Neurovascular and Clinical Outcomes of the Percutaneous Endoscopically Assisted Calcaneal Osteotomy (PECO) Technique to Correct Hindfoot Malalignment

Background: Standard open calcaneal osteotomies to correct hindfoot malalignment have been associated with high complication rates, including nerve damage and wound infection. This has resulted in the development of minimally invasive techniques such as the percutaneous endoscopically assisted calcaneal osteotomy (PECO), which in cadaver studies has been shown to be potentially safer than open surgeries. The aim of this study was to demonstrate the safety and effectiveness of PECO in a clinical setting, with regard to neurovascular injury rates, infection, and short-term radiographic and functional outcomes. Methods: Forty-one (41) patients with planovalgus or cavovarus foot deformities underwent treatment using PECO. Outcomes were analyzed at 6 months and primarily included neurovascular outcomes and wound infection rates. Secondarily, radiographic and functional (visual analog scale for pain [VAS], 36-Item Short Form Medical Outcomes Survey [SF-36], and Foot Function Index [FFI] scores) outcomes were also assessed. Results: There were no reported cases of superficial wound infections, lateral calcaneal or sural nerve dysesthesia. Minor complications occurred in 6/41 feet. The mean postoperative hindfoot correction was 8.3 ± 2.2 mm (range: 6-15mm) compared to preoperative status. Compared to preoperative status, significant improvements ( P = .001 for all) were seen in the VAS, SF-36, and FFI at 6 months postoperatively. Conclusions: PECO resulted in minimal complications with no lateral calcaneal or sural nerve dysesthesias and no wound complications. It also resulted in significant improvements in postoperative radiographic and functional outcomes from baseline to 6-months postoperatively, demonstrating its use as a safe and effective means of treating hindfoot malalignment. Level of Evidence: Level IV, retrospective case series.

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Outcomes of Operative Management of Insertional Achilles Tendinopathy in the Young vs Elderly

Foot & Ankle Orthopaedics ◽

10.1177/2473011420926101 ◽

2020 ◽

Vol 5 (3) ◽

pp. 247301142092610

Author(s):

Huai Ming Phen ◽

Wesley J. Manz ◽

Danielle Mignemi ◽

Joel T. Greenshields ◽

Jason T. Bariteau

Keyword(s):

Linear Regression ◽

Wound Infection ◽

Surgical Management ◽

Short Form ◽

Achilles Tendinopathy ◽

Heel Pain ◽

Complication Rates ◽

Sf 36 ◽

Significant Difference ◽

Insertional Achilles Tendinopathy

Background: Insertional Achilles tendinopathy (IAT) is a common cause of chronic posterior heel pain. Surgical intervention reproducibly improves patients’ pain and functional status. We hypothesized that patients older than 60 years would have similar improvements in pain and function and low rates of complications after surgery for IAT when compared to a younger cohort. Methods: Retrospective review of adult case series in patients undergoing surgical management of IAT. Patients were stratified into those 60 years and younger and those older than 60 years. Patients with prior or concomitant surgical procedures and revisions were excluded. Visual analog scale (VAS), Short Form–36 Physical Component Summary and Mental Component Summary (SF-36 PCS/MCS) scores, wound infection, and recurrence, defined as a redevelopment of heel pain in the operative extremity within 6 months, were assessed with a minimum follow-up of 12 months. Statistical analysis was performed using linear regression mixed models and χ2 analysis. Thirty-seven patients were enrolled, with 38 operative heels. The younger cohort had an average age of 49.1 (range, 26-60) years. The older group had an average age of 66.8 (range, 61-76) years. Results: VAS and SF-36 PCS scores for the entire cohort significantly improved at 6 and 12 months postoperatively ( P < .001). Postoperative SF-36 MCS scores for the cohort significantly improved only at 12 months ( P < .001). No significant differences between the young and elderly were seen with regard to improvements in VAS and SF-36 PCS/MCS at 6 or 12 months postoperatively. Multiple linear regression models showed no significant difference between age groups and VAS score, SF-36 PCS/MCS, or change in pain scores after controlling for comorbidities. No significant difference in overall complication rates was seen between the 2 groups (4.9% vs 29.4%, P = .104). There was 1 recurrence of heel pain in the younger group and 4 recurrences of pain in the older group (23.5%) at 6 months, of which 2 resolved at 1 year. There was 1 case of a superficial wound infection requiring antibiotics in the older cohort (5.9%). No patients required surgical revision. Conclusion: Surgical management of IAT in an older population produced similar improvements in clinical results when compared to a younger cohort, with no significant increase in postoperative complications. Level of Evidence: Level III, retrospective comparative series.

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Effect of Age on Complication Rates and Outcomes Following First Metatarsophalangeal Arthrodesis for Hallux Rigidus

Foot & Ankle International ◽

10.1177/1071100720942140 ◽

2020 ◽

Vol 41 (11) ◽

pp. 1347-1354

Author(s):

Matthew P. Lunati ◽

Wesley J. Manz ◽

Samuel D. Maidman ◽

Nathan R. Kukowski ◽

Danielle Mignemi ◽

...

Keyword(s):

Older Patients ◽

Patient Reported Outcomes ◽

Short Form ◽

Age Groups ◽

Hallux Rigidus ◽

Wound Complications ◽

Complication Rates ◽

Level Of Evidence ◽

Sf 36 ◽

Patient Reported

Background: Hallux rigidus is one of the most common toe pathologies in patients greater than 50 years old. Although metatarsophalangeal (MTP) arthrodesis is used to improve pain and function, older patients are often considered to be higher-risk operative candidates. There are minimal data on outcomes of MTP fusion and no studies comparing outcomes between geriatric and younger patients. Methods: This is a single-center, prospective study of all patients who underwent MTP fusion between August 1, 2015, and July 1, 2018. Patient-reported outcomes were assessed using the Short Form Health Survey (SF-36), Life-Space Assessment survey (LSA), and visual analog scale (VAS) for pain administered preoperatively as well as 6 months and 1 year postoperatively. Baseline characteristics and operative outcomes were collected from the electronic medical record. Clinical and patient-reported outcomes were compared between patients <65 years old and ≥65 years old. Of 143 included patients, 79 were in the younger group (mean of 56.5 years) and 64 were in the older group (mean of 72.0 years). Results: Compared with the younger group, the older group was more predominantly female (95.3% older group, 77.2% younger group, P = .002). More patients in the older group had hypertension (73.4% older group, 50.6% younger group, P = .005) and coronary artery disease (9.4% older group, 0.0% younger group, P = .005). Both age groups had similar rates of postoperative wound complications requiring operative irrigation and debridement, deep vein thrombosis, deformity recurrence, and revision surgery. No differences were detected in SF-36, LSA, and VAS surveys administered at baseline, 6 months postoperation, or 1 year postoperation between younger and older patients. Conclusion: Despite more comorbidities, older patients had similar rates of postoperative complications and reported similar outcomes for pain, function, and mobility following MTP fusion. These findings support increased implementation of MTP fusion surgery for older patients with hallux rigidus. Level of Evidence: Level II, prospective cohort.

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Early results of patellofemoral inlay resurfacing arthroplasty using the HemiCap Wave prosthesis

Journal of Orthopaedic Surgery ◽

10.1177/2309499017692705 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901769270 ◽

Cited By ~ 9

Author(s):

Akash Patel ◽

Zakir Haider ◽

Amarjit Anand ◽

Dominic Spicer

Keyword(s):

Disease Progression ◽

Functional Outcomes ◽

Short Form ◽

Oxford Knee Score ◽

Published Data ◽

Complication Rates ◽

Patellofemoral Osteoarthritis ◽

Resurfacing Arthroplasty ◽

Early Results ◽

Sf 36

Background: Common surgical treatment options for isolated patellofemoral osteoarthritis include arthroscopic procedures, total knee replacement and patellofemoral replacement. The HemiCap Wave patellofemoral resurfacing prosthesis is a novel inlay design introduced in 2009 with scarce published data on its functional outcomes. We aim to prospectively evaluate early functional outcomes and complications, for patients undergoing a novel inlay resurfacing arthroplasty for isolated patellofemoral arthrosis in an independent centre. Methods: From 2010 to 2013, 16 consecutive patients underwent patellofemoral resurfacing procedures using HemiCap Wave (Arthrosurface Inc., Franklin, Massachusetts, USA) for anterior knee pain with confirmed radiologically and/or arthroscopically isolated severe patellofemoral arthrosis. Standardized surgical technique, as recommended by the implant manufacturer, was followed. Outcome measures included range of movement, functional knee scores (Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Short Form-36 (SF-36)), radiographic disease progression, revision rates and complications. Results: Eight men and eight women underwent patellofemoral HemiCap Wave resurfacing, with an average age of 63 years (range: 46–83). Average follow-up was 24.1 months (6–34). Overall, post-operative scores were excellent. There was a statistically significant improvement in the post-operative OKS, KOOS and SF-36 scores ( p < 0.01). One patient had radiological disease progression. One patient underwent revision for deep infection. Two other minor complications were observed and treated conservatively. Conclusions: The HemiCap Wave patellofemoral resurfacing prosthesis has excellent early results in terms of functional outcomes, radiological outcomes and low complication rates. At the very least, early results show that the HemiCap Wave is comparable to more established onlay prostheses. The HemiCap Wave thus provides a safe and effective surgical option in the treatment of isolated patellofemoral osteoarthritis in selected patients.

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Early Outcomes Following Dorsal Denervation of the Midfoot for Management of Arthritic Pain

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00383 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0038

Author(s):

Glenn G. Shi ◽

Arun Kumar ◽

Meredith A. Williams ◽

Benjamin K. Wilke ◽

Joseph L. Whalen ◽

...

Keyword(s):

Pain Relief ◽

Functional Outcomes ◽

Nonoperative Management ◽

Short Form ◽

Safe Alternative ◽

Sf 36 ◽

The Mean ◽

Protective Sensation ◽

And Function ◽

Complications Rate

Category: Midfoot/Forefoot Introduction/Purpose: Debilitating midfoot arthritic pain is reported to affect up to 12% of adults over 50 years. After failure of nonoperative management, midfoot arthrodesis has been favored as the primary operative treatment producing acceptable outcomes with associated potentially long postoperative immobilization and 17% major complications rate. The aim of this study was to evaluate the pain and functional outcomes of dorsal midfoot surgical denervation by deep peroneal neurectomy as a safe alternative for management of dorsal midfoot pain. Methods: In this retrospective study, 18 patients (21 feet) who underwent dorsal denervation of the midfoot by deep peroneal neurectomy by a single surgeon were evaluated. There were 13 women and 5 men with mean age 70.4 (range, 47 to 88) at the time of surgery. Indications for the procedure include painful midfoot arthritis, lack of radiographic collapse, intact plantar protective sensation, failed nonoperative management for 6 months, and greater than 75% transient pain relief from preoperative diagnostic block of deep peroneal nerve. Preoperative and postoperative (3 months, 6 months) Visual Analog Scale (VAS), Short- Form 36 (SF-36), and Foot and Ankle Outcome Score (FAOS) were reviewed. Complications were recorded. Results: The mean VAS score improved from 7.4 +/-1.9 to 1.9 +/-1.9 at 3 months and 1.4 +/-1.9 at 6 months (p<0.001). Six patients reported being pain free (VAS=0) at 3 months. All subscales of FAOS showed significant improvement at both 3 and 6 months (Table 1). The mean SF-36 total score improved from 51.4 +/-17.9 to 72.5 +/-7.6 and 74.5 +/-7.5 at 3 and 6 months respectively (p<0.001). Available radiographs at 6 months showed no further collapse. Complications include one patient with delayed wound healing and another patient with inadequate pain relief. No patients reported symptomatic paresthesia. Conclusion: Deep peroneal neurectomy for dorsal midfoot denervation is a safe and effective alternative to arthrodesis for management of dorsal arthritic midfoot pain showing significant improvements in both pain and functional outcomes at early follow up. Our study demonstrated clinical and function outcomes similar to those previously reported for arthrodesis yet with the advantages of earlier postoperative weightbearing and lower complication rate.

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Anatomically Contoured Anterior Plating for Isolated Tibiotalar Arthrodesis: A Systematic Review

Foot & Ankle Specialist ◽

10.1177/1938640017700974 ◽

2017 ◽

Vol 10 (4) ◽

pp. 352-358 ◽

Cited By ~ 2

Author(s):

Nicholas Kusnezov ◽

John C. Dunn ◽

Logan R. Koehler ◽

Justin D. Orr

Keyword(s):

Systematic Review ◽

Functional Outcomes ◽

Surgical Techniques ◽

Wound Complications ◽

Posttraumatic Arthritis ◽

Complication Rates ◽

Inclusion Criteria ◽

Tibiotalar Arthrodesis ◽

Anterior Plating

Introduction. We performed a systematic review of the published literature to characterize patient demographic, surgical techniques, and functional outcomes to elucidate the complication and revision rates following isolated tibiotalar arthrodesis with anatomically contoured anterior plating. Methods. A comprehensive literature search was performed. Inclusion criteria were peer-reviewed studies in English, after 1990, at least 10 patients, and reporting clinical outcomes following contoured anterior plating and with follow-up of at least 80% and 1 year. Primary outcomes were fusion rate, time to fusion, return to activities, satisfaction, and functional outcome scores. Complication rates, reoperation, and revision were also extracted. Results. Eight primary studies with 164 patients met the inclusion criteria. The average sample size was 21 ± 10.0 patients and average age was 49.2 years with 61.6% male. Posttraumatic arthritis (49.4%) was the most common operative indication, followed by primary osteoarthrosis (18.9%). The average follow-up was 21.1 months. At this time, 97.6% of patients went on to uneventful union at a weighted average time of 18.7 weeks postoperatively. AOFAS scores improved significantly ( P < .05). 25% complication rate was reported with wound complication (7.9%) and hardware irritation (6.7%) most common. Overall, 21.3% of patients underwent reoperation; 4 for revision arthrodesis following nonunion. Conclusion. Isolated tibiotalar arthrodesis utilizing anatomically contoured anterior plating demonstrates excellent clinical and functional outcomes at short-term follow-up. Overall, 97.6% of patients went on to fusion and functional outcomes consistently improved following surgery. Furthermore, while one-quarter of patients experienced complications, wound complications were relatively uncommon and less than one-quarter of these required surgical intervention. Levels of Evidence: Level IV: Systematic Review

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Chronic Deltoid Ligament Insufficiency Repair with Internal Brace™ Augmentation

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000071 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Manuel Pellegrini ◽

Giovanni Carcuro ◽

Natalio Cuchacovic ◽

Marcelo Somarriva ◽

Mario Escudero Heldt ◽

...

Keyword(s):

Functional Outcomes ◽

Short Form ◽

Stage Iv ◽

Deltoid Ligament ◽

Foot And Ankle ◽

Ankle Pain ◽

Ligament Repair ◽

Sf 36 ◽

Internal Brace

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Patients with chronic deltoid ligament insufficiency (CDLI) present a challenging situation in foot and ankle surgery. Although numerous surgical procedures have been described, optimal treatment is still a matter of debate. While the treatment armamentarium ranges from simple ligament repair to complex deltoid reconstructions with or without realignment osteotomies, direct repair augmented with an Internal Brace™ (Arthrex, Inc., Naples FL, USA) device appears to be an attractive intermediate option. We investigated functional outcomes and complications in patients with CDLI operated on using Internal Brace™ augmentation. Methods: After IRB approval, a prospective study was conducted. Patients were included if they were older than 18 years, presented medial ankle pain and/or giving way, exhibited asymmetric flexible hindfoot valgus, failed conservative treatment, and had a positive MRI evaluated by an independent radiologist. Patients with less than six months of follow-up, stage IV flatfoot deformity, neuropathy and/or inflammatory arthritis were excluded from the study. CDLI diagnosis was confirmed intraoperatively with the arthroscopic ankle drive-through sign. Patients were evaluated preoperatively and postoperatively using foot and ankle ability measure (FAAM) score, 36-item short form survey (SF-36), and grade of satisfaction. Paired t-tests were used to assess the pre- and postoperative FAAM and SF-36 scores. Results: Eleven patients met inclusion criteria. Nine patients were male and two female, with a mean age of 32 (18-61). Six ankles were right and five left. 88% presented with medial ankle pain, 67% medial drawer, 88% asymmetric hindfoot valgus, and 44% multidirectional ankle instability. No patient was lost to follow-up, with a mean follow-up time of 13.5 months (6-21). Preoperative FAAM and SF-36 scores improved from 58.7 to 75.3 and from 60.2 to 84.4 postoperatively, respectively (p<0.05). Two implant failures were observed, with no apparent compromise of construct stability. No patient was re-operated. Conclusion: Our results suggest that deltoid ligament repair with Internal Brace™ augmentation in patients with CDLI is a reliable option with good functional outcomes and high satisfaction grade in short term follow-up.

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Arthroscopic Microfracture for Osteochondral Lesions of the Talus: Functional Outcomes at a Mean of 6.7 Years in 165 Consecutive Ankles

The American Journal of Sports Medicine ◽

10.1177/0363546519887957 ◽

2019 ◽

Vol 48 (1) ◽

pp. 153-158 ◽

Cited By ~ 6

Author(s):

Seung-Won Choi ◽

Gun-Woo Lee ◽

Keun-Bae Lee

Keyword(s):

Functional Outcomes ◽

Short Form ◽

Arthroscopic Surgery ◽

Case Series ◽

Osteochondral Lesions ◽

Study Cohort ◽

Arthroscopic Microfracture ◽

Sf 36 ◽

The Mean

Background: Arthroscopic microfracture for osteochondral lesions of the talus (OLT) has shown good functional outcomes. However, some studies have reported that functional outcomes deteriorate over time after surgery. Purpose: To use various functional scoring systems to evaluate functional outcomes in a large sample of patients with OLT treated by arthroscopic microfracture. Study Design: Case series; Level of evidence, 4. Methods: The study cohort consisted of 165 ankles (156 patients) that underwent arthroscopic microfracture for small to mid-sized OLT. The mean lesion size was 73 mm2 (range, 17-146 mm2), and the mean follow-up period was 6.7 years (range, 2.0-13.6 years). The Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, visual analog scale (VAS) for pain, and 36-Item Short Form Health Survey (SF-36) were used to compare the functional outcomes between the preoperative and final follow-up assessments. Results: The mean FAOS significantly improved in regard to all subscores ( P < .001). The AOFAS ankle-hindfoot scale showed an improvement from 71.0 points (range, 47.0-84.0) preoperatively to 89.5 points (range, 63.0-100) at the final follow-up ( P < .001). The VAS score showed an improvement from 6.2 points (range, 4.0-9.0) preoperatively to 1.7 points (range, 0-6.0) at the final follow-up ( P < .001). The mean SF-36 score improved from 62.4 points (range, 27.4-76.6) preoperatively to 76.2 points (range, 42.1-98.0) at the final follow-up ( P < .001). Among 165 ankles, 22 ankles (13.3%) underwent repeat arthroscopic surgery for evaluation of repaired cartilage status. Conclusion: Arthroscopic microfracture showed good functional outcomes and improved quality of life with maintenance of satisfactory outcomes at a mean follow-up of 6.7 years. Therefore, arthroscopic microfracture seems to be reliable as a first-line treatment for OLT at an intermediate-term follow-up.

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Comparative Outcomes and Complications of Open versus Endoscopic Gastrocnemius Recession: A Prospective Randomized Control Trial

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00416 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0041

Author(s):

Chamnanni Rungprai ◽

Yantarat Sripanich ◽

Warongporn Pongpinyopap

Keyword(s):

Short Form ◽

Ankle Dorsiflexion ◽

Endoscopic Technique ◽

Wound Complications ◽

Endoscopic Techniques ◽

Operative Outcomes ◽

Sf 36 ◽

Significant Difference ◽

Gastrocnemius Recession ◽

Open Versus

Category: Other Introduction/Purpose: Both open and endoscopic gastrocnemius recession are commonly used for treatment of gastrosoleus contracture, however; there was a paucity of evidence in literatures to compare post-operative outcomes between the two techniques. The purpose of this study is to compare outcomes and complications between open and endoscopic techniques. Methods: A prospective, randomized collected data of 53 consecutive patients who were diagnosed with gastrosoleus contracture and underwent either open (26 patients) or endoscopic (27 patients) gastrocnemius recession between 2016 and 2018. The primary outcome was ankle dorsiflexion and secondary outcomes were visual analogue scale (VAS), Short Form-36 (SF- 36), FAAM, plantarflexion weakness, operative times, and complications. Results: There were 53 patients with mean age of 49.1 years, mean BMI of 26.5 kg/m2, and mean follow-up of 11.5 months. Both techniques demonstrated significant improvement of ankle dorsiflexion (12.1 vs 11.3 degrees, p<0.001) and all functional outcomes (FAAM, SF-36, and VAS (p<0.001 all)); however, there was no significant difference between the two groups, (p>0.05 all). In addition, there were significant shorter operative times in endoscopic technique (7.3 vs 18.7 minutes, p<0.01). Complications included wound complications (3.8 vs 0%), painful scar (7.7 vs 0%), sural nerve injury (3.8 vs 0%), and plantarflexion weakness (3.8 vs 3.8%) for open and endoscopic techniques respectively. Conclusion: Both open and endoscopic techniques were demonstrated significant improvement of post-operative outcomes as measured with ankle dorsiflexion, FAAM, SF-36, and VAS. Although the post-operative outcomes were not significantly different between the two groups, the endoscopic technique demonstrated lesser complications and shorter operative times.

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Conventional vs Accelerated Rehabilitation Protocol Following Reattachment of Achilles Tendon for Insertional Achilles Tendinopathy

Foot & Ankle International ◽

10.1177/10711007211003871 ◽

2021 ◽

pp. 107110072110038

Author(s):

Marut Arunakul ◽

Waroot Pholsawatchai ◽

Preeyaphan Arunakul ◽

Akaradech Pitakveerakul

Keyword(s):

Achilles Tendon ◽

Functional Outcomes ◽

Short Form ◽

Achilles Tendinopathy ◽

Level Of Evidence ◽

Accelerated Program ◽

Suture Bridge ◽

Sf 36 ◽

Prospective Comparative Study ◽

Insertional Achilles Tendinopathy

Background: No studies have compared early vs conventional postoperative weightbearing following suture bridge Achilles tendon reattachment. We, therefore, evaluated postoperative functional outcomes in these patients. Methods: We collected data on 49 patients who underwent surgical treatment of insertional Achilles tendinopathy using a central Achilles tendon-splitting approach and reattachment with suture bridge technique by a single surgeon. Functional outcomes were measured by a visual analog scale (VAS) for pain, Foot and Ankle Ability Measure (FAAM), and Short Form Health Survey (SF-36) at 3, 6, and 12 months postoperatively. The differences in outcomes were analyzed using multiple linear regression. Results: Eighteen and 31 patients underwent the conventional and accelerated protocols, respectively; their corresponding mean ages were similar, 53 and 57 years, as were all other baseline characteristics. The mean scores (conventional vs accelerated group) for VAS for pain, FAAM, and SF-36 in the conventional group at 3 months postoperatively were 4 ± 1 vs 3 ± 1 points, 53 ± 8 vs 68 ± 3 points, and 57 ± 15 vs 67 ± 10 points ( P < .05 for each comparison). There were no statistically significant differences between the groups at 6 and 12 months postoperatively. All patients could perform the single heel raise test at 6 months, and none experienced complications. Conclusion: In this small study, short-term functional outcomes were better in the accelerated group. More data are needed before the accelerated program can be recommended. Level of Evidence: Level II, prospective comparative study.

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Effect of Leg Dominance on Medium- to Long-Term Functional Outcomes, Quality of Life, and Revision Rates After Isolated ACL Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121995808 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712199580

Author(s):

Erdal Uzun ◽

Abdulhamit Misir ◽

Ahmet Guney

Keyword(s):

Quality Of Life ◽

Patient Satisfaction ◽

Functional Outcomes ◽

Short Form ◽

Return To Sports ◽

Sf 36 ◽

Functional Scores ◽

Leg Dominance

Background: The effect of leg dominance on short-term functional outcomes and return to sports after arthroscopic anterior cruciate ligament reconstruction (ACLR) has been evaluated. However, postoperative medium- to long-term recovery and revision rates are not well known. Purpose: To investigate whether leg dominance affects medium- to long-term clinical and functional scores and revision rates after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Included in this study were 235 patients (205 male and 30 female) who underwent isolated arthroscopic ACLR. Patients were divided according to the leg dominance status of their injured limb into 2 groups: dominant leg injured (120 patients) and nondominant leg injured (115 patients). Preoperative and postoperative functional outcomes and health-related quality of life (HRQoL) were evaluated using the visual analog scale for pain, Tegner activity scale, Lysholm knee score, International Knee Documentation Committee (IKDC) subjective knee evaluation form, 36-Item Short Form Health Survey (SF-36), and overall patient satisfaction. Moreover, the revision rates of the 2 groups were compared according to leg dominance, patient characteristics, and operative features. Results: The mean follow-up period was 8.0 ± 2.3 years (range, 5-13 years). A significant preoperative to postoperative improvement in range of motion and functional scores was noticed in both groups ( P < .001 for all). However, the improvement was significantly higher in the dominant leg group for the Tegner ( P = .001), Lysholm ( P = .006), and IKDC ( P < .001) scores as well as for the SF-36 domain scores for general health ( P = .009), social role ( P = .048), and emotional role ( P = .032). Also, patient satisfaction was significantly higher in the dominant leg group ( P = .007). The dominant leg group was associated with a lower revision rate compared with the nondominant leg group (5.8% vs 15.7%, respectively; P = .015). Conclusion: High recovery rates were seen after arthroscopic ACLR, regardless of leg dominance. However, leg dominance had a significant effect on postoperative medium- to long-term functional outcomes, HRQoL, and revision rates.

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