scholarly journals A Randomized Clinical Trial Comparing Patellar Tendon, Hamstring Tendon and Double-Bundle ACL Reconstructions: Patient-Reported and Clinical Outcomes at Five-Year Follow-Up

2017 ◽  
Vol 33 (10) ◽  
pp. e138-e139
Author(s):  
Nick Mohtadi ◽  
Denise S. Chan ◽  
Rhamona Barber
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Clinical Outcomes ◽  
Patellar Tendon ◽  
Hamstring Tendon ◽  
Double Bundle ◽  
Patient Reported

A Randomized Clinical Trial Comparing Patellar Tendon, Hamstring Tendon, and Double-Bundle ACL Reconstructions

2015 ◽  
Vol 25 (4) ◽  
pp. 321-331 ◽  
Author(s):  
Nicholas Mohtadi ◽  
Denise Chan ◽  
Rhamona Barber ◽  
Elizabeth Oddone Paolucci
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Patellar Tendon ◽  
Hamstring Tendon ◽  
Double Bundle

scholarly journals Comparison of Clinical Outcomes Following Anatomic Single vs. Double-Bundle ACL Reconstruction: A Randomized Clinical Trial

2017 ◽  
Vol 5 (7_suppl6) ◽  
pp. 2325967117S0024
Author(s):  
James J. Irrgang ◽  
Scott Tashman ◽  
Charity Moore ◽  
Volker Musahl ◽  
Robin Vereeke West ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Double Bundle ◽  
Double Bundle Acl Reconstruction

scholarly journals Clinical Outcomes of Asynchronous v Synchronous Telepsychiatry in Primary Care: A Randomized Clinical Trial. (Preprint)

2020 ◽  
Author(s):  
Peter M Yellowlees ◽  
Michelle Burke Parish ◽  
Alvaro D Gonzalez ◽  
Steven R Chan ◽  
Donald M Hilty ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Trial ◽  
Health Outcomes ◽  
Randomized Clinical Trial ◽  
Clinical Outcomes ◽  
Primary Care Physicians ◽  
Drop Out ◽  
Global Functioning ◽  
Spanish Speaking

BACKGROUND Asynchronous Telepsychiatry (ATP) consultations (delayed time) can extend psychiatric expertise into primary care, and across languages. OBJECTIVE This is the first clinical outcomes study of ATP compared with Synchronous (real time) Telepsychiatry (STP), the current gold standard telepsychiatry “usual care” method. We hypothesized that patients in the ATP arm would show a better clinical trajectory than those in the STP arm as measured by clinician and patient self-reported ratings of depression, global functioning and health outcomes. METHODS In this randomized clinical trial 36 Primary Care Physicians (PCP) referred a heterogeneous sample of 401 treatment seeking adult depressed or anxious patients over a 5- year period from 3 primary care clinics. 184 English and Spanish speaking participants were enrolled and randomized, of whom 160 (80 ATP, 80 STP) completed baseline evaluations and were entered into the 2-year follow up study. Patients were treated by their PCPs in consultation with University of California Davis Health (UCDH) psychiatrists who consulted with the patients every 6 months for up to 2 years using ATP or STP and then made treatment recommendations to the PCP’s. Patients’ depression, clinical global functioning and health outcomes were assessed every 6 months using both clinician (primary outcomes) and patient (secondary outcomes) self-reported ratings. RESULTS Patients in both ATP and STP groups had significant improvements at 6- and 12-month follow-up on both clinician-rated outcomes. There were no significant differences in improvement between ATP and STP on any clinician or patient self-reported ratings at any follow-up. Drop-out rates at 1 year were 63/160, and at 2 years were 114/143, all somewhat higher for STP than ATP. 19% of the CONCLUSIONS This trial provides evidence of the clinical validity of ATP in English and Spanish speaking primary care patients and may be a key part of a stepped series of mental health interventions available within the primary care treatment setting. ATP presents a possible solution to the workforce shortage of psychiatrists and to the provision of mental healthcare in the home. CLINICALTRIAL NCT02084979

scholarly journals Lateral Extra-Articular Tenodesis Reduces Failure of Hamstring Tendon Autograft ACL Reconstruction -Two Year Outcomes from the STABILITY Study Randomized Clinical Trial

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0028 ◽  
Author(s):  
Alan M. Getgood ◽  
Dianne Bryant ◽  
Robert B. Litchfield ◽  
Robert Gordon McCormack ◽  
Mark Heard ◽  
...  
Keyword(s):  
Clinical Trial ◽  
High Risk ◽  
Randomized Clinical Trial ◽  
Graft Failure ◽  
Primary Outcome ◽  
Pivot Shift ◽  
Hamstring Tendon ◽  
Rotatory Laxity ◽  
Ligamentous Laxity

Objectives: Persistent anterolateral rotatory laxity following anterior cruciate ligament reconstruction (ACLR) has been correlated with poor outcome and graft failure. We hypothesized that anterolateral complex reconstruction by way of a Lateral Extra-articular Tenodesis (LET) in combination with single bundle ACLR would reduce the risk of persistent rotatory laxity in young individuals who are deemed as being at high risk of failure. Methods: This is a pragmatic, multicenter, randomized clinical trial comparing standard hamstring tendon ACLR with combined ACLR and LET, utilizing a strip of iliotibial band (Modified Lemaire). Patients aged 25 years or less with an ACL deficient knee were included. They also had to have two of the following three criteria: 1) Grade 2 pivot shift or greater; 2) Returning to high risk/pivoting sports; 3) Generalized ligamentous laxity. The primary outcome was graft failure defined as either the need for revision ACLR or symptomatic instability associated with a positive asymmetric pivot shift, indicating persistent rotational laxity. Secondary outcome measures included the P4 pain scale, KOOS, IKDC. Patients were followed for two years with visits at 3, 6, 12 and 24 months postoperatively. A sample size of 300 per group was calculated based on a relative reduction in graft failure by 40%, with type 1 error of 5%, 80% power and 15% loss to follow-up rate. Results: 624 patients were randomized with a mean age of 18.9 (range: 14-25), 293 male. 436 (87.9%) patients presented pre-operatively with high-grade rotatory laxity (grade 2 pivot or greater) and 215 (42.1%) were diagnosed as having generalized ligamentous laxity (Beighton Score of 4 or greater). 523 of the 624 patients are at least 2 years postoperative; 29 lost to follow-up (˜5%). In the ACLR group 104/252 (41%) of patients suffered the primary outcome compared to 61/242 (25%) of the ACLR+LET patients (RR=0.61, 95%CI 0.47 to 0.79), p<0.0001. 39 patients suffered graft rupture, 28/252 (11%) in the ACLR group compared to 11/242 (4.5%) in the ACL+LET group (RR=0.41, 95%CI 0.21 to 0.80, p<0.001). At 3 months postoperative, patients in the ACLR group had less pain (p=0.004); at 3 and 6 months all KOOS subdomains, the IKDC favored the ACLR alone group (p=0.03). At 12 and 24 months, no important between-group differences were observed in any patient reported outcome. Conclusion: The addition of LET to a hamstring autograft ACLR in young active patients significantly reduces graft failure and persistent anterolateral rotatory laxity at 2 years post operatively.

Splinting versus extension-block pinning of bony mallet finger: a randomized clinical trial

2020 ◽  
Vol 45 (6) ◽  
pp. 574-581 ◽  
Author(s):  
Janni K. Thillemann ◽  
Theis M. Thillemann ◽  
Pia K. Kristensen ◽  
Anders D. Foldager-Jensen ◽  
Bo Munk
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Interphalangeal Joint ◽  
Joint Surface ◽  
Distal Interphalangeal Joint ◽  
Level Of Evidence ◽  
Pain Scores ◽  
Patient Reported ◽  
Distal Interphalangeal

Surgical treatment of bony mallet fingers is frequently recommended, but the evidence is sparse. This randomized clinical trial aimed to compare nonoperative splinting versus extension-block pinning of bony mallet fingers with involvement of more than one-third of the joint surface but without primary joint subluxation. Thirty-two patients were randomized and 28 fulfilled the protocol. At 6 months follow-up, there were no significant differences in active extension lag in the distal interphalangeal joint (the primary outcome) or in patient-reported function and pain scores. Flexion and active range of motion in the distal interphalangeal joint and finger-to-palm distance were better in the splinting group, but three patients developed secondary subluxation. We conclude from this study, that splinting these injuries is safe and efficient in restoring joint motion, but splinting does not sufficiently prevent secondary subluxation of the joint. Radiographic follow-up during splinting appears to be necessary. Level of evidence: I

Comparison of Clinical Outcomes after Revision Anterior Cruciate Ligament Reconstruction using a Bone-patellar Tendon-bone Autograft and that Using a Double-Bundle Hamstring Tendon Autograft

2021 ◽  
Author(s):  
Hiroki Katagiri ◽  
Yusuke Nakagawa ◽  
Kazumasa Miyatake ◽  
Nobutake Ozeki ◽  
Yuji Kohno ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Knee Laxity ◽  
Hamstring Tendon ◽  
Double Bundle ◽  
Pivot Shift Test ◽  
Anterior Knee Laxity ◽  
Patient Reported ◽  
Anterior Cruciate ◽  
Anterior Knee

Abstract Purpose The purpose of this study was to compare clinical outcomes between revision anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone (BPTB) autograft and that using a double-bundle hamstring tendon (HT) autograft. Methods Consecutive cases of revision ACLRs were reviewed. The Lysholm knee scale and Knee Osteoarthritis Outcome Score (KOOS) were recorded at the final follow-up. The pivot shift test, Lachman test, and anterior knee laxity measurement using an arthrometer were evaluated before revision ACLR and at final follow-up. Contralateral knee laxity was also evaluated, and side-to-side differences noted. The Lysholm knee scale, KOOS, the pivot shift test, Lachman test, and anterior knee laxity were compared between HT versus BPTB autograft recipient groups using the Mann–Whitney test or the t-test. Results Forty-one patients who underwent revision ACLR and followed up for at least 2 years were included. The graft source was a BPTB autograft in 23 patients (BPTB group) and a double-bundle HT autograft in 18 patients (HT group). The mean postoperative follow-up period was 44 ± 28 months in the BPTB group and 36 ± 18 in the HT group (p = 0.38). The HT group had significantly higher KOOS in the pain subscale (less pain) than the BPTB group at the final follow-up (BPTB group 84.2 vs. HT group 94.4; p = 0.02). The BPTB group showed significantly smaller side-to-side difference in anterior knee laxity (superior stability) than the HT group (0.3 vs. 2.6 mm; p < 0.01). The percentage of patients with residual anterior knee laxity in the BPTB group was significantly lower than that in the HT group (9.5% vs. 46.7%; odds ratio, 8.3; p = 0.02). Study Design This was a level 3 retrospective study. Conclusion Revision ACLR with a BPTB autograft was associated with superior results regarding restoration of knee joint stability as compared with that with a double-bundle HT autograft, whereas double-bundle HT autograft was superior to BPTB autograft in terms of patient-reported outcomes of pain. The rest of the patient-reported outcomes were equal between the two groups.

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