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Rezansoff A, Firth AD, Bryant DM, Litchfield R, McCormack RG, Heard M, MacDonald PB, Spalding T, Verdonk PCM, Peterson D, Bardana D, Getgood AMJ. Anterior Cruciate Ligament Reconstruction Plus Lateral Extra-articular Tenodesis Has a Similar Return-to-Sport Rate to Anterior Cruciate Ligament Reconstruction Alone but a Lower Failure Rate. Arthroscopy 2024; 40:384-396.e1. [PMID: 37270112 DOI: 10.1016/j.arthro.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/02/2023] [Accepted: 05/17/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To determine whether the addition of lateral extra-articular tenodesis (LET) to anterior cruciate ligament reconstruction (ACLR) would improve return-to-sport (RTS) rates in young, active patients who play high-risk sports. METHODS This multicenter randomized controlled trial compared standard hamstring tendon ACLR with combined ACLR and LET using a strip of the iliotibial band (modified Lemaire technique). Patients aged 25 years or younger with an anterior cruciate ligament-deficient knee were included. Patients also had to meet 2 of the following criteria: (1) pivot-shift grade 2 or greater, (2) participation in a high-risk or pivoting sport, and (3) generalized ligamentous laxity. Time to return and level of RTS were determined via administration of a questionnaire at 24 months postoperatively. RESULTS We randomized 618 patients in this study, 553 of whom played high-risk sports preoperatively. The proportion of patients who did not RTS was similar between the ACLR (11%) and ACLR-LET (14%) groups; however, the graft rupture rate was significantly different (11.2% in ACLR group vs 4.1% in ACLR-LET group, P = .004). The most cited reason for no RTS was lack of confidence and/or fear of reinjury. A stable knee was associated with nearly 2 times greater odds of returning to a high-level high-risk sport postoperatively (odds ratio, 1.92; 95% confidence interval, 1.11-3.35; P = .02). There were no significant differences in patient-reported functional outcomes or hop test results between groups (P > .05). Patients who returned to high-risk sports had better hamstring symmetry than those who did not RTS (P = .001). CONCLUSIONS At 24 months postoperatively, patients who underwent ACLR plus LET had a similar RTS rate to those who underwent ACLR alone. Although the subgroup analysis did not show a statistically significant increase in RTS with the addition of LET, on returning, the addition of LET kept subjects playing longer by reducing graft failure rates. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Alex Rezansoff
- University of Calgary Sport Medicine Centre, Calgary, Canada
| | - Andrew D Firth
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Canada
| | - Dianne M Bryant
- Fowler Kennedy Sport Medicine Clinic, London, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada; School of Physical Therapy, Western University, London, Canada
| | - Robert Litchfield
- Fowler Kennedy Sport Medicine Clinic, London, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Robert G McCormack
- Department of Orthopedics, University of British Columbia, Vancouver, Canada; New West Orthopaedic & Sports Medicine Centre, New Westminster, Canada
| | - Mark Heard
- Department of Surgery, University of Calgary, Calgary, Canada; Banff Sport Medicine, Banff, Canada
| | - Peter B MacDonald
- Department of Surgery, University of Manitoba, Winnipeg, Canada; Pan Am Clinic, Winnipeg, Canada
| | - Tim Spalding
- University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, England
| | - Peter C M Verdonk
- Department of Physical Medicine and Orthopedics, Ghent University, Ghent, Belgium; Antwerp Orthopedic Center, Antwerp, Belgium
| | - Devin Peterson
- Department of Surgery, Queen's University, Kingston, Canada
| | - Davide Bardana
- Department of Surgery, McMaster University, Hamilton, Canada; Department of Surgery, Queen's University, Kingston, Canada
| | - Alan M J Getgood
- Fowler Kennedy Sport Medicine Clinic, London, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada.
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Heard M, Marmura H, Bryant D, Litchfield R, McCormack R, MacDonald P, Spalding T, Verdonk P, Peterson D, Bardana D, Rezansoff A, Getgood A. Corrigendum to 'No increase in adverse events with lateral extra-articular tenodesis augmentation of anterior cruciate ligament reconstruction - Results from the stability randomized trial' [Journal of ISAKOS 8 (2023) 246-254]. J ISAKOS 2023; 8:513. [PMID: 37845163 DOI: 10.1016/j.jisako.2023.09.006] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- M Heard
- Deparment of Surgery, University of Calgary, T2N 1N4, Canada; Banff Sport Medicine, T1W 0L5, Canada
| | - H Marmura
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; School of Physical Therapy, Western University, N6A 3K7, Canada
| | - D Bryant
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; School of Physical Therapy, Western University, N6A 3K7, Canada
| | - R Litchfield
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, N6A 5C1, Canada
| | - R McCormack
- Department of Orthopaedics, University of British Columbia, V5Z 1M9, Canada; New West Orthopaedic & Sports Medicine Centre, V3L 5P5, Canada
| | - P MacDonald
- Department of Surgery, University of Manitoba, R3A 1R9, Canada; Pan Am Clinic, R3M 3E4, Canada
| | - T Spalding
- University Hospital Coventry and Warwickshire NHS Trust, CV2 2DX, UK
| | - P Verdonk
- Department of Physical Medicine and Orthopedics, Ghent University, 9000, Belgium; Antwerp Orthopedic Center, 2018, Belgium
| | - D Peterson
- Department of Surgery, McMaster University, L8S 4K1, Canada
| | - D Bardana
- Department of Surgery, Queen's University, K7L 2V7, Canada
| | - A Rezansoff
- Deparment of Surgery, University of Calgary, T2N 1N4, Canada; University of Calgary Sport Medicine Centre, T2N 1N4, Canada
| | - A Getgood
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, N6A 5C1, Canada.
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Heard M, Marmura H, Bryant D, Litchfield R, McCormack R, MacDonald P, Spalding T, Verdonk P, Peterson D, Bardana D, Rezansoff A, Getgood A. No increase in adverse events with lateral extra-articular tenodesis augmentation of anterior cruciate ligament reconstruction - Results from the stability randomized trial. J ISAKOS 2023; 8:246-254. [PMID: 36646169 DOI: 10.1016/j.jisako.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Results from the Stability Study suggest that adding a lateral extra-articular tenodesis (LET) to a hamstring tendon autograft reduces the rate of anterior cruciate ligament reconstruction (ACLR) failure in high-risk patients. The purpose of this study is to report adverse events over the 2-year follow-up period and compare groups (ACLR alone vs. ACLR + LET). METHODS Stability is a randomized clinical trial comparing hamstring tendon ACLR with and without LET. Patients aged 14-25 years with an ACL deficient knee were included. Patients were followed and adverse events documented (type, actions taken, resolution) with visits at 3, 6, 12, and 24 months postoperatively. Adverse events were categorized as none, minor medical, minor surgical, contralateral ACL rupture, or graft rupture. Patient reported outcome measures (PROMs) collected at each visit included the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Score (IKDC), and ACL Quality of Life Questionnaire (ACL-QOL). RESULTS In total, 618 patients were randomized (mean age 18.9 years, 302 (49%) male). Forty-five patients (7%) suffered graft rupture; 34 (11%) in the ACLR group compared to 11 (4%) in the ACLR + LET group (RRR = 0.67, 95% CI 0.36 to 0.83, p < 0.001). There were no differences in effusion or infection rates between groups. The ACLR + LET group experienced an increased number of hardware removals (10 vs. 4). Overall, the rate of minor medical events (11%), minor surgical events (7%), and ipsilateral or contralateral ACL tears (10%) were low considering the high-risk patient profile. Increasing severity of adverse events was associated with lower PROMs at 24 months post-operative. Patients in the ACLR + LET group reported greater degree of pain at 3 months only. There were no clinically significant differences in range of motion between groups. CONCLUSIONS The addition of LET to hamstring tendon autograft ACLR in young patients at high risk of re-injury resulted in a statistically significant reduction in graft rupture. While the addition of LET may increase rates of hardware irritation, there was no significant increase in overall rates of minor medical adverse events, minor surgical events, or overall re-operation rates. The concerns regarding complications associated with a LET did not materialize in this study. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- M Heard
- Deparment of Surgery, University of Calgary, T2N 1N4, Canada; Banff Sport Medicine, T1W 0L5, Canada
| | - H Marmura
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; School of Physical Therapy, Western University, N6A 3K7, Canada
| | - D Bryant
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; School of Physical Therapy, Western University, N6A 3K7, Canada
| | - R Litchfield
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, N6A 5C1, Canada
| | - R McCormack
- Department of Orthopaedics, University of British Columbia, V5Z 1M9, Canada; New West Orthopaedic & Sports Medicine Centre, V3L 5P5, Canada
| | - P MacDonald
- Department of Surgery, University of Manitoba, R3A 1R9, Canada; Pan Am Clinic, R3M 3E4, Canada
| | - T Spalding
- University Hospital Coventry and Warwickshire NHS Trust, CV2 2DX, UK
| | - P Verdonk
- Department of Physical Medicine and Orthopedics, Ghent University, 9000, Belgium; Antwerp Orthopedic Center, 2018, Belgium
| | - D Peterson
- Department of Surgery, McMaster University, L8S 4K1, Canada
| | - D Bardana
- Department of Surgery, Queen's University, K7L 2V7, Canada
| | - A Rezansoff
- Deparment of Surgery, University of Calgary, T2N 1N4, Canada; University of Calgary Sport Medicine Centre, T2N 1N4, Canada
| | - A Getgood
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, N6A 5C1, Canada.
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McNeill K, Reyes N, Choe S, Peterson D, Bryant D, Sonnadara RR. A History of Musculoskeletal Medicine and Its Place and Progress in Undergraduate Medical Education. Med Sci Educ 2023; 33:777-790. [PMID: 37501799 PMCID: PMC10368607 DOI: 10.1007/s40670-023-01782-3] [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] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 07/29/2023]
Abstract
Musculoskeletal diseases are responsible for some of the most prevalent conditions affecting population health in the world. Despite the prevalence of these conditions, musculoskeletal medicine has a fraught history within the world of undergraduate medical education. We review the origins of musculoskeletal medicine, its evolution in undergraduate medical education, and progress that has been made over the last decade as a result of global initiatives such as the Bone and Joint Decade. Understanding the history of musculoskeletal medicine is essential to contextualizing the problems that exist today and creating comprehensive solutions to fill the gaps that persist in musculoskeletal curricula.
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Affiliation(s)
- Kestrel McNeill
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Natasha Reyes
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Stella Choe
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Devin Peterson
- Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Dianne Bryant
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Ranil R. Sonnadara
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, University of Toronto, 27 King’s College Cir, Toronto, ON M5S 1A1 Canada
- Compute Ontario, Toronto, ON Canada
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Vivekanantha P, Cohen D, Peterson D, de Sa D. Patellofemoral Instability in the Pediatric Population. Curr Rev Musculoskelet Med 2023:10.1007/s12178-023-09836-0. [PMID: 37071284 DOI: 10.1007/s12178-023-09836-0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE OF REVIEW This review focuses on the etiology, diagnosis, and management of patellar instability in pediatric patients. RECENT FINDINGS Radiological outcomes such as tibial-tubercle to trochlear groove (TT-TG) distance used in diagnosis are subject to factors of influence such as femoral anteversion and knee flexion angle, and new measure such as tibial-tubercle to posterior cruciate ligament distance as well as TT-TG/trochlear width (TT-TG/TW) are under investigation. To prevent recurrent instability, surgical intervention for acute patellar dislocations may be advantageous compared to conservative management. Patellar instability is a common pathology found in pediatric cohorts. Diagnosis can be performed via a combination of history, physical examination maneuvers, and radiological risk factors such as patella alta, patellar tilt, trochlear dysplasia, and elevated TT-TG distances. Current literature advocates the usage of additional radiological measures to TT-TG such as TT-TG/TW, especially as TT-TG varies with age in younger patients. Recent literature potentially suggests the utilization of surgical procedures such as MPFL reconstruction or repair for acute dislocations in the hope of preventing recurrent instability. Special indications for pediatric patients include osteochondral fracture identification to help prevent patellofemoral osteoarthritis. A comprehensive workup and understanding of current literature can aid clinicians in aiming to prevent recurrent patellar dislocation in pediatric patients.
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Affiliation(s)
- Prushoth Vivekanantha
- Michael DeGroote School of Medicine, McMaster University, 1280 Main Street W, Hamilton, ON, Canada.
| | - Dan Cohen
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Devin Peterson
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Darren de Sa
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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6
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Lodhia P, Nazari G, Bryant D, Getgood A, McCormack R, Getgood AM, Bryant DM, Litchfield R, Willits K, Birmingham T, Hewison C, Firth AD, Wanlin S, Pinto R, Martindale A, O’Neill L, Jennings M, Daniluk M, McCormack RG, Boyer D, Zomar M, Moon K, Moon R, Fan B, Mohan B, Payne K, Heard M, Buchko GM, Hiemstra LA, Kerslake S, Tynedal J, MacDonald PB, Stranges G, Mcrae S, Gullett L, Brown H, Legary A, Longo A, Christian M, Ferguson C, Rezansoff A, Mohtadi N, Barber R, Chan D, Campbell C, Garven A, Pulsifer K, Mayer M, Peterson D, Simunovic N, Duong A, Robinson D, Levy D, Skelly M, Shanmugaraj A, Bardana D, Howells F, Tough M, Spalding T, Thompson P, Metcalfe A, Asplin L, Dube A, Clarkson L, Brown J, Bolsover A, Bradshaw C, Belgrove L, Milan F, Turner S, Verdugo S, Lowe J, Dunne D, McGowan K, Suddens CM, Verdonk PC, Declerq G, Vuylsteke K, Van Haver M. Performance of 5-Strand Hamstring Autograft Anterior Cruciate Ligament Reconstruction in the STABILITY Study: A Subgroup Analysis. Am J Sports Med 2022; 50:3502-3509. [PMID: 36260487 PMCID: PMC9630854 DOI: 10.1177/03635465221128581] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstructions (ACLRs) with graft diameters <8mm have been shown to have higher revision rates. The 5-strand (5S) hamstring autograft configuration is a proposed option to increase graft diameter. PURPOSE To investigate the differences in clinical outcomes between 4-strand (4S) and 5S hamstring autografts for ACLR in patients who underwent ACLR alone or concomitantly with a lateral extra-articular tenodesis (LET) procedure. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Data from the STABILITY study were analyzed to compare a subgroup of patients undergoing ACLR alone or with a concomitant LET procedure (ACLR + LET) with a minimum graft diameter of 8mm that had either a 4S or 5S hamstring autograft configuration. The primary outcome was clinical failure, a composite of rotatory laxity and/or graft failure. The secondary outcome measures consisted of 2 patient-reported outcome scores (PROs)-namely, the ACL Quality of Life Questionnaire (ACL-QoL) and the International Knee Documentation Committee (IKDC) score at 24 months postoperatively. RESULTS Of the 618 patients randomized in the STABILITY study, 399 (228 male; 57%) fit the inclusion criteria for this study. Of these, 191 and 208 patients underwent 4S and 5S configurations of hamstring ACLR, respectively, with a minimum graft diameter of 8mm. Both groups had similar characteristics other than differences in anthropometric factors-namely, sex, height, and weight, and Beighton scores. The primary outcomes revealed no difference between the 2 groups in rotatory stability (odds ratio [OR], 1.19; 95% CI, 0.77-1.84; P = .42) or graft failure (OR, 1.13; 95% CI, 0.51-2.50; P = .76). There was no significant difference between the groups in Lachman (P = .46) and pivot-shift (P = .53) test results at 24 months postoperatively. The secondary outcomes revealed no differences in the ACL-QoL (P = .67) and IKDC (P = .83) scores between the 2 subgroups. CONCLUSION At the 24-month follow-up, there were no significant differences in clinical failure rates and PROs in an analysis of patients with 4S and 5S hamstring autografts of ≥8mm diameter for ACLR or ACLR + LET. The 5S hamstring graft configuration is a viable option to produce larger-diameter ACL grafts.
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Affiliation(s)
- Parth Lodhia
- Parth Lodhia, MD, University of British Columbia, 403-233
Nelson’s Crescent, New Westminster, V3L 0E4, Canada (
)
| | - Goris Nazari
- Canadian Institutes of Health Research, Ottawa,
Ontario, Canada
| | - Dianne Bryant
- The University of Western Ontario, London,
Ontario, Canada
| | - Alan Getgood
- Western Ontario University, London, Ontario,
Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michal Daniluk
- London Health Sciences Centre, Western
University, Fowler Kennedy Sport Medicine Clinic, London, Canada
| | | | | | | | | | | | | | | | - Kyrsten Payne
- Fraser Orthopaedic Institute, New Westminster,
Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michelle Mayer
- Sport Medicine Centre, University of Calgary,
Calgary, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mieke Van Haver
- Antwerp Orthopaedic Center, Ghent,
Belgium,Investigation performed at University of
British Columbia, Vancouver, BC, Canada
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Marmura H, Firth A, Batty L, Bryant DM, Getgood AMJ, Bryant D, Litchfield R, Willits K, Birmingham T, Hewison C, Wanlin S, Firth A, Pinto R, Martindale A, O’Neill L, Jennings M, Daniluk M, Boyer D, McCormack B, Zomar M, Moon K, Moon R, Fan B, Mohan B, Heard M, Buchko GM, Hiemstra LA, Kerslake S, Tynedal J, MacDonald P, Stranges G, Mcrae S, Gullett L, Brown H, Legary A, Longo A, Christian M, Ferguson C, Rezansoff A, Mohtadi N, Barber R, Chan D, Campbell C, Garven A, Pulsifer K, Mayer M, Peterson D, Simunovic N, Duong A, Robinson D, Levy D, Skelly M, Shanmugaraj A, Bardana D, Howells F, Tough M, Spalding T, Thompson P, Metcalfe A, Asplin L, Dube A, Clarkson L, Brown J, Bolsover A, Bradshaw C, Belgrove L, Millan F, Turner S, Verdugo S, Lowe J, Dunne D, McGowan K, Suddens CM, Verdonk P, Declerq G, Vuylsteke K, Van Haver M. Meniscal repair at the time of primary ACLR does not negatively influence short term knee stability, graft rupture rates, or patient-reported outcome measures: the STABILITY experience. Knee Surg Sports Traumatol Arthrosc 2022; 30:3689-3699. [PMID: 35451638 DOI: 10.1007/s00167-022-06962-z] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess how meniscal repair and excision impact short term patient-reported outcome measures (PROMs), knee stability, and early graft rupture rates following primary hamstring anterior cruciate ligament reconstruction (ACLR) with or without lateral extra-articular tenodesis (LET) in a group of young active patients where meniscal repair is commonly advocated. METHODS Six hundred and eighteen patients under 25 years of age at high-risk of graft failure following ACLR were recruited to the Stability 1 study. Multivariable regression models were developed to identify statistically and clinically significant surgical and demographic predictors of Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Subjective Knee Form (IKDC), ACL Quality of Life Questionnaire (ACL-QOL) and Marx Activity Rating Scale (MARS) scores. Chi-Square tests of independence were used to explore the association between meniscal status (torn, not torn), meniscal treatment (excision or repair), graft rupture, and rotatory knee laxity. RESULTS Medial meniscus repair was associated with worse outcomes on the KOOS (β = -1.32, 95% CI: -1.57 to -1.10, p = 0.003), IKDC (β = -1.66, 95% CI: -1.53 to -1.02, p = 0.031) and ACL-QOL (β = -1.25, 95% CI: -1.61 to 1.02, p = n.s.). However, these associations indicated small, clinically insignificant changes based on reported measures of clinical relevance. Other important predictors of post-operative PROMs included age, sex, and baseline scores. Medial meniscus excision and lateral meniscus treatment (repair or excision) did not have an important influence on PROMs. There was no significant association between meniscal treatment and graft rupture or rotatory knee laxity. CONCLUSION While repairing the medial meniscus may result in a small reduction in PROM scores at two-year follow-up, these differences are not likely to be important to patients or clinicians. Any surgical morbidity associated with meniscal repair appears negligible in terms of PROMs. Meniscal repair does not affect rotatory laxity or graft failure rates in the short term. Therefore, meniscal repair should likely be maintained as the standard of care for concomitant meniscal tears with ACLR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,Bone and Joint Institute, Western University, London, Canada.,Lawson Research, London Health Sciences Centre, London, Canada
| | - Andrew Firth
- Faculty of Health Sciences, Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,Bone and Joint Institute, Western University, London, Canada.,Lawson Research, London Health Sciences Centre, London, Canada
| | - Lachlan Batty
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,OrthoSport Victoria Research Unit, Richmond, Australia.,St. Vincent's Hospital, Melbourne, Australia
| | - Dianne M Bryant
- Faculty of Health Sciences, Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,Bone and Joint Institute, Western University, London, Canada.,Lawson Research, London Health Sciences Centre, London, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Alan M J Getgood
- Faculty of Health Sciences, Western University, London, Canada. .,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada. .,Bone and Joint Institute, Western University, London, Canada. .,Lawson Research, London Health Sciences Centre, London, Canada. .,Schulich School of Medicine and Dentistry, Western University, London, Canada.
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Goemans N, McDonald C, Muntoni F, Signorovitch J, Sajeev G, Done N, Manzur A, Wong B, Tian C, Mercuri E, He C, Peterson D, Akbarnejad H, Ward S. P.65 Consistency of changes in percent-predicted forced vital capacity between real-world data and trial placebo arms in ambulatory Duchenne muscular dystrophy. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lameire DL, Khalik HA, Phillips M, MacDonald AE, Banfield L, de Sa D, Ayeni OR, Peterson D. Thromboprophylaxis after knee arthroscopy does not decrease the risk of deep vein thrombosis: a network meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2364-2376. [PMID: 35112181 DOI: 10.1007/s00167-021-06857-5] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The primary aim of this network meta-analysis (NMA) is to compare the incidence of venous thromboembolisms (VTE) and bleeding risk following the use of pharmacological and non-pharmacological thromboprophylaxis for arthroscopic knee surgery (AKS). This study assumed the null hypothesis which was that there will be no difference in the incidence of VTE and bleeding risk when comparing no treatment, pharmacological treatment, and non-pharmacological treatment for preventing VTE events following AKS. METHODS A systematic electronic search of CENTRAL, Medline, Embase, and ClinicalTrials.gov was carried out. All English language prospective randomized clinical trials published from date of database inception to November 21, 2021 were eligible for inclusion. All papers addressing arthroscopic knee surgery were eligible for inclusion regardless of timing of surgery, operation, surgical technique, or rehabilitation. Multiple random effects NMAs were conducted to compare all treatments for each outcome. The primary outcome was the incidence of pulmonary embolism (PE) and secondary outcomes consisted of overall deep vein thrombosis (DVT), symptomatic DVT, asymptomatic DVT, and all-cause mortality. Adverse outcomes consisted of major and minor bleeding, as well as adverse events. RESULTS A total of nine studies with 4526 patients were included for analysis. There were 1054 patients in the no treatment/placebo group (NT/Placebo), 1646 patients in the graduated compression stockings, 810 patients in the extended-duration (> 10 days) low molecular weight heparin (Ext-LMWH) group, 650 patients in the short-duration (< 10 days) LMWH group (Short-LMWH), and 356 patients in the rivaroxaban group. GCS, Ext-LMWH, Short-LMWH and rivaroxaban all demonstrated low risks of PE, symptomatic DVT, asymptomatic DVT, combined DVT and all-cause mortality. Similarly, all interventions demonstrated a low risk of major bleeding. CONCLUSION There is no significant difference in the risk reduction of PEs, symptomatic DVTs, major/minor bleeding, and/or all-cause mortality when using LWMH (including short or extended regimens), rivaroxaban, graduated compression stockings or no treatment following arthroscopic knee surgery. Future primary research on the efficacy of thromboprophylaxis following arthroscopic knee surgery should stratify outcomes based on key patient (i.e., age, sex, comorbidities) and surgical (i.e., major vs. minor surgery) characteristics and should include acetylsalicylic acid as an intervention. LEVEL OF EVIDENCE I, network meta-analysis of Level I studies.
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Affiliation(s)
| | - Hassaan Abdel Khalik
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Mark Phillips
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Austin Edward MacDonald
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Devin Peterson
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8P 1H6, Canada.
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Perkins R, Swallow E, Wang W, Gao E, Olson S, Sung J, Nguyen H, Peterson D, Billmyer E, Chang A. POS-050 THE PATIENT JOURNEY FOR IMMUNOGLOBULIN A NEPHROPATHY: DIAGNOSTIC DELAY AND CHANGE IN KIDNEY FUNCTION FROM FIRST CLINICAL SIGN. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.04.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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Mackos AR, O'Piela DR, Escobar Y, Peterson D, Bernier M, Somogyi A, Wold LE. Air Particulate Matter Significantly Alters Bacterial‐Derived Metabolites in APP/PS1 Mice. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.l7912] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Firth AD, Bryant DM, Litchfield R, McCormack RG, Heard M, MacDonald PB, Spalding T, Verdonk PC, Peterson D, Bardana D, Rezansoff A, Getgood AM, Willits K, Birmingham T, Hewison C, Wanlin S, Pinto R, Martindale A, O’Neill L, Jennings M, Daniluk M, Boyer D, Zomar M, Moon K, Moon R, Fan B, Mohan B, Buchko GM, Hiemstra LA, Kerslake S, Tynedal J, Stranges G, Mcrae S, Gullett L, Brown H, Legary A, Longo A, Christian M, Ferguson C, Mohtadi N, Barber R, Chan D, Campbell C, Garven A, Pulsifer K, Mayer M, Simunovic N, Duong A, Robinson D, Levy D, Skelly M, Shanmugaraj A, Howells F, Tough M, Thompson P, Metcalfe A, Asplin L, Dube A, Clarkson L, Brown J, Bolsover A, Bradshaw C, Belgrove L, Milan F, Turner S, Verdugo S, Lowe J, Dunne D, McGowan K, Suddens CM, Declerq G, Vuylsteke K, Van Haver M. Predictors of Graft Failure in Young Active Patients Undergoing Hamstring Autograft Anterior Cruciate Ligament Reconstruction With or Without a Lateral Extra-articular Tenodesis: The Stability Experience. Am J Sports Med 2022; 50:384-395. [PMID: 35050817 PMCID: PMC8829733 DOI: 10.1177/03635465211061150] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction (ACLR) has higher failure rates in young active patients returning to sports as compared with older, less active individuals. Augmentation of ACLR with an anterolateral procedure has been shown to reduce failure rates; however, indications for this procedure have yet to be clearly defined. PURPOSE/HYPOTHESIS The purpose of this study was to identify predictors of ACL graft failure in high-risk patients and determine key indications for when hamstring ACLR should be augmented by a lateral extra-articular tenodesis (LET). We hypothesized that different preoperative characteristics and surgical variables may be associated with graft failure characterized by asymmetric pivot shift and graft rupture. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were obtained from the Stability 1 Study, a multicenter randomized controlled trial of young active patients undergoing autologous hamstring ACLR with or without a LET. We performed 2 multivariable logistic regression analyses, with asymmetric pivot shift and graft rupture as the dependent variables. The following were included as predictors: LET, age, sex, graft diameter, tear chronicity, preoperative high-grade knee laxity, preoperative hyperextension on the contralateral side, medial meniscal repair/excision, lateral meniscal repair/excision, posterior tibial slope angle, and return-to-sports exposure time and level. RESULTS Of the 618 patients in the Stability 1 Study, 568 with a mean age of 18.8 years (292 female; 51.4%) were included in this analysis. Asymmetric pivot shift occurred in 152 (26.8%) and graft rupture in 43 (7.6%). The addition of a LET (odds ratio [OR], 0.56; 95% CI, 0.37-0.83) and increased graft diameter (OR, 0.62; 95% CI, 0.44-0.87) were significantly associated with lower odds of asymmetric pivot shift. The addition of a LET (OR, 0.40; 95% CI, 0.18-0.91) and older age (OR, 0.83; 95% CI, 0.72-0.96) significantly reduced the odds of graft rupture, while greater tibial slope (OR, 1.15; 95% CI, 1.01-1.32), preoperative high-grade knee laxity (OR, 3.27; 95% CI, 1.45-7.41), and greater exposure time to sport (ie, earlier return to sport) (OR, 1.18; 95% CI, 1.08-1.29) were significantly associated with greater odds of rupture. CONCLUSION The addition of a LET and larger graft diameter were significantly associated with reduced odds of asymmetric pivot shift. Adding a LET was protective of graft rupture, while younger age, greater posterior tibial slope, high-grade knee laxity, and earlier return to sport were associated with increased odds of graft rupture. Orthopaedic surgeons should consider supplementing hamstring autograft ACLR with a LET in young active patients with morphological characteristics that make them at high risk of reinjury.
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Affiliation(s)
| | | | - Robert Litchfield
- London Health Sciences Centre, Western University, Fowler Kennedy Sport Medicine Clinic, London, Canada
| | | | | | | | - Tim Spalding
- University Hospitals Coventry Warwickshire NHS Trust, Coventry, UK
| | | | | | | | - Alex Rezansoff
- Sport Medicine Centre, University of Calgary, Calgary, Canada
| | | | - Alan M.J. Getgood
- Alan M.J. Getgood, MD, Fowler Kennedy Sport Medicine Clinic, Western University, 3M Centre, London, ON N6A 3K7, Canada () (Twitter: FKSMC_Getgood)
| | | | | | | | | | | | | | | | | | - Michal Daniluk
- London Health Sciences Centre, Western University, Fowler Kennedy Sport Medicine Clinic, London, Canada
| | | | | | | | | | | | - Bindu Mohan
- Fraser Orthopaedic Institute, New Westminster, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michelle Mayer
- Sport Medicine Centre, University of Calgary, Calgary, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mieke Van Haver
- Antwerp Orthopaedic Center, Ghent, Belgium,Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
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Thornley P, Peterson D, Kishta W. Child Abuse with Thoracolumbar Fracture-Dislocation Treated with Pedicle Screw Fixation in a 2-Year-Old: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00081. [PMID: 34937046 DOI: 10.2106/jbjs.cc.21.00129] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE A nonverbal 2-year-old boy presented with acute-on-chronic thoracolumbar fracture-subluxation with associated chylothorax and progressive neurologic dysfunction secondary to nonaccidental trauma. We discussed the successful management of this patient with short-segment pedicle screw instrumentation resulting in complete resolution of his chylothoraxes and neurologic impairment. A clinical follow-up is reported out to 12 months after hardware removal. CONCLUSION Thoracolumbar fracture-subluxation with massive chylothorax is a rare and important presentation of nonaccidental trauma that must be recognized. Temporary pedicle screw fixation is a successful treatment option for young children presenting with this difficult spinal pathology.
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Affiliation(s)
- Patrick Thornley
- Department of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
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14
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Kerns S, Morlang A, Lee S, Hall W, Peterson D, Marples B, Zhang H, Bylund K, Rosenzweig D, de Ruyck K, Rosenstein B, CaamaNo A, Vega A, Parker C, West C, Janelsins M, Chen Y, Messing E, Morrow G. Use of Angiotensin Converting Enzyme Inhibitors and Risk of Late Bladder Toxicity Following Radiotherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Olotu O, Siddiqui A, Peterson D, de Sa D. The Superficial "Swing-Down" Quadriceps Tendon Autograft Is a Viable Option for Medial Patellofemoral Ligament Reconstruction: A Systematic Review. Arthroscopy 2021; 37:3187-3197. [PMID: 33961979 DOI: 10.1016/j.arthro.2021.04.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review is to ascertain the reported clinical outcomes and complication profiles of medial patellofemoral ligament (MPFL) reconstruction performed using a superficial "swing-down" quadriceps tendon autograft. METHODS Three databases (PubMed, EMBASE, and MEDLINE) were searched from January 1, 2000, to April 06, 2020. Keywords used in the search included: "medial patellofemoral ligament" and "reconstruction". After screening based on inclusion and exclusion criteria, patient demographics, graft type, outcomes, and complications were extracted. Methodological Index for Non-Randomized Studies criteria were used to assess the quality of each included study. RESULTS Eleven studies were included, comprising data from 226 patients with mean follow up ranging from 12 to 38 months. All reconstructions used a superficial "swing-down" quadriceps tendon autograft fixed at 20-30 degrees of knee flexion where reported. Eight of eleven studies reported significant improvement in patient reported outcomes such as Kujala score, Lysholm score, and Tegner score. The mean preoperative Kujala score ranged from 35.8 to 82.1 (167 patients), while the mean postoperative Kujala score ranged from 88.4 to 94.8 (197 patients). The mean of the preoperative Lysholm score ranged from 43.3 to 79.3 (77 patients), while the mean of the postoperative Lysholm score ranged from 81.9 to 90.9 (99 patients). The I2 statistic for Lysholm and Kujala scores was 94% and 97%, respectively. Across data reported on 194 patients, there was no incidence of patellar redislocation, patellar fracture, or graft site morbidity. CONCLUSION The quadriceps tendon produced improved clinical outcomes with low rates of recurrent postoperative patellar dislocation. These data suggest that the quadriceps tendon remains a suitable alternative for MPFL reconstruction and should remain part of the arsenal of knee ligament surgeons. LEVEL OF EVIDENCE Systematic review of Level III and IV studies.
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Affiliation(s)
- Olumide Olotu
- MACSports Research Program, McMaster University, Hamilton, Ontario, Canada; School of Medicine, St. George's University, True Blue, Grenada, West Indies
| | - Ali Siddiqui
- MACSports Research Program, McMaster University, Hamilton, Ontario, Canada
| | - Devin Peterson
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
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16
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Szkwarko D, Amisi JA, Peterson D, Burudi S, Angala P, Carter EJ. Using a mobile application to improve pediatric presumptive TB identification in western Kenya. Int J Tuberc Lung Dis 2021; 25:468-474. [PMID: 34049609 DOI: 10.5588/ijtld.20.0890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Early recognition of TB symptoms in children is critical in order to link children to appropriate testing and treatment. Healthcare workers (HCWs) in high TB burden countries are often overburdened with competing clinical priorities, leading to incomplete presumptive TB screening. We assessed if implementing a community health volunteer (CHV) led presumptive pediatric TB mobile android application (PPTBMAPP) in pediatric outpatient, primary care clinics in western Kenya would be feasible, appropriate, and effective.METHODS: We used a mixed-methods participatory, iterative approach to design and implement the PPTBMAPP during a 6-month period. We compared the proportion of children identified in presumptive TB and active TB disease registers out of all patients before and after the implementation of the intervention.RESULTS: Of the 1787 children aged ≤15 years screened using the PPTBMAPP, 376 (21%) met the criteria for presumptive TB. There was a statistically significant increase in the proportion of children to all patients in the presumptive TB registers (97/908, 10.7% vs. 160/989, 16.2%; P = 0.0005), and a trend towards an increase in the proportion of children to all patients in the TB case register (17/117, 14.5% vs. 15/83, 18.1%; P = 0.5). HCWs interviewed commented that the application sped up the presumptive TB screening process.CONCLUSION: Our CHV-led mobile screening intervention significantly increased presumptive TB notification. HCWs reported that the mobile screening intervention was feasible, appropriate, and effective.
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Affiliation(s)
- D Szkwarko
- Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
| | - J A Amisi
- Department of Family Medicine, College of Health Sciences, Moi University, Eldoret, Kenya, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - D Peterson
- Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - S Burudi
- Webuye County Hospital, Webuye, Kenya
| | - P Angala
- Center for Health Solutions-Kenya, Nairobi, Kenya
| | - E J Carter
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
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17
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de Sa D, Crum RJ, Rabuck S, Ayeni O, Bedi A, Baraga M, Getgood A, Kaar S, Kropf E, Mauro C, Peterson D, Vyas D, Musahl V, Lesniak BP. The REVision Using Imaging to Guide Staging and Evaluation (REVISE) in ACL Reconstruction Classification. J Knee Surg 2021; 34:509-519. [PMID: 31569256 PMCID: PMC8995042 DOI: 10.1055/s-0039-1697902] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Revision anterior cruciate ligament (ACL) procedures are increasing in incidence and possess markedly inferior clinical outcomes (76% satisfaction) and return-to-sports (57%) rates than their primary counterparts. Given their complexity, a universal language is required to identify and communicate the technical challenges faced with revision procedures and guide treatment strategies. The proposed REV: ision using I: maging to guide S: taging and E: valuation (REVISE) ACL (anterior cruciate ligament) Classification can serve as a foundation for this universal language that is feasible and practical with acceptable inter-rater agreement. A focus group of sports medicine fellowship-trained orthopaedic surgeons was assembled to develop a classification to assess femoral/tibial tunnel "usability" (placement, widening, overlap) and guide the revision reconstruction strategy (one-stage vs. two-stage) post-failed ACL reconstruction. Twelve board-certified sports medicine orthopaedic surgeons independently applied the classification to the de-identified computed tomographic (CT) scan data of 10 patients, randomly selected, who failed ACL reconstruction. An interclass correlation coefficient (ICC) was calculated (with 95% confidence intervals) to assess agreement among reviewers concerning the three major classifications of the proposed system. Across surgeons, and on an individual patient basis, there was high internal validity and observed agreement on treatment strategy (one-stage vs. two-stage revision). Reliability testing of the classification using CT scan data demonstrated an ICC (95% confidence interval) of 0.92 (0.80-0.98) suggesting "substantial" agreement between the surgeons across all patients for all elements of the classification. The proposed REVISE ACL Classification, which employs CT scan analysis to both identify technical issues and guide revision ACL treatment strategy (one- or two-stage), constitutes a feasible and practical system with high internal validity, high observed agreement, and substantial inter-rater agreement. Adoption of this classification, both clinically and in research, will help provide a universal language for orthopaedic surgeons to discuss these complex clinical presentations and help standardize an approach to diagnosis and treatment to improve patient outcomes. The Level of Evidence for this study is 3.
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Affiliation(s)
- Darren de Sa
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Raphael J Crum
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen Rabuck
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Olufemi Ayeni
- Department of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael Baraga
- Department of Orthopaedic Surgery, University of Miami, Miami, Florida
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Scott Kaar
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri
| | - Eric Kropf
- Temple Orthopaedics at the Navy Yard, Vincera Institute, Philadelphia, Pennsylvania
| | - Craig Mauro
- Burke and Bradley Orthopaedics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Devin Peterson
- Department of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dharmesh Vyas
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Abstract
Effective options exist for acute nonoperative management of anterior tibial spine fractures, yet there exists a paucity of literature describing long-term outcomes for these patients. This systematic review thus aims to consolidate management strategies and complications for patients with nonoperative anterior tibial spine fractures. In accordance with PRISMA guidelines, 5 databases (CINAHL, MEDLINE, EMBASE, Cochrane, and Pubmed) were searched and screened in duplicate. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Of 485 studies identified in the initial search, a total of 18 studies involving 369 patients were eligible for this review. These were stratified into 173 type I, 124 type II, and 72 type III injuries as described by Meyers and McKeever. All patients were treated with knee immobilization in either full extension or slight flexion, with possible closed reduction and/or aspiration of hemarthrosis. Complications at final follow-up comprised 33.9% of patients with persistent stiffness, 19.4% persistent instability, 11.1% mechanical symptoms, 6.37 delayed anterior cruciate ligament reconstruction, 4.9% delayed operative intervention for other complications, and 1.9% extension impingement. Given the lack of comparative studies in this review, definitive conclusions for nonoperative management are difficult to establish on the basis of the current body of literature alone. A modestly higher rate of arthrofibrosis and persistent laxity are seen in higher-grade injuries, however, only a minority of studies stratified complications by Meyers and McKeever classification in this review. A better understanding of variables in treatment decision making require further prospective study focused on the collection of functional and patient-reported outcome measures, whereas also further delineating complications by injury severity.
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Affiliation(s)
- Kailai Zhang
- Department of Physical Medicine and Rehabilitation
| | - Michael Catapano
- Department of Physical Medicine and Rehabilitation, University of Toronto, Toronto
| | - Sasha Carsen
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Devin Peterson
- Division of Orthopaedic Surgery, McMaster University, Hamilton
| | - Darren de Sa
- Division of Orthopaedic Surgery, McMaster University, Hamilton
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19
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Youssef M, Soliman J, Burrow S, Kishta W, Simunovic N, Duong A, Ayeni OR, Peterson D. Does curve magnitude in adolescent idiopathic scoliosis (AIS) affect frequency and quality of sport participation? A feasibility study. Pilot Feasibility Stud 2021; 7:26. [PMID: 33436071 PMCID: PMC7802301 DOI: 10.1186/s40814-020-00745-4] [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] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This pilot study explores whether large adolescent idiopathic scoliosis (AIS) curves (≥ 45°) lead to decreased frequency and quality of sport participation, lower health-related quality of life (HRQL), and more pronounced shortness of breath (SOB) as compared to smaller curvatures (< 45°). METHODS Patients were divided into two groups based on their spinal curvature: Cobb angle < 45° (n = 31) and ≥ 45° (n = 21). We assessed feasibility outcomes including agreement to be approached, participation, recruitment rates and missing data. All participants completed five questionnaires to assess the frequency and quality of sport participation, HRQL and SOB outcomes. Estimates of effects 95% confidence intervals (CIs) were reported. RESULTS This study enrolled 52 surgically untreated AIS patients between the ages of 10 and 18 (44 females, 8 males, mean age = 14.60). All feasibility threshold criteria were successfully met (100% agreement to be approached, 100% participation with n ≥ 12 in each group, and 94.2% of patients without missing data). AIS patients with large curvatures (≥ 45°) trended towards decreased frequency and quality of sport participation, more pronounced SOB and worse HRQL outcomes, as compared to patients with smaller curve sizes. CONCLUSION The study findings show that a study addressing sport participation in the setting of AIS is feasible. The size of curvature in AIS may have an impact on sport participation, HRQL and SOB, but larger studies are required.
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Affiliation(s)
- Michael Youssef
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - John Soliman
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Sarah Burrow
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Waleed Kishta
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nicole Simunovic
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Andrew Duong
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Devin Peterson
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
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20
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Getgood AMJ, Bryant DM, Litchfield R, Heard M, McCormack RG, Rezansoff A, Peterson D, Bardana D, MacDonald PB, Verdonk PCM, Spalding T, Willits K, Birmingham T, Hewison C, Wanlin S, Firth A, Pinto R, Martindale A, O'Neill L, Jennings M, Daniluk M, Boyer D, Zomar M, Moon K, Pritchett R, Payne K, Fan B, Mohan B, Buchko GM, Hiemstra LA, Kerslake S, Tynedal J, Stranges G, Mcrae S, Gullett L, Brown H, Legary A, Longo A, Christian M, Ferguson C, Mohtadi N, Barber R, Chan D, Campbell C, Garven A, Pulsifer K, Mayer M, Simunovic N, Duong A, Robinson D, Levy D, Skelly M, Shanmugaraj A, Howells F, Tough M, Spalding T, Thompson P, Metcalfe A, Asplin L, Dube A, Clarkson L, Brown J, Bolsover A, Bradshaw C, Belgrove L, Millan F, Turner S, Verdugo S, Lowe J, Dunne D, McGowan K, Suddens CM, Declercq G, Vuylsteke K, Van Haver M. Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial. Am J Sports Med 2020; 48:285-297. [PMID: 31940222 DOI: 10.1177/0363546519896333] [Citation(s) in RCA: 291] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Persistent anterolateral rotatory laxity after anterior cruciate ligament (ACL) reconstruction (ACLR) has been correlated with poor clinical outcomes and graft failure. HYPOTHESIS We hypothesized that a single-bundle, hamstring ACLR in combination with a lateral extra-articular tenodesis (LET) would reduce the risk of ACLR failure in young, active individuals. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This is a multicenter, prospective, randomized clinical trial comparing a single-bundle, hamstring tendon ACLR with or without LET performed using a strip of iliotibial band. Patients 25 years or younger with an ACL-deficient knee were included and also had to meet at least 2 of the following 3 criteria: (1) grade 2 pivot shift or greater, (2) a desire to return to high-risk/pivoting sports, (3) and generalized ligamentous laxity (GLL). The primary outcome was ACLR clinical failure, a composite measure of rotatory laxity or a graft rupture. Secondary outcome measures included the P4 pain scale, Marx Activity Rating Scale, Knee injury Osteoarthritis and Outcome Score (KOOS), International Knee Documentation Committee score, and ACL Quality of Life Questionnaire. Patients were reviewed at 3, 6, 12, and 24 months postoperatively. RESULTS A total of 618 patients (297 males; 48%) with a mean age of 18.9 years (range, 14-25 years) were randomized. A total of 436 (87.9%) patients presented preoperatively with high-grade rotatory laxity (grade 2 pivot shift or greater), and 215 (42.1%) were diagnosed as having GLL. There were 18 patients lost to follow-up and 11 who withdrew (~5%). In the ACLR group, 120/298 (40%) patients sustained the primary outcome of clinical failure, compared with 72/291 (25%) in the ACLR+LET group (relative risk reduction [RRR], 0.38; 95% CI, 0.21-0.52; P < .0001). A total of 45 patients experienced graft rupture, 34/298 (11%) in the ACLR group compared with 11/291 (4%) in the ACL+LET group (RRR, 0.67; 95% CI, 0.36-0.83; P < .001). The number needed to treat with LET to prevent 1 patient from graft rupture was 14.3 over the first 2 postoperative years. At 3 months, patients in the ACLR group had less pain as measured by the P4 (P = .003) and KOOS (P = .007), with KOOS pain persisting in favor of the ACLR group to 6 months (P = .02). No clinically important differences in patient-reported outcome measures were found between groups at other time points. The level of sports activity was similar between groups at 2 years after surgery, as measured by the Marx Activity Rating Scale (P = .11). CONCLUSION The addition of LET to a single-bundle hamstring tendon autograft ACLR in young patients at high risk of failure results in a statistically significant, clinically relevant reduction in graft rupture and persistent rotatory laxity at 2 years after surgery. REGISTRATION NCT02018354 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Alan M J Getgood
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Dianne M Bryant
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Robert Litchfield
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Mark Heard
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Robert G McCormack
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alex Rezansoff
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Devin Peterson
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Davide Bardana
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Peter B MacDonald
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Peter C M Verdonk
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Tim Spalding
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Kevin Willits
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Trevor Birmingham
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Chris Hewison
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Stacey Wanlin
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Andrew Firth
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Ryan Pinto
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Ashley Martindale
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Lindsey O'Neill
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Morgan Jennings
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Michal Daniluk
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Dory Boyer
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Mauri Zomar
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Karyn Moon
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Raely Pritchett
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Krystan Payne
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Brenda Fan
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Bindu Mohan
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Gregory M Buchko
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Laurie A Hiemstra
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Sarah Kerslake
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Jeremy Tynedal
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Greg Stranges
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Sheila Mcrae
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - LeeAnne Gullett
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Holly Brown
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alexandra Legary
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alison Longo
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Mat Christian
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Celeste Ferguson
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Nick Mohtadi
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Rhamona Barber
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Denise Chan
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Caitlin Campbell
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alexandra Garven
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Karen Pulsifer
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Michelle Mayer
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Nicole Simunovic
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Andrew Duong
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - David Robinson
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - David Levy
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Matt Skelly
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Ajaykumar Shanmugaraj
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Fiona Howells
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Murray Tough
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Tim Spalding
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Pete Thompson
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Andrew Metcalfe
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Laura Asplin
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alisen Dube
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Louise Clarkson
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Jaclyn Brown
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alison Bolsover
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Carolyn Bradshaw
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Larissa Belgrove
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Francis Millan
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Sylvia Turner
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Sarah Verdugo
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Janet Lowe
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Debra Dunne
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Kerri McGowan
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Charlie-Marie Suddens
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Geert Declercq
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Kristien Vuylsteke
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Mieke Van Haver
- Investigation performed at The Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
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Nawar K, Eliya Y, Burrow S, Peterson D, Ayeni O, de SA D. Operative Versus Non-operative Management of Mid-diaphyseal Clavicle Fractures in the Skeletally Immature Population: A Systematic Review and Meta-analysis. Curr Rev Musculoskelet Med 2020; 13:38-49. [PMID: 31970646 PMCID: PMC7083995 DOI: 10.1007/s12178-020-09604-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study is to compare the outcomes and complications of operative vs non-operative management of mid-diaphyseal clavicle fractures in the skeletally immature population. RECENT FINDINGS Traditionally, skeletally immature clavicle fractures have been managed non-operatively. However, there has been an increasing trend towards operative management with a lack of evidence indicating its effectiveness. METHODS Two reviewers searched three online databases (MEDLINE, EMBASE and PubMed), independently and in duplicates, for literature comparing the outcomes and complications of operative versus non-operative management in skeletally-immature patients (defined as birth to 18 years of age) with a middiaphyseal clavicle fracture. Where possible, risk ratios (RR) and mean differences (MD) were combined using a random effects model. RESULTS Seven studies, containing 522 skeletally immature patients (with 528 mid-diaphyseal clavicle fractures) with an age range of 8 to 18 years, with 148 patients undergoing operative management and 380 patients undergoing non-operative management, were included. Across the 6 studies that reported gender (N = 444), there were 335 males and 109 females. Patients were followed up from 2 weeks to 3.7 years across five studies (N = 201 patients) that reported follow-up time. There was no significant difference in the time to achieve union (p = 0.1), the time to return to activity (p = 0.09), and the overall complication rate (p = 0.50) between the operative and the non-operative groups. There is no significant difference between operative and non-operative management of skeletally immature mid-diaphyseal clavicle fractures. Clinical equipoise exists to study this further by means of a prospective, randomized, blinded control trial. LEVEL OF EVIDENCE Level IV, systematic review and meta-analysis of level II, III, and IV.
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Affiliation(s)
- Khaled Nawar
- MacSports Research Program, McMaster University, Hamilton, ON Canada
| | - Yousif Eliya
- MacSports Research Program, McMaster University, Hamilton, ON Canada
| | - Sarah Burrow
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON Canada
| | - Devin Peterson
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON Canada
| | - Olufemi Ayeni
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON Canada
| | - Darren de SA
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON Canada
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22
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Zygmunt LC, Paisley SD, Bromley G, Durany G, Ellis C, Elrefaie J, Fein R, Lewis S, Lee S, Marlett J, Peterson D, Prodolliet J, Tassin D, Weisz J, White P, Xia L. Enzymatic Method for Determination of (1→3)(1→4)-Beta-D-glucans in Grains and Cereals: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/76.5.1069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
The McCleary enzymatic assay for mixed linkage (1→3)(1→4)-beta-D-glucans has been modified to apply to oat and barley fractions and ready-to-eat (RTE) cereals. The proposed method involves lower sample concentrations; stirring the samples; a longer, warmer lichenase digestion; and longer beta-glucosidase digestion. These changes result in higher recovery of beta-glucan. This modification expands on the American Association of Cereal Chemists (AACC) Method 32-22 by the addition of a desugaring procedure, which is necessary for RTE cereals. Results from collaborative studies sponsored by AACC and AOAC demonstrate good precision for an enzymatic assay. The average relative standard deviation for reproducibility (RSDR, a measure of inter laboratory variation) for 20 oat, barley, and cereal samples was 9.7%. The average RSD for repeatability (RSDr, intralaboratory variation) was 5.0%. The enzymatic method has been adopted first action by AOAC International for determination of beta-glucans in oat and barley fractions, and ready-to-eat cereals.
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Affiliation(s)
- Lucian C Zygmunt
- The Quaker Oats Co., John Stuart Research Laboratory, 617 W Main St, Barrington, IL 60010
| | - Steven D Paisley
- The Quaker Oats Co., John Stuart Research Laboratory, 617 W Main St, Barrington, IL 60010
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23
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Rudrapatna S, Bhatt M, Wang KW, Bierbrier R, Wang PW, Banfield L, Elsheikh W, Sims ED, Peterson D, Thabane L, Tarnopolsky MA, Steinberg GR, Samaan MC. Obesity and muscle-macrophage crosstalk in humans and mice: A systematic review. Obes Rev 2019; 20:1572-1596. [PMID: 31410961 DOI: 10.1111/obr.12922] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 12/12/2022]
Abstract
Obesity is associated with the production of inflammatory cytokines that are implicated in insulin resistance (IR), and if not addressed, can lead to type 2 diabetes (T2D). The role of the immune system in skeletal muscle (SM) inflammation and insulin sensitivity is not yet well characterized. As SM IR is an important determinant of glycaemia, it is critical that the muscle-immune phenotype is mapped to help design interventions to target T2D. This systematic review synthesized the evidence for SM macrophage content and phenotype in humans and murine models of obesity, and the association of muscle macrophage content and phenotype with IR. Results were synthesized narratively, as we were unable to conduct a meta-analysis. We included 28 studies (n=10 human, n=18 murine), and all studies detected macrophage markers in SM. Macrophage content was positively associated with IR. In humans and mice, there was variability in muscle macrophage content and phenotype in obesity. Overall certainty in the evidence was low due to heterogeneity in detection methods and incompleteness of data reporting. Macrophages are detected in human and murine SM in obesity and a positive association between macrophage content and IR is noted; however, the standardization of markers, detection methods, and reporting of study details is warranted to accurately characterize macrophages and improve the potential for creating specific and targeted immune-based therapies in obesity.
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Affiliation(s)
- Srikesh Rudrapatna
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Meha Bhatt
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kuan-Wen Wang
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Rachel Bierbrier
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pei-Wen Wang
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Laura Banfield
- Health Science Library, McMaster University, Hamilton, Ontario, Canada
| | - Wagdi Elsheikh
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - E Danielle Sims
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Devin Peterson
- Division of Orthopedics, Department of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.,Centre for Evaluation of Medicines, Hamilton, Ontario, Canada.,Biostatistics Init, St Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada
| | - Mark A Tarnopolsky
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - M Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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24
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Hiemstra LA, Peterson D, Youssef M, Soliman J, Banfield L, Ayeni OR. Trochleoplasty provides good clinical outcomes and an acceptable complication profile in both short and long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2019; 27:2967-2983. [PMID: 30499027 DOI: 10.1007/s00167-018-5311-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/20/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study is to report on the global distribution and clinical outcomes of published articles related to trochleoplasty. METHODS The online databases OVID Medline, OVID EMBASE, and the Cochrane Library were searched for the literature assessing trochleoplasty performed for lateral patellofemoral instability (LPI). Study data were abstracted looking at global trends in the literature, as well as clinical and patient-reported outcomes following this technique. RESULTS For the assessment of global distribution, 29 studies including 998 patients met the inclusion criteria. The majority of the studies were conducted in Europe (93%) and most used an open thin flap technique (52%). For the secondary analysis of clinical outcomes, 21 studies were included with significant heterogeneity in patient selection, reporting on the degree of trochlear dysplasia, and patient-reported outcomes. All trochleoplasty techniques showed statistically significant improvement in clinical outcomes at average 50 months (range 3-228 months) post-operative, with most patients being satisfied with their procedure. Re-dislocation and complication rates were low. CONCLUSIONS European centers have published majority of data on trochleoplasty surgery, which has been shown to be an acceptable procedure for patients with high-grade trochlear dysplasia and LPI. Trochleoplasty has demonstrated good clinical outcomes, a low re-dislocation rate, and an acceptable complication profile in both short and long-term follow-up. This study highlights the difficulty in reporting outcomes in this group of patients due to heterogeneity in patient selection, grading of trochlear dysplasia, and the lack of disease-specific outcome measures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Laurie A Hiemstra
- Banff Sport Medicine, Box 1300, Banff, AB, T1L 1B3, Canada. .,Department of Surgery, University of Calgary, Calgary, AB, Canada.
| | - Devin Peterson
- Division of Orthopaedic Surgery, Department Surgery, McMaster University, Hamilton, ON, Canada
| | - Michael Youssef
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John Soliman
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Laura Banfield
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department Surgery, McMaster University, Hamilton, ON, Canada
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Hall W, Baran A, Peterson D, Bergom C, Lawton C, Zhang H, Bylund K, Messing E, Chen Y, Morrow G, Kerns S. Characterization of the Host Immuno-Inflammatory State in Response to Radiation Therapy and Correlation with Patient Reported Toxicities In Prostate Adenocarcinoma, A Prospective Observational Trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Irvine S, Awan M, Chharawala F, Bhagawati D, Lawrance N, Peck G, Peterson D, Banerjee S, Camp S. Factors affecting patient flow in a neurosurgery department. Ann R Coll Surg Engl 2019; 102:18-24. [PMID: 31233336 DOI: 10.1308/rcsann.2019.0090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Patient flow is the process by which movement of patients and clinical productivity is achieved. The objectives of this study were to implement and evaluate the NHS Improvement SAFER patient flow bundle, evaluate the impact of the Red2Green initiative, and assess the impact of frailty on patient flow. MATERIALS AND METHODS All patients admitted to a neurosurgery unit from 1 September to 30 November 2017 were included. Using guidance set out by NHS, data were prospectively collected from daily ward lists and patient notes, including demographics, admission and discharge details, length of stay, anticipated discharge date, red days with reasons and frailty (Rockwood Clinical Frailty Scale). NHS reference costs were used for cost analyses. RESULTS A total of 420 patients (55% elective) were included, totalling 3909 bed days. All patients received daily senior reviews before midday, and anticipated discharge dates were set at daily multidisciplinary team meetings. Ten per cent of patients were discharged before midday. There were 21% (837) red days, significantly more (76%) for emergency patients (639 vs 198 elective; P < 0.001); 63% red days were attributed to awaiting a bed in a local hospital; 25% (106) patients were classed as frail (50 elective), which was associated with a significantly longer length of stay (17.3 vs 6; P < 0.01), and more red days (615 vs 222; p<0.01). Considering excess bed charges and lost revenue (with penalties), red days cost over £1 million per year. CONCLUSIONS SAFER has identified areas for improvement in patient flow, with obvious cost implications. It has created a platform for discussion within the referral network and identified a role for a geriatric liaison service.
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Affiliation(s)
- S Irvine
- University Hospital North Durham, Durham, UK
| | - M Awan
- Neurosurgery Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - F Chharawala
- Neurosurgery Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - D Bhagawati
- Neurosurgery Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - N Lawrance
- Improvement Team, Imperial College Healthcare NHS Trust, London, UK
| | - G Peck
- Major Trauma Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - D Peterson
- Neurosurgery Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - S Banerjee
- Stroke Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - S Camp
- Neurosurgery Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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27
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Salimnia T, Peterson D, Ralh N, Qaqi O. NOVEL PERCUTANEOUS THROMBECTOMY DEVICE FOR PULMONARY EMBOLISM PATIENTS WITH TPA CONTRAINDICATION, TPA FAILURE, OR TOO HIGH RISK FOR SURGICAL THROMBECTOMY. Chest 2019. [DOI: 10.1016/j.chest.2019.04.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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28
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Zheng L, Cockerham G, Hoffman J, Heydlauf M, Peterson D, Bhalla A. A statistical analysis solution to measure the impact of sample processing methods on diagnostic laboratory turnaround time. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Irvine S, Chharawala F, Lawrance N, Peterson D, Banerjee S, Camp S. FP1-4 Factors affecting patient flow in a neurosurgery department. J Neurol Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesThe objectives of this study were to audit the NHS Improvement SAFER patient flow bundle, evaluate the impact of the Red2Green initiative, and assess the impact of frailty on patient flow.DesignA prospective review over a 3 month period.SubjectsAll patients admitted to a Neurosurgery Unit from 01/09/2017 to 30/11/2017 were included.MethodsData were prospectively collected from daily ward lists and patient notes, including demographics, admission/discharge details, length of stay (LOS), expected discharge date, red days with reasons, and frailty (Rockwood Clinical Frailty Scale). NHS Improvement Reference Costs were used for cost analyses.Results420 patients (55% elective) were included, total 3909 bed days. All patients received a daily senior review before midday, and EDDs were set at daily MDT meetings. 10% patients were discharged before midday. There were 21% (837) red days, significantly more (76%) for emergency patients (639 vs 198 elective; p<0.001). 63% red days were attributed to awaiting a bed in a local hospital. 25% (106) patients were classed as frail (50 elective), which was associated with a significantly longer LOS (17.3 vs 6; p<0.01), and more red days (615 vs 222; p<0.01). Considering bed costs and lost revenue (with penalties), red days cost is estimated at over £1M per year.ConclusionsSAFER has identified areas for improvement in patient flow, with obvious cost implications. It has created a platform for discussion within the referral network, and identified a role for a geriatric liaison service.
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Cioana M, Peterson D, Missiuna P, El-Hawary R, Carey T, Potter MA, Banfield L, Thabane L, Samaan MC. The creation of a national coalition to target adolescent idiopathic scoliosis: a meeting report. Adolesc Health Med Ther 2019; 10:15-19. [PMID: 30863194 PMCID: PMC6390871 DOI: 10.2147/ahmt.s199489] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this report, we document the discussions and recommendations of a national conference designed to create a coalition to tackle adolescent idiopathic scoliosis (AIS) held on June 6 and 7, 2017 in Hamilton, ON, Canada. The goal of the establishment of this coalition is to join the efforts of patients, parents, physicians, researchers and other stakeholders to identify stakeholders' perspectives and to categorize gaps in knowledge and target further AIS research and clinical care priorities. The participants' main priorities included focus on shared decision making regarding clinical and research priorities between the stakeholders on the clinical, research and policy sides with patients and families. In addition, improvements in the dissemination of information via digital platforms and identification of cost-effective screening strategies that may help early identification and intervention were also recognized as a priority. Commitment was reached to form a national coalition to understand the determinants of this condition and enhance patient outcomes through improved clinical care and research efforts.
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Affiliation(s)
- Milena Cioana
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada, .,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, ON, Canada,
| | - Devin Peterson
- Division of Orthopedics, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Paul Missiuna
- Division of Orthopedics, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ron El-Hawary
- Orthopedic Surgery Department, IWK Children's Health Center, Dalhousie University, Halifax, NS, Canada
| | - Timothy Carey
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Murray A Potter
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada, .,Department of Anesthesia, McMaster University, Hamilton, ON, Canada.,Centre for Evaluation of Medicines, St Joseph's Health Care, Hamilton, ON, Canada.,Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada
| | - M Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada, .,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, ON, Canada, .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
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Farrokhyar F, Sivakumar G, Savage K, Koziarz A, Jamshidi S, Ayeni OR, Peterson D, Bhandari M. Effects of Vitamin D Supplementation on Serum 25-Hydroxyvitamin D Concentrations and Physical Performance in Athletes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Sports Med 2018; 47:2323-2339. [PMID: 28577257 DOI: 10.1007/s40279-017-0749-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND There is currently no systematic review examining the effects of vitamin D supplementation among athletes. A rigorous systematic review and meta-analysis is important to provide a balanced view of current knowledge on the effect of vitamin D on serum 25-hydroxyvitamin D [25(OH)D] concentrations and physical performance. OBJECTIVES This systematic review of randomized controlled trials (RCTs) evaluated the effects of oral vitamin D supplementation on serum 25(OH)D concentrations and physical performance in athletes. METHODS Multiple electronic databases were searched, and study eligibility, methodological quality assessment, and data extraction were completed independently and in duplicate. Studies were stratified by baseline vitamin D sufficiency, season, and latitude. A cut-off of 30 ng/ml (75 nmol/l) of 25(OH)D was used for sufficiency. Absolute mean differences (AMDs) between vitamin D and placebo using random effects analysis, and heterogeneity using Q statistic and I 2 index, were calculated. AMD with 95% confidence interval (CI), p value, and I 2 are reported. RESULTS In total, 13 RCTs (2005-2016) with 532 athletes (vitamin D 311, placebo 221) were eligible. A total of 433 athletes (vitamin D 244, placebo 189) had complete outcome data. Among athletes with baseline values suggesting insufficiency, vitamin D supplementation led to significant increases from 3000 IU (AMD 15.2 ng/ml; 95% CI 10.7-19.7, p < 0.0001, I 2 = 0%) and 5000 IU (AMD 27.8 ng/ml; 95% CI 16.9-38.8, p < 0.0001, I 2 = 78%) per day at >45° latitudes. Both doses led to sufficiency concentrations during winter months. Among athletes with baseline vitamin D suggesting sufficiency, serum 25(OH)D sufficiency was maintained from different doses at both latitudes. Of 13 included trials, only seven measured different physical performances and none demonstrated a significant effect of vitamin D supplementation during 12 weeks of follow-up. CONCLUSION Despite achieving sufficiency in vitamin D concentrations from ≥3000 IU supplementation, physical performance did not significantly improve. Between-study heterogeneity was large, and well-designed RCTs examining the effect of vitamin D supplementation on serum 25(OH)D concentrations, physical performance, and injuries in different sports, latitudes, ethnicities, and vitamin D status are needed.
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Affiliation(s)
- Forough Farrokhyar
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Department of Health, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
- , 39 Charlton Avenue East, Hamilton, ON, L8N 1Y3, Canada.
| | | | - Katey Savage
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Alex Koziarz
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Olufemi R Ayeni
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Devin Peterson
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Affiliation(s)
- M Bhandari
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - D Peterson
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
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Abstract
AIMS The aims of this systematic review were to describe the quantity and methodological quality of meta-analyses in orthopaedic surgery published during the last 17 years. MATERIALS AND METHODS MEDLINE, EMBASE, and PubMed, between 1 January 2000 and 31 December 2016, were searched for meta-analyses in orthopaedic surgery dealing with at least one surgical intervention. Meta-analyses were included if the interventions involved a human muscle, ligament, bone or joint. RESULTS A total of 392 meta-analyses met eligibility criteria, for which the mean AMSTAR quality score was 7.1/11. There was a positive correlation between the year of publication and the quality of the meta-analysis (r = 0.238, p < 0.001). Between 2000 and 2011, the mean AMSTAR score corresponded to that of a medium quality review. However, between 2012 and 2016, the mean scores have been consistently equivalent to those of a high-quality review. The number of meta-analyses published increased 10-fold between 2005 and 2014. CONCLUSION The quantity and quality of meta-analyses in orthopaedic surgery which have been published has increased, reaching a plateau in 2012. Methodological flaws remain to be addressed in future meta-analyses in order to continue increasing the quality of the orthopaedic literature. Cite this article: Bone Joint J 2018;100-B:1270-4.
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Affiliation(s)
- A Manta
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - E Opingari
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - A Saleh
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - N Simunovic
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - A Duong
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - S Sprague
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - D Peterson
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - M Bhandari
- Department of Health Research Methods, Evidence and Impact and Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
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Kokkinidou S, Peterson D, Bloch T, Bronston A. The Important Role of Carbohydrates in the Flavor, Function, and Formulation of Oral Nutritional Supplements. Nutrients 2018; 10:E742. [PMID: 29890616 PMCID: PMC6024762 DOI: 10.3390/nu10060742] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 12/18/2022] Open
Abstract
Patients who are malnourished or at-risk for malnutrition often benefit from the consumption of oral nutritional supplements (ONS). ONS supply a range of micro- and macro-nutrients, and they can be used to supplement a diet or provide total nutrition. Since ONS are specially formulated products, all ONS ingredients—including carbohydrates—are added ingredients. This may seem to be at odds with the growing public health discourse on the need to reduce “added sugars” in the diet. However, carbohydrate is an essential nutrient for human health and is a critical ingredient in ONS. Helping to educate patients on the value of “added sugars” in ONS may be useful to improve compliance with nutritional recommendations when ONS are indicated. This perspective paper reviews the important roles of “added sugars” in ONS, in terms of flavor, function, and product formulation.
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Affiliation(s)
| | - Devin Peterson
- Flavor Research and Education Center, The Ohio State University, Columbus, OH 43210, USA.
| | - Tama Bloch
- Abbott Nutrition, Columbus, OH 43219, USA.
| | - Ashley Bronston
- Nutrition Consultant, Abbott Nutrition, Columbus, OH 43219, USA.
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Kay J, Memon M, Marx RG, Peterson D, Simunovic N, Ayeni OR. Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26:1019-1036. [PMID: 29332225 DOI: 10.1007/s00167-018-4830-9] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/03/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the rate at which children and adolescent athletes return to sporting activities after anterior cruciate ligament (ACL) reconstruction. METHODS Three databases, PubMed, MEDLINE, and EMBASE, were searched from database inception until September 9, 2017 by two reviewers independently and in duplicate. The inclusion criteria were English language studies that reported return to sport outcomes. Book chapters, conference papers, review articles, and technical reports were excluded. The rate of return to sports was combined in a meta-analysis of proportions using a random-effects model. RESULTS Overall, 20 studies with a combined total of 1156 ACL reconstructions met the inclusion criteria, with a mean age of 14.3 years (range 6-19) and a mean follow-up time of 6.5 years (range 1-22). All studies were level IV evidence (14 retrospective case series and 6 prospective case series). The pooled rate of return to any sport participation was 92.0% [95% confidence interval (CI), 86-96%]. The pooled rate of return to pre-injury level of sport was 78.6% (95% CI 71-86%) and that to competitive level of sport was 81.0% (95% CI 62-94%). A total of 93 of the 717 assessed athletes (13%) sustained re-injuries with graft ruptures, and in 91 of 652 patients (14%), contralateral ACL injuries were reported on final follow-up. CONCLUSION Pooled results suggest a high rate of return to sport following ACL reconstruction in children and adolescent athletes; however, this is associated with a relatively high rate of graft rupture and a similar rate of contralateral ACL injury. This study provides clinicians with evidence-based data on the ability of children and adolescent athletes to return to sport after ACL reconstruction, an important consideration for athletes of this population with ACL injuries. LEVEL OF EVIDENCE IV, systematic review of level IV studies.
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Affiliation(s)
- Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Robert G Marx
- Department of Orthopedic Surgery and Sports Medicine, Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Devin Peterson
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nicole Simunovic
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. .,McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada.
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Affiliation(s)
- L. Bielby
- Department of Health and Human Services Victoria; Blood Matters Program; Australian Red Cross Blood Service; Melbourne VIC Australia
| | - D. Peterson
- Women's and Children's Hospital; BloodSafe eLearning Australia; North Adelaide SA Australia
| | - T. Spigiel
- Australian Red Cross Blood Service; Adelaide SA Australia
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Rudrapatna S, Peterson D, Missiuna P, Aditya I, Drew B, Sahar N, Thabane L, Samaan MC. Understanding muscle-immune interactions in adolescent idiopathic scoliosis: a feasibility study. Pilot Feasibility Stud 2017; 3:50. [PMID: 29225911 PMCID: PMC5715623 DOI: 10.1186/s40814-017-0193-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 10/20/2017] [Indexed: 11/29/2022] Open
Abstract
Background Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis in children, and its cause remains unknown. The Immune-metabolic CONnections to Scoliosis (ICONS) Study was designed to elucidate the potential mechanisms by which immune system-paraspinal muscle crosstalk contributes to the development of AIS. In this report, we document the evaluation of ICONS Study feasibility. Methods This study was conducted at a tertiary pediatric academic center in Hamilton, Ontario, Canada. We included boys and girls, aged 10–17 years with a diagnosis of AIS requiring corrective spinal surgery. Exclusion criteria included patients on high-dose steroids, immunosuppressive therapy, anti-thrombotic medications, those with an active infection for 15 days before participation, autoimmune disease, pregnancy, and patients who were unwilling to consent. Pre-determined feasibility criteria included permission to approach participants and recruitment rates of 80%, consenting of at least 80% of participants to provide biological samples, 90% or higher case report form and questionnaire completion, resources to be sufficient in at least 80% of recruitments, and the ability to successfully collect and process 80% or more of the biological samples needed for this study. Results Between August 2013 and October 2014, we identified 32 potential participants with AIS, but had the resources to approach only 16, of which 12 (75%) agreed to be approached by the research team, and all consented to participate. Of the 12 participants recruited, 11 questionnaire packages and muscle biopsies (91.7% for each objective) were collected, while other biological samples (serum, plasma, whole blood for DNA and RNA processing, urine) were collected from all participants. Conclusions The ICONS study protocols and procedures are feasible. However, recruitment rates were less than predicted. For the full study, we plan on prolonging the recruitment phase and the inclusion of additional centers to achieve recruitment targets.
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Affiliation(s)
- Srikesh Rudrapatna
- Department of Pediatrics, McMaster University, 1280 Main Street West, HSC-3A57, Hamilton, Ontario Canada
| | - Devin Peterson
- Department of Pediatric Surgery, Division of Orthopedics, McMaster University, Hamilton, ON Canada
| | - Paul Missiuna
- Department of Pediatric Surgery, Division of Orthopedics, McMaster University, Hamilton, ON Canada
| | - Ishan Aditya
- Department of Pediatrics, McMaster University, 1280 Main Street West, HSC-3A57, Hamilton, Ontario Canada
| | - Brian Drew
- Department of Pediatric Surgery, Division of Orthopedics, McMaster University, Hamilton, ON Canada
| | - Nicola Sahar
- Department of Pediatrics, McMaster University, 1280 Main Street West, HSC-3A57, Hamilton, Ontario Canada
| | - Lehana Thabane
- Department of Pediatrics, McMaster University, 1280 Main Street West, HSC-3A57, Hamilton, Ontario Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario Canada.,Department of Anesthesia, McMaster University, Hamilton, ON Canada.,Centre for Evaluation of Medicines, Hamilton, ON Canada.,Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, ON Canada
| | - M Constantine Samaan
- Department of Pediatrics, McMaster University, 1280 Main Street West, HSC-3A57, Hamilton, Ontario Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, ON Canada
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Haeri Hendy S, de Sa D, Ainsworth K, Ayeni OR, Simunovic N, Peterson D. Juvenile Osteochondritis Dissecans of the Knee: Does Magnetic Resonance Imaging Instability Correlate With the Need for Surgical Intervention? Orthop J Sports Med 2017; 5:2325967117738516. [PMID: 29164166 PMCID: PMC5692145 DOI: 10.1177/2325967117738516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Several magnetic resonance imaging (MRI) classification systems have been developed to determine the degree of instability of juvenile osteochondritis dissecans (JOCD) lesions. Our current practice involves correlating the patients’ symptoms with their MRI findings, but there are many cases in which this correlation is poor and results in incorrect classification of the stability of a JOCD lesion. Purpose: To determine whether certain MRI findings of JOCD instability are associated with the necessity for arthroscopic intervention to assess lesion stability. A secondary objective was to determine the interobserver agreement of the Kijowski et al (2008) MRI criteria for osteochondritis dissecans (OCD) instability. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed of patients who had documented femoral condyle OCD lesions, had open growth plates, and had been evaluated with serial MRI examinations. Each OCD lesion on MRI was classified according to the Kijowski classification as either stable or likely unstable. Results: The study included 16 patients (17 knees) with 49 MRI examinations. The initial MRI lesion was graded as stable in 59% (10/17), and 7 of these remained stable throughout the study period, with only 1 requiring operative intervention. Two became unstable on MRI, with 1 requiring surgery and 1 reverting back to stable with nonoperative management. The initial MRI lesion was graded as unstable in 41% (7/17) of the knees, with 2 of these becoming stable on MRI during the follow-up period with nonoperative management. The other 5 lesions remained unstable, with 3 eventually requiring surgery. The most important finding in this study was that MRI instability is a poor predictor of the necessity for surgery for JOCD lesions. The correlation between a nonradiologist and a trained musculoskeletal radiologist in the interpretation of the MRI criteria by Kijowski et al showed only substantial agreement for multiple cysts. Conclusion: MRI criteria for OCD instability in the pediatric knee do not always correlate with the necessity for surgery. They are, at times, a helpful adjunct to the management of these patients; however, care must be taken to interpret all available clinical and radiographic information in surgical decision making.
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Affiliation(s)
- Simon Haeri Hendy
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Kelly Ainsworth
- Department of Radiology, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Devin Peterson
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
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Memon M, Ginsberg L, de Sa D, Nashed A, Simunovic N, Phillips M, Denkers M, Ogilvie R, Peterson D, Ayeni OR. Patient perceptions regarding physician reimbursements, wait times, and out-of-pocket payments for anterior cruciate ligament reconstruction in Ontario. J Exp Orthop 2017; 4:1. [PMID: 28116554 PMCID: PMC5256624 DOI: 10.1186/s40634-017-0076-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Received: 10/04/2016] [Accepted: 01/13/2017] [Indexed: 11/12/2022] Open
Abstract
Background Currently, there is a lack of knowledge regarding patient perceptions surrounding physician reimbursements, appropriate wait times, and out-of-pocket payment options for anterior cruciate ligament reconstruction (ACLR). Our objective was to determine the current state of these perceptions in an Ontario setting. Methods A survey was developed and pretested to address patient perceptions about physician reimbursements, appropriate wait times, and out-of-pocket payment options for ACLR using a focus group of experts and by reviewing prior surveys. The survey was administered to patients in a waiting room setting. Results Two hundred and fifty completed surveys were obtained (79.9% response rate). Participants responded that an appropriate physician reimbursement for ACLR was $1000.00 and that the Ontario Health Insurance Plan (OHIP) reimbursed physicians $700.00 for ACLR. Seventy-four percent of participants responded that the OHIP reimbursement of $615.20 for the procedure was either lower or much lower than what they considered to be an appropriate reimbursement for ACLR. Over 90% of participants responded that an ACLR should occur within 90 days of injury. Thirty-five percent of participants were willing to pay $750.00 out-of-pocket to have an ACLR done sooner, while 16.4% of participants were willing to pay $2500.00 out-of-pocket to travel outside of Canada for expedited surgery. Conclusion This survey study demonstrates that patients’ estimates of both appropriate and actual physician reimbursements were greater than the current reimbursement for ACLR. Further, the majority of individuals report that the surgical fee for ACLR is lower than what they consider to be an appropriate amount of compensation for the procedure. Additionally, nearly all respondents believe that a ruptured ACL should be reconstructed within 90 days of injury. Consequently, a number of patients are willing to pay out-of-pocket for expedited surgery either in Canada or abroad. However, patients’ preferences for shorter wait times must be balanced with the known risk of arthrofibrosis associated with early ACLR. Electronic supplementary material The online version of this article (doi:10.1186/s40634-017-0076-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Muzammil Memon
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lydia Ginsberg
- Department of Science, McMaster University, Hamilton, ON, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Andrew Nashed
- Department of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Nicole Simunovic
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Mark Phillips
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Matthew Denkers
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Rick Ogilvie
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Devin Peterson
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. .,McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada.
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Kay J, Naji L, de SA D, Simunovic N, Peterson D, Samuelsson K, Musahl V, Ayeni OR. Graft choice has no significant influence on the rate of return to sport at the preinjury level after revision anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Yeung M, Leblanc MC, Ayeni OR, Khan M, Hiemstra LA, Kerslake S, Peterson D. Indications for Medial Patellofemoral Ligament Reconstruction: A Systematic Review. J Knee Surg 2016; 29:543-554. [PMID: 26516072 DOI: 10.1055/s-0035-1564730] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The medial patellofemoral ligament (MPFL) plays a key role in lateral patellofemoral stability, and there has been significant clinical and research interest in MPFL reconstruction (MPFLR) in recent years. The primary objective of this systematic review of clinical studies is to investigate the reported indications for an isolated MPFLR and secondarily to examine some of the reasons reported for not performing an isolated MPFLR. A comprehensive search of the MEDLINE, EMBASE, PUBMED, and Cochrane databases was conducted to identify surgical studies investigating MPFLR. Study information including author, publication date, sample size, patient age, follow-up period, procedure performed, surgical indications and contraindications, and study design were extracted. The most common indication for isolated MPFLR was recurrent patellofemoral instability (82.1%). Common reasons given for not performing an isolated MPFLR included bony malalignment (51.8%), trochlear dysplasia (30.4%), and patella alta (23.2%). This systematic review identified recurrent patellofemoral instability as the primary indication for an isolated MPFLR; however, a large number of the studies did not provide clear criteria for when an isolated MPFLR should be performed. Similarly, there was significant variability in the reasons given for not performing an isolated MPFLR.
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Affiliation(s)
- Marco Yeung
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Olufemi R Ayeni
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Moin Khan
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Devin Peterson
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Samaan MC, Missiuna P, Peterson D, Thabane L. Understanding the role of the immune system in adolescent idiopathic scoliosis: Immunometabolic CONnections to Scoliosis (ICONS) study protocol. BMJ Open 2016; 6:e011812. [PMID: 27401365 PMCID: PMC4947809 DOI: 10.1136/bmjopen-2016-011812] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Adolescent idiopathic scoliosis (AIS) affects up to 3% of children around the world. There is limited knowledge of AIS aetiopathogenesis, and this evidence is needed to develop new management strategies. Paraspinal muscle in AIS demonstrates evidence of differential fibrosis based on curve sidedness. Fibrosis is the hallmark of macrophage-driven inflammation and tissue remodelling, yet the mechanisms of fibrosis in paraspinal muscle in AIS are poorly understood. OBJECTIVES The primary objective of this study is to determine the influence of curve sidedness on paraspinal muscle inflammation. Secondary objectives include defining the mechanisms of macrophage homing to muscle, and determining muscle-macrophage crosstalk in muscle fibrosis in AIS. METHODS AND ANALYSIS This is a cross-sectional study conducted in a tertiary paediatric centre in Hamilton, Ontario, Canada. We will recruit boys and girls, 10-17 years of age, who are having surgery to correct AIS. We will exclude children who have an active infection or are on immunosuppressive therapies within 2 weeks of surgery, smokers and pregnant girls. Paraspinal muscle biopsies will be obtained at the start of surgery. Also, blood and urine samples will be collected from participants, who will fill questionnaires about their lifestyle. Anthropometric measures will also be collected including height, weight, waist and hip circumferences. ETHICS AND DISSEMINATION This study has received ethics authorisation by the institutional review board. This work will be published in peer-reviewed journals and will be presented in oral and poster formats at scientific meetings. DISCUSSION This study will explore the mechanisms of paraspinal muscle inflammation, remodelling and fibrosis in AIS. This will help identify pathways and molecules as potential therapeutic targets to treat and prevent AIS. It may also yield markers that predict scoliosis progression and response to treatment in these children.
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Affiliation(s)
- M Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Paul Missiuna
- Division of Orthopedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Devin Peterson
- Division of Orthopedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicines, Hamilton, Ontario, Canada
- Biostatistics unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Abstract
Prolonged surgical wait times have been associated with reduced quality of life (QoL) in patients requiring orthopedic surgery. However, the effects on patients awaiting anterior cruciate ligament (ACL) reconstruction surgery remains to be established. Here, it is determined that being on a waitlist for ACL reconstruction surgery reduces patients' QoL through negatively impacting disability, physical, and emotional health. A survey assessing patients' disability, physical, and emotional health was administered to 50 patients on the waitlist for ACL reconstruction surgery. Data were divided into two groups based on the wait time for surgery: ≤ 182 and > 182 days. Patients on the waitlist > 182 days either lost their job or had it significantly modified more often than those waiting ≤ 182 days. A total of 63% of the respondents reported feeling that their overall physical health deteriorated significantly or somewhat due to their ACL injury. A total of 51% of all patients reported feeling sad/depressed all or most of the time because they were not able to participate in their main sport due to their ACL injury. Our findings provide evidence that the wait times for ACL reconstruction surgery be reduced or nonoperative modalities be prescribed to mitigate the negative impact that prolonged surgical wait times have on patients' QoL.
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Affiliation(s)
- Lauren Salci
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi Ayeni
- Department of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Dyda Dao
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rick Ogilvie
- Department of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Devin Peterson
- Department of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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de SA D, Thornley P, Niroopan G, Khan M, McCarthy C, Simunovic N, Adamich J, Jamshidi S, Farrokhyar F, Peterson D, Musahl V, Ayeni OR. No difference in outcome between early versus delayed weight-bearing following microfracture surgery of the hip, knee or ankle: a systematic review of outcomes and complications. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Ordidge K, Grech-Sollars M, Honeyfield L, Khan S, O'Neill K, Peterson D, Vaqas B, Roncaroli F, Towey D, Barwick T, Waldman A. PO2818F- FLUOROMETHYLCHOLINE (18F-FMC) PET/CT AND MAGNETIC RESONANCE SPECTROSCOPY (MRS) IMAGING AND TISSUE BIOMARKERS OF CELL MEMBRANE TURNOVER IN PRIMARY BRAIN GLIOMAS- A PILOT STUDY. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov284.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dao D, Sodhi S, Tabasinejad R, Peterson D, Ayeni OR, Bhandari M, Farrokhyar F. Serum 25-Hydroxyvitamin D Levels and Stress Fractures in Military Personnel: A Systematic Review and Meta-analysis. Am J Sports Med 2015; 43:2064-72. [PMID: 25371440 DOI: 10.1177/0363546514555971] [Citation(s) in RCA: 42] [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 Low serum 25-hydroxyvitamin D (25(OH)D) levels have been associated with stress fractures in various physically active populations such as the military. PURPOSE To examine the association between serum 25(OH)D levels and stress fractures in the military. STUDY DESIGN Systematic review and meta-analysis. METHODS Relevant studies were identified through searching multiple databases and manually screening reference lists. Two reviewers independently selected the included studies by applying the eligibility criteria to the title, abstract, and/or full text of the articles yielded in the search. Two reviewers also independently conducted the methodological quality assessment and data extraction. A random-effects model was used to calculate the mean difference (MD) with 95% CI in serum 25(OH)D levels between stress fracture cases and controls. RESULTS Nine observational studies on lower extremity stress fractures were eligible, and 1 was excluded due to inadequate data. A total of 2634 military personnel (age, 18-30 years; 44% male) with 761 cases (16% male) and 1873 controls (61% male) from 8 studies were included in the analysis. Three of the 8 studies measured serum 25(OH)D levels at the time of stress fracture diagnosis, and the 5 remaining studies measured serum 25(OH)D levels at the time of entry into basic training. The mean serum 25(OH)D level was lower in stress fracture cases than in controls at the time of entry into basic training (MD, -2.63 ng/mL; 95% CI, -5.80 to 0.54; P = .10; I(2) = 65%) and at the time of stress fracture diagnosis (MD, -2.26 ng/mL; 95% CI, -3.89 to -0.63; P = .007; I(2) = 42%). CONCLUSION Despite the inherent limitations of the included studies, the study results suggest some association between low serum 25(OH)D levels and lower extremity stress fractures in military personnel. Given the rigorous training of military personnel, implementing strategies to ensure sufficient 25(OH)D levels may be beneficial for reducing the risk of stress fractures.
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Affiliation(s)
- Dyda Dao
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Sukhmani Sodhi
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Rasam Tabasinejad
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Devin Peterson
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Department of Surgery, McMaster University, Hamilton, Ontario, Canada Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Department of Surgery, McMaster University, Hamilton, Ontario, Canada Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
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Van der Watt L, Khan M, Rothrauff BB, Ayeni OR, Musahl V, Getgood A, Peterson D. The structure and function of the anterolateral ligament of the knee: a systematic review. Arthroscopy 2015; 31:569-82.e3. [PMID: 25744324 DOI: 10.1016/j.arthro.2014.12.015] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review was to evaluate the anatomic structure and function of the anterolateral ligament (ALL) of the knee. METHODS The Medline, Embase, and Cochrane databases were screened for all studies related to the ALL of the knee. Two reviewers independently reviewed all eligible articles and the references of these articles. Inclusion and exclusion criteria were applied to all searched studies. Quality assessment was completed for the included studies. RESULTS Nineteen studies were identified for final analysis. Pooled analysis identified the ALL in 430 of 449 knees (96%) examined. The ligament was found to originate from the region of the lateral femoral epicondyle and insert on the proximal tibia midway between the Gerdy tubercle and the fibular head. The ALL was found to be 34.1 to 41.5 mm in length, 5.1 to 8.3 mm in width above the lateral meniscus, and 8.9 to 11.2 mm in width below the lateral meniscus. By use of magnetic resonance imaging, the ALL was identified in 93% of knees examined (clinical, 64 of 70; cadaveric, 16 of 16). In one case study the ligament was clearly visualized by ultrasound examination. Histologic analysis across 3 studies showed characteristics consistent with ligamentous tissue. Though not shown in biomechanical studies, it is hypothesized that the ALL provides anterolateral stability to the knee, preventing anterolateral subluxation of the proximal tibia on the femur. One study identified a network of peripheral nerves, suggesting a proprioceptive function of the ALL. CONCLUSIONS This systematic review shows the ALL to be a distinct structure with a consistent origin and insertion sites. The ALL is an extra-articular structure with a clear course from the lateral femoral epicondyle region, running anteroinferiorly, to the proximal tibia at a site midway between the Gerdy tubercle and the head of the fibula. The function of this ligament is theorized to provide anterolateral knee stability. LEVEL OF EVIDENCE Level IV, systematic review of cadaveric and imaging studies.
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Affiliation(s)
- Leon Van der Watt
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, Department of Orthopaedic Surgery, Western University, London, Ontario, Canada
| | - Devin Peterson
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Evaniew N, Devji T, Drew B, Peterson D, Ghert M, Bhandari M. The surgical management of scoliosis: a scoping review of the literature. Scoliosis 2015; 10:1. [PMID: 25628756 PMCID: PMC4307902 DOI: 10.1186/s13013-014-0026-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/15/2014] [Indexed: 01/08/2023]
Abstract
Background Scoping reviews are innovative studies that can map a range of evidence to convey the breadth and depth of a large field. An evidence-based approach to the wide spectrum of surgical interventions for scoliosis is paramount to enhance clinical outcomes. The objectives of this scoping review were to identify critical knowledge gaps and direct future research. Methods This study was completed according to the methodology of Arksey and O’Malley. Two reviewers performed duplicate systematic screening of eligibility. Studies were classified according to patient age, scoliosis etiology, outcomes reported, study design, and overall research theme. Results There were 1763 eligible studies published between 1966 and 2013. The literature focused on adolescents (83% of studies) with idiopathic scoliosis (72%). There was a dominance of observational designs (88%), and a paucity of randomized trials (4%) or systematic reviews (1%). Fifty six percent of studies were conducted in North America, followed by 23% in Europe and 18% in Asia. Few high-level studies investigated surgical indications, surgical approaches, surgical techniques, or implant selection. Patient important outcomes including function, health-related quality of life, pain, and rates or re-operation were infrequently reported. Conclusions Current research priorities are to (1) undertake high-quality knowledge synthesis and knowledge translation activities; (2) conduct a series of planning meetings to engage clinicians, patients, and methodologists; and (3) clarify outcome reporting and strategies for methodological improvement. Higher-quality studies are specifically needed to inform surgical indications, surgical approaches, surgical techniques, and implant selection. Engaging global partners may increase generalizability.
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Affiliation(s)
- Nathan Evaniew
- Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington St N, Suite 110, Hamilton, ON L8L 8E7 Canada
| | - Tahira Devji
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - Brian Drew
- Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington St N, Suite 110, Hamilton, ON L8L 8E7 Canada
| | - Devin Peterson
- Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington St N, Suite 110, Hamilton, ON L8L 8E7 Canada
| | - Michelle Ghert
- Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington St N, Suite 110, Hamilton, ON L8L 8E7 Canada
| | - Mohit Bhandari
- Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington St N, Suite 110, Hamilton, ON L8L 8E7 Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
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Hak A, Rajaratnam K, Ayeni OR, Moro J, Peterson D, Sprague S, Bhandari M. A Double-Blinded Placebo Randomized Controlled Trial Evaluating Short-term Efficacy of Platelet-Rich Plasma in Reducing Postoperative Pain After Arthroscopic Rotator Cuff Repair: A Pilot Study. Sports Health 2015; 7:58-66. [PMID: 25553214 PMCID: PMC4272693 DOI: 10.1177/1941738114548413] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 01/08/2023] Open
Abstract
Background: We aimed to determine whether patients with arthroscopically repaired rotator cuff (RC) tears would have reduced pain and improved function after ultrasound-guided platelet-rich plasma (PRP) injections compared with placebo injection. Hypothesis: PRP compared with placebo (saline) was more effective in reducing pain at the site of an RC injury that has undergone arthroscopic repair. Study Design: Randomized controlled trial. Level of Evidence: Level 2. Methods: We conducted a 2-centered, blinded, randomized controlled trial comparing the level of pain in patients undergoing arthroscopic repair. Patients were randomized to either PRP or saline (placebo). They received 2 ultrasound-guided injections of the randomized product: 1 intraoperatively and 1 at 4 weeks postoperatively. The primary outcome measure was shoulder pain demonstrated using a visual analog scale (VAS) at 6 weeks postoperatively. Secondary outcomes included the EuroQol-5 Dimensions (EQ-5D); the Western Ontario Rotator Cuff Index (WORC); and the Disabilities of the Arm, Shoulder, and Hand Score (DASH), as well as adverse events and revision surgeries. Patients were assessed clinically preoperatively and at 2, 4, and 6 weeks postsurgery. A prespecified interim analysis was conducted after 50% of patients were recruited and followed. Results: We recruited 25 patients when interim power analysis led to an early trial termination. Follow-up was 96%. The mean difference between groups was not statistically significant (–1.81; 95% CI, –4.3 to 1.2; P = 0.16). The EQ-5D, WORC, and DASH scores also did not show significant differences between groups at week 6 (P = 0.5, 0.99, and 0.9, respectively). There were no revision surgeries, and 4 adverse events (3 PRP, 1 saline). Conclusion: There was no statistical difference in outcome measures when augmenting arthroscopically repaired RC tears with PRP. Clinical Relevance: Identifying therapies that improve outcomes in patients with RC tears remains a challenge and deserves ongoing investigation.
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Affiliation(s)
- Alisha Hak
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Krishan Rajaratnam
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jaydeep Moro
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Devin Peterson
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Sheila Sprague
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Waldman A, Upadhyay N, Adams A, Peterson D, Roncaroli F. NI-02 * ELEVATED MYOINOSITOL IN DIFFUSE ASTROCYTOMA; A MARKER OF ANAPLASTIC PHENOTYPE, AND NOT ATTRIBUTABLE TO MICROGLIAL INFILTRATION. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou264.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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