scholarly journals Patients with complex proximal tibial fractures overestimate the prognosis of their injury

2021 ◽  
Author(s):  
Lena Keppler ◽  
Alexander Martin Keppler ◽  
Christoph Ihle ◽  
Philipp Minzlaff ◽  
Julian Fürmetz ◽  
...  
Keyword(s):  
Return To Work ◽  
Tibial Fracture ◽  
Knee Function ◽  
Physical Work ◽  
Return To Sports ◽  
Work Intensity ◽  
Proximal Tibial Fracture ◽  
Level Of Evidence ◽  
Patient Comprehension ◽  
Group B

Abstract Purpose To investigate, if patients with complex proximal tibial fracture have realistic expectations on open reduction and internal fixation. Methods 114 patients (mean 49 years, SD ± 13) with closed AO-type B and C proximal tibial fracture were grouped (group B, respectively C). Prior to surgery expectations concerning knee function, pain, return to work/sports, and the risk for osteoarthritis was assessed with the Hospital for Special Surgery-Knee Surgery Expectations Survey (HFSS-KSE) and a non-validated ten-item survey. Results 92% of patients expected at least an almost natural knee postoperatively. All items regarding restoring knee function were ranked to be at least important in both groups. 65% in group B and 47% in group C expected at most occasional pain. 83% in group B and 67% in group C expected full return to work without any limitations. Patients with low physical work intensity expected significantly shorter incapacity to work in both groups (7.8, respectively 8.9 weeks). 71% in group B and 60% in group C expected to return to sports with at most small limitations. 33% in group B and 22% in group C assumed risk for osteoarthritis will be prevented by surgery. Conclusion Expectations on surgery for complex proximal tibial fracture are high regardless of fracture type. The prognosis of many health and lifestyle domains was overestimated. The risk for osteoarthritis was underestimated. This study should sensitize surgeons to discuss realistic expectations. This may help to improve patient comprehension what leads to sensible expectations, resulting in improved patients´ satisfaction. Level of evidence IV. Trial registration number 14104, Date of registration: 06/2015.

scholarly journals Use of an Elastomeric Knee Brace in Patellofemoral Pain Syndrome: Short-Term Results

Joints ◽  
2018 ◽  
Vol 06 (02) ◽  
pp. 085-089 ◽  
Author(s):  
Francesco Uboldi ◽  
Paolo Ferrua ◽  
Daniele Tradati ◽  
Pietro Zedde ◽  
Jim Richards ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Return To Sport ◽  
Pain Syndrome ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Rehabilitation Program ◽  
Return To Sports ◽  
Level Of Evidence ◽  
Group A ◽  
Group B

Purpose This article verifies the effectiveness of a new brace on patellofemoral pain syndrome (PFPS) in adjunct to a specifically developed rehabilitation program. Methods Two groups of 30 patients with PFPS were prospectively and randomly allocated to a rehabilitation protocol, with (group A) or without (group B) the use of a specific brace. All the patients were assessed at 3, 6, and 12 months using the disease-specific Kujala scale and a visual analog scale (VAS) for pain; time to return to sport and patient satisfaction with the brace were also recorded. Results Kujala scale's values showed constant and progressive improvement. The mean score at 6 months was 79.8 ± 6.8 points in group A and 76.8 ± 8.6 in group B, rising at 12 months to 80.9 ± 7.5 in group A and 78.4 ± 8.3 in group B. VAS scores significantly differed (p < 0.05) between the two groups at both 6 and 12 months; the score recorded at 12 months was 0.9 ± 1.3 in the brace-treated group and 1.8 ± 1.6 in the controls. The patients who used a brace showed a quicker return to sports and 75% of the patients in this group were satisfied. Conclusion All the scores improved progressively in both groups. The most significant improvement concerned pain, showing that the brace used in this study may allow a better subjective outcome and a quicker return to sport. Level of Evidence Level II, prospective randomized controlled trial.

scholarly journals What do patients expect from osteosynthetic stabilization of proximal tibial fractures?

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0031
Author(s):  
Lena Hellinger ◽  
Alexander M. Keppler ◽  
Christoph Ihle ◽  
Fabian Stuby ◽  
Tim Saier
Keyword(s):  
Surgical Treatment ◽  
Return To Work ◽  
Tibial Fracture ◽  
Return To Sport ◽  
Tibial Fractures ◽  
Proximal Tibial Fracture ◽  
Younger Patients ◽  
High Expectations ◽  
Proximal Tibial Fractures ◽  
Very High

Aims and Objectives: Surgical treatment of proximal tibial fractures is often associated with complications and postoperative limitations in knee motion. Unrealistic patient expectations of the operation may lead to dissatisfaction with the surgical outcome despite successful surgery. The hypothesis of this study was that patients with proximal tibial fracture have very high expectations of surgical intervention in terms of painlessness, return to work and sport ability. Further, underestimation of the risk for the development of secondary gonarthrosis was hypothesized. Materials and Methods: From 2017-2018, n=79 patients (n=35 w, mean age 48 years ±13.6 years) with proximal tibial fracture were prospectively and consecutively enrolled at three level A trauma centers. Preoperatively, demographic data, fracture classification according to AO classification, the HSS -Knee Surgery Expectations Survey using the 4-point Likert scale, the workload according to REFA criteria and the non-standardized expectations regarding the return to work/sport ability and the secondary risk for developing gonarthrosis were collected and analysed. A statistical significance of p<0.05 was assumed. Results: 81% (n=63) of the patients expect a maximum duration of incapacity for work of 12 weeks regardless of age, gender and workload (n.s.). 74% (n=58) expect a return to work and 70% (n=55) a return to sport with no or only minor restrictions. Younger patients (younger than 55 years) had significantly higher expectations of an unrestricted return to work (p=0.045) and sport (p=0.04). Gender and workload had no significant influence on this expectation (n.s.). 33% (n=26) do not expect any residual pain postoperatively, regardless of activity. Younger patients expect significantly less residual pain than older patients (p=0.03). 92% (n=73) expect a completely normal knee joint or only minor differences to a healthy knee, regardless of age, gender and workload (n.s.). At least 72% (n=57) of the patients consider an unrestricted or only slightly restricted knee function to be at least important, regardless of age, sex and workload (n.s.). 29% (n=23) of the patients, regardless of age, sex and workload (n.s.) assume that the operation prevents secondary gonarthrosis. Conclusion: The results confirm our hypothesis that patients have very high expectations of the surgical treatment of proximal tibial fractures. For younger patients in particular, an unrestricted return to sport, work and painlessness is very important. The risk assessment regarding developing secondary gonarthrosis seems unrealistic. This study should help surgeons to discuss realistic expectations and results of osteosynthetic stabilization of proximal tibial fractures with their patients in order to improve patients’ satisfaction.

scholarly journals Return to Work After Distal Femoral Varus Osteotomy

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096596
Author(s):  
Richard N. Puzzitiello ◽  
Joseph N. Liu ◽  
Grant H. Garcia ◽  
Michael L. Redondo ◽  
Enrico M. Forlenza ◽  
...  
Keyword(s):  
Return To Work ◽  
Small Sample Size ◽  
Lateral Compartment ◽  
Valgus Deformity ◽  
Small Sample ◽  
Work Intensity ◽  
Level Of Evidence ◽  
Varus Osteotomy ◽  
Meniscal Allograft ◽  
Significant Difference

Background: Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. There is a paucity of information available regarding patients’ ability to return to work (RTW) after DFVO. Purpose: To report the objective findings for RTW rates and times for patients receiving a DFVO for lateral compartment osteoarthritis secondary to valgus deformity of the knee. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective study of patients who received a lateral-wedge opening DFVO. Patients must have worked within 3 years before their operation to be included for analysis. Patients were contacted at a minimum of 2 years postoperatively for interview and questionnaire evaluation, including a subjective work questionnaire, visual analog scale (VAS) for pain, Single Assessment Numerical Evaluation (SANE), and a satisfaction questionnaire. Results: Overall, 32 patients were contacted at a mean follow-up of 7.1 ± 4.1 years (range, 2.2-13.3 years). The mean ± SD age at the time of surgery was 30.8 ± 8.8 years (range, 17.2-46.5 years), and 65.6% of patients were female. Eleven patients (34.4%) received a concomitant meniscal allograft transplant, and 12 (37.5%) received a cartilage grafting procedure. The average VAS pain score decreased significantly from 6.1 preoperatively to 3.2 postoperatively ( P = .03). All patients were able to RTW, at a mean time of 6.0 ± 13.2 months postoperatively (range, 0-72 months). When stratified by work intensity, the average time to return was 13.8, 3.1, 2.7, and 2.9 months for high, moderate, light, and sedentary occupations, respectively. There was no significant difference between these RTW times ( P = .16), although this analysis may have been limited by the small sample size. Four patients whose work was classified as heavy work (50%) and 3 whose work was classified as moderate work (18.8%) either switched jobs or kept the same job with lighter physical duties as a result of their procedures. Conclusion: In a young and active population, DFVO for valgus deformity reliably afforded the ability to RTW within a relatively short time for patients with sedentary, light, and moderate occupational demands. However, patients with moderate- to high-intensity occupational demands may be unable to RTW at their preoperative level.

scholarly journals Combined posterolateral knee reconstruction: ACL-based injuries perform better compared to PCL-based injuries

2021 ◽  
Author(s):  
Patricia M. Lutz ◽  
Michael Merkle ◽  
Philipp W. Winkler ◽  
Stephanie Geyer ◽  
Elmar Herbst ◽  
...  
Keyword(s):  
Return To Work ◽  
Rating Scale ◽  
Cruciate Ligament ◽  
Return To Sports ◽  
Work Intensity ◽  
Injury Group ◽  
Patient Reported ◽  
Activity Scale ◽  
Tegner Activity Scale

Abstract Purpose To compare post-operative physical activity and return to work after combined posterolateral corner (PLC) reconstruction (PLC-R) in anterior cruciate ligament (ACL)- or posterior cruciate ligament (PCL)-based injuries. Methods Patients aged > 18 years undergoing PLC-R using the Larson technique combined with either ACL or PCL reconstruction were included. Outcome was evaluated retrospectively after a minimum follow-up of 24 months using Tegner Activity Scale, Activity Rating Scale (ARS), Knee Injury and Osteoarthritis Outcome Score (KOOS), work intensity according to REFA classification, and a questionnaire about type of occupation and time to return to work. Results A total of 32 patients (11 ACL-based injuries and 21 PCL-based injuries) were included. Mean follow-up was 56 ± 26 months in the ACL-based injury group and 59 ± 24 months in the PCL-based injury group. All patients in the ACL-based injury group and 91% of patients in the PCL-based injury group returned to sports activities. Comparing pre- and post-operative values, a significant deterioration of the Tegner Activity Scale and ARS was observed in the PCL-based injury group, whereas no significant change was observed in the ACL-based injury group. KOOS subscales were generally higher in the ACL-based injury with significant differences in the subscale sports and recreational activities. Patients with ACL-based injuries returned to work significantly earlier compared to patients with PCL-based injuries (11 ± 4 weeks vs. 21 ± 10 weeks, p < 0.05). Conclusion High rates of return to sports and work can be expected after combined PLC-R in both ACL- and PCL-based injuries. However, deterioration of sports ability must be expected in PCL-based injuries. ACL-based injuries led to superior patient-reported outcomes and an earlier return to work, as compared to PCL-based injuries. Level of evidence Level IV.

Fifth Metatarsal Jones Fractures in the Athlete

2017 ◽  
Vol 39 (2) ◽  
pp. 250-258 ◽  
Author(s):  
David A. Porter
Keyword(s):  
Screw Fixation ◽  
Nonoperative Treatment ◽  
Fracture Site ◽  
Medullary Canal ◽  
Return To Sports ◽  
Stress Reactions ◽  
Current Standard ◽  
Level Of Evidence ◽  
Metatarsal Fractures ◽  
Intramedullary Screw

Fifth metatarsal fractures, otherwise known as “Jones” fractures, occur commonly in athletes and nonathletes alike. While recent occurrence in the popular elite athlete has increased public knowledge and interest in the fracture, this injury is common at all levels of sport. This review will focus on all three types of Jones fractures. The current standard for treatment is operative intervention with intramedullary screw fixation. Athletes typically report an acute episode of lateral foot pain, described as an ache. Radiographic imaging with multiple views of the weightbearing injured foot are needed to confirm diagnosis. If these images are inconclusive, further magnetic resonance imaging (MRI) or computed tomography (CT) is used. Nonoperative treatment is not commonly used as the sole treatment, except when following reinjury of a stable screw fixation. While screw selection is still controversial, operative treatment with intramedullary screw fixation is the standard approach. Technical tips on screw displacement are provided for Torg (types I, II, III) fractures, cavovarus foot fractures, recurrent fractures, revision surgery, occult fractures/high-grade stress reactions, and Jones’ variants. Excellent clinical outcomes can be expected in 80% to 100% of patients when using the intramedullary screw fixation to “fit and fill” the medullary canal with threads across the fracture site. Most studies show the timing for return to sports with optimal healing to be seven to twelve weeks after fixation. Level of Evidence: Level V, expert opinion.

Perceived Exertion: An Active or Passive Process?

1985 ◽  
Vol 7 (4) ◽  
pp. 371-378 ◽  
Author(s):  
W. Jack Rejeski
Keyword(s):  
Parallel Processing ◽  
Empirical Study ◽  
Perceived Exertion ◽  
Theoretical Models ◽  
Physical Work ◽  
Future Research ◽  
Work Intensity ◽  
Ratings Of Perceived Exertion ◽  
Subjective Estimates ◽  
Parallel Processing Model

Subjective estimates of physical work intensity are considered of major importance to those concerned with prescription of exercise. This article reviews major theoretical models which might guide research on the antecedents for ratings of perceived exertion (RPE). It is argued that an active rather than passive view of perception is warranted in future research, and a parallel-processing model is emphasized as providing the needed structure for such reconceptualization. Moreover, existing exercise research is reviewed as support for this latter approach and several suggestions are offered with regard to needed empirical study.

Return to Work After Primary Rotator Cuff Repair: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652097542
Author(s):  
Eric D. Haunschild ◽  
Ron Gilat ◽  
Ophelie Lavoie-Gagne ◽  
Michael C. Fu ◽  
Tracy Tauro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Return To Work ◽  
Rotator Cuff Repair ◽  
Meta Analysis ◽  
Work Outcomes ◽  
Workers Compensation ◽  
Work Intensity ◽  
Rates Of Return ◽  
Cuff Repair

Background: Rotator cuff tears are a prevalent pathology in injured workers, causing significant economic ramifications and time away from work. To date, published articles on work outcomes after rotator cuff repair have not been cumulatively assessed and analyzed. Purpose: To systematically review reports on return to work after rotator cuff repair and perform a meta-analysis on factors associated with improved work outcomes. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review of return-to-work investigations was performed using PubMed, Embase, and the Cochrane Database of Systematic Reviews in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Individual studies reporting rates of return to previous work with level of evidence 1 to 4 were independently screened by 2 authors for inclusion, and study quality was assessed using the Methodologic Index for Non-randomized Studies and Newcastle-Ottawa Scale. Work outcome data were synthesized and analyzed using random effects modeling to identify differences in rates of return to previous work as a function of operative technique, work intensity, and workers’ compensation status. Results: Thirteen retrospective investigations comprising 1224 patients who underwent rotator cuff repair met inclusion criteria for this investigation. Across all investigations, a weighted average of 62.3% of patients returned to previous level of work at 8.15 ± 2.7 months (mean ± SD) after surgery. Based on random effects modeling, higher rates of return to previous work were identified with decreasing work intensity ( P < .001), while rates were similar between open and arthroscopic repair technique ( P = .418) and between workers’ compensation and non–workers’ compensation cohorts ( P = .089). All shoulder pain and functional outcome assessments demonstrated significant improvements at final follow-up when compared with baseline across all investigations. Conclusion: The majority of injured workers undergoing rotator cuff repair return to previous work at approximately 8 months after surgery. Despite this, >35% of patients are unable to return to their previous work level after their repair procedure. Similar rates of return to work can be anticipated regardless of workers’ compensation status and operative technique, while patients in occupations with higher physical intensity experience inferior work outcomes.

scholarly journals Surgical Treatment Outcomes for Everted Bursal Flap of Delaminated Supraspinatus Tear

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199042
Author(s):  
Hyungsuk Kim ◽  
Chu Hwan Byun ◽  
Sung Bin Han ◽  
Hyun Seok Song
Keyword(s):  
Los Angeles ◽  
Constant Score ◽  
Early Postoperative Period ◽  
Level Of Evidence ◽  
Supraspinatus Tear ◽  
Functional Scores ◽  
Group A ◽  
Vas Scores ◽  
Group B

Background: Although everted bursal flaps of delaminated tears have been reported, few studies have reported radiologic images, arthroscopic findings, and clinical results after repair. Purpose: To compare the repair outcomes of everted delaminated tears with those of classic delaminated supraspinatus tears. Study Design: Cohort study; Level of evidence, 3. Methods: Among 153 patients who underwent arthroscopic rotator cuff repair for a delaminated supraspinatus tear, everted bursal flap tears were observed in 24 patients upon arthroscopy (group A). Another 24 patients with classic delaminated supraspinatus tears, matched for age and sex, were selected for group B. Magnetic resonance imaging (MRI) and ultrasonography were performed preoperatively and postoperatively. Patients were evaluated using a visual analog scale (VAS) for pain as well as functional scores (American Shoulder and Elbow Surgeons [ASES] score, Constant score, and University of California Los Angeles shoulder score). Scores were compared preoperatively and at final follow-up (mean follow-up, 32 months). Results: Patients in both groups A and B reported improved VAS and functional scores at the final follow-up. In group A, preoperative VAS scores were higher and functional scores were poorer than in group B. Subacromial effusions with tendon swelling on preoperative MRI were more common in group A. During follow-up ultrasonography, group A patients exhibited persistent subacromial effusion. However, VAS scores at final follow-up were significantly better in group A (0.4 ± 0.7) than in group B (1.6 ± 1.4) ( P < .001), and ASES scores at final follow-up were better in group A (84.3 ± 4.3) than in group B (77.0 ± 10.2) ( P = .005). Conclusion: Everted bursal flap delaminated tears were associated with higher VAS scores and poorer functional scores preoperatively. Although subacromial effusions were experienced by group A during the early postoperative period, clinical outcomes at final follow-up were significantly better for everted delaminated tears compared with classic delaminated tears.

Criteria for Return to Play After Hip Arthroscopy in the Treatment of Femoroacetabular Impingement: A Systematic Review

2021 ◽  
pp. 036354652110389
Author(s):  
Martin S. Davey ◽  
Eoghan T. Hurley ◽  
Matthew G. Davey ◽  
Jordan W. Fried ◽  
Andrew J. Hughes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Operative Management ◽  
Return To Play ◽  
Return To Sports ◽  
Level Of Evidence ◽  
The Mean

Background: Femoroacetabular impingement (FAI) is a common pathology in athletes that often requires operative management in the form of hip arthroscopy. Purpose: To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software. Results: Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy. Conclusion: The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.

scholarly journals A modification of the Ponseti method for clubfoot management: a prospective comparative study

2021 ◽  
pp. 1-10
Author(s):  
Reda Ali Sheta ◽  
Mohamed El-Sayed ◽  
Hisham Abdel-Ghani ◽  
Sameh Saber ◽  
Amani Salah Eldin Mohammed ◽  
...  
Keyword(s):  
Treatment Method ◽  
Ponseti Method ◽  
Level Of Evidence ◽  
Home Based ◽  
Multicentre Cohort Study ◽  
Group A ◽  
Prospective Comparative Study ◽  
Group B ◽  
Multicentre Cohort

Purpose We aimed to compare our parent-based exercise programem’s efficacy with the foot abduction brace (FAB) Ponseti manipulation as a retention programme. Methods We conducted this prospective multicentre cohort study between August 2009 and November 2019. The included children were allocated into one of two groups according to the retention protocol. The Pirani and Laaveg-Ponseti scores were used to assess the feet clinically and functionally. Radiological assessment was performed using standing anteroposterior and lateral radiographs of the feet. We assessed the parents’ satisfaction and adherence to the retention method. SPSS version 25 was used for the statistical analysis. Results A total of 1265 feet in 973 children were included. Group A included 637 feet managed with FAB, while group B included 628 feet managed with our retention programme. All patients were followed up to the age of four years. At the final follow-up, Pirani scores in group A participants were excellent, good and poor in 515, 90, and 32 feet, respectivel, while in group B the scores were excellent, good and poor in 471, 110 and 44 feet, respectively. The mean total score of Laaveg-Ponseti was 87.81 (sd 19.82) in group A and 90.55 (sd 20.71) in group B (p = 0.02). Group B participants showed higher satisfaction with the treatment method (p = 0.011) and more adherence to the treatment (p = 0.013). Conclusion The deformity’s recurrence related to the brace’s non-compliance in the Ponseti method might be reduced by substituting the brace with our home-based daily stretching exercises. Level of Evidence II

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