnad
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
| | - James Williams
- Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
| | - Jin Yuxuan
- Department of Quantitative Health Sciences, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
| | - Kurt P Spindler
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
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14
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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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15
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Santana DC, Oak SR, Jin Y, Rothy A, Lee LL, Katz JN, Winalski CS, Duryea J, Jones MH. Increased Joint Space Narrowing After Arthroscopic Partial Meniscectomy: Data From the Osteoarthritis Initiative. Am J Sports Med 2022; 50:2075-2082. [PMID: 35604336 DOI: 10.1177/03635465221096790] [Citation(s) in RCA: 2] [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 partial meniscectomy (APM) is widely performed and remains an important therapeutic option for patients with a meniscal tear. However, it is debated whether or not APM accelerates the progression of osteoarthritis (OA) in the long term. PURPOSE/HYPOTHESIS The purpose was to compare the progression of OA measured by the change in tibiofemoral joint space width (JSW)-a quantitative measure of OA radiographic severity-across 3 groups with a midterm follow-up: (1) patients undergoing APM; (2) those with a meniscal tear treated nonoperatively; and (3) those without a tear. We hypothesized that the reduction in JSW would be greatest in patients undergoing APM and least in those patients without a tear. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Using the Osteoarthritis Initiative cohort, a total of 144 patients were identified that underwent APM with at least 12 months of follow up and without previous knee surgery. Those with a meniscal tear who did not have APM (n = 144) and those without a tear (n = 144) were matched to patients who had APM by sex, age, Kellgren-Lawrence (KL) grade, and follow up time. Participants underwent magnetic resonance imaging at baseline. Knee radiographs to assess JSW were collected annually or biannually. The change in minimum medial compartment JSW was calculated using a validated automated method. A piecewise linear mixed effects model was constructed to examine the relationship between JSW decline over time and treatment group-adjusting for age, body mass index, smoking status, KL grade, and baseline JSW. RESULTS All groups had comparable baseline JSW-ranging from 4.33 mm to 4.38 mm. The APM group had a rate of JSW decline of -0.083 mm/mo in the first 12 months and -0.014 mm/mo between 12 and 72 months. The rate of JSW decline in the APM group was approximately 27 times greater in the first 12 months than that in the nonsurgical group (-0.003 mm/mo) and 5 times greater than that in the no tear group (-0.015 mm/mo); however, there was no significant difference between groups for 12 to 72 months (nonsurgical group: -0.009 mm/mo; no tear group: -0.010 mm/mo). The adjusted JSW in the APM group was 4.38 mm at baseline and decreased to 2.57 mm at 72 months; the JSW in the nonsurgical group declined from 4.31 mm to 3.73 mm, and in the no tear group it declined from 4.33 mm to 3.54 mm. There was a statistically significant difference in JSW change between baseline and 72 months for the APM group compared with the other groups (P < .001), but not between the nonsurgical and no tear groups (P = .12). CONCLUSION In the first postoperative year, APM results in a faster rate of joint space narrowing compared with knees undergoing nonsurgical management of meniscal tears. Thereafter, there are comparable rates of OA progression regardless of the chosen management. APM results in a persistent decrease in JSW over at least 72 months. An untreated meniscal tear does not contribute to radiographic progression-assessed by JSW-as compared with an intact meniscus.
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Affiliation(s)
- Daniel C Santana
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Sameer R Oak
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Yuxuan Jin
- Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Ling-Ling Lee
- Cleveland Clinic Family Medicine Residency, Lakewood, Ohio, USA
| | - Jeffrey N Katz
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carl S Winalski
- Department of Radiology and Biomedical Engineering, Program of Advanced Musculoskeletal Imaging, Lerner Research Institute, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jeff Duryea
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Morgan H Jones
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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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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Yang M, Colak C, Chundru KK, Gaj S, Nanavati A, Jones MH, Winalski CS, Subhas N, Li X. Automated knee cartilage segmentation for heterogeneous clinical MRI using generative adversarial networks with transfer learning. Quant Imaging Med Surg 2022; 12:2620-2633. [PMID: 35502381 PMCID: PMC9014147 DOI: 10.21037/qims-21-459] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/26/2021] [Indexed: 08/27/2023]
Abstract
BACKGROUND This study aimed to build a deep learning model to automatically segment heterogeneous clinical MRI scans by optimizing a pre-trained model built from a homogeneous research dataset with transfer learning. METHODS Conditional generative adversarial networks pretrained on the Osteoarthritis Initiative MR images was transferred to 30 sets of heterogenous MR images collected from clinical routines. Two trained radiologists manually segmented the 30 sets of clinical MR images for model training, validation and test. The model performance was compared to models trained from scratch with different datasets, as well as two radiologists. A 5-fold cross validation was performed. RESULTS The transfer learning model obtained an overall averaged Dice coefficient of 0.819, an averaged 95 percentile Hausdorff distance of 1.463 mm, and an averaged average symmetric surface distance of 0.350 mm on the 5 random holdout test sets. A 5-fold cross validation had a mean Dice coefficient of 0.801, mean 95 percentile Hausdorff distance of 1.746 mm, and mean average symmetric surface distance of 0.364 mm. It outperformed other models and performed similarly as the radiologists. CONCLUSIONS A transfer learning model was able to automatically segment knee cartilage, with performance comparable to human, using heterogeneous clinical MR images with a small training data size. In addition, the model proved robust when tested through cross validation and on images from a different vendor. We found it feasible to perform fully automated cartilage segmentation of clinical knee MR images, which would facilitate the clinical application of quantitative MRI techniques and other prediction models for improved patient treatment planning.
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Affiliation(s)
- Mingrui Yang
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
| | - Ceylan Colak
- Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kishore K. Chundru
- Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sibaji Gaj
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
| | - Andreas Nanavati
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
| | - Morgan H. Jones
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Carl S. Winalski
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
- Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Naveen Subhas
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
- Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Xiaojuan Li
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
- Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
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18
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Scarcella MJ, Farrow LD, Jones MH, Rosneck J, Briskin I, Spindler KP. Opioid Use After Simple Arthroscopic Knee Surgery. Am J Sports Med 2022; 50:1644-1650. [PMID: 35404151 DOI: 10.1177/03635465221080788] [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 Evidence-based prescribing guidelines are lacking for opioids after most orthopaedic surgical procedures. HYPOTHESIS Opioids are commonly overprescribed after simple knee arthroscopy. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A cohort of 174 patients who underwent simple arthroscopic knee surgery were prospectively evaluated using data from the Outcome Management and Evaluation database. All patients received 10 combined hydrocodone 5 mg and acetaminophen 325 mg pills postoperatively. Patients were excluded if they (1) had revision surgery, (2) had concomitant complex surgery (eg, ligament surgery, osteotomy), (3) had current opioid use, (4) had open surgery for removal of hardware, (5) or had bilateral knee surgery. Total opioid consumption was reported at the first postoperative visit, and a distribution was created based on patient response. Based on the distribution, patients were separated into low (0-2 pills) versus high (3 or more pills) opioid consumption groups for evaluating risk factors for opioid use. The risk factors included were age, body mass index, smoking status, education level, baseline pain (Knee injury and Osteoarthritis Outcome Score pain subscale [KOOS Pain]), and baseline mental health (Veterans RAND 12-Item Health Survey Mental Component Score), as well as intraoperative findings such as synovial characteristics and extent of osteoarthritis in the multivariate model. RESULTS Total opioid consumption ranged from 0 to 19 pills. The median pill count was 2 (25th; 75th interquartile range, 0; 4). Of total patients, 59% were categorized as having low opioid consumption, and the remaining 41% were in the high opioid consumption group. Only 23 patients (13.2%) took 6 or more pills. Preoperative pain as measured by KOOS Pain score was a significant predictor of high opioid consumption postoperatively (odds ratio, 0.97; 95% CI, 0.95-0.99; P = .003). CONCLUSION The clinically relevant conclusion is that opioids are overprescribed after simple arthroscopic knee surgery. Based on distribution, the authors recommend that 4 pills be prescribed after simple arthroscopic knee surgery. After accounting for confounding variables, preoperative pain was associated with higher postoperative opioid consumption.
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Affiliation(s)
- Michael J Scarcella
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio, USA
| | - Lutul D Farrow
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio, USA
| | - Morgan H Jones
- Department of Orthopaedic Surgery,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - James Rosneck
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio, USA
| | - Isaac Briskin
- Department of Quantitative Health Services, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Florida Region, Weston, Florida, USA
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19
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Collins JE, Shrestha S, Losina E, Marx RG, Guermazi A, Jarraya M, Jones MH, Levy BA, Mandl LA, Williams EE, Wright RW, Spindler KP, Katz JN. Five-Year Structural Changes in Patients with Meniscal Tear and Osteoarthritis: Data from an RCT of Arthroscopic Partial Meniscectomy vs. Physical Therapy. Arthritis Rheumatol 2022; 74:1333-1342. [PMID: 35245416 PMCID: PMC9339455 DOI: 10.1002/art.42105] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/12/2021] [Accepted: 02/28/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Data from long-term follow-up of several randomized controlled trials (RCTs) of arthroscopic partial meniscectomy (APM) vs. non-operative therapy or sham have suggested that APM may be associated with increased risk of worsening in radiographic features of osteoarthritis (OA). Our objective was to estimate the risk of MRI-based OA structural changes using baseline, 18-month, and 60-month MRI data from an RCT of APM vs. physical therapy in participants with meniscal tear and OA. METHODS We used data from the MeTeOR (Meniscal Tear in Osteoarthritis Research) Trial. MRIs were read using the MRI OA Knee Score (MOAKS). We used linear mixed effects models to examine the association between treatment group and continuous MOAKS summary scores, and Poisson regression to assess categorical change in joint structure. Analyses assessed change from baseline to 18 months and 18-to-60 months. We performed both intention-to-treat and as-treated analyses. RESULTS The analytic sample included 302 participants. For both treatment groups, more change was seen over the earlier (baseline - 18 months) interval than the later interval. APM was associated with increased risk of any worsening in cartilage surface area damage score (relative risk 1.35, 95% CI 1.14-1.61), osteophytes, and effusion-synovitis over the earlier time period. Only change in osteophytes was significantly different between treatment groups in the later time period. CONCLUSION These findings suggest the association between APM and MRI-based changes is most apparent in the 18 months after surgery. The reason for the attenuation of this association over longer follow-up merits further investigation.
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Affiliation(s)
- Jamie E Collins
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Swastina Shrestha
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Boston University School of Public Health, Boston, MA
| | - Robert G Marx
- Department of Orthopaedic Surgery, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine Boston, MA
| | - Mohamed Jarraya
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine Boston, MA.,Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Morgan H Jones
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Lisa A Mandl
- Department of Medicine, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY
| | - Emma E Williams
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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20
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Altahawi F, Reinke EK, Briskin I, Cantrell WA, Flanigan DC, Fleming BC, Huston LJ, Li X, Oak S, Obuchowski NA, Scaramuzza EA, Winalski CS, Zajichek A, Spindler KP, Jones MH, Jones MH. Meniscal Treatment as a Predictor of Worse Articular Cartilage Damage on MRI at 2 Years After ACL Reconstruction: The MOON Nested Cohort. Am J Sports Med 2022; 50:951-961. [PMID: 35373606 PMCID: PMC9176689 DOI: 10.1177/03635465221074662] [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 anterior cruciate ligament reconstruction (ACLR) are at an increased risk for posttraumatic osteoarthritis (PTOA). While we have previously shown that meniscal treatment with ACLR predicts more radiographic PTOA at 2 to 3 years postoperatively, there are a limited number of similar studies that have assessed cartilage directly with magnetic resonance imaging (MRI). HYPOTHESIS Meniscal repair or partial meniscectomy at the time of ACLR independently predicts more articular cartilage damage on 2- to 3-year postoperative MRI compared with a healthy meniscus or a stable untreated tear. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A consecutive series of patients undergoing ACLR from 1 site within the prospective, nested Multicenter Orthopaedic Outcomes Network (MOON) cohort underwent bilateral knee MRI at 2 to 3 years postoperatively. Patients were aged <36 years without previous knee injuries, were injured while playing sports, and had no history of concomitant ligament surgery or contralateral knee surgery. MRI scans were graded by a board-certified musculoskeletal radiologist using the modified MRI Osteoarthritis Knee Score (MOAKS). A proportional odds logistic regression model was built to predict a MOAKS-based cartilage damage score (CDS) relative to the contralateral control knee for each compartment as well as for the whole knee, pooled by meniscal treatment, while controlling for sex, age, body mass index, baseline Marx activity score, and baseline operative cartilage grade. For analysis, meniscal injuries surgically treated with partial meniscectomy or meniscal repair were grouped together. RESULTS The cohort included 60 patients (32 female; median age, 18.7 years). Concomitant meniscal treatment at the time of index ACLR was performed in 17 medial menisci (13 meniscal repair and 4 partial meniscectomy) and 27 lateral menisci (3 meniscal repair and 24 partial meniscectomy). Articular cartilage damage was worse in the ipsilateral reconstructed knee (P < .001). A meniscal injury requiring surgical treatment with ACLR predicted a worse CDS for medial meniscal treatment (medial compartment CDS: P = .005; whole joint CDS: P < .001) and lateral meniscal treatment (lateral compartment CDS: P = .038; whole joint CDS: P = .863). Other predictors of a worse relative CDS included age for the medial compartment (P < .001), surgically observed articular cartilage damage for the patellofemoral compartment (P = .048), and body mass index (P = .007) and age (P = .020) for the whole joint. CONCLUSION A meniscal injury requiring surgical treatment with partial meniscectomy or meniscal repair at the time of ACLR predicted worse articular cartilage damage on MRI at 2 to 3 years after surgery. Further research is required to differentiate between the effects of partial meniscectomy and meniscal repair.
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Affiliation(s)
- Faysal Altahawi
- Department of Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Ave., A-21, Cleveland, OH
| | - Emily K Reinke
- Department of Orthopaedic Surgery, Duke University, 3475 Erwin Rd., Durham, NC 27705
| | - Isaac Briskin
- Department of Quantitative Health Services, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - William A Cantrell
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr., Suite 2212, Columbus, OH 43202
| | - Braden C Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Coro West, Suite 404, 1 Hoppin Street, Providence RI 02903
| | - Laura J Huston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, MCE, South Tower, Suite 4200, Nashville, TN 37232
| | - Xiaojuan Li
- Imaging Institute, Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine (CCLCM), 9500 Euclid Avenue, ND20, Cleveland, OH 44195
| | - Sameer Oak
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Nancy A Obuchowski
- Department of Quantitative Health Services, Cleveland Clinic, JJN3-296, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Erica A Scaramuzza
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, MCE, South Tower, Suite 4200, Nashville, TN 37232
| | - Carl S Winalski
- Department of Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Ave., A-21, Cleveland, OH
| | - Alex Zajichek
- Department of Quantitative Health Services, Cleveland Clinic, Cleveland, OH
| | - Kurt P Spindler
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 5555 Transportation Blvd., Garfield Heights, OH 44125
| | - Morgan H Jones
- Brigham and Women’s Hospital, Department of Orthopaedic Surgery, 75 Francis Street, Boston, MA 02115
| | - Morgan H Jones
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA and Venderbilt Medical Center, Nashville, Tennessee
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21
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Spindler KP, Imrey PB, Yalcin S, Beck GJ, Calbrese G, Cox CL, Fadale PD, Farrow L, Fitch R, Flanigan D, Fleming BC, Hulstyn MJ, Jones MH, Kaeding C, Katz JN, Kriz P, Magnussen R, McErlean E, Melgaard C, Owens BD, Saluan P, Strnad G, Winalski CS, Wright R. Design Features and Rationale of the BEAR-MOON (Bridge-Enhanced ACL Restoration Multicenter Orthopaedic Outcomes Network) Randomized Clinical Trial. Orthop J Sports Med 2022; 10:23259671211065447. [PMID: 35097143 PMCID: PMC8793429 DOI: 10.1177/23259671211065447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: BEAR (bridge-enhanced anterior cruciate ligament [ACL] restoration), a paradigm-shifting technology to heal midsubstance ACL tears, has been demonstrated to be effective in a single-center 2:1 randomized controlled trial (RCT) versus hamstring ACL reconstruction. Widespread dissemination of BEAR into clinical practice should also be informed by a multicenter RCT to demonstrate exportability and compare efficacy with bone--patellar tendon–bone (BPTB) ACL reconstruction, another clinically standard treatment. Purpose: To present the design and initial preparation of a multicenter RCT of BEAR versus BPTB ACL reconstruction (the BEAR: Multicenter Orthopaedic Outcomes Network [BEAR-MOON] trial). Design and analytic issues in planning the complex BEAR-MOON trial, involving the US National Institute of Arthritis and Musculoskeletal and Skin Diseases, the US Food and Drug Administration, the BEAR implant manufacturer, a data and safety monitoring board, and institutional review boards, can usefully inform both clinicians on the trial’s strengths and limitations and future investigators on planning of complex orthopaedic studies. Study Design: Clinical trial. Methods: We describe the distinctive clinical, methodological, and operational challenges of comparing the innovative BEAR procedure with the well-established BPTB operation, and we outline the clinical motivation, experimental setting, study design, surgical challenges, rehabilitation, outcome measures, and planned analysis of the BEAR-MOON trial. Results: BEAR-MOON is a 6-center, 12-surgeon, 200-patient randomized, partially blinded, noninferiority RCT comparing BEAR with BPTB ACL reconstruction for treating first-time midsubstance ACL tears. Noninferiority of BEAR relative to BPTB will be claimed if the total score on the International Knee Documentation Committee (IKDC) subjective knee evaluation form and the knee arthrometer 30-lb (13.61-kg) side-to-side laxity difference are both within respective margins of 16 points for the IKDC and 2.5 mm for knee laxity. Conclusion: Major issues include patient selection, need for intraoperative randomization and treatment-specific postoperative physical therapy regimens (because of fundamental differences in surgical technique, initial stability construct, and healing), and choice of noninferiority margins for short-term efficacy outcomes of a novel intervention with evident short-term advantages and theoretical, but unverified, long-term benefits on other dimensions.
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Affiliation(s)
| | - Kurt P. Spindler
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Peter B. Imrey
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Sercan Yalcin
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Gerald J. Beck
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Gary Calbrese
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Charles L. Cox
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Paul D. Fadale
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Lutul Farrow
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Robert Fitch
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - David Flanigan
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Braden C. Fleming
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Michael J. Hulstyn
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Morgan H. Jones
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Christopher Kaeding
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Jeffrey N. Katz
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Peter Kriz
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Robert Magnussen
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Ellen McErlean
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Carrie Melgaard
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Brett D. Owens
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Paul Saluan
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Greg Strnad
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Carl S. Winalski
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Rick Wright
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
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22
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Wentt CL, Farrow LD, Everhart JS, Spindler KP, Jones MH. Are There Racial Disparities in Knee Symptoms and Articular Cartilage Damage in Patients Presenting for Arthroscopic Partial Meniscectomy? JB JS Open Access 2022; 7:JBJSOA-D-21-00130. [PMID: 36159080 PMCID: PMC9489158 DOI: 10.2106/jbjs.oa.21.00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of the present study was to examine whether Black patients presenting for arthroscopic partial meniscectomy (APM) have worse baseline knee pain, worse knee function, and greater articular cartilage damage than White patients.
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Affiliation(s)
| | - Lutul D. Farrow
- Cleveland Clinic Orthopaedic and Rheumatology Institute, Cleveland, Ohio
| | | | - Kurt P. Spindler
- Cleveland Clinic Orthopaedic and Rheumatology Institute, Cleveland, Ohio
| | - Morgan H. Jones
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
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23
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Salem HS, Huston LJ, Zajichek A, McCarty EC, Vidal AF, Bravman JT, Spindler KP, Frank RM, Amendola A, Andrish JT, Brophy RH, Jones MH, Kaeding CC, Marx RG, Matava MJ, Parker RD, Wolcott ML, Wolf BR, Wright RW. Anterior Cruciate Ligament Reconstruction With Concomitant Meniscal Repair: Is Graft Choice Predictive of Meniscal Repair Success? Orthop J Sports Med 2021; 9:23259671211033584. [PMID: 34541016 PMCID: PMC8445540 DOI: 10.1177/23259671211033584] [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: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background When meniscal repair is performed during anterior cruciate ligament (ACL) reconstruction (ACLR), the effect of ACL graft type on meniscal repair outcomes is unclear. Hypothesis The authors hypothesized that meniscal repairs would fail at the lowest rate when concomitant ACLR was performed with bone--patellar tendon--bone (BTB) autograft. Study Design Cohort study; Level of evidence, 3. Methods Patients who underwent meniscal repair at primary ACLR were identified from a longitudinal, prospective cohort. Meniscal repair failures, defined as any subsequent surgical procedure addressing the meniscus, were identified. A logistic regression model was built to assess the association of graft type, patient-specific factors, baseline Marx activity rating score, and meniscal repair location (medial or lateral) with repair failure at 6-year follow-up. Results A total of 646 patients were included. Grafts used included BTB autograft (55.7%), soft tissue autograft (33.9%), and various allografts (10.4%). We identified 101 patients (15.6%) with a documented meniscal repair failure. Failure occurred in 74 of 420 (17.6%) isolated medial meniscal repairs, 15 of 187 (8%) isolated lateral meniscal repairs, and 12 of 39 (30.7%) of combined medial and lateral meniscal repairs. Meniscal repair failure occurred in 13.9% of patients with BTB autografts, 17.4% of patients with soft tissue autografts, and 19.4% of patients with allografts. The odds of failure within 6 years of index surgery were increased more than 2-fold with allograft versus BTB autograft (odds ratio = 2.34 [95% confidence interval, 1.12-4.92]; P = .02). There was a trend toward increased meniscal repair failures with soft tissue versus BTB autografts (odds ratio = 1.41 [95% confidence interval, 0.87-2.30]; P = .17). The odds of failure were 68% higher with medial versus lateral repairs (P < .001). There was a significant relationship between baseline Marx activity level and the risk of subsequent meniscal repair failure; patients with either very low (0-1 points) or very high (15-16 points) baseline activity levels were at the highest risk (P = .004). Conclusion Meniscal repair location (medial vs lateral) and baseline activity level were the main drivers of meniscal repair outcomes. Graft type was ranked third, demonstrating that meniscal repairs performed with allograft were 2.3 times more likely to fail compared with BTB autograft. There was no significant difference in failure rates between BTB versus soft tissue autografts. Registration NCT00463099 (ClinicalTrials.gov identifier).
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Affiliation(s)
| | - Laura J Huston
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexander Zajichek
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | | | - Kurt P Spindler
- Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA
| | | | | | - Annunziato Amendola
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Jack T Andrish
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Robert H Brophy
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Morgan H Jones
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Christopher C Kaeding
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Robert G Marx
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Matthew J Matava
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Richard D Parker
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Michelle L Wolcott
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Brian R Wolf
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Rick W Wright
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
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Lynch TS, Oak SR, Cossell C, Strnad G, Zajichek A, Goodwin R, Jones MH, Spindler KP, Rosneck J. Effect of Baseline Mental Health on 1-Year Outcomes After Hip Arthroscopy: A Prospective Cohort Study. Orthop J Sports Med 2021; 9:23259671211025526. [PMID: 34485585 PMCID: PMC8414618 DOI: 10.1177/23259671211025526] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Patient factors, including mental health, sex, and smoking, have been found
to be more predictive of preoperative hip pain and function than
intra-articular findings during hip arthroscopy for femoroacetabular
impingement (FAI); however, little is known about how these factors may
influence patients’ postoperative outcomes. Hypothesis: We hypothesized that lower patient-reported mental health scores would be
significant risk factors for worse patient-reported outcomes (PROs) 1 year
after arthroscopic hip surgery for FAI and that baseline intra-articular
pathology would fail to demonstrate an association with outcomes 1 year
after FAI surgery. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort of patients undergoing hip arthroscopy for FAI were
electronically enrolled. Baseline and 1-year follow-up PROs were collected,
including Hip disability and Osteoarthritis Outcome Score for pain
(HOOS-Pain), HOOS–Physical Function Short Form (HOOS-PS), and Veterans RAND
12-Item Health Survey–Mental Component Score (VR-12 MCS). Intra-articular
operative findings and treatment were documented at the time of surgery.
Proportional odds logistic regression models were built for 1-year outcomes
(HOOS-Pain, HOOS-PS, and VR-12 MCS). Risk factors included patient
characteristics and intraoperative anatomic and pathologic findings. Results: Overall, 494 patients underwent hip arthroscopy for FAI, and 385 (78%) were
evaluated at 1 year with at least 1 PRO. The median patient age was 33
years, mean body mass index was 25.5 kg/m2, and 72% were female.
Multivariable analysis demonstrated that better baseline HOOS-Pain, HOOS-PS,
and VR-12 MCS were significantly associated with improvement in the 1-year
scores for each PRO. Higher VR-12 MCS was significantly associated with
better 1-year HOOS-Pain and HOOS-PS, while current and former smokers had
worse 1-year outcomes than those who never smoked. In ranking each
variable’s relative importance, baseline HOOS-Pain and HOOS-PS and baseline
VR-12 MCS were identified as the strongest predictors of 1-year HOOS-Pain
and HOOS-PS in our multivariable model. Conclusion: During hip arthroscopy for FAI, patient factors, including baseline hip pain
and function, mental health, and smoking, were independently associated with
1-year PROs of hip pain and function, while intra-articular pathology such
as the presence of labral tear and its treatment, tear size, tear location,
and anchors placed were not independently associated.
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Affiliation(s)
- T Sean Lynch
- Columbia University Irving Medical Center, New York, New York, USA
| | - Sameer R Oak
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
| | | | | | - Alexander Zajichek
- Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio, USA
| | - Ryan Goodwin
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
| | | | | | - James Rosneck
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
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25
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Brophy RH, Huston LJ, Briskin I, Amendola A, Cox CL, Dunn WR, Flanigan DC, Jones MH, Kaeding CC, Marx RG, Matava MJ, McCarty EC, Parker RD, Vidal AF, Wolcott ML, Wolf BR, Wright RW, Spindler KP. Articular Cartilage and Meniscus Predictors of Patient-Reported Outcomes 10 Years After Anterior Cruciate Ligament Reconstruction: A Multicenter Cohort Study. Am J Sports Med 2021; 49:2878-2888. [PMID: 34324369 PMCID: PMC9112230 DOI: 10.1177/03635465211028247] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/31/2023]
Abstract
BACKGROUND Articular cartilage and meniscal damage are commonly encountered and often treated at the time of anterior cruciate ligament reconstruction (ACLR). Our understanding of how these injuries and their treatment relate to outcomes of ACLR is still evolving. HYPOTHESIS/PURPOSE The purpose of this study was to assess whether articular cartilage and meniscal variables are predictive of 10-year outcomes after ACLR. We hypothesized that articular cartilage lesions and meniscal tears and treatment would be predictors of the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS) (all 5 subscales), and Marx activity level outcomes at 10-year follow-up after ACLR. STUDY DESIGN Cohort study (prognosis); Level of evidence, 1. METHODS Between 2002 and 2008, individuals with ACLR were prospectively enrolled and followed longitudinally using the IKDC, KOOS, and Marx activity score completed at entry, 2, 6, and 10 years. A proportional odds logistic regression model was built incorporating variables from patient characteristics, surgical technique, articular cartilage injuries, and meniscal tears and treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx outcomes at 10 years. RESULTS A total of 3273 patients were enrolled (56% male; median age, 23 years at time of enrollment). Ten-year follow-up was obtained on 79% (2575/3273) of the cohort. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC], 22%; lateral femoral condyle [LFC], 15%; medial tibial plateau [MTP], 4%; lateral tibial plateau [LTP], 11%; patella, 18%; trochlea, 8%) and meniscal pathology (medial, 37%; lateral, 46%). Variables that were predictive of poorer 10-year outcomes included articular cartilage damage in the patellofemoral (P < .01) and medial (P < .05) compartments and previous medial meniscal surgery (7% of knees; P < .04). Compared with no meniscal tear, a meniscal injury was not associated with 10-year outcomes. Medial meniscal repair at the time of ACLR was associated with worse 10-year outcomes for 2 of 5 KOOS subscales, while a medial meniscal repair in knees with grade 2 MFC chondrosis was associated with better outcomes on 2 KOOS subscales. CONCLUSION Articular cartilage injury in the patellofemoral and medial compartments at the time of ACLR and a history of medial meniscal surgery before ACLR were associated with poorer 10-year ACLR patient-reported outcomes, but meniscal injury present at the time of ACLR was not. There was limited and conflicting association of medial meniscal repair with these outcomes.
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Affiliation(s)
- Robert H Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, Chesterfield, Missouri, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Laura J Huston
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Isaac Briskin
- Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Annunziato Amendola
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Warren R Dunn
- Fondren Orthopedic Research Institute, Houston, Texas, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Morgan H Jones
- Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Christopher C Kaeding
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Robert G Marx
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Matthew J Matava
- Department of Orthopaedics, Washington University School of Medicine, Chesterfield, Missouri, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Eric C McCarty
- CU Sports Medicine, Boulder, Colorado, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Richard D Parker
- Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Armando F Vidal
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Michelle L Wolcott
- CU Sports Medicine, Boulder, Colorado, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Brian R Wolf
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
| | - Kurt P Spindler
- Department of Orthopaedics, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA
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26
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Magnussen R, Reinke EK, Huston LJ, Spindler KP, Cox CL, Dunn WR, Flanigan DC, Jones MH, Kaeding CC, Matava MJ, Parker RD, Smith MV, Wright RW, Spindler KP. Neither Residual Anterior Knee Laxity Up to 6 mm nor a Pivot Glide Predict Patient-Reported Outcome Scores or Subsequent Knee Surgery Between 2 and 6 Years After ACL Reconstruction. Am J Sports Med 2021; 49:2631-2637. [PMID: 34269610 PMCID: PMC9202674 DOI: 10.1177/03635465211025003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A primary goal of anterior cruciate ligament reconstruction (ACLR) is to reduce pathologically increased anterior and rotational laxity of the knee, but the effects of residual laxity on patient-reported outcomes (PROs) after ACLR remain unclear. HYPOTHESIS Increased residual laxity at 2 years postoperatively is predictive of a higher risk of subsequent ipsilateral knee surgery and decreases in PRO scores from 2 to 6 years after surgery. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS From a prospective multicenter cohort, 433 patients aged <36 years were identified at a minimum 2 years after primary ACLR. These patients underwent a KT-1000 arthrometer assessment and pivot-shift test and completed PRO assessments with the Knee injury and Osteoarthritis Outcome Score and International Knee Documentation Committee (IKDC) scores. Patients completed the same PROs at 6 years postoperatively, and any subsequent ipsilateral knee procedures during this period were recorded. Subsequent surgery risk and change in PROs from 2 to 6 years postoperatively were compared based on residual side-to-side KT-1000 arthrometer differences (<-1 mm, -1 to 2 mm, 2 to 6 mm, and >6 mm) in laxity at 2 years postoperatively. Multiple linear regression models were built to determine the relationship between 2-year postoperative knee laxity and 2- to 6-year change in PROs while controlling for age, sex, body mass index, smoking status, meniscal and cartilage status, and graft type. RESULTS A total of 381 patients (87.9%) were available for follow-up 6 years postoperatively. There were no significant differences in risk of subsequent knee surgery based on residual knee laxity. Patients with a difference >6 mm in side-to-side anterior laxity at 2 years postoperatively were noted to have a larger decrease in PROs from 2 to 6 years postoperatively (P < .05). No significant differences in any PROs were noted among patients with a difference <6 mm in side-to-side anterior laxity or those with pivot glide (IKDC B) versus no pivot shift (IKDC A). CONCLUSION The presence of a residual side-to-side KT-1000 arthrometer difference <6 mm or pivot glide at 2 years after ACLR is not associated with an increased risk of subsequent ipsilateral knee surgery or decreased PROs up to 6 years after ACLR. Conversely, patients exhibiting a difference >6 mm in side-to-side anterior laxity were noted to have significantly decreased PROs at 6 years after ACLR.
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Affiliation(s)
- Robert Magnussen
- Wexner Medical Center, The Ohio State University, Columbus, OH 43202
| | - Emily K Reinke
- Sports Medicine, Orthopaedic Surgery Research, Duke University Medical Center, Duke Sports Science Institute, DUMC Box 3615, 3475 Erwin Road
| | - Laura J Huston
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21 Avenue South, MCE, South Tower, Suite 4200, Nashville, TN 37232
| | | | - Kurt P Spindler
- Department of Orthopaedics, Cleveland Clinic Foundation, 5555 Transportation Blvd., Cleveland, OH 44125
| | - Charles L Cox
- Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at The Ohio State University, Columbus, Ohio, USA; the Vanderbilt University Medical Center, Nashville, Tennessee, USA; and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Warren R Dunn
- Texas Orthopedic Hospital, Houston, Texas, USA.,Investigation performed at The Ohio State University, Columbus, Ohio, USA; the Vanderbilt University Medical Center, Nashville, Tennessee, USA; and the Cleveland Clinic, Cleveland, Ohio, USA
| | - David C Flanigan
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at The Ohio State University, Columbus, Ohio, USA; the Vanderbilt University Medical Center, Nashville, Tennessee, USA; and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Morgan H Jones
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at The Ohio State University, Columbus, Ohio, USA; the Vanderbilt University Medical Center, Nashville, Tennessee, USA; and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher C Kaeding
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at The Ohio State University, Columbus, Ohio, USA; the Vanderbilt University Medical Center, Nashville, Tennessee, USA; and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew J Matava
- Washington University, St. Louis, Missouri, USA.,Investigation performed at The Ohio State University, Columbus, Ohio, USA; the Vanderbilt University Medical Center, Nashville, Tennessee, USA; and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard D Parker
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at The Ohio State University, Columbus, Ohio, USA; the Vanderbilt University Medical Center, Nashville, Tennessee, USA; and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew V Smith
- Washington University, St. Louis, Missouri, USA.,Investigation performed at The Ohio State University, Columbus, Ohio, USA; the Vanderbilt University Medical Center, Nashville, Tennessee, USA; and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Rick W Wright
- Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at The Ohio State University, Columbus, Ohio, USA; the Vanderbilt University Medical Center, Nashville, Tennessee, USA; and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Department of Orthopaedics, Cleveland Clinic Foundation, Cleveland, Ohio, USA.,Investigation performed at The Ohio State University, Columbus, Ohio, USA; the Vanderbilt University Medical Center, Nashville, Tennessee, USA; and the Cleveland Clinic, Cleveland, Ohio, USA
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27
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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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Jones MH. Indications for Knee Arthroscopy in Patients with Osteoarthritis: Commentary on an article by Alex Gu, MD, et al.: "Comparison of Revision Risk Based on Timing of Knee Arthroscopy Prior to Total Knee Arthroplasty". J Bone Joint Surg Am 2021; 103:e33. [PMID: 33849051 DOI: 10.2106/jbjs.21.00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Everhart JS, Jones MH, Yalcin S, Reinke EK, Huston LJ, Andrish JT, Cox CL, Flanigan DC, Kaeding CC, Magnussen RA, Obuchowski N, Parker RD, Pedroza AD, Sanders RA, Winalski CS, Spindler KP. The Clinical Radiographic Incidence of Posttraumatic Osteoarthritis 10 Years After Anterior Cruciate Ligament Reconstruction: Data From the MOON Nested Cohort. Am J Sports Med 2021; 49:1251-1261. [PMID: 33793363 PMCID: PMC8375261 DOI: 10.1177/0363546521995182] [Citation(s) in RCA: 14] [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 The incidence of posttraumatic osteoarthritis (PTOA) based on clinical radiographic grading criteria at 10 years after anterior cruciate ligament (ACL) reconstruction (ACLR) has not been well-defined in a prospective cohort of young athletic patients. HYPOTHESIS Among young athletic patients, there is a high incidence of clinical radiographic PTOA at 10 years after ACLR. Additionally, there is a significant difference in clinical radiographic osteoarthritis (OA) changes (joint space narrowing and osteophyte formation) between ACL-reconstructed and contralateral knees at 10 years. STUDY DESIGN Case series; Level of evidence, 4. METHODS The first 146 patients in an ongoing nested cohort study of the Multicenter Orthopaedic Outcomes Network (MOON) prospective cohort presented for a minimum 10-year follow-up. Included patients had a sports-related ACL injury, were aged <33 years at the time of ACLR, had no history of ipsilateral or contralateral knee surgery, and did not undergo revision ACLR before follow-up. Bilateral knee metatarsophalangeal view radiographs were obtained and graded according to International Knee Documentation Committee (IKDC), Osteoarthritis Research Society International (OARSI), and modified Kellgren-Lawrence (KL) criteria by 2 blinded reviewers. The incidence and severity of ipsilateral and contralateral radiographic OA were determined among patients without a contralateral ACL injury before 10-year follow-up (N = 133). RESULTS Interrater reliability was substantial for the IKDC (Gwet Agreement Coefficient [AC] 1 = 0.71), moderate for the KL (0.48), and almost perfect for the OARSI (0.84) grading systems. Among patients with a contralateral radiographically normal knee, the 10-year incidence of clinical radiographic PTOA after ACLR was 37% as defined by osteophytes and 23% as defined by joint space narrowing. The maximum side-to-side difference in the OARSI osteophyte grade in the medial or lateral compartment was 0 in 65% of patients, 1 in 20%, and ≥2 in 15%. The maximum side-to-side difference in the OARSI joint space narrowing grade was 0 in 77% of patients, 1 in 19%, and ≥2 in 4%. CONCLUSION In young active patients, the 10-year incidence of clinical radiographic PTOA after ACLR was 37% as defined by osteophytes and 23% as defined by joint space narrowing. The mean difference in the degree of osteophyte formation (≤1 grade in 85%) and joint space narrowing (≤1 grade in 96%) between the ACL-reconstructed and contralateral knees was small. REGISTRATION NCT02717559 (ClinicalTrials.gov identifier).
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Affiliation(s)
| | - Josh S. Everhart
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Morgan H. Jones
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Sercan Yalcin
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Emily K. Reinke
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura J. Huston
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Jack T. Andrish
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Charles L. Cox
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - David C. Flanigan
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Nancy Obuchowski
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard D. Parker
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Angela D. Pedroza
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Carl S. Winalski
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P. Spindler
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
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Karnuta JM, Dalton S, Bena J, Farrow LD, Featherall J, Jones MH, Miniaci AA, Parker RD, Rosneck JT, Saluan P, Strnad G, Spindler KP, Williams JS, Oak SR. Do Narcotic Use, Physical Therapy Location, or Payer Type Predict Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction? Orthop J Sports Med 2021; 9:2325967121994833. [PMID: 33997058 PMCID: PMC8085373 DOI: 10.1177/2325967121994833] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/21/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Opioid use and public insurance have been correlated with worse outcomes in a number of orthopaedic surgeries. These factors have not been investigated with anterior cruciate ligament reconstruction (ACLR). PURPOSE/HYPOTHESIS To evaluate if narcotic use, physical therapy location, and insurance type are predictors of patient-reported outcomes after ACLR. It was hypothesized that at 1 year postsurgically, increased postoperative narcotic use would be associated with worse outcomes, physical therapy obtained within the authors' integrated health care system would lead to better outcomes, and public insurance would lead to worse outcomes and athletic activity. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS All patients undergoing unilateral, primary ACLR between January 2015 and February 2016 at a large health system were enrolled in a standard-of-care prospective cohort. Knee injury and Osteoarthritis Score (KOOS) and the Hospital for Special Surgery Pediatric-Functional Activity Brief Scale (HSS Pedi-FABS) were collected before surgery and at 1 year postoperatively. Concomitant knee pathology was assessed arthroscopically and electronically captured. Patient records were analyzed to determine physical therapy location, insurance status, and narcotic use. Multivariable regression analyses were used to identify significant predictors of the KOOS and HSS Pedi-FABS score. RESULTS A total of 258 patients were included in the analysis (mean age, 25.8; 51.2% women). In multivariable regression analysis, narcotic use, physical therapy location, and insurance type were not independent predictors of any KOOS subscales. Public insurance was associated with a lower HSS Pedi-FABS score (-4.551, P = .047) in multivariable analysis. Narcotic use or physical therapy location was not associated with the HSS Pedi-FABS score. CONCLUSION Increased narcotic use surrounding surgery, physical therapy location within the authors' health care system, and public versus private insurance were not associated with disease-specific KOOS subscale scores. Patients with public insurance had worse HSS Pedi-FABS activity scores compared with patients with private insurance, but neither narcotic use nor physical therapy location was associated with activity scores. Physical therapy location did not influence outcomes, suggesting that patients be given a choice in the location they received physical therapy (as long as a standardized protocol is followed) to maximize compliance.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Kurt P. Spindler
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
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31
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MacFarlane LA, Yang H, Collins JE, Brophy RH, Cole BJ, Spindler KP, Guermazi A, Jones MH, Mandl LA, Martin S, Marx RG, Levy BA, Stuart M, Safran-Norton C, Wright J, Wright RW, Losina E, Katz JN. Association Between Baseline "Meniscal symptoms" and Outcomes of Operative and Non-Operative Treatment of Meniscal Tear in Patients with Osteoarthritis. Arthritis Care Res (Hoboken) 2021; 74:1384-1390. [PMID: 33650303 PMCID: PMC8408275 DOI: 10.1002/acr.24588] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/06/2021] [Accepted: 02/25/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Patients with meniscal tears reporting "meniscal symptoms" such as catching or locking, have traditionally undergone arthroscopy. We investigated whether patients with meniscal tears who report "meniscal symptoms" have greater improvement with arthroscopic partial meniscectomy (APM) than physical therapy (PT). METHODS We used data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, which randomized participants with knee osteoarthritis (OA) and meniscal tear to APM or PT. The frequency of each "meniscal symptom" (clicking, catching, popping, intermittent locking, giving way, swelling) was measured at baseline and 6-months. We used linear regression models to determine whether the difference in improvement in KOOS Pain at 6-months between those treated with APM versus PT was modified by the presence of each "meniscal symptom". We also determined the percent of participants with resolution of "meniscal symptoms" by treatment group. RESULTS We included 287 participants. The presence (vs. absence) of any of the "meniscal symptoms" did not modify the improvement in KOOS Pain between APM vs. PT by more than 0.5 SD (all p-interaction >0.05). APM led to greater resolution of intermittent locking and clicking than PT (locking 70% vs 46%, clicking 41% vs 25%). No difference in resolution of the other "meniscal symptoms" was observed. CONCLUSION "Meniscal symptoms" were not associated with improved pain relief. Although symptoms of clicking and intermittent locking had a greater reduction in the APM group, the presence of "meniscal symptoms" in isolation should not inform clinical decisions surrounding APM vs. PT in patients with meniscal tear and knee OA.
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Affiliation(s)
- Lindsey A MacFarlane
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States.,Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Heidi Yang
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Jamie E Collins
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Robert H Brophy
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Brian J Cole
- Department of Orthopedic Surgery, Rush University, Chicago, Illinois, United States
| | - Kurt P Spindler
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Ali Guermazi
- Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, United States
| | - Morgan H Jones
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Scott Martin
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Robert G Marx
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Michael Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Clare Safran-Norton
- Department of Physical Therapy, Brigham and Women's Hospital, Boston, MA, United States
| | - John Wright
- Johnson& Johnson, Raynham, Massachusetts, United States
| | - Rick W Wright
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States.,Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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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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Oak SR, Cantrell WA, Altahawi F, Li X, Winalski CS, Flanigan DC, Reinke EK, Huston LJ, Jones MH, Spindler KP. Do Bone-Patellar Tendon-Bone ACL-Reconstructed Knees Have More Signs of Patellofemoral Posttraumatic Osteoarthritis Than Their Uninjured Contralateral Knees at 2 Years? Orthop J Sports Med 2021; 9:2325967120973050. [PMID: 33490295 PMCID: PMC7809528 DOI: 10.1177/2325967120973050] [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: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 11/16/2022] Open
Abstract
Background The prevalence of patellofemoral joint (PFJ) osteoarthritis ranges from 8% to 47% at 7 to 10 years after anterior cruciate ligament reconstruction (ACLR) using bone-patellar tendon-bone (BTB) autograft. In performing BTB ACLR, some hypothesize that either trauma caused by harvest of the BTB autograft or altered biomechanics contributes to PFJ posttraumatic osteoarthritis. Purpose/Hypothesis To determine whether knees with ACLR using a BTB autograft show early signs of posttraumatic osteoarthritis as compared with the contralateral uninjured knee 2 years after ACLR. We hypothesized that a BTB autograft will not increase the prevalence of PFJ osteoarthritis. Study Design Cohort study; Level of evidence, 3. Methods Bilateral knee 3-T magnetic resonance imaging (MRI) scans were collected in 57 patients (mean age, 20.3 years; 28 men) from a single site at a minimum of 2 years after ACLR. Structural MRI assessment of the knees was performed using the MRI Osteoarthritis Knee Score semiquantitative scoring system by a board-certified musculoskeletal radiologist. The presence of cartilage defects in the patellofemoral compartment was compared between the reconstructed and contralateral uninjured knees using logistic regression analyses. Results There were no significant differences in the prevalence of cartilage defects (full thickness or any thickness) in the PFJ between the BTB ACLR knees and the contralateral control knees: 38.6% of BTB ACLR knees had PFJ cartilage defects versus 31.6% of contralateral control knees (P > .391). The 95% CI for the difference between these groups was -9.0% to 23.0%. Conclusion When comparing BTB ACLR knees with the uninjured contralateral knees in the study patients, we failed to observe statistically significant differences in the prevalence of PFJ cartilage lesions of full thickness or any thickness. These results should be used in shared decision-making with athletes when choosing the appropriate autograft during reconstruction. Our wide 95% CIs secondary to a smaller sample size demonstrate a need for larger studies in this area to more accurately describe the difference between the operative and contralateral knees.
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Affiliation(s)
- Sameer R Oak
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - William A Cantrell
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Xiaojuan Li
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Carl S Winalski
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Emily K Reinke
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Laura J Huston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Morgan H Jones
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Tariq MB, Jones MH, Strnad G, Sosic E, Spindler KP. A Last-Ditch Effort and Personalized Surgeon Letter Improves PROMs Follow-Up Rate in Sports Medicine Patients: A Crossover Randomized Controlled Trial. J Knee Surg 2021; 34:130-136. [PMID: 31390674 DOI: 10.1055/s-0039-1694057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/07/2023]
Abstract
Patient-reported outcomes measures (PROMs) are important for the advancement of orthopaedic surgeries. The primary difficulty while collecting PROMs is obtaining adequate follow-up rates. Therefore, it is important to find methods to improve follow-up, especially in patients who have failed to respond to initial attempts. We hypothesized that PROMs follow-up could be effectively increased by sending a salvage-effort personalized surgeon letter to sports medicine patients who failed to respond to initial (centralized electronic, mail, and/or phone contacts) PROMs collection 1 year after surgery. Patients who failed to respond to 1-year follow-up of postoperative PROMs collection at our outpatient sports medicine surgery center were included. Patients were randomized into an intervention or control group. Patients in the intervention group were mailed PROMs form and an Institutional Review Board-approved letter that was personalized with surgical information, surgeon picture, and surgeon signature. Control group was mailed the same letter a month later. Chi-squared analysis was conducted at 5 weeks. Out of 843 surgeries, our initial 1-year PROMs follow-up rate was 65%, which allowed for 292 patients to be eligible for our study. After exclusions, 281 patients (randomized to 140 control group and 141 intervention group) were included in our study. We found a 20% response rate in the intervention group with 28 patients returning PROMs as compared with a 1.4% rate in the control group with two patients returning PROMs. The odds ratio was 17.1 (95% confidence interval: 4-73.3; p < 0.0001). A salvage-effort personalized surgeon letter is an efficient and relatively cost-effective method to increase PROMs follow-up rate, which means that a personalized surgeon letter can reach and engage patients who would otherwise be considered lost to follow-up, allowing for better outcomes monitoring after surgery.
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Affiliation(s)
- Muhammad B Tariq
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.,Cleveland Clinic Orthopaedic Sports Medicine, Cleveland, Ohio
| | - Morgan H Jones
- Cleveland Clinic Orthopaedic Sports Medicine, Cleveland, Ohio
| | - Greg Strnad
- Cleveland Clinic Orthopaedic Sports Medicine, Cleveland, Ohio
| | - Elizabeth Sosic
- Cleveland Clinic Orthopaedic Sports Medicine, Cleveland, Ohio
| | | | - Kurt P Spindler
- Cleveland Clinic Orthopaedic Sports Medicine, Cleveland, Ohio
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Bayomy AF, Schickendantz MS, Briskin IN, Farrow LD, Grobaty LE, Jones MH, McCoy BW, Miniaci A, Ricchetti ET, Rosneck JT, Sosic E, Spindler KP, Stearns KL, Strnad GJ, Williams J, Saluan PM. What Are the Predictors of Poor Patient-Reported Outcomes After Shoulder Instability Surgery? Orthop J Sports Med 2020; 8:2325967120966343. [PMID: 33447618 PMCID: PMC7780330 DOI: 10.1177/2325967120966343] [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: 06/01/2020] [Accepted: 06/16/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Prospectively collected responses to Patient Acceptable Symptom State (PASS) questions after shoulder instability surgery are limited. Responses to these outcome measures are imperative to understanding their clinical utility. Purpose/Hypothesis: The purpose of this study was to evaluate which factors predict unfavorable patient-reported outcomes after shoulder instability surgery, including “no” to the PASS question. We hypothesized that poor outcomes would be associated with male adolescents, bone loss, combined labral tears, and articular cartilage injuries. Study Design: Cohort study; Level of evidence, 2. Methods: Patients aged ≥13 years undergoing shoulder instability surgery were included in point-of-care data collection at a single institution across 12 surgeons between 2015 and 2017. Patients with anterior-inferior labral tears were included, and those with previous ipsilateral shoulder surgery were excluded. Demographics, American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores, and surgical findings were obtained at baseline. ASES and SANE scores, PASS responses, and early revision surgery rates were obtained at a minimum of 1 year after the surgical intervention. Regression analyses were performed. Results: A total of 234 patients met inclusion criteria, of which 176 completed follow-up responses (75.2%). Nonresponders had a younger age, greater frequency of glenoid bone loss, fewer combined tears, and more articular cartilage injuries (P < .05). Responders’ mean age was 25.1 years, and 22.2% were female. Early revision surgery occurred in 3.4% of these patients, and 76.1% responded yes to the PASS question. A yes response correlated with a mean 25-point improvement in the ASES score and a 40-point improvement in the SANE score. On multivariate analysis, combined labral tears (anterior-inferior plus superior or posterior tears) were associated with greater odds of responding no to the PASS question, while both combined tears and injured capsules were associated with lower ASES and SANE scores (P < .05). Sex, bone loss, and grade 3 to 4 articular cartilage injuries were not associated with variations on any patient-reported outcome measure. Conclusion: Patients largely approved of their symptom state at ≥1 year after shoulder instability surgery. A response of yes to the PASS question was given by 76.1% of patients and was correlated with clinically and statistically significant improvements in ASES and SANE scores. Combined labral tears and injured capsules were negative prognosticators across patient-reported outcome measures, whereas sex, bone loss, and cartilage injuries were not.
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Affiliation(s)
| | - Ahmad F Bayomy
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Isaac N Briskin
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Lutul D Farrow
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Lauren E Grobaty
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Morgan H Jones
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Brett W McCoy
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Anthony Miniaci
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric T Ricchetti
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - James T Rosneck
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Elizabeth Sosic
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Kim L Stearns
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Greg J Strnad
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - James Williams
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul M Saluan
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
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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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Collins JE, Losina E, Marx RG, Guermazi A, Jarraya M, Jones MH, Levy BA, Mandl LA, Martin SD, Wright RW, Spindler KP, Katz JN. Early Magnetic Resonance Imaging-Based Changes in Patients With Meniscal Tear and Osteoarthritis: Eighteen-Month Data From a Randomized Controlled Trial of Arthroscopic Partial Meniscectomy Versus Physical Therapy. Arthritis Care Res (Hoboken) 2020; 72:630-640. [PMID: 30932360 DOI: 10.1002/acr.23891] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/26/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The present study was undertaken to evaluate changes in knee magnetic resonance imaging (MRI) findings over the course of 18 months in subjects with osteoarthritic change and meniscal tear treated with arthroscopic partial meniscectomy (APM) or nonoperatively with physical therapy (PT). METHODS We used 18-month follow-up data from the Meniscal Tear in Osteoarthritis Research Trial. MRI results were read with reference to the MRI Osteoarthritis Knee Score. We focused on 18-month change in bone marrow lesions (BMLs), cartilage thickness, cartilage surface area, osteophyte size, effusion-synovitis, and Hoffa-synovitis. We used multinomial logistic regression to assess associations between MRI-based changes in each feature and treatment type. RESULTS A total of 351 subjects were randomized, and 225 had both baseline and 18-month MRI results. In both treatment groups, patients experienced substantial changes in several MRI-based markers. In 60% of the APM group, versus 33% of the PT group, cartilage surface area damage advanced in ≥2 subregions (adjusted odds ratio 4.2 [95% confidence interval 2.0-9.0). Patients who underwent APM also had greater advancement in scores for osteophytes and effusion-synovitis. We did not find significant associations between treatment type and change in cartilage thickness, BMLs, or Hoffa-synovitis. CONCLUSION This cohort of patients with meniscal tear and osteoarthritis showed marked advancement in MRI-based features over 18 months. Patients treated with APM showed more advancement in some features compared to those treated nonoperatively. The clinical relevance of these early findings is unknown and requires further study.
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Affiliation(s)
- Jamie E Collins
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elena Losina
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert G Marx
- Weill Cornell Medicine, Hospital for Special Surgery, New York, New York
| | - Ali Guermazi
- Boston University School of Medicine, Boston, Massachusetts
| | - Mohamed Jarraya
- Boston University School of Medicine, Boston, Massachusetts, and Mercy Catholic Medical Center, Darby, Pennsylvania
| | | | | | - Lisa A Mandl
- Weill Cornell Medicine, Hospital for Special Surgery, New York, New York
| | | | - Rick W Wright
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Bois AJ, Mayer MJ, Fening SD, Jones MH, Miniaci A. Management of bone loss in recurrent traumatic anterior shoulder instability: a survey of North American surgeons. JSES Int 2020; 4:574-583. [PMID: 32939489 PMCID: PMC7479034 DOI: 10.1016/j.jseint.2020.04.015] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Management of bone loss in recurrent traumatic anterior shoulder instability remains a topic of debate and controversy in the orthopedic community. The purpose of this study was to survey members of 4 North American orthopedic surgeon associations to assess management trends for bone loss in recurrent anterior shoulder instability. Methods An online survey was distributed to all members of the American Shoulder and Elbow Surgeons, American Orthopaedic Society for Sports Medicine, and Canadian Orthopaedic Association and to fellow members of the Arthroscopy Association of North America. The survey comprised 3 sections assessing the demographic characteristics of survey respondents, the influence of prognostic factors on surgical decision making, and the operative management of 12 clinical case scenarios of varying bone loss that may be encountered in clinical practice. Results A total of 150 survey responses were returned. The age of the patient and quantity of bone loss were consistently considered important prognostic criteria. However, little consensus was reached for critical thresholds of bone loss and how this affected the timing (ie, primary or revision surgery) and type of bony augmentation procedure to be performed once a critical threshold was reached, especially in the context of critical humeral and bipolar bone loss. Conclusions Consistent trends were found for the management of recurrent anterior shoulder instability in cases in which no bone loss existed and when isolated critical glenoid bone loss was present. However, inconsistencies were observed when isolated critical humeral bone loss and bipolar bone loss were present.
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Affiliation(s)
- Aaron J Bois
- Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Michelle J Mayer
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Stephen D Fening
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Morgan H Jones
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anthony Miniaci
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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Spindler KP, Huston LJ, Zajichek A, Reinke EK, Amendola A, Andrish JT, Brophy RH, Dunn WR, Flanigan DC, Jones MH, Kaeding CC, Marx RG, Matava MJ, McCarty EC, Parker RD, Vidal AF, Wolcott ML, Wolf BR, Wright RW. Anterior Cruciate Ligament Reconstruction in High School and College-Aged Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates? Am J Sports Med 2020; 48:298-309. [PMID: 31917613 PMCID: PMC7319140 DOI: 10.1177/0363546519892991] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [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 Physicians' and patients' decision-making process between bone-patellar tendon-bone (BTB) and hamstring tendon autografts for anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by a variety of factors in the young, active athlete. PURPOSE To determine the incidence of both ACL graft revisions and contralateral ACL tears resulting in subsequent ACLR in a cohort of high school- and college-aged athletes who initially underwent primary ACLR with either a BTB or a hamstring autograft. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Study inclusion criteria were patients aged 14 to 22 years who were injured in sports, had a contralateral normal knee, and were scheduled to undergo unilateral primary ACLR with either a BTB or a hamstring autograft. All patients were prospectively followed for 6 years to determine whether any subsequent ACLR was performed in either knee after their initial ACLR. Multivariable regression modeling controlled for age, sex, ethnicity/race, body mass index, sport and competition level, baseline activity level, knee laxity, and graft type. The 6-year outcomes were the incidence of subsequent ACLR in either knee. RESULTS A total of 839 patients were eligible, of which 770 (92%) had 6-year follow-up for the primary outcome measure of the incidence of subsequent ACLR. The median age was 17 years, with 48% female, and the distribution of BTB and hamstring grafts was 492 (64%) and 278 (36%), respectively. The incidence of subsequent ACLR at 6 years was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal knee, and 19.7% for either knee. High-grade preoperative knee laxity (odds ratio [OR], 2.4 [95% confidence interval [CI], 1.4-3.9]; P = .001), autograft type (OR, 2.1 [95% CI, 1.3-3.5]; P = .004), and age (OR, 0.8 [95% CI, 0.7-1.0]; P = .009) were the 3 most influential predictors of ACL graft revision in the ipsilateral knee. The odds of ACL graft revision were 2.1 times higher for patients receiving a hamstring autograft than patients receiving a BTB autograft (95% CI, 1.3-3.5; P = .004). No significant differences were found between autograft choices when looking at the incidence of subsequent ACLR in the contralateral knee. CONCLUSION There was a high incidence of both ACL graft revisions and contralateral normal ACL tears resulting in subsequent ACLR in this young athletic cohort. The incidence of ACL graft revision at 6 years after index surgery was 2.1 times higher with a hamstring autograft compared with a BTB autograft.
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Affiliation(s)
| | - Kurt P. Spindler
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura J. Huston
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexander Zajichek
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emily K. Reinke
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annunziato Amendola
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jack T. Andrish
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert H. Brophy
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Warren R. Dunn
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David C. Flanigan
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Morgan H. Jones
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher C. Kaeding
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert G. Marx
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew J. Matava
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric C. McCarty
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard D. Parker
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Armando F. Vidal
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michelle L. Wolcott
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian R. Wolf
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rick W. Wright
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Featherall J, Oak SR, Strnad GJ, Farrow LD, Jones MH, Miniaci AA, Parker RD, Rosneck JT, Saluan PM, Spindler KP. Smartphone Data Capture Efficiently Augments Dictation for Knee Arthroscopic Surgery. J Am Acad Orthop Surg 2020; 28:e115-e124. [PMID: 31977610 PMCID: PMC6964865 DOI: 10.5435/jaaos-d-19-00074] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The objectives of this study are (1) to develop a provider-friendly, evidence-based data capture system for lower-limb orthopaedic surgeries and (2) to assess the performance of the data capture system on the dimensions of agreement with operative note and implant log, consistency of data, and speed of provider input. METHODS A multidisciplinary team developed a database and user interfaces for Android and iOS operating systems. Branching logic and discrete fields were created to streamline provider data input. One hundred patients were randomly selected from the first four months of data collection (February to June 2015). Patients were limited to those undergoing anterior cruciate ligament reconstruction, meniscal repair, partial meniscectomy, or a combination of these procedures. Duplicate data on these 100 patients were collected through chart review. These two data sets were compared. Cohen's kappa statistic was used to assess agreement. RESULTS The database and smartphone data capture tool show almost perfect agreement (kappa > 0.81) for all data tested. In addition, data are more comprehensive with near-perfect provider completion (100% for all data tested). Furthermore, provider data entry is extremely efficient (median 151-second completion time). CONCLUSION A well-designed database and user-friendly interface have greater potential for research utility, clinical efficiency, and, thus, cost-effectiveness when compared with standard voice-dictated operative notes. Widespread utilization of such tools can accelerate the pace and improve the quality of orthopaedic clinical research. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Joseph Featherall
- From the Cleveland Clinic Lerner College of Medicine (Mr. Featherall), the Department of Orthopaedic Surgery, Cleveland Clinic (Dr. Oak, Mr. Strnad, Dr. Farrow, Dr. Jones, Dr. Miniaci, Dr. Parker, Dr. Rosneck, Dr. Saluan, and Dr. Spindler), and the Cleveland Clinic Sports Health Center, Cleveland Clinic (Dr. Farrow, Dr. Jones, Dr. Miniaci, Dr. Parker, Dr. Rosneck, Dr. Saluan, and Dr. Spindler), Cleveland, OH
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Katz JN, Shrestha S, Losina E, Jones MH, Marx RG, Mandl LA, Levy BA, MacFarlane LA, Spindler KP, Silva GS, Collins JE. Five-Year Outcome of Operative and Nonoperative Management of Meniscal Tear in Persons Older Than Forty-Five Years. Arthritis Rheumatol 2019; 72:273-281. [PMID: 31429198 DOI: 10.1002/art.41082] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/08/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine the 5-year outcome of treatment for meniscal tear in osteoarthritis. METHODS We examined 5-year follow-up data from the Meniscal Tear in Osteoarthritis Research trial (METEOR) of physical therapy versus arthroscopic partial meniscectomy. We performed primary intent-to-treat (ITT) and secondary as-treated analyses. The primary outcome measure was the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain scale; total knee replacement (TKR) was a secondary outcome measure. We used piecewise linear mixed models to describe change in KOOS pain. We calculated 5-year cumulative TKR incidence and used a Cox model to estimate hazard ratios (HRs) for TKR, with 95% confidence intervals (95% CIs). RESULTS Three hundred fifty-one participants were randomized. In the ITT analysis, the KOOS pain scores were ~46 (scale of 0 [no pain] to 100 [most pain]) at baseline in both groups. Pain scores improved substantially in both groups over the first 3 months, continued to improve through the next 24 months (to ~18 in each group), and were stable at 24-60 months. Results of the as-treated analyses of the KOOS pain score were similar. Twenty-five participants (7.1% [95% CI 4.4-9.8%]) underwent TKR over 5 years. In the ITT model, the HR for TKR was 2.0 (95% CI 0.8-4.9) for subjects randomized to the arthroscopic partial meniscectomy group, compared to those randomized to the physical therapy group. In the as-treated analysis, the HR for TKR was 4.9 (95% CI 1.1-20.9) for subjects ultimately treated with arthroscopic partial meniscectomy, compared to those treated nonoperatively. CONCLUSION Pain improved considerably in both groups over 60 months. While ITT analysis revealed no statistically significant differences following TKR, greater frequency of TKR in those undergoing arthroscopic partial meniscectomy merits further study.
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Affiliation(s)
- Jeffrey N Katz
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Swastina Shrestha
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elena Losina
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Robert G Marx
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Lisa A Mandl
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | | | | | - Genevieve S Silva
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Jamie E Collins
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Ramkumar PN, Tariq MB, Spindler KP, Andrish JT, Brophy RH, Dunn WR, Flanigan DC, Huston LJ, Jones MH, Kaeding CC, Kattan MW, Marx RG, Matava MJ, McCarty EC, Parker RD, Vidal AF, Wolcott ML, Wolf BR, Wright RW, Spindler KP. Risk Factors for Loss to Follow-up in 3202 Patients at 2 Years After Anterior Cruciate Ligament Reconstruction: Implications for Identifying Health Disparities in the MOON Prospective Cohort Study. Am J Sports Med 2019; 47:3173-3180. [PMID: 31589465 PMCID: PMC7269366 DOI: 10.1177/0363546519876925] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Understanding the risk factors for loss to follow-up in prospective clinical studies may allow for a targeted approach to minimizing follow-up bias and improving the generalizability of conclusions in anterior cruciate ligament reconstruction (ACLR) and other sports-related interventions. PURPOSE To identify independent risk factors associated with failure to complete (ie, loss to follow-up) patient-reported outcome measures (PROMs) at 2 years after ACLR within a well-funded prospective longitudinal cohort. STUDY DESIGN Cohort study (prognosis); Level of evidence, 2. METHODS All patients undergoing primary or revision ACLR enrolled in the prospectively collected database of the multicenter consortium between 2002 and 2008 were included. Multivariate regression analyses were conducted to determine which baseline risk factors were significantly associated with loss to follow-up at a minimum of 2 years after surgery. Predictors assessed for loss to follow-up were as follows: consortium site, sex, race, marital status, smoking status, phone number provided (home or cell), email address provided (primary or secondary), years of school completed, average hours worked per week, working status (full-time, part-time, homemaker, retired, student, or disabled), number of people living at home, and preoperative PROMs (Knee injury and Osteoarthritis Outcome Score, Marx Activity Rating Scale, and International Knee Documentation Committee). RESULTS A total of 3202 patients who underwent ACLR were enrolled. The 2-year PROM follow-up rate for this cohort was 88% (2821 of 3202). Multivariate analyses showed that patient sex (male: odds ratio [OR], 1.80) and race (black: OR, 3.64; other nonwhite: OR, 1.81) were independent predictors of 2-year loss to follow-up of PROMs. Education level was a nonconfounder. CONCLUSION While education level did not predict loss to follow-up, patients who are male and nonwhite are at increased risk of loss to follow-up of PROM at 2 years. Capturing patient outcomes with minimal loss depends on equitable, not equal, opportunity to maximize generalizability and mitigate potential population-level health disparities. REGISTRATION NCT00478894 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Prem N. Ramkumar
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Muhammad B. Tariq
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | | | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Jack T Andrish
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert H Brophy
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Warren R Dunn
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - David C Flanigan
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura J Huston
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Morgan H Jones
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Michael W Kattan
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert G Marx
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew J Matava
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric C McCarty
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard D Parker
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Armando F Vidal
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Brian R Wolf
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Rick W Wright
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA
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43
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Mohr J, Strnad GJ, Farrow L, Heinlein K, Hettrich CM, Jones MH, Miniaci A, Ricchetti E, Rosneck J, Schickendantz M, Saluan P, Vega JF, Spindler KP. A smart decision: smartphone use for operative data collection in arthroscopic shoulder instability surgery. J Am Med Inform Assoc 2019; 26:1030-1036. [PMID: 31188454 PMCID: PMC6748799 DOI: 10.1093/jamia/ocz074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 10/15/2018] [Revised: 04/23/2019] [Accepted: 05/01/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study tested validity, accuracy, and efficiency of the Orthopaedic Minimal Data Set Episode of Care (OME) compared with traditional operative report in arthroscopic surgery for shoulder instability. As of November 2017, OME had successfully captured baseline data on 97% of 18 700 eligible cases. MATERIALS AND METHODS This study analyzes 100 cases entered into OME through smartphones by 12 surgeons at an institution from February to October 2015. A blinded reviewer extracted the same variables from operative report into a separate database. Completion rates and agreement were compared. They were assessed using raw percentages and McNemar's test (with continuity correction). Agreement between nominal variables was assessed by unweighted Cohen's kappa and a concordance correlation coefficient measured agreement between continuous variables. Efficiency was assessed by median time to complete. RESULTS Of 37 variables, OME demonstrated equal or higher completion rates for all but 1 and had significantly higher capture rates for 49% (n = 18; P < .05). Of 33 nominal variables, raw proportional agreement was ≥0.90 for 76% (n = 25). Raw proportional agreement was perfect for 15% (n = 5); no agreement statistic could be calculated due to a single variable in operative note and OME. Calculated agreement statistic was substantial or better (κ > 0.61) for 51% (n = 17) for the 33 nominal variables. All continuous variables assessed (n = 4) demonstrated poor agreement (concordance correlation coefficient <0.90). Median time for completing OME was 103.5 (interquartile range, 80.5-151) seconds. CONCLUSIONS The OME smartphone data capture system routinely captured more data than operative report and demonstrated acceptable agreement for nearly all nominal variables, yet took <2 minutes to complete on average.
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Affiliation(s)
- Jill Mohr
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Gregory J Strnad
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lutul Farrow
- Sports Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kate Heinlein
- Sports Health, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | | | | | - James Rosneck
- Sports Health, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Paul Saluan
- Sports Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jose F Vega
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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44
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Egger AC, Peterson J, Jones MH, Miniaci A. Total shoulder arthroplasty with nonspherical humeral head and inlay glenoid replacement: clinical results comparing concentric and nonconcentric glenoid stages in primary shoulder arthritis. JSES Open Access 2019; 3:145-153. [PMID: 31709354 PMCID: PMC6834987 DOI: 10.1016/j.jses.2019.07.009] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Glenoid morphology can influence the outcomes of total shoulder arthroplasty. This study examines the results of a new technique according to preoperative glenoid staging. We hypothesized that there would be no statistically significant difference in outcomes between Levine concentric (Walch A) and Levine nonconcentric (Walch B) glenoids treated for primary glenohumeral arthritis using nonspherical humeral head and inlay glenoid replacement. Methods This retrospective case series included 31 shoulders in 29 patients (25 male, 4 female), with an average age of 58.5 years. Outcomes included the Penn Shoulder Score (PSS), visual analog scale for pain (VAS-Pain), range of motion, radiographic analysis, and complications. Inclusion criteria were primary glenohumeral arthritis, intact rotator cuff, and no prior open shoulder surgeries. Results Mean follow-up was 42.6 months (range, 24-74 months). The study included 7 concentric and 24 nonconcentric glenoids. Outcomes comparison showed no statistically significant differences in PSS domains including Pain (P = .92), Function (P = .98), Satisfaction (P = .89), and Total (P = .98); forward flexion (P = .78); external rotation (P = .64); and VAS-Pain (P = 0.12). At the last follow-up, the mean PSS Pain was 25.3/30, Function 52.7/60, Satisfaction 8.4/10, and Total 87.0/100. The mean forward flexion was 167.3°, external rotation 56.6°, and VAS-Pain 0.9. There were no signs of periprosthetic fracture, component loosening, osteolysis, and hardware failure, and no revisions or 90-day rehospitalizations were required. One patient was prophylactically treated with oral antibiotics for a history of prior infection and 1 patient required a later open biceps tenodesis after a traumatic proximal biceps rupture postoperatively. Conclusion Nonspherical shoulder arthroplasty with inlay glenoid replacement demonstrated excellent clinical benefits for both concentric and nonconcentric glenoids. The technique appears to be a promising option for glenohumeral arthritis even in the presence of posterior glenoid erosion.
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Affiliation(s)
- Anthony C Egger
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jennifer Peterson
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Morgan H Jones
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Anthony Miniaci
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
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45
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Jones MH, Oak SR, Andrish JT, Brophy RH, Cox CL, Dunn WR, Flanigan DC, Fleming BC, Huston LJ, Kaeding CC, Kolosky M, Kuyumcu G, Lynch TS, Magnussen RA, Matava MJ, Parker RD, Reinke EK, Scaramuzza EA, Smith MV, Winalski C, Wright RW, Zajichek A, Spindler KP. Predictors of Radiographic Osteoarthritis 2 to 3 Years After Anterior Cruciate Ligament Reconstruction: Data From the MOON On-site Nested Cohort. Orthop J Sports Med 2019; 7:2325967119867085. [PMID: 31516911 PMCID: PMC6719483 DOI: 10.1177/2325967119867085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/02/2022] Open
Abstract
Background: Multiple studies have shown that patients are susceptible to posttraumatic osteoarthritis (PTOA) after an anterior cruciate ligament (ACL) injury, even with ACL reconstruction (ACLR). Prospective studies using multivariable analysis to identify risk factors for PTOA are lacking. Purpose/Hypothesis: This study aimed to identify baseline predictors of radiographic PTOA after ACLR at an early time point. We hypothesized that meniscal injuries and cartilage lesions would be associated with worse radiographic PTOA using the Osteoarthritis Research Society International (OARSI) atlas criteria. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 421 patients who underwent ACLR returned on-site for standardized posteroanterior semiflexed knee radiography at a minimum of 2 years after surgery. The mean age was 19.8 years, with 51.3% female patients. At baseline, data on demographics, graft type, meniscal status/treatment, and cartilage status were collected. OARSI atlas criteria were used to grade all knee radiographs. Multivariable ordinal regression models identified baseline predictors of radiographic OARSI grades at follow-up. Results: Older age (odds ratio [OR], 1.06) and higher body mass index (OR, 1.05) were statistically significantly associated with a higher OARSI grade in the medial compartment. Patients who underwent meniscal repair and partial meniscectomy had statistically significantly higher OARSI grades in the medial compartment (meniscal repair OR, 1.92; meniscectomy OR, 2.11) and in the lateral compartment (meniscal repair OR, 1.96; meniscectomy OR, 2.97). Graft type, cartilage lesions, sex, and Marx activity rating scale score had no significant association with the OARSI grade. Conclusion: Older patients with a higher body mass index who have an ACL tear with a concurrent meniscal tear requiring partial meniscectomy or meniscal repair should be advised of their increased risk of developing radiographic PTOA. Alternatively, patients with an ACL tear with an articular cartilage lesion can be reassured that they are not at an increased risk of developing early radiographic knee PTOA at 2 to 3 years after ACLR.
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Affiliation(s)
| | - Morgan H Jones
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Sameer R Oak
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Jack T Andrish
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert H Brophy
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Charles L Cox
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Warren R Dunn
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - David C Flanigan
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Braden C Fleming
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura J Huston
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher C Kaeding
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Kolosky
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Gokhan Kuyumcu
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - T Sean Lynch
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert A Magnussen
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew J Matava
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard D Parker
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Emily K Reinke
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Erica A Scaramuzza
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew V Smith
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Carl Winalski
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Rick W Wright
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Alexander Zajichek
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA, and the Cleveland Clinic, Cleveland, Ohio, USA
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46
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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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47
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Westermann RW, Marx RG, Spindler KP, Huston LJ, Amendola A, Andrish JT, Brophy RH, Dunn WR, Flanigan DC, Jones MH, Kaeding CC, Matava MJ, McCarty EC, Parker RD, Reinke EK, Vidal AF, Wolcott ML, Wolf BR. No Difference Between Posterolateral Corner Repair and Reconstruction With Concurrent ACL Surgery: Results From a Prospective Multicenter Cohort. Orthop J Sports Med 2019; 7:2325967119861062. [PMID: 31431898 PMCID: PMC6685111 DOI: 10.1177/2325967119861062] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Injuries to the posterolateral corner (PLC) may occur concurrently with anterior cruciate ligament (ACL) injury. Purpose/Hypothesis: This study evaluated the outcomes of patients who underwent operative management of PLC injuries concurrently with ACL reconstruction in a prospective multicenter cohort. We hypothesized that there would be no differences in outcomes between patients who were treated with PLC repair and PLC reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing ACL reconstruction were enrolled into a prospective longitudinal multicenter cohort between 2002 and 2008. Those with complete 6-year follow-up data (patient-reported outcomes and subsequent surgery information) were identified. Excluded from the study were patients with posterior cruciate ligament injuries. Patients who underwent PLC repair were compared with those who underwent PLC reconstruction with regard to interval from injury to surgery, need for revision surgery, and long-term outcomes at 6 years. Results: During the identified time frame, 3026 identified patients underwent primary ACL reconstruction; 34 (1.1%) also underwent concurrent PLC surgery (15 repairs, 19 reconstructions [18 allografts, 1 autograft]). With the numbers available, we did not detect significant differences between groups regarding the rate of meniscal or chondral injuries. Median time to PLC reconstruction was 121 days as compared with 19 days for concurrent ACL reconstruction and PLC repair (P = .01). There were no between-group differences in Marx activity scores prior to surgery (P = .4). At 6-year follow-up, there were no between-group differences in Knee injury and Osteoarthritis Outcome Score (P = .36-.83) or International Knee Documentation Committee score (P = .84); however, patients treated with PLC reconstructions had lower Marx activity scores (4.1 vs 9.4; P = .02). There was 1 ACL revision in the PLC reconstruction group, and 1 of the PLC repairs was revised to a reconstruction during the follow-up period. Conclusion: Good outcomes were achieved at 6-year follow-up with both repair and reconstruction of PLC injuries treated concurrently with ACL reconstruction. The PLC reconstruction group had lower activity levels 6 years after surgery. The present data suggest that, for appropriately selected patients undergoing acute surgical treatment of combined ACL and PLC injuries, PCL repair can achieve good long-term outcomes.
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Affiliation(s)
- Robert W Westermann
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Robert G Marx
- Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA
| | - Kurt P Spindler
- Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA
| | - Laura J Huston
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Annunziato Amendola
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Jack T Andrish
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Robert H Brophy
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Warren R Dunn
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - David C Flanigan
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Morgan H Jones
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Christopher C Kaeding
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Matthew J Matava
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Eric C McCarty
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Richard D Parker
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Emily K Reinke
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Armando F Vidal
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Michelle L Wolcott
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Brian R Wolf
- Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA, and University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
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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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Magnussen R, Reinke EK, Huston LJ, Spindler KP, Cox CL, Dunn WR, Flanigan DC, Hewett T, Jones MH, Kaeding CC, Lorring D, Matava MJ, Parker RD, Pedroza A, Preston E, Richardson B, Schroeder B, Smith MV, Wright RW, Spindler KP. Anterior and Rotational Knee Laxity Does Not Affect Patient-Reported Knee Function 2 Years After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:2077-2085. [PMID: 31307221 PMCID: PMC7269119 DOI: 10.1177/0363546519857076] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While a primary goal of anterior cruciate ligament (ACL) reconstruction is to reduce pathologically increased anterior and rotational knee laxity, the relationship between knee laxity after ACL reconstruction and patient-reported knee function remains unclear. HYPOTHESIS There would be no significant correlation between the degree of residual anterior and rotational knee laxity and patient-reported outcomes (PROs) 2 years after primary ACL reconstruction. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS From a prospective multicenter nested cohort of patients, 433 patients younger than 36 years of age injured in sports with no history of concomitant ligament surgery, revision ACL surgery, or surgery of the contralateral knee were identified and evaluated at a minimum 2 years after primary ACL reconstruction. Each patient underwent Lachman and pivot-shift evaluation as well as a KT-1000 arthrometer assessment along with Knee injury and Osteoarthritis Outcome Score and subjective International Knee Documentation Committee (IKDC) scores. A proportional odds logistic regression model was used to predict each 2-year PRO score, controlling for preoperative score, age, sex, body mass index, smoking, Marx activity score, education, subsequent surgery, meniscal and cartilage status, graft type, and range of motion asymmetry. Measures of knee laxity were independently added to each model to determine correlation with PROs. RESULTS Side-to-side manual Lachman differences were IKDC A in 246 (57%) patients, IKDC B in 183 (42%) patients, and IKDC C in 4 (<1%) patients. Pivot-shift was classified as IKDC A in 209 (48%) patients, IKDC B in 183 (42%) patients, and IKDC C in 11 (2.5%) patients. The mean side-to-side KT-1000 difference was 2.0 ± 2.6 mm. No significant correlations were noted between pivot-shift or anterior tibial translation as assessed by Lachman or KT-1000 and any PRO. All predicted differences in PROs based on IKDC A versus B pivot-shift and anterior tibial translation were less than 4 points. CONCLUSION Neither the presence of IKDC A versus B pivot-shift nor increased anterior tibial translation of up to 6 mm is associated with clinically relevant decreases in PROs 2 years after ACL reconstruction.
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Affiliation(s)
- Robert Magnussen
- Department of Orthopaedics, The Ohio State University Wexner Medical Center
| | - Emily K. Reinke
- Sports Medicine, Orthopaedic Surgery Research, Duke University Medical Center, Duke Sports Science Institute
| | | | -
MOON Knee Group
AndrishJack T.MDCleveland ClinicCoxCharles L.MD, MPHVanderbilt UniversityDunnWarren R.MD, MPHFlaniganDavid C.MDDepartment of Orthopaedics, The Ohio State UniversityHewettTimothyPhDDepartment of Biomedical Engineering, The Ohio State UniversityJonesMorgan H.MD, MPHOrthopaedic Sports Health, Cleveland ClinicKaedingChristopher C.MDDepartment of Orthopaedics, The Ohio State UniversityLorringDawnPT, MPT, SCS, CSCSOrthopaedic Sports Health, Cleveland ClinicMatavaMatthew J.MDDepartment of Orthopaedics, Washington University School of MedicineParkerRichard D.MDDepartment of Orthopaedics, Cleveland ClinicPedrozaAngelaMPHSports Medicine, The Ohio State UniversityPrestonEmilyPTVanderbilt UniversityRichardsonBrianPT, MS, SCS, CSCSVanderbilt UniversitySchroederBettinaDPTThe Ohio State UniversitySmithMatthew V.MDWashington University, St. LouisWrightRick W.MDWashington University, St. Louis
| | | | - Charles L Cox
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | - Warren R Dunn
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | - David C Flanigan
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | - Timothy Hewett
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | - Morgan H Jones
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | | | - Dawn Lorring
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | - Matthew J Matava
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | - Richard D Parker
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | - Angela Pedroza
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | - Emily Preston
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | - Brian Richardson
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | - Bettina Schroeder
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | - Matthew V Smith
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | - Rick W Wright
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
| | - Kurt P Spindler
- Investigation performed at The Ohio State University, Columbus, Ohio, USA
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50
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Jones MH, Oak SR, Andrish JT, Brophy RH, Cox CL, Dunn WR, Flanigan DC, Fleming BC, Huston LJ, Kaeding CC, Kolosky M, Lynch TS, Magnussen RA, Matava MJ, Parker RD, Reinke EK, Scaramuzza E, Smith MV, Winalski CS, Wright RW, Zajichek A, Spindler KP. Predictors of Radiographic Osteoarthritis 2-3 Years after ACL Reconstruction: Data from MOON Onsite Nested Cohort. Orthop J Sports Med 2019. [PMCID: PMC6676432 DOI: 10.1177/2325967119s00348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Morgan H. Jones
- Cleveland Clinic Orthopaedic Sports Health, Cleveland, OH, USA
| | - Sameer R. Oak
- Cleveland Clinic Orthopaedic Sports Health, Cleveland, OH, USA
| | - Jack T. Andrish
- Cleveland Clinic Department of Orthopaedics, Cleveland, OH, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Richard D. Parker
- Cleveland Clinic Orthopaedic Sports Health, Mayfield Heights, OH, USA
| | | | | | | | | | | | - Alex Zajichek
- Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, OH, USA
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