The effect of meniscal pathology and management with ACL reconstruction on patient-reported outcomes, strength, and jump performance ten months post-surgery

The Knee ◽  
2021 ◽  
Vol 32 ◽  
pp. 72-79
Author(s):  
Laura Byrne ◽  
Enda King ◽  
Ciaran Mc Fadden ◽  
Mark Jackson ◽  
Ray Moran ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Jump Performance ◽  
Post Surgery ◽  
Patient Reported ◽  
Meniscal Pathology

scholarly journals Poor Associations Between Radiographic Tibiofemoral Osteoarthritis and Patient-Reported Outcomes at 16 Years After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712095117
Author(s):  
Fredrik Identeg ◽  
Eric Hamrin Senorski ◽  
Eleonor Svantesson ◽  
Kristian Samuelsson ◽  
Ninni Sernert ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Grade 3

Background: Radiographic tibiofemoral (TF) osteoarthritis (OA) is common in patients after anterior cruciate ligament (ACL) reconstruction at long-term follow-up. The association between radiographic OA and patient-reported outcomes has not been thoroughly investigated. Purpose: To determine the association between radiographic TF OA and patient-reported outcome measure (PROM) scores at 16 years after ACL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: This study was based on 2 randomized controlled studies comprising 193 patients who underwent unilateral ACL reconstruction. A long-term follow-up was carried out at 16.4 ± 1.7 years after surgery and included a radiographic examination of the knee and recording of PROM scores. Correlation analyses were performed between radiographic OA (Kellgren-Lawrence [K-L], Ahlbäck, and cumulative Fairbank grades) and the PROMs of the International Knee Documentation Committee (IKDC) subjective knee form, Lysholm score, and Tegner activity scale. A linear univariable regression model was used to assess how the IKDC score differed with each grade of radiographic OA. Results: Of 193 patients at baseline, 147 attended the long-term follow-up. At long-term follow-up, 44.2% of the patients had a K-L grade of ≥2 in the injured leg, compared with 6.8% in the uninjured leg. The mean IKDC score at follow-up was 71.2 ± 19.9. Higher grades of radiographic OA were significantly correlated with lower IKDC and Lysholm scores ( r = –0.36 to –0.22). Patients with a K-L grade of 3 to 4 had significantly lower IKDC scores compared with patients without radiographic OA (K-L grade 0-1). Adjusted beta values were –15.7 (95% CI, –27.5 to –4.0; P = .0093; R 2 = 0.09) for K-L grade 3 and –25.2 (95% CI, –41.7 to –8.6; P = .0033; R 2 = 0.09) for K-L grade 4. Conclusion: There was a poor but significant correlation between radiographic TF OA and more knee-related limitations, as measured by the IKDC form and the Lysholm score. Patients with high grades of radiographic TF OA (K-L grade 3-4) had a statistically significant decrease in IKDC scores compared with patients without radiographic TF OA at 16 years after ACL reconstruction. No associations were found between radiographic TF OA and the Tegner activity level.

scholarly journals Knee Kinematics Are Related to Patient-Reported Outcomes 6 Months After Anatomic ACL Reconstruction

2015 ◽  
Vol 3 (7_suppl2) ◽  
pp. 2325967115S0003 ◽  
Author(s):  
Jay Kalawadia ◽  
Eric Thorhauer ◽  
Fabio Vicente Arilla ◽  
Amir Ata Rahnemai Azar ◽  
Caiyan Zhang ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Knee Kinematics ◽  
Anatomic Acl Reconstruction ◽  
Patient Reported

Patient-reported outcomes during hospitalization for patients with late discharge after an open surgery for GYN tumors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18078-e18078
Author(s):  
Xin Shelley Wang ◽  
Qiuling Shi ◽  
Charles S. Cleeland ◽  
Ting-Yu Chen ◽  
Araceli Garcia-Gonzalez ◽  
...  
Keyword(s):  
Perioperative Care ◽  
Open Surgery ◽  
Patient Reported Outcomes ◽  
Enhanced Recovery ◽  
Dry Mouth ◽  
Major Surgery ◽  
Cancer Center ◽  
Post Surgery ◽  
Patient Reported ◽  
Md Anderson

e18078 Background: Using patient-reported outcomes (PRO) in perioperative care is increasingly common in patients undergoing major surgery. Few reports relate the patient’s symptomatic status using validated PROs during hospitalization with other outcomes, such as length of stay (LOS). Methods: Patients with GYN tumors scheduled for open surgery at MD Anderson Cancer Center were recruited prospectively. The MD Anderson Symptom Inventory gynecology perioperative care module (MDASI-PeriOp-GYN) was used to assess symptoms daily during hospitalization. Longitudinal analysis compared patient’s PROs between groups who were discharged within and beyond the median LOS. Results: From Feb 2018–Dec 2018, 83 patients were evaluable. The median LOS was 3 days. 70% of patients were discharged within 3 days, and 30% were hospitalized longer (defined as late discharge group, range 4-10 days). The median LOS for the two groups was 5.64 vs. 2.41 days, P < .0001. Compared to patients who were discharged within 3 days, late discharge patients had longer surgical time (310 min vs. 209 min, P < .0001), and greater operative blood loss (668mL vs. 289 mL, P < .001). Additionally, more patients in the late discharge group had a worse performance status (ECOG PS 2-3: 24% vs. 3.5%, P < .05), and higher comorbidity (Charlson comorbidity Index > 1: 92% vs. 69%, P < .05), and more used opioids within 6 month pre-surgery (16% vs. 1.7%, P < .05). For all patients, the 5 worst symptoms during the first 3 hospital days were pain, fatigue, drowsiness, dry mouth, bloating. Late discharge patients reported significant more severe pain, distress, dry mouth, and interference with walking during the first 3 days post-surgery (all P < .05). Conclusions: Despite all patients undergoing standardized perioperative care on an Enhanced Recovery pathway, this study demonstrates how baseline and intraoperative factors are associated with longer LOS and more severe symptom burden, especially pain and interference with walking.

scholarly journals Development of the KOOSglobal Platform to Measure Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 46 (12) ◽  
pp. 2915-2921 ◽  
Author(s):  
Cale A. Jacobs ◽  
Michael R. Peabody ◽  
Christian Lattermann ◽  
Jose F. Vega ◽  
Laura J. Huston ◽  
...  
Keyword(s):  
Psychometric Properties ◽  
Acl Reconstruction ◽  
Relative Efficiency ◽  
Convergent Validity ◽  
Patient Reported Outcomes ◽  
Short Form ◽  
Cruciate Ligament ◽  
Patient Reported ◽  
Anterior Cruciate

Background: The Knee injury and Osteoarthritis Outcome Score (KOOS) has demonstrated inferior psychometric properties when compared with the International Knee Documentation Committee (IKDC) subjective knee form when assessing outcomes after anterior cruciate ligament (ACL) reconstruction. The KOOS, Joint Replacement (KOOS, JR) is a validated short-form instrument to assess patient-reported outcomes (PROs) after knee arthroplasty, and the purpose of this study was to determine if augmenting the KOOS, JR with additional KOOS items would allow for the creation of a short-form KOOS-based global knee score for patients undergoing ACL reconstruction, with psychometric properties similar to those of the IKDC. Hypothesis: An augmented version of the KOOS, JR could be created that would demonstrate convergent validity with the IKDC but avoid the ceiling effects and limitations previously noted with several of the KOOS subscales. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Based on preoperative and 2-year postoperative responses to the KOOS questionnaires from a sample of 1904 patients undergoing ACL reconstruction, an aggregate score combining the KOOS, JR and the 4 KOOS Quality of Life subscale questions, termed the KOOSglobal, was developed. Psychometric properties of the KOOSglobal were then compared with those of the IKDC subjective score. Convergent validity between the KOOSglobal and IKDC was assessed with a Spearman correlation (ρ). Responsiveness of the 2 instruments was assessed by calculating the pre- to postoperative effect size and relative efficiency. Finally, the presence of a preoperative floor or postoperative ceiling effect was defined with the threshold of 15% of patients reporting either the worst possible (0 for KOOSglobal and IKDC) or the best possible (100 for KOOSglobal and IKDC) scores, respectively. Results: The newly developed KOOSglobal was responsive after ACL reconstruction and demonstrated convergent validity with the IKDC. The KOOSglobal significantly correlated with the IKDC scores (ρ = 0.91, P < .001), explained 83% of the variability in IKDC scores, and was similarly responsive (relative efficiency = 0.63). While there was a higher rate of perfect postoperative scores with the KOOSglobal (213 of 1904, 11%) than with the IKDC (6%), the KOOSglobal was still below the 15% ceiling effect threshold. Conclusion: The large ceiling effects limit the ability to use several of the KOOS subscales with the younger, more active ACL population. However, by creating an aggregate score from the KOOS, JR and 4 KOOS Quality of Life subscale questions, the 11-item KOOSglobal offers a responsive PRO tool after ACL reconstruction that converges with the information captured with the IKDC. Also, by offering the ability to calculate multiple scores from a single questionnaire, the KOOSglobal may provide the orthopaedic community a single PRO platform to be used across knee-related subspecialties. Registration: NCT00478894 ( ClinicalTrials.gov identifier).

scholarly journals Patient-Reported Outcomes After Multiple-Revision ACL Reconstruction: Good but Not Great

2020 ◽  
Vol 2 (5) ◽  
pp. e539-e546
Author(s):  
Ian D. Engler ◽  
Matthew J. Salzler ◽  
Andrew J. Wall ◽  
William R. Johnson ◽  
Amun Makani ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Revision Acl Reconstruction ◽  
Patient Reported

scholarly journals COMPARISON OF BONE-PATELLA TENDON-BONE (BTB) AND QUADRICEPS AUTOGRAFT FOR ACL RECONSTRUCTION IN PATIENTS UNDER 18 YEARS OF AGE

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0027
Author(s):  
Seth L. Sherman ◽  
Daniel W. Hogan ◽  
Derek W. Geeslin ◽  
Joseph M. Rund ◽  
M. Benjamin Burch ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patient Population ◽  
Patient Reported Outcomes ◽  
Skeletal Maturity ◽  
Surgical Patient ◽  
Cartilage Restoration ◽  
Graft Choice ◽  
Patient Reported ◽  
Subjective Outcomes

Background: Graft choice for ACL reconstruction in patients under 18 years old remains controversial. BTB autograft has long been considered for young athletes who are at or near skeletal maturity. Quadriceps autograft has emerged as an alternative graft choice in the young patient population. However, there remains a paucity of comparative outcomes. Hypothesis/Purpose: Our purpose is to compare subjective outcomes and complications of ACL reconstruction in patients under 18 years old using either BTB or quadriceps autograft. Our hypothesis is that there will be no difference in subjective outcome or complication between groups. Methods: Following IRB approval, retrospective review of prospectively collected data identified consecutive cohorts of patients under 18 years old undergoing ACL reconstruction with either BTB or quadriceps autograft. Surgery was performed by a single sports fellowship trained surgeon between 2011-2019. Patients undergoing concomitant osteotomies, cartilage restoration, and other ligament reconstruction procedures were excluded. Pre- and post-surgical patient reported outcomes (PROs) including IKDC, KOOS, PROMIS, SANE, Tegner, and Marx were compared between groups. Complications requiring re-operation (i.e., infection, stiffness, reconstruction failure) were recorded. Results were analyzed statistically. Results: 71 patients met inclusion criteria. There were 41 BTB and 30 quadriceps autografts. Mean age was 16.5 years in the BTB group and 14.5 in the quadriceps group (p=0.0000006). 27 of 41 (66%) BTB and 13 of 30 (43%) quadriceps were female. There were no significant differences in PROs between groups. At minimum 6-month follow-up (range 6-25.7 months), patients in both quadriceps and BTB autograft cohorts reported statistically significant improvements in IKDC scores (31.10%, p=0.0009; 34.25%, p=0.00000008), all KOOS domains, SANE (41.80%, p=0.0000006; 42.42%, p=0.000000002), and Tegner scores (2.99%, p=0.0002; 3.35%, p=0.000004). Post-operative PROs were not significantly different between groups (p>0.05). Complications were low and not significant between groups. Both quadriceps and BTB autograft cohorts required 3 post-operative re-operations (10% and 7%, p=0.7), each group including 2 revision reconstructions (7% and 5%, p=0.8) and 1 procedure for stiffness (3% and 2%, p=0.8). Conclusion: For ACL reconstruction in patients under 18 years old, both BTB and quadriceps autografts demonstrated significant subjective improvements and low rates of complications requiring re-operation. Quadriceps autograft appears to be a safe and effective alternative to BTB autograft in this challenging patient population. [Table: see text][Table: see text]

scholarly journals Generalizability and Validation of PROMIS Scores to Predict Surgical Success in Foot and Ankle Patients

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000 ◽  
Author(s):  
Judith Baumhauer ◽  
Michael Anderson ◽  
Charles Saltzman ◽  
Man Hung ◽  
Florian Nickisch ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Significant Proportion ◽  
Geographic Area ◽  
Current Data ◽  
Foot And Ankle ◽  
Chi Square ◽  
Data Set ◽  
Post Surgery ◽  
Patient Reported ◽  
Chi Square Analysis

Category: Patient Reported Outcomes Introduction/Purpose: Patient-reported outcomes are advancing clinical care by improving patient satisfaction and engagement. A recent publication reported preoperative PROMIS scores to be highly predictive in selecting patients who would and would not benefit from foot and ankle (F/A) surgery. Although this publication used the data from 5 fellowship trained foot and ankle surgeons at one institution, the generalizability to other patient populations and geographic areas is unknown. This validation study assesses the pre-operative PROMIS physical function (PF) and pain interference (PI) t-scores as a predictor of post-operative success from a separate geographic area. Methods: Prospective consecutive patient visits to a multi-surgeon tertiary F/A clinic were obtained between 1/2014-11/2016 resulting in 18,565 unique visits and 1,408 new patients. Patients undergoing elective operative intervention for F/A were identified by ICD-9/10; CPT code. PROMIS PF and PI were assessed at initial and follow-up visits (minimum 6 months, mean 7.8 months). Two-way ANOVA was used to determine differences in PROMIS PF and PI from pre to post surgery with age and gender as co- variates. The distributive method of estimating a minimal clinical important difference (MCID) was used. Receiver operator curve (ROC) analysis was used to determine cut offs for achieving and failing to achieve MCID. To determine the validity of previously published cut offs, 1) they were compared to cut offs for this data set and 2) the percentage of patients achieving and failing to achieve MCID based on previous cut offs were evaluated using a chi-square analysis. Results: There were significant improvements in PROMIS PF scores (mean=6.0; sd=11.6; p<0.01) and PI scores (mean=-7.0; sd=8.4; p<0.01). The AUC for PROMIS PF (0.77) was significant (p < 0.01) and the cut offs for achieving MCID (current data = <23.8 versus previous study= <29.7) and failing to achieve MCID (current data=>41.1 versus previous study=>42) were comparable (Figure 1). Of the patients identified as unlikely to achieve MCID, a significant proportion (88.9%) failed to achieve an MCID ((Chi square=4.7; p=0.03). Of the patients identified as likely to achieve MCID, a significant proportion (84.2%) achieved MCID ((Chi square=17.8; p<0.01). This validates the prior preoperative PROMIS PF thresholds for patients undergoing F/A surgery who will and will not demonstrate MCID improvement in PROMIS PF. The AUC for PROMIS PI was not significant. Conclusion: PROMIS PF cut offs from published data were successful in classifying patients who would improve in PF with surgery from a different geographic area and academic institution with a broad unique array of surgical procedures, diagnoses, and a diverse patient population. This study provides validation evidence to support using the PROMIS PF as a potential tool for surgical selection to help identify patients who would benefit from surgery as well as those who would not. This can allow for appropriate utilization of healthcare dollars and manpower resources to benefit our patients.

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