scholarly journals Sex differences in outcomes after arthroscopic bankart repair

2020 ◽  
Vol 6 (1) ◽  
pp. e000965
Author(s):  
Natalie A Lowenstein ◽  
Peter J Ostergaard ◽  
Daniel B Haber ◽  
Kirsten D Garvey ◽  
Elizabeth G Matzkin
Keyword(s):  
Mental Health ◽  
Sex Differences ◽  
Patient Reported Outcomes ◽  
Strength Function ◽  
Bankart Repair ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair ◽  
Patient Reported ◽  
Males And Females

ObjectivesRisk factors for anterior shoulder dislocation include young age, contact activities and male sex. The influence of sex on patient-reported outcomes of arthroscopic Bankart repair (ABR) is unclear, with few studies reporting potential differences. This study’s purpose was to compare patient-reported outcomes of males and females following ABR.MethodsProspectively collected data was analysed for 281 patients (males: 206, females: 75) after ABR with preoperative, 1-year and 2-year follow-up responses. The Wilcoxon signed-rank and χ2 tests, preoperative, 1 year and 2 year follow-up results were examined to determine differences of scores in males versus females.ResultsNo statistically significant sex differences were observed in Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Visual Analogue Scale (VAS) or Single Assessment Numerical Evaluation (SANE) Scores at 1-year or 2-year follow-up. Females had lower Veterans RAND 12-item health survey (VR-12) mental health subscores at 2-year follow-up (females: 52.3±9.0, males: 55.8±7.6, p=0.0016). Females were more likely to report that treatment had ‘exceeded expectations’ at 2-year follow-up regarding motion, strength, function and normal sports activities.ConclusionResults of study demonstrate that ABR has similar outcomes for both males and females. There were no statistically significant sex-related differences in SST, ASES, VAS or SANE scores following ABR. VR-12 mental health subscores showed a minimal difference at 2-year follow-up, with lower scores in females.Level of evidenceRetrospective cohort study; level II.

scholarly journals Arthroscopic Bankart Repair Versus Open Latarjet for First-Time Dislocators in Athletes

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110238
Author(s):  
Eoghan T. Hurley ◽  
Martin S. Davey ◽  
Connor Montgomery ◽  
Ross O’Doherty ◽  
Mohamed Gaafar ◽  
...  
Keyword(s):  
Shoulder Dislocation ◽  
Return To Play ◽  
Bankart Repair ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
Patient Reported ◽  
First Time

Background: In athletes with a first-time shoulder dislocation, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are the most commonly utilized surgical procedures to restore stability and allow them to return to play (RTP). Purpose: To compare the outcomes of ABR and OL in athletes with a first-time shoulder dislocation. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of patients with first-time shoulder dislocation who underwent primary ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. Patients who underwent ABR were pair-matched in a 2:1 ratio with patients who underwent OL by age, sex, sport, and level of preoperative play. The rate, level, and timing of RTP, as well as the Shoulder Instability–Return to Sport after Injury (SIRSI) score were evaluated. Additionally, we compared recurrence, visual analog scale pain score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the surgery again. Results: Overall, 80 athletes who underwent ABR and 40 who underwent OL were included, with a mean follow-up of 50.3 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, or recurrent dislocation rate. There were also no differences between ABR and OL in patient-reported outcome scores or patient satisfaction. When collision athletes were compared between ABR and OL, there were no differences in RTP, SIRSI score, or redislocation rate. Conclusion: ABR and OL resulted in excellent clinical outcomes, with high rates of RTP and low recurrence rates. Additionally, there were no differences between the procedures in athletes participating in collision sports.

scholarly journals PROMIS and FAAM Minimal Clinically Important Differences in Foot and Ankle Orthopedics

2018 ◽  
Vol 40 (1) ◽  
pp. 65-73 ◽  
Author(s):  
Man Hung ◽  
Judith F. Baumhauer ◽  
Frank W. Licari ◽  
Maren W. Voss ◽  
Jerry Bounsanga ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Minimum Clinically Important Difference ◽  
Measurement Information ◽  
Diagnostic Study ◽  
Foot And Ankle ◽  
Meaningful Change ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Level I

Background: Establishing score points that reflect meaningful change from the patient perspective is important for interpreting patient-reported outcomes. This study estimated the minimum clinically important difference (MCID) values of 2 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments and the Foot and Ankle Ability Measure (FAAM) Sports subscale within a foot and ankle orthopedic population. Methods: Patients seen for foot and ankle conditions at an orthopedic clinic were administered the PROMIS Physical Function (PF) v1.2, the PROMIS Pain Interference (PI) v1.1, and the FAAM Sports at baseline and all follow-up visits. MCID estimation was conducted using anchor-based and distribution-based methods. Results: A total of 3069 patients, mean age of 51 years (range = 18-94), were included. The MCIDs for the PROMIS PF ranged from approximately 3 to 30 points (median = 11.3) depending on the methods being used. The MCIDs ranged from 3 to 25 points (median = 8.9) for the PROMIS PI, and from 9 to 77 points (median = 32.5) for the FAAM Sports. Conclusions: This study established a range of MCIDs in the PROMIS PF, PROMIS PI, and FAAM Sports indicating meaningful change in patient condition. MCID values were consistent across follow-up periods, but were different across methods. Values below the 25th percentile of MCIDs may be useful for low-risk clinical decisions. Midrange values (eg, near the median) should be used for high stakes decisions in clinical practice (ie, surgery referrals). The MCID values within the interquartile range should be utilized for most decision making. Level of Evidence: Level I, diagnostic study, testing of previously developed diagnostic measure on consecutive patients with reference standard applied.

Arthroscopic ligament-specific repair for triangular fibrocartilage complex foveal avulsions: a minimum 2-year follow-up study

2020 ◽  
pp. 175319342095790
Author(s):  
Bo Liu ◽  
Margareta Arianni ◽  
Feiran Wu
Keyword(s):  
Patient Reported Outcomes ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Flexion Extension ◽  
Patient Reported ◽  
Triangular Fibrocartilage ◽  
The Mean ◽  
Viable Method

This study reports the arthroscopic ligament-specific repair of the triangular fibrocartilage complex (TFCC) that anatomically restores both the volar and dorsal radioulnar ligaments into their individual foveal footprints. Twenty-five patients underwent arthroscopic ligament-specific repair with clinical and radiological diagnoses of TFCC foveal avulsions. The mean age was 28 years (range 14–47) and the mean follow-up was 31 months (range 24–47). Following arthroscopic assessment, 20 patients underwent double limb radioulnar ligament repairs and five had single limb repairs. At final follow-up, there were significant improvements in wrist flexion–extension, forearm pronation–supination and grip strength. There were also significant improvements in pain and patient-reported outcomes as assessed by the patient-rated wrist evaluation, Disabilities of the Arm, Shoulder and Hand score and modified Mayo wrist scores. Arthroscopic ligament-specific repair of the TFCC does not require specialist dedicated equipment or consumables and offers a viable method of treating these injuries. Level of evidence: IV

Clinical Outcome of Arthroscopic Bankart Repair Combined With Simultaneous Capsular Repair

2017 ◽  
Vol 45 (6) ◽  
pp. 1289-1296 ◽  
Author(s):  
Shigeto Nakagawa ◽  
Ryo Iuchi ◽  
Tatsuo Mae ◽  
Naoko Mizuno ◽  
Yasuhiro Take
Keyword(s):  
Postoperative Recurrence ◽  
Bankart Repair ◽  
Level Of Evidence ◽  
Old Patients ◽  
Glenohumeral Ligament ◽  
Capsular Repair ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
Competitive Athletes

Background: A capsular tear and humeral avulsion of the glenohumeral ligament lesion are not uncommon findings in association with a Bankart lesion. However, there have been few reports regarding the prevalence of such capsular lesions and the postoperative recurrence after capsular repair. Purpose/Hypothesis: This study investigated the prevalence of capsular lesions and clarified their influence on the postoperative recurrence of instability. In addition, factors were identified that were associated with the occurrence of capsular lesions and the postoperative recurrence of instability. We hypothesized that clinical outcomes would be improved by combining arthroscopic Bankart repair with simultaneous capsular repair. Study Design: Cohort study; Level of evidence, 3. Methods: Capsular lesions were retrospectively examined through operative records, still pictures, and videos in 172 shoulders with traumatic anterior instability. First, the prevalence of capsular lesions and their severity were investigated. Then, postoperative recurrence was determined in shoulders observed for a minimum of 2 years. Finally, factors were assessed that were associated with the occurrence of capsular lesions and the postoperative recurrence of instability. Results: A capsular lesion was recognized in 37 shoulders (21.5%), being severe and mild in 20 and 17, respectively. All were repaired simultaneously with the arthroscopic Bankart procedure. After follow-up for at least 2 years, recurrence of instability was detected in 10 of 34 shoulders (29.4%), including 6 (31.6%) with severe capsular lesions and 4 (26.7%) with mild lesions. The recurrence rate was significantly higher in shoulders with a capsular lesion than in shoulders without a capsular lesion (18 of 120, 15%; P = .013), but there was no significant difference between severe and mild lesions. Regardless of the sport played, capsular lesions were significantly more frequent in patients ≥30 years old, patients with complete dislocation, and patients with a coexisting Hill-Sachs lesion. Postoperative recurrence of instability was significantly more frequent in patients <30 years and competitive athletes. Conclusion: In shoulders undergoing arthroscopic Bankart repair, capsular lesions were often present and were associated with higher postoperative recurrence of instability. While these lesions were more frequent in older patients, postoperative recurrence of instability was more likely in young competitive athletes.

scholarly journals Correlation of 2-year SRS-22r and ODI patient-reported outcomes with 5-year patient-reported outcomes after complex spinal fusion: a 5-year single-institution study of 118 patients

2018 ◽  
Vol 29 (4) ◽  
pp. 422-428 ◽  
Author(s):  
Owoicho Adogwa ◽  
Isaac O. Karikari ◽  
Aladine A. Elsamadicy ◽  
Amanda R. Sergesketter ◽  
Diego Galan ◽  
...  
Keyword(s):  
Mental Health ◽  
Spinal Fusion ◽  
Patient Reported Outcomes ◽  
Research Society ◽  
Scoliosis Research Society ◽  
Self Image ◽  
Patient Reported ◽  
Spinal Arthrodesis

OBJECTIVEPatient-reported outcomes (PROs) are often measured up to 2 years after surgery; however, prospective collection of longitudinal outcomes for 5 years postoperatively can be challenging due to lack of patient follow-up. The aim of this study was to determine whether PROs collected at 2-year follow-up accurately predict long-term PROs 5 years after complex spinal fusion (≥ 5 levels).METHODSThis was an ambispective study of 118 adult patients (≥ 18 years old) undergoing ≥ 5-level spinal arthrodesis to the sacrum with iliac fixation from January 2002 to December 2011. Patient demographics and radiographic parameters as well as intraoperative variables were collected. PRO instruments (Scoliosis Research Society [SRS]-22r function, self-image, mental health, pain, and Oswestry Disability Index [ODI]) were completed before surgery then at 2 and 5 years after surgery. Primary outcome investigated in this study was the correlation between SRS-22r domains and ODI collected at 2- and 5-year follow-up.RESULTSOf the 118 patients, 111 patients had baseline PROs, 105 patients had 2-year follow-up data, and 91 patients had 5-year follow-up PRO data with 72% undergoing revision surgery. The average pre- and postoperative major coronal curve Cobb angles for the cohort were 32.1° ± 23.7° and 19.8° ± 19.3°, respectively. There was a strong correlation between 2- and 5-year ODI (r2 = 0.80, p < 0.001) and between 2- and 5-year SRS-22r domains, including function (r2 = 0.79, p < 0.001), self-image (r2 = 0.82, p < 0.001), mental health (r2 = 0.77, p < 0.001), and pain (r2 = 0.79, p < 0.001). Of the PROs, ODI showed the greatest absolute change from baseline to 2- and 5-year follow-up (2-year Δ 17.6 ± 15.9; 5-year Δ 16.5 ± 19.9) followed by SRS-22r self-image (2-year Δ 1.4 ± 0.96; 5-year Δ 1.3 ± 1.0), pain (2-year Δ 0.94 ± 0.97; 5-year Δ 0.80 ± 1.0), function (2-year Δ 0.60 ± 0.62; 5-year Δ 0.49 ± 0.79), and mental health (2-year Δ 0.49 ± 0.77; 5-year Δ 0.38 ± 0.84).CONCLUSIONSPatient-reported outcomes collected at 2-year follow-up may accurately predict long-term PROs (5-year follow-up).

scholarly journals The Impact of Pre-Operative Mental Health and Depression on Outcomes after Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0018
Author(s):  
Daniel J. Cunningham ◽  
John Steele ◽  
Samuel B. Adams
Keyword(s):  
Mental Health ◽  
Patient Reported Outcomes ◽  
Total Ankle Arthroplasty ◽  
Linear Regression Models ◽  
Ankle Arthroplasty ◽  
Change Scores ◽  
Short Musculoskeletal Function Assessment ◽  
Patient Reported ◽  
The Impact

Category: Ankle Introduction/Purpose: Poor pre-operative mental health and depression have been shown to negatively impact patient- reported outcomes (PROMs) after a broad array of orthopaedic procedures involving the spine, hip, knee, shoulder, and hand. However, the relationship of mental health and patient-reported outcomes in foot and ankle surgery is less clear. The purpose of this study is to characterize the impact of pre-operative mental health and depression on patient-reported outcomes after total ankle arthroplasty. The study hypothesis is that depression and decreased SF36 MCS will be significantly associated with diminished improvement in PROMs after total ankle arthroplasty. Methods: All patients undergoing primary TAA between January 2007 and December 2016 who were enrolled into a prospective, observational study and who had at least 1 to 2-year minimum study follow-up were included. Patients were separated into 4 groups based on the presence or absence of SF36 MCS<35 and diagnosis of depression. Pre-operative to post- operative change scores in the SF36 physical and mental component summary scores (PCS and MCS), Short Musculoskeletal Function Assessment (SMFA) function and bother components, and visual analog scale (VAS) pain were calculated in 1 to 2-year follow-up. Multivariable, main effects linear regression models were constructed to evaluate the impact of SF36 and depression status on pre-operative to 1 to 2-year follow-up change scores with adjustment for age, sex, race, body mass index, current smoking, American Society of Anesthesiologist’s score, smoking, and Charlson-Deyo comorbidity score. Results: As in Table 1, adjusted analyses demonstrated that patients with MCS<35 and depression had significantly lower improvements in all change scores including SF36 MCS (-5.1 points) and PCS (-7.6 points), SMFA bother (6 points) and function scores (5.7 points), and VAS pain (7.5 points) compared with patients that had SF36>=35 and no depression. Patients with MCS<35 and no depression had significantly greater improvement in SF36 MCS (5.3 points) compared with patients that had MCS>=35 and no depression. Patients with MCS>=35 and depression had significantly lower improvement in SF36 MCS (-3.2 points) compared with patients that had MCS>=35 and no depression. Adjusted analyses of minimum 5-year outcomes demonstrated significantly increased improvement in MCS and SMFA function for patients with pre-operative MCS<35 and no depression. Conclusion: Presence of depression and decreased SF36 MCS are risk factors for diminished improvement in PROMs. Patients with depression and decreased MCS should be counseled about their risk of diminished improvement in outcomes compared to peers. As PROM’s become part of physician evaluations, it is becoming increasingly important to identify factors for diminished improvement outside of the physician’s control. [Table: see text]

scholarly journals Patient-Reported Outcomes following Arthroscopic Triangular Fibrocartilage Complex Repair

2019 ◽  
Vol 09 (01) ◽  
pp. 058-062 ◽  
Author(s):  
Caroline A. Selles ◽  
Philip N. d'Ailly ◽  
Niels W.L. Schep
Keyword(s):  
Patient Reported Outcomes ◽  
Primary Outcome ◽  
Additional Treatment ◽  
Triangular Fibrocartilage Complex ◽  
Level Of Evidence ◽  
Additional Surgery ◽  
Patient Reported ◽  
Triangular Fibrocartilage ◽  
Operative Findings

Abstract Background Triangular fibrocartilage complex (TFCC) injury is a common cause of ulnar-sided wrist pain, which may lead to serious physical impairments. Arthroscopic repair has benefits such as less soft tissue damage, greater surgical accuracy, and may lead to faster recovery than open repair. Objective The purpose of this study was to determine the functional outcome of patients with symptomatic TFCC injuries treated with arthroscopic debridement or repair. Patients and Methods A retrospective study of all consecutive patients with a TFCC injury treated arthroscopically was conducted. The primary outcome was the patient-rated wrist evaluation (PRWE) score. Secondary outcomes were, pain, operative findings, complications, and additional treatment. Results A total of 51 patients with a median follow-up of 16.5 months (interquartile range [IQR]: 13–25) were included. Injuries were treated with TFCC debridement (n = 25), TFCC ligament to capsule suturing (n = 10), TFCC debridement and ligament to capsule suturing (n = 7), TFCC debridement and synovectomy (n = 5), and TFCC foveal reinsertion with a suture anchor (n = 4). The median PRWE was 19.5 (IQR: 6–49). Complications occurred in three patients and in nine patients additional surgery was performed. Conclusion Arthroscopic treatment of TFCC lesions leads to satisfactory functional outcomes. Level of Evidence This is a Level IV study.

scholarly journals Patient-Reported Outcomes After Multiligament Knee Injury

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769481 ◽  
Author(s):  
Jessica M. Hanley ◽  
Christopher A. Anthony ◽  
David DeMik ◽  
Natalie Glass ◽  
Annunziato Amendola ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patient Reported Outcomes ◽  
Knee Injury ◽  
Lysholm Score ◽  
Level Of Evidence ◽  
Time To Surgery ◽  
Patient Reported ◽  
Ikdc Score ◽  
Univariate Analyses

Background: Management of the medial collateral ligament (MCL) in the setting of a multiligamentous knee injury (MLKI) represents an area of great controversy. Purpose: Our study was designed to compare long-term patient-reported outcomes (PROs) after MCL repair versus reconstruction in the setting of a multiligamentous injury of the knee. Study Design: Cohort study; Level of evidence, 3. Methods: At a single institution, 68 patients were identified over a 10-year period as having MCL intervention in the setting of MLKI. Of these patients, 34 (50%) were successfully contacted via telephone to collect Lysholm and International Knee Documentation Committee (IKDC) scores. A retrospective chart review of these subjects was also conducted to identify patient and surgical factors affecting PROs. Results: At a mean 6-year follow-up (range, 2-11 years), the mean Lysholm score was 77.4 ± 23.1 and mean IKDC score was 72.6 ± 23.6. Univariate analyses identified time to surgery ( P = .005) and MCL reconstruction ( P = .001) as risk factors for Lysholm score ≤75. Univariate analyses identified patient age ( P = .049), time to surgery ( P = .018), and MCL reconstruction ( P = .004) as risk factors for IKDC score ≤75. On subsequent multivariate analysis, MCL reconstruction was found to be a predictor of Lysholm or IKDC score of ≤75. Conclusion: Patients undergoing MCL repair in the setting of MLKI generally had higher PROs than those undergoing reconstructions at a mean 6 years of follow-up. Further work is needed to elucidate patient and surgical factors that may influence subjective outcomes after multiligament knee injuries.

Comparison of 5-Year Patient-Reported Outcomes (PROMs) of Total Ankle Replacement (TAR) to Total Knee Replacement (TKR) and Total Hip Replacement (THR)

2020 ◽  
Vol 41 (7) ◽  
pp. 767-774
Author(s):  
Jayasree Ramaskandhan ◽  
Anjum Rashid ◽  
Simon Kometa ◽  
Malik S. Siddique
Keyword(s):  
Mental Health ◽  
Hip Replacement ◽  
Patient Reported Outcomes ◽  
Ankle Replacement ◽  
Sf 36 ◽  
Patient Reported ◽  
Total Knee ◽  
End Stage ◽  
Satisfaction Rates

Background: Total ankle replacement (TAR) is becoming a more common alternative to ankle arthrodesis for the improvement of pain and function in end-stage arthritis of the ankle. The effects of end-stage arthritis of the ankle are similar to those of end-stage hip arthritis. There is a paucity of literature on patient-reported outcome measures (PROMs) following TARs in comparison with total hip replacement (THR) or total knee replacement (TKR). We aimed to study the 1-, 3-, and 5-year outcomes of TAR in comparison with TKR and THR. Methods: PROMs data from patients who underwent a primary THR, TKR, or TAR performed between March 2008 and 2013 over a 5-year period were collected from our hospital patient registry. They were divided into 3 groups based on the type of primary joint replacement. Patient demographics and patient-reported outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 36-item Short-Form (SF-36) scores, and patient satisfaction scores at follow-up) were compared preoperatively and at the 1-, 3-, and 5-year follow-ups. Results: There were data available on 2672 THR, 3520 TKR, and 193 TAR patients preoperatively. Preoperatively, TAR patients reported statistically significantly higher function scores when compared with THR and TKR patients (40 vs 33; P = .001 [ P < .05] and 40 vs 36; P = .001 [ P < .05]). For SF-36 scores, there was no statistically significant difference between groups for the general health and role emotional components ( P = .171 and .064, respectively [ P > .05]); TAR patients reported similar scores to TKR patients for physical domains at the 3- and 5-year follow-ups ( P > .05), and TAR patients also reported similar scores to both THR and TKR patients for the mental domains ( P > .05). At 5 years postoperatively, TAR patients reported lower scores than THR and TKR patients for function and stiffness. For SF-36 scores, TAR patients reported similar outcomes to THR and TKR patients for mental health components ( P > .05), similar scores to TKR patients for 3 of 4 physical domains ( P < .05), but lower satisfaction rates for activities of daily living (ADL) and recreation when compared with THR ( P < .05). Conclusion: TAR patients had similar outcomes to THR and TKR patients for disease-specific and mental health domains, and lower patient satisfaction rates in terms of pain relief, ADL, and recreation. Further research is warranted including clinical outcomes along with PROMs with a long-term follow-up. Level of Evidence: Level III, retrospective comparative series.

Salter-Harris II distal radial fractures treated with the intrafocal K-wire technique: a retrospective study of 20 cases

2020 ◽  
pp. 175319342095307
Author(s):  
J. Terrence Jose Jerome
Keyword(s):  
Patient Reported Outcomes ◽  
Age Groups ◽  
Treatment Delay ◽  
Distal Radial Fractures ◽  
Level Of Evidence ◽  
Wrist Motion ◽  
Fracture Displacement ◽  
Patient Reported ◽  
Salter Harris

We retrospectively reviewed 20 children with Salter-Harris II fractures of the distal radius treated with intrafocal pinning according to Kapandji. Unlike conventional crossed K-wire pinning, this method avoids crossing the physis with the pins and thus minimizes the risk of physeal damage. None of the children had fracture re-displacement, angulation or growth deformities. The age, sex, side of injury, fracture displacement or angulation, treatment delay or immobilization period had any significant impact on the functional outcome. At a mean follow-up of 49 months (range 47–60), plain radiographs and MRI showed no growth arrests or physeal bars or bridges. Grip strength, wrist motion and patient-reported outcomes were almost normal with no or minimal pain at the injury site. We conclude that intrafocal K-wire pinning is simple, safe and affordable. We cannot provide data on what is acceptable fracture displacement for different age groups to allow for acceptable final remodelling of any malalignment. Level of evidence: IV

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