Three-Dimensional Biometric Weightbearing CT Evaluation of the Operative Treatment of Adult-Acquired Flatfoot Deformity

2020 ◽  
Vol 41 (8) ◽  
pp. 930-936
Author(s):  
Jonathan Day ◽  
Cesar de Cesar Netto ◽  
Danilo R. C. Nishikawa ◽  
Jonathan Garfinkel ◽  
Andrew Roney ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Three Dimensional ◽  
Hindfoot Alignment ◽  
3 Dimensional ◽  
Patient Reported ◽  
Significant Correction ◽  
Prospective Comparative Study ◽  
Adult Acquired Flatfoot Deformity ◽  
Preoperative Deformity

Background: Assessment of operative correction of adult-acquired flatfoot deformity (AAFD) has been traditionally performed by clinical evaluation and conventional radiographic imaging. Previously, a 3-dimensional biometric weightbearing computed tomography (WBCT) tool, the foot ankle offset (FAO), has been developed and validated in assessing hindfoot alignment. The purpose of this study was to investigate the role of FAO in evaluating operative deformity correction in AAFD. Methods: In this prospective comparative study, 19 adult patients (20 feet) with stage II (flexible) flatfoot deformity underwent preoperative and postoperative standing WBCT examination at mean 19 months (range, 6-24) after surgery. Three-dimensional coordinates of the foot tripod and center of the ankle joint were acquired by 2 independent and blinded observers. These coordinates were used to calculate the FAO using dedicated software, and subsequently compared pre- and postoperatively. The FAO is a previously validated biometric measurement that represents centering of the foot tripod as well as hindfoot alignment, with a normal mean FAO of 2.3% ± 2.9%. In addition, Patient Reported Outcomes Measurement Information System (PROMIS) clinical outcomes scores were compared pre- and postoperatively with a mean follow-up of 22.6 months (range, 14-37). Results: There was significant correction of flatfoot deformity from a mean preoperative FAO of 9.8% to a mean postoperative value of 1.3% ( P < .001). Additionally, there was statistically significant improvement in all PROMIS domains ( P < .05), except depression, at an average follow-up of 22.6 months. Spring ligament reconstruction was the only procedure associated with a significant correction in FAO ( P = .0064). Conclusion: The FAO was a reliable and sensitive tool that was used to evaluate preoperative deformity as well as postoperative correction, with patients demonstrating both significant improvement in FAO as well as patient-reported outcomes. These findings demonstrate the role for biometric 3-dimensional WBCT imaging in assessing operative correction after flatfoot reconstruction, as well as the potential role for operative planning to address preoperative deformity. Level of Evidence: Level II, prospective comparative study.

scholarly journals The Efficacy of Surgical Treatment in the Correction of Adult Acquired Flatfoot Deformity: A Three- dimensional Biometric Weightbearing Computed Tomography Evaluation

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0003
Author(s):  
Cesar de Cesar Netto ◽  
Jonathan Day ◽  
Alexandre L. Godoy-Santos ◽  
Jonathan H. Garfinkel ◽  
Chris Cychosz ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Ankle Joint ◽  
Surgical Procedures ◽  
Three Dimensional ◽  
Spring Ligament ◽  
Patient Reported ◽  
Significant Correction ◽  
Adult Acquired Flatfoot Deformity ◽  
The Mean

Category: Hindfoot; Ankle; Midfoot/Forefoot Introduction/Purpose: Multiple surgical techniques are used in the correction of Adult Acquired Flatfoot Deformity (AAFD). Assessment of the efficacy of a surgical treatment in the correction of the deformity is usually performed by clinical evaluation and conventional radiographic imaging. Weightbearing CT (WBCT) allows a more reliable and multiplanar evaluation of AAFD. The Foot and Ankle Offset (FAO) is a WBCT biometric semi-automatic measurement that gauges the relative positioning between the foot tripod and the center of the ankle joint. This study aimed to investigate the efficacy of surgical treatment in correcting AAFD, comparing preoperative and postoperative FAO measurements. We hypothesized that surgical treatment would provide significant correction of the deformity, centering the tripod of the foot underneath the ankle joint. Methods: In this prospective comparative study, 21 adult patients (22 feet) with flexible AAFD were included, mean age 55 (range, 23-81) years, 13 females and eight males. Patients underwent preoperative and postoperative standing WBCT examination. Three-dimensional coordinates (X, Y and Z planes) of the foot tripod (weightbearing point of the first and fifth metatarsals and calcaneal tuberosity) and center of the ankle (apex of the talar dome) were harvested by two independent and blinded observers. The FAO was automatically calculated from the harvested 3D coordinates by dedicated software. Data regarding the surgical technique used was recorded. Patient Reported Outcomes (PROs) were collected preoperatively and postoperatively at a mean follow-up of 22 (range, 8-36) months. Pre and postoperative FAO measurements were compared by paired T-tests. Multivariate analysis was used to assess the influence of surgical procedures in the amount of FAO correction. P-values of less than 0.05 were considered significant. Results: We found excellent intra (0.98) and interobserver reliability (0.96) for FAO measurements. The mean preoperative FAO was 10.4 (95% CI, 8.5 to 12.1). There was a significant correction of the deformity postoperatively (p<0.0001), with a mean postoperative FAO of 1.4 (CI, -0.1 to 2.9), and mean improvement of 8.9 (95% CI, 6.6 to 11.2). Average increase in PROs was (p<0.05): physical function (8; CI, 4 to 12), pain interference (10.3; CI, 4.8 to 15.9), pain intensity (5.3; CI, -10:20.6), mental health (4.2; CI, 0.2:8.2), physical health (4.3; CI, 0.9 to 9.8), and depression (10.4; CI, -0.6 to 21.4). The mean number of surgical procedures performed was 8 (range, 2-12). Spring ligament reconstruction was the only technique that influenced the amount of FAO correction (P<0.001). Conclusion: To the author’s knowledge, this is the first study to assess the amount of surgical correction of AAFD using standing WBCT images and semiautomatic 3D measurements. We found that surgical treatment provided a significant and pronounced amount of correction in the FAO, with the foot tripod more centered underneath the ankle joint. We also found a significant improvement in the PROMIS after an average postoperative follow-up of 22 months. Among multiple different surgical procedures performed, reconstruction of the spring ligament was the only technique that significantly influenced the amount of FAO correction. Longer-term follow-up studies are needed. [Figure: see text]

scholarly journals Contribution of First Tarsometatarsal Joint Fusion to Deformity Correction in the Treatment of Adult Acquired Flatfoot Deformity

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0018
Author(s):  
Jonathan Day ◽  
Matthew S. Conti ◽  
Nicholas Williams ◽  
Scott J. Ellis ◽  
Jonathan T. Deland ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patient Reported Outcomes ◽  
Interobserver Reliability ◽  
Deformity Correction ◽  
Measurement Information ◽  
Radiographic Parameters ◽  
Metatarsal Angle ◽  
Patient Reported ◽  
Adult Acquired Flatfoot Deformity

Category: Midfoot/Forefoot; Other Introduction/Purpose: Severe adult-acquired flatfoot deformity (AAFD) is often associated with painful medial column collapse at the naviculocuneiform (NC) joint. The purpose of this study was to examine the role of first tarsometatarsal (1st TMT) fusion combined with subtalar fusion in correcting deformity at this joint. Methods: We retrospectively analyzed 40 patients (41 feet) who underwent 1st TMT and subtalar (ST) fusion as part of a flatfoot reconstructive procedure. We assessed six radiographic parameters both preoperatively and at a minimum of 6 months postoperatively, including talonavicular (TN) coverage angle, lateral talo-first metatarsal angle, lateral talocalcaneal angle, calcaneal pitch, hindfoot moment arm, and a newly defined navicular-cuneiform incongruency angle (NCIA). Patient-Reported Outcomes Measurement Information System (PROMIS) clinical outcomes were assessed preoperatively and at a minimum 1 year follow-up. Results: The NCIA demonstrated excellent interobserver reliability, with no significant change between pre- and postoperative measurements. All other radiographic parameters, except calcaneal pitch, demonstrated statistically significant improvement postoperatively (p <0.01). Overall, patients had statistically significant improvement in all PROMIS domains (p <0.01), except for depression. Worsening NC deformity was not associated with worse patient-reported outcomes. Conclusion: Our data suggests that when addressing collapse of the medial arch in patients with AAFD, fusion of the 1st TMT joint in combination with other procedures leads to acceptable radiographic and clinical outcomes. There was no change in deformity at the NC joint at short-term follow-up, and patients achieved significant improvement in multiple PROMIS domains. Based on our findings, deformity through the NC joint does not significantly impact clinical outcomes. In addition, the NCIA was established as a reliable radiographic parameter that can be used to assess NC deformity in the presence of talonavicular and/or 1st TMT fusion. [Table: see text]

scholarly journals Contribution of First-Tarsometatarsal Joint Fusion to Deformity Correction in the Treatment of Adult-Acquired Flatfoot Deformity

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142092732 ◽  
Author(s):  
Jonathan Day ◽  
Matthew S. Conti ◽  
Nicholas Williams ◽  
Scott J. Ellis ◽  
Jonathan T. Deland ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patient Reported Outcomes ◽  
Interobserver Reliability ◽  
Deformity Correction ◽  
Measurement Information ◽  
Radiographic Parameters ◽  
Metatarsal Angle ◽  
Patient Reported ◽  
Adult Acquired Flatfoot Deformity

Background: Severe adult-acquired flatfoot deformity (AAFD) is often associated with painful medial column collapse at the naviculocuneiform (NC) joint. However, many surgeons surgically correct the deformity without directly addressing this joint. The purpose of this study was to examine the role of first-tarsometatarsal (TMT) fusion combined with subtalar fusion in correcting deformity at the NC joint. Methods: We retrospectively analyzed 40 patients (41 feet) who underwent first-TMT and subtalar (ST) fusion as part of a flatfoot reconstructive procedure. We assessed 6 radiographic parameters both preoperatively and at a minimum of 6 months postoperatively, including talonavicular (TN) coverage angle, lateral talo–first metatarsal angle, lateral talocalcaneal angle, calcaneal pitch, hindfoot moment arm, and a newly defined navicular-cuneiform incongruency angle (NCIA). Patient-Reported Outcomes Measurement Information System (PROMIS) clinical outcomes were assessed preoperatively and at a minimum 1-year follow-up. Results: The NCIA demonstrated excellent interobserver reliability, with no significant change between pre- and postoperative measurements. All other radiographic parameters, except calcaneal pitch, demonstrated statistically significant improvement postoperatively ( P < .01). Overall, patients had statistically significant improvement in all PROMIS domains ( P < .01), except for depression. Worsening NC deformity was not associated with worse patient-reported outcomes. Conclusions: Our data suggest that when addressing painful collapse of the medial arch in patients with AAFD, fusion of the first-TMT joint in combination with other procedures leads to acceptable radiographic and clinical outcomes. There was no change in deformity at the NC joint in our patient cohort at short-term follow-up, and patients achieved significant improvement in multiple PROMIS domains. Although TMT fusion had no effect on NC deformity, residual or worsening NC deformity did not significantly affect clinical outcomes. In addition, the NCIA was found to be a reliable radiographic parameter to assess NC deformity in the presence of talonavicular and/or first-TMT fusion. Level of Evidence: Level III, retrospective comparative study.

Individualized cancer follow-up supported by electronic Patient-Reported Outcomes: Development and evaluation (Preprint)

2020 ◽  
Author(s):  
Sissel Ravn ◽  
Henriette Vind Thaysen ◽  
Lene Seibaek ◽  
Victor Jilbert Verwaal ◽  
Lene Hjerrild Iversen
Keyword(s):  
Ct Scan ◽  
Advanced Cancer ◽  
Patient Reported Outcomes ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Structured Interviews ◽  
European Organization ◽  
Individualized Care ◽  
Patient Reported

BACKGROUND Cancer survivors experience unmet needs during follow-up. Besides recurrence, a follow-up includes detection of late side effects, rehabilitation, palliation and individualized care. OBJECTIVE We aimed to describe the development and evaluate the feasibility of an intervention providing individualized cancer follow-up supported by electronic patient-reported outcomes (e-PRO). METHODS The study was carried out as an interventional study at a Surgical and a Gynecological Department offering complex cancer surgery and follow-up for advanced cancer. The e-PRO screened for a priori defined clinical important symptoms and needs providing individualized follow-up. We included following questionnaires in the e-PRO; the general European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC validated for colorectal and ovarian cancer patients. To support individualization, we included three prioritized issues of the patient’s preference in each e-PRO. The response-algorithm was aggregated based on the severity of the patient’s response. To ensure the sensitivity of the e-PRO, we performed semi-structured interviews with five patients. All clinicians (surgeons and gynecologists) performing the consultations reviewed the e-PRO. The evaluation was divided in two, 1)The feasibility was assessed by a)Patients’ response rate of the e-PRO, b)Number of follow-up visits documenting the use of e-PRO and c)Patients’ prioritized issues prior to the consultation(‘yes’ / ‘no’), and after the follow-up 2)Patients assessment of a)The need and purpose of the follow-up visit and b)the support provided during the follow-up visit. RESULTS In total, 187 patients were included in the study, of which 73%(n=136/187) patients responded to the e-PRO and were subjected to an individualized follow-up. The e-PRO was documented as applied in 79% of the follow-up visits. In total, 23% of the prioritized issues did not include a response. Stratified by time since surgery, significantly more patients did not fill out a prioritized issue had a follow-up >6 months since surgery. In total, 72 % follow-up visits were evaluated to be necessary in order to discuss the outcome of the CT scan, symptoms, and/or prioritized issues. Contrary, 19% of the follow-up visits were evaluated to be necessary only to discuss the result of the CT scan. A range from 19.3–56.3% of patients assessed the follow-up visit to provide support with respect to physical (42% of patients), mental (56%), sexual (19%) or dietary (27%) issues. Further, a range from 34–60% of the patients reported that they did not need support regarding physical (43% of patients), mental (34%), sexual (63%) or dietary (57%) issues. CONCLUSIONS An individualized follow-up based on e-PRO is feasible, and support most patients surgically treated for advanced cancer. However, results indicate that follow-up based on e-PRO may not be beneficial for all patients and circumstances. A thorough cost-benefit analysis may be warranted before implementation in routine clinic.

Minimum 10-Year Outcomes of Primary Arthroscopic Transosseous-Equivalent Double-Row Rotator Cuff Repair

2021 ◽  
pp. 036354652110154
Author(s):  
Adam M. Johannsen ◽  
Justin W. Arner ◽  
Bryant P. Elrick ◽  
Philip-C. Nolte ◽  
Dylan R. Rakowski ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Revision Surgery ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcomes ◽  
Long Term Results ◽  
Double Row ◽  
Kaplan Meier ◽  
Patient Reported ◽  
Cuff Repair

Background: Modern rotator cuff repair techniques demonstrate favorable early and midterm outcomes, but long-term results have yet to be reported. Purpose: To determine 10-year outcomes and survivorship after arthroscopic double-row transosseous-equivalent (TOE) rotator cuff repair. Study Design: Case series; Level of evidence 4. Methods: The primary TOE rotator cuff repair procedure was performed using either a knotted suture bridge or knotless tape bridge technique on a series of patients with 1 to 3 tendon full-thickness rotator cuff tears involving the supraspinatus. Only patients who were 10 years postsurgery were included. Patient-reported outcomes were collected pre- and postoperatively, including American Shoulder and Elbow Surgeons (ASES), 12-Item Short Form Health Survey (SF-12), Single Assessment Numeric Evaluation (SANE), shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and satisfaction. Kaplan-Meier survivorship analysis was performed. Failure was defined as progression to revision surgery. Results: A total of 91 shoulders (56 men, 31 women) were included between October 2005 and December 2009. Mean follow-up was 11.5 years (range, 10.0-14.1 years). Of 91 shoulders, 5 (5.5%) failed and required revision surgery. Patient-reported outcomes for patients who survived were known for 80% (69/86). Outcomes scores at final follow-up were as follows: ASES, 93.1 ± 10.8; SANE, 87.5 ± 14.2; QuickDASH, 11.1 ± 13.5; and SF-12 physical component summary (PCS), 49.2 ± 10.1. There were statistically significant declines in ASES, SANE, and SF-12 PCS from the 5-year to 10-year follow-up, but none of these changes met the minimally clinically important difference threshold. Median satisfaction at final follow-up was 10 (range, 3-10). From this cohort, Kaplan-Meier survivorship demonstrated a 94.4% survival rate at a minimum of 10 years. Conclusion: Arthroscopic TOE rotator cuff repair demonstrates high patient satisfaction and low revision rates at a mean follow-up of 11.5 years. This information may be directly utilized in surgical decision making and preoperative patient counseling regarding the longevity of modern double-row rotator cuff repair.

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 Strain Elastography and Tendon Response to an Exercise Program in Patients With Supraspinatus Tendinopathy: An Exploratory Study

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096518
Author(s):  
Karen Brage ◽  
Birgit Juul-Kristensen ◽  
John Hjarbaek ◽  
Eleanor Boyle ◽  
Per Kjaer ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Structural Changes ◽  
Supraspinatus Tendon ◽  
Patient Reported Outcome ◽  
Minimal Detectable Change ◽  
Detectable Change ◽  
Tendon Stiffness ◽  
Patient Reported ◽  
Tendon Thickness

Background: Shoulder pain is common, with a lifetime prevalence of up to 67%. Evidence is conflicting in relation to imaging findings and pain in the shoulder. Sonoelastography can be used to estimate tissue stiffness and may be a clinically relevant technique for diagnosing and monitoring tendon healing. Purpose: To evaluate changes in supraspinatus tendon stiffness using strain elastography (SEL) and associations with changes in patient-reported outcomes, supraspinatus tendon thickness, and grade of tendinopathy after 12 weeks of unilateral shoulder exercises in patients with supraspinatus tendinopathy. Study Design: Controlled laboratory study. Methods: A total of 23 patients with unilateral clinical supraspinatus tendinopathy performed 12 weeks of “standard care” exercises. At baseline and follow-up, supraspinatus tendon stiffness was measured bilaterally using SEL and compared with tendinopathy grading on magnetic resonance imaging scans and tendon thickness measured using conventional ultrasound. Patient-reported outcome measures included physical function and symptoms from the Disabilities of the Arm, Shoulder and Hand questionnaire and pain rating (visual analog scale). Results: No significant changes in SEL within or between groups (asymptomatic vs symptomatic tendon) were seen. All patient-reported outcomes showed significant improvement from baseline to follow-up, but with no change in tendinopathy grading and tendon thickness. No significant differences in the proportion of patients changing above the minimal detectable change in SEL and PROM were seen, except for discomfort while sleeping. Conclusion: Despite no significant within-group or between-group changes in SEL, significant improvements were found in patient-reported outcomes. An acceptable agreement between patients changing above the minimal detectable change in SEL and patient-reported outcome measure was seen. Further studies should explore the use of SEL to detect changes after tendon repair and long-term training potentially in subgroups of different tendinopathy phases. Clinical Relevance: In the short term, structural changes in supraspinatus tendons could not be visualized using SEL, indicating that a longer time span should be expected in order to observe structural changes, which should be considered before return to sports. Subgrouping based on stage of tendinopathy may also be important in order to evaluate changes over time with SEL among patients with supraspinatus tendinopathy. Registration: NCT03425357 ( ClinicalTrials.gov identifier).

scholarly journals Acceptability of no-test medical abortion provided via telemedicine: analysis of patient-reported outcomes

2021 ◽  
pp. bmjsrh-2020-200954
Author(s):  
Chelsey Porter Erlank ◽  
Jonathan Lord ◽  
Kathryn Church
Keyword(s):  
Patient Reported Outcomes ◽  
Medical Abortion ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Post Procedure ◽  
High Satisfaction ◽  
First Choice ◽  
Patient Reported ◽  
At Home

IntroductionThe English government approved both stages of early medical abortion (EMA), using mifepristone and misoprostol under 10 weeks’ gestation, for at-home use on 30 March 2020. MSI Reproductive Choices UK (MSUK), one of the largest providers of abortion services in England, launched a no-test telemedicine EMA pathway on 6 April 2020. The objectives of this study were to report key patient-reported outcome measures and to assess whether our sample was representative of the whole population receiving no-test telemedicine EMA.MethodsA sample of all MSUK’s telemedicine EMA patients between April and August 2020 were invited to opt in to a follow-up call to answer clinical and satisfaction questions. A total of 1243 (13.7% of all telemedicine EMAs) were successfully followed-up, on average within 5 days post-procedure.ResultsPatients reported high confidence in telemedicine EMA and high satisfaction with the convenience, privacy and ease of managing their abortion at home. The sample responding were broadly equivalent to the whole population receiving telemedicine. No patient reported that they were unable to consult privately. The majority (1035, 83%) of patients reported preferring the telemedicine pathway, with 824 (66%) indicating that they would choose telemedicine again if COVID-19 were no longer an issue.ConclusionsTelemedicine EMA is a valued, private, convenient and more accessible option that is highly acceptable for patients seeking an abortion, especially those for whom in-clinic visits are logistically or emotionally challenging. Evidence that this pathway would be a first choice again in future for most patients supports the case to make telemedicine EMA permanent.

Sign in / Sign up

Export Citation Format

Share Document