In a small retrospective cohort of patients with syndesmotic injury, only athletes benefited from placement of a suture button device: a pilot study

ObjectivesInjuries to the ankle are common, with a significant number of ligamentous injuries involving the syndesmosis. In syndesmotic injuries severe enough to require surgical fixation, the two leading techniques are rigid screw and suture button fixation. The literature has shown that both techniques are effective, but there remains debate on the optimum method of treatment. The goal of this study was to evaluate patient-reported outcomes for these repair methods in a population of athletes.MethodsThis study was a retrospective cross-sectional study of patients who had undergone rigid screw or suture button fixation for an injury to the ankle syndesmosis. Specifically, a subpopulation of athletes was examined as it was hypothesised that these high-demand patients would have higher patient-reported outcomes with ongoing suture button fixation. Study participants were identified through a search of the medical record and were recruited through mailed letters and phone calls. Participants completed patient-reported outcome questionnaires including the Activities of Daily Living and Sports Subscales of the Foot and Ankle Ability Measure (FAAM) survey, FAAM Sports Subscale survey, Veteran’s Rand 12-item Health Survey (VR-12) and a customised athletic activity questionnaire. These patient-reported outcomes were compared between those who underwent screw fixation and those who underwent suture button fixation.Results32 patients completed the study, with 17 of these designated as ‘athletes’ competing in strenuous sports activities that involve jumping, cutting and hard pivoting including football, soccer, basketball, volleyball and gymnastics at the high school level or above. Patients were on average 3.9 years post op (SD 2.2). With the numbers available, no difference in outcomes between patients with rigid screw or suture button fixation was observed in the study as a whole. In a subpopulation of athletes, patients who received suture button fixation had higher FAAM scores compared with those treated with rigid screw fixation (p=0.02). Still, in the subpopulation of athletes, no statistical difference was observed with the available numbers for the other patient-reported outcomes.ConclusionThis pilot study of outcomes in an athletic population suggests that athletic patients may benefit from suture button fixation and lays the groundwork for future work examining the use of suture button fixation in high-demand patients.Level of evidenceLevel III—Retrospective Comparative Study.

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An In Vivo Biomechanical Analysis of Syndesmotic Surgical Repair in Elite Athletes: Screw versus Suture Button Fixation

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00152 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0015

Author(s):

Stephen P. Canton ◽

Tom Gale ◽

Dukens LaBaze ◽

William Anderst ◽

MaCalus V. Hogan

Keyword(s):

Patient Reported Outcomes ◽

Screw Fixation ◽

Tracking System ◽

Surgical Techniques ◽

Biomechanical Analysis ◽

Fixation Method ◽

Patient Specific ◽

Suture Button ◽

Patient Reported

Category: Trauma; Basic Sciences/Biologics Introduction/Purpose: Syndesmotic injuries account for 1-11% of all ankle sprains and are the most predictive factor of chronic ankle dysfunction 6 months after injury. Common surgical techniques include screw fixation (the ‘gold standard’) and dynamic fixation with a suture button device, which may lead to better clinical outcomes than rigid screw. To date, there are no studies comparing the in vivo biomechanics of suture button and rigid screw syndesmotic fixation, and no report of the correlations between biomechanics and patient outcomes. The goal of this study is to characterize the biomechanics of the native ankle syndesmosis, rigid screw fixation, suture button fixation, along with associated patient-reported outcomes. This study will elucidate mechanisms for improved patient-reported outcomes based on the fixation method. Methods: 6 patients (average age:23.6, 4M/1F, 2 suture button, 2 screw fixation and 1 hybrid) consented to participate in this IRB-approved study. After being medically cleared to return to full athletic participation, each participant performed seven movements (two single leg hops (straight and lateral), two alternating single-leg push-offs (front-to-back and side-to-side), vertical jumping, running, and walking within a biplane radiographic system (Figure 1). A validated volumetric model-based tracking system matched patient-specific 3D bone models (obtained from CT) to the synchronized biplane radiographs (Figure 1). Six degree of freedom ankle kinematics were determined for each movement and for the repaired and contralateral ankle of each participant. Patient reported outcomes were also measured using the Foot and Ankle Ability Measure (FAAM) and a Visual Analogue Scale (VAS). Results: The results show that the screw fixation (-0.99 mm) has greater tibiotalar lateral-medial translation of the injured side relative contralateral healthy side compared to the tightrope fixation (-0.73 mm) and hybrid (.05 mm). For the syndesmosis translation, the screw fixation (2.00 mm) also exhibits greater total magnitude of translation compared to the tightrope ((-0.44 mm) and hybrid fixation (1.02 mm). Conclusion: This study shows that the screw fixation exhibits greater translation of the syndemosis and lateral/medial translation of the Talus. This may suggest that this method is inferior to the tight-rope and hybrtid. Future studies will include all the motions and more subjects.

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Sex differences in outcomes after arthroscopic bankart repair

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000965 ◽

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.

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Comparison of Direct Surgical Costs for Proximal Row Carpectomy and Four-Corner Arthrodesis

Journal of Wrist Surgery ◽

10.1055/s-0038-1675791 ◽

2018 ◽

Vol 08 (01) ◽

pp. 066-071 ◽

Cited By ~ 5

Author(s):

Andrew Stephens ◽

Angela Presson ◽

Yizhe Xu ◽

Ross Feller ◽

Andrew Tyser ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Operative Time ◽

Tertiary Care ◽

Proximal Row Carpectomy ◽

Level Of Evidence ◽

Surgical Costs ◽

Patient Reported ◽

Simultaneous Procedures ◽

Supply Costs ◽

Staple Fixation

Background Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) are common treatments for stage II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists, with similar functional and patient-reported outcomes reported in the peer-reviewed literature. Questions Study questions included (1) whether surgical encounter total direct costs (SETDCs) differ between PRC and FCA, and (2) whether SETDC differs by method of fixation for FCA. Patients and Methods Consecutive adult patients (≥ 18 years) undergoing PRC and FCA between July 2011 and May 2017 at a single tertiary care academic institution were identified. Patients undergoing additional simultaneous procedures were excluded. Using our institution's information technology value tools, we extracted prospectively collected cost data for each surgical encounter. SETDCs were compared between PRC and FCA, and between FCA subgroups (screws, plating, or staples). Results Of 42 included patients, mean age was similar between the 23 PRC and 19 FCA patients (51.2 vs. 54.5 years, respectively). SETDCs were significantly greater for FCA than PRC by 425%. FCA involved significantly greater facility costs (2.3-fold), supply costs (10-fold), and operative time (121 vs. 57 minutes). Implant costs were absent for PRC, which were responsible for 55% of the SETDC for FCA. Compared with compression screws, plating and staple fixation were significantly more costly (70% and 240% greater, respectively). Conclusion SETDCs were 425% greater for FCA than PRC. Implant costs for FCA alone were 130% greater than the entire surgical encounter for PRC. For FCA, SETDC varied depending on the method of fixation. Level of Evidence This is a level III, cost analysis study.

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Sleep Tracking and Exercise in Patients With Type 2 Diabetes Mellitus (Step-D): Pilot Study to Determine Correlations Between Fitbit Data and Patient-Reported Outcomes (Preprint)

10.2196/preprints.8122 ◽

2017 ◽

Author(s):

James Weatherall ◽

Yurek Paprocki ◽

Theresa M Meyer ◽

Ian Kudel ◽

Edward A Witt

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Pilot Study ◽

Patient Reported Outcomes ◽

Sleep Problems ◽

Health Data ◽

Patient Reported

BACKGROUND Few studies assessing the correlation between patient-reported outcomes and patient-generated health data from wearable devices exist. OBJECTIVE The aim of this study was to determine the direction and magnitude of associations between patient-generated health data (from the Fitbit Charge HR) and patient-reported outcomes for sleep patterns and physical activity in patients with type 2 diabetes mellitus (T2DM). METHODS This was a pilot study conducted with adults diagnosed with T2DM (n=86). All participants wore a Fitbit Charge HR for 14 consecutive days and completed internet-based surveys at 3 time points: day 1, day 7, and day 14. Patient-generated health data included minutes asleep and number of steps taken. Questionnaires assessed the number of days of exercise and nights of sleep problems per week. Means and SDs were calculated for all data, and Pearson correlations were used to examine associations between patient-reported outcomes and patient-generated health data. All respondents provided informed consent before participating. RESULTS The participants were predominantly middle-aged (mean 54.3, SD 13.3 years), white (80/86, 93%), and female (50/86, 58%). Use of oral T2DM medication correlated with the number of mean steps taken (r=.35, P=.001), whereas being unaware of the glycated hemoglobin level correlated with the number of minutes asleep (r=−.24, P=.04). On the basis of the Fitbit data, participants walked an average of 4955 steps and slept 6.7 hours per day. They self-reported an average of 2.0 days of exercise and 2.3 nights of sleep problems per week. The association between the number of days exercised and steps walked was strong (r=.60, P<.001), whereas the association between the number of troubled sleep nights and minutes asleep was weaker (r=.28, P=.02). CONCLUSIONS Fitbit and patient-reported data were positively associated for physical activity as well as sleep, with the former more strongly correlated than the latter. As extensive patient monitoring can guide clinical decisions regarding T2DM therapy, passive, objective data collection through wearables could potentially enhance patient care, resulting in better patient-reported outcomes.

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Pilot Study to Integrate Patient Reported Outcomes After Lung Cancer Operations Into The Society of Thoracic Surgeons Database

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2017.01.110 ◽

2017 ◽

Vol 104 (1) ◽

pp. 245-253 ◽

Cited By ~ 22

Author(s):

Onkar V. Khullar ◽

Mohammed H. Rajaei ◽

Seth D. Force ◽

Jose N. Binongo ◽

Yi Lasanajak ◽

...

Keyword(s):

Lung Cancer ◽

Pilot Study ◽

Patient Reported Outcomes ◽

Patient Reported

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

Foot & Ankle International ◽

10.1177/1071100718800304 ◽

2018 ◽

Vol 40 (1) ◽

pp. 65-73 ◽

Cited By ~ 21

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.

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

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420957901 ◽

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

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