scholarly journals Endoscopic Repair of Partial Thickness Under-Surface Tears of The Abductor Tendon (pusta): Clinical Outcomes with Minimum Two-year Follow-up

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0011
Author(s):  
David Edward Hartigan ◽  
Itay Perets ◽  
Sherwin S.W. Ho ◽  
John P. Walsh ◽  
Leslie Yuen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Benefit ◽  
Gluteus Medius ◽  
Partial Thickness ◽  
Patient Satisfaction Scores ◽  
Substantial Clinical Benefit ◽  
Patient Reported ◽  
Average Patient ◽  
Minimally Clinical Important Difference

Objectives: To report the minimum two-year outcomes of trans-tendinous repairs of Partial Thickness Undersurface Tears of the Abductor (PUSTA) tendon using patient reported outcomes (PROs), visual analog scale (VAS), and patient satisfaction scores. Methods: All patients who underwent endoscopic trans-tendinous gluteus medius repair between October 2009 and May 2013 at one institution were prospectively evaluated. Exclusion criteria consisted of less than two-year follow-up, previous hip surgery, inflammatory arthritis, open surgery, full thickness abductor tear, and worker’s compensation patients. All patients had a documented pre-operative physical exam with strength testing (0-5) and observation of their gait. Patient satisfaction and PRO scores were recorded preoperatively, at 3 months postoperatively, and annually thereafter. The PRO scores collected were mHHS, HOS-ADL, HOS-SSS, NAHS, and VAS. Preoperative strength and gait were compared to latest follow-up. Results: There were 25 patients that fit our criteria. Significant improvement in PRO scores were demonstrated for mHHS, HOS-ADL, HOS-SSS, NAHS, and VAS from 54.9-76.2, 50.2-80.6, 30.1-67.3, 51.9-82.4, and 7.1-2.7 respectively (p<0.001). There were 11 patients with objective weakness prior to surgery; seven of these patients moved up at least one strength grade by final follow-up. There were 14 patients who had a Trendelenbrug gait pre-operatively, 12 of them had a normal gait at latest follow-up (p-<0.001). Average patient satisfaction was 7.5. There were no revision surgeries, and no complications noted. Conclusion: PUSTA lesions can be treated successfully with endoscopic trans-tendinous repair preserving the intact attachment of superficial fibers of the gluteus medius. We recommend this treatment for partial undersurface tears recalcitrant to non-operative treatment, as patients demonstrated clinical benefit at greater than 2 years follow up that exceeds substantial clinical benefit and minimally clinical important difference.

scholarly journals 1038 Patient’s Experiences and Lessons Learned Following Establishment of a New Regional Day Procedure Centre in Response To COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C Gilmore ◽  
R Coulson ◽  
V Graham ◽  
I McAllister
Keyword(s):  
Patient Satisfaction ◽  
Hernia Repair ◽  
Day Surgery ◽  
Lessons Learned ◽  
Information Leaflets ◽  
Patient Reported ◽  
Average Patient ◽  
Qualitative Responses ◽  
The Impact

Abstract Aim Due to the impact of COVID-19 on elective services an exclusive day procedure centre has been established for the region. This study aims to review the patient experiences of the service. Method A 26-question feedback survey assessed patient outcomes, complications, and experiences. All patients who underwent hernia repair from September to November 2020 were contacted 6 weeks postoperatively by telephone to participate. Results Over 10 weeks, 55 patients underwent unilateral inguinal hernia repair. 49 patients completed the survey, 5 patients were not contactable, and 1 patient declined to participate. Overall high levels of patient satisfaction were reported, when asked the question “Rate the overall experience (out of 10) from the time you were contacted to proceed with surgery to now?” The average patient reported score was 9.5. Results indicated excellent use of written patient information leaflets. 92% (N = 46) of participants had a travel time of less than 60 minutes and 94% (N = 45) of those contacted reported the centre as a convenient location. Qualitative responses described pain at 48-72hrs following the procedure when local anaesthetic had worn off, to the detriment of overall patient satisfaction. Conclusions A dedicated site for day-surgery can be successful during the period of COVID-19 restrictions. High levels of patient satisfaction reported. However, lessons learned include need for improved education regarding postoperative analgesia; the effects of local anesthesia and patient directed follow up via the well-established local surgical hub.

scholarly journals Establishing the Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State following Primary Medial Patellofemoral Ligament Reconstruction

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0046
Author(s):  
Hailey Huddleston ◽  
Neal Naveen ◽  
Taylor Southworth ◽  
Benedict Nwachukwu ◽  
Brian Cole ◽  
...  
Keyword(s):  
Clinical Benefit ◽  
Surgical Procedure ◽  
Predictive Power ◽  
Medial Patellofemoral Ligament ◽  
Minimal Clinically Important Difference ◽  
Mpfl Reconstruction ◽  
Clinically Important Difference ◽  
Substantial Clinical Benefit ◽  
Patient Reported

Objectives: Medial patellofemoral ligament (MPFL) reconstruction is an effective surgical procedure for patients with recurrent lateral dislocations. Outcome measurements can identify the success of a surgical procedure but are shifting away from absolute values or deltas of patient-reported outcomes (PROs) towards the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS), representing the smallest clinical improvement that patients perceive as important, the threshold at which patients notice a considerable improvement, and patient satisfaction with their outcome, respectively. To our knowledge no prior study has defined these thresholds in MPFL reconstruction patients. Methods: An institutional database was reviewed for patients who underwent primary MPFL reconstruction between August 2015 to February 2018 with a minimum 6-month follow-up. IKDC, Kujala and KOOS were administered to all patients pre-operatively and at 6-months and 1-year post-operatively. An anchor-based approach with a receiver-operator curve/area under the curve analysis using the Youden index was performed to calculate the MCID, SCB and PASS. The predictive power was determined to be acceptable with AUC≥70% and excellent with AUC≥80%. Results: From 2015 to 2018, 93 of 162 patients (mean age 23.7±10.1 years; 25 males, 68 females) completed for 6-month follow-up. At 6-months follow-up, SCB and PASS were defined with acceptable predictive power for all scores listed, while MCID achieved this for KOOS pain and sports subscores only (Table 1). At 1-year follow-up, SCB and PASS were each defined with acceptable predictive power for all scores listed, while MCID achieved this mark for KOOS pain and quality of life subscores as well as both Kujala scales. Conclusion: This study establishes MCID, SCB and PASS for IKDC, Kujala, and KOOS subscores at 6-months and 1-year postoperatively with excellent predictive power for 19/23 PROMs investigated at 1-year. These findings represent important benchmarks in patients undergoing primary MPFL reconstruction.

scholarly journals Long-Term Patient Satisfaction and Quality of Life After Breast-Conserving Therapy: A Prospective Study Using the BREAST-Q

2021 ◽  
Author(s):  
Ilona Stolpner ◽  
Jörg Heil ◽  
Fabian Riedel ◽  
Markus Wallwiener ◽  
Benedikt Schäfgen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Patient Satisfaction ◽  
Repeated Measures ◽  
Aesthetic Surgery ◽  
Well Being ◽  
Breast Conserving Therapy ◽  
Patient Reported

Abstract Background Poor patient-reported satisfaction after breast-conserving therapy (BCT) has been associated with impaired health-related quality of life (HRQOL) and subsequent depression in retrospective analysis. This prospective cohort study aimed to assess the HRQOL of patients who have undergone BCT using the BREAST-Q, and to identify clinical risk factors for lower patient satisfaction. Methods Patients with primary breast cancer undergoing BCT were asked to complete the BREAST-Q preoperatively (T1) for baseline evaluation, then 3 to 4 weeks postoperatively (T2), and finally 1 year after surgery (T3). Clinicopathologic data were extracted from the patients’ charts. Repeated measures analysis of variance (ANOVA) was used to determine significant differences in mean satisfaction and well-being levels among the test intervals. Multiple linear regression was used to evaluate risk factors for lower satisfaction. Results The study enrolled 250 patients. The lowest baseline BREAST-Q score was reported for “satisfaction with breast” (mean, 61 ± 19), but this increased postoperatively (mean, 66 ± 18) and was maintained at the 1 year follow-up evaluation (mean, 67 ± 21). “Physical well-being” decreased from T1 (mean, 82 ± 17) to T2 (mean, 28 ± 13) and did not recover much by T3 (mean, 33 ± 13), being the lowest BREAST-Q score postoperatively and in the 1-year follow-up evaluation. In multiple regression, baseline psychosocial well-being, body mass index (BMI), and type of incision were risk factors for lower “satisfaction with breasts.” Conclusion Both the aesthetic/surgery-related and psychological aspects are equally important with regard to “satisfaction with breasts” after BCT. The data could serve as the benchmark for future studies.

Prospective Clinical Study of Zirconia Full-coverage Restorations on Teeth Prepared With Biologically Oriented Preparation Technique on Gingival Health: Results After Two-year Follow-up

2018 ◽  
Vol 43 (5) ◽  
pp. 482-487 ◽  
Author(s):  
R Agustín-Panadero ◽  
B Serra-Pastor ◽  
A Fons-Font ◽  
MF Solá-Ruíz
Keyword(s):  
Patient Satisfaction ◽  
Prospective Clinical Study ◽  
Preparation Technique ◽  
Finish Line ◽  
Gingival Margin ◽  
Gingival Health ◽  
Patient Satisfaction Scores ◽  
Satisfaction With Treatment ◽  
The University

SUMMARY Objectives: To evaluate the clinical behavior of one-piece complete-coverage crowns and fixed partial dentures (FPDs) on teeth with vertical preparation without finish line biologically oriented preparation technique (BOPT). Methods and Materials: This prospective study included 52 patients requiring treatment with restorations in the esthetic region: 74 crowns and 27 FPDs. The sample included a total of 149 teeth that were prepared vertically without finish line. The sample was divided into two groups: one-piece crowns and FPDs, all with zirconia cores, feldspathic ceramic veneer, and a 0.5-mm prosthetic finish line of zirconia. All procedures were carried out at the University of Valencia from 2013 to 2014. The following parameters were evaluated over a two-year follow-up: oral hygiene, periodontal state, gingival thickening, gingival margin stability, the presence of complications, and restoration survival rate. Patient satisfaction with treatment was assessed by means of a visual analogue scale (VAS). Results: Two years after treatment, 80.5% of treated teeth remained free of gingival inflammation and bleeding. Mean gingival thickening was 0.41 ± 0.28 mm for one-piece crowns and 0.38 ± 0.36 mm for FPDs. Gingival margin stability was 100%, but 2% of the sample presented biological complications. The VAS patient satisfaction scores were eight out of a maximum score of 10. Conclusions: Two years after treatment, vertical preparation without finish line produces gingival thickening, margin stability, and optimal esthetics. Neither crowns nor FPDs presented any mechanical complications.

scholarly journals A tiered system using substantial clinical benefit and patient acceptable symptomatic state scores to evaluate 2-year outcomes of hip arthroscopy with the Hip Outcome Score

2020 ◽  
Vol 7 (1) ◽  
pp. 62-69
Author(s):  
RobRoy L Martin ◽  
Benjamin R Kivlan ◽  
John J Christoforetti ◽  
Andrew B Wolff ◽  
Shane J Nho ◽  
...  
Keyword(s):  
Clinical Benefit ◽  
Hip Arthroscopy ◽  
Self Report ◽  
Initial Assessment ◽  
Characteristic Analysis ◽  
Level Of Evidence ◽  
Outcome Score ◽  
Substantial Clinical Benefit ◽  
Tiered System

Abstract There is no information to define variations in hip arthroscopy outcomes at 2-year follow-up using the Hip Outcome Score (HOS). To offer a tiered system using HOS absolute substantial clinical benefit (SCB) and patient acceptable symptomatic state (PASS) scores for 2-year hip arthroscopy outcome assessment. This was a retrospective review of patients having hip arthroscopy for femoroacetabular impingement and/or chondrolabral pathology. On initial assessment and 2 years (±2 months) post-operatively, subjects completed the HOS activity of daily living (ADL) and Sports subscales, categorical self-rating of function and visual analog scale for satisfaction with surgery. Receiver operator characteristic analysis identified absolute SCB and PASS HOS ADL and Sports subscale scores. Subjects consisted of 462 (70%) females and 196 (30%) males with a mean age of 35.3 years [standard deviation (SD) 13] and mean follow-up of 722 days (SD 29). SCB and PASS scores for the HOS ADL and Sports subscales were accurate in identifying those at a ‘nearly normal’ and ‘normal’ self- report of function and at least 75% and 100% levels of satisfaction (area under the curve &gt;0.70). This study provides tiered SCB and PASS HOS scores to define variations in 2-year (±2 months) outcome after hip arthroscopy. HOS ADL subscale scores of 84 and 94 and Sports subscale scores of 61 and 87 were associated with a ‘nearly normal’ and ‘normal’ self-report of function, respectively. HOS ADL subscale scores of 86 and 94 and Sports subscale score of 74 and 87 were associated with being at least 75% and 100% satisfied with surgery, respectively. Level of evidence: III, retrospective comparative study.

scholarly journals Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0001
Author(s):  
Jack Allport ◽  
Adam Bennett ◽  
Jayasree Ramaskandhan ◽  
Malik Siddique
Keyword(s):  
Patient Satisfaction ◽  
Weight Bearing ◽  
Surgical Techniques ◽  
Womac Pain ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Patient Reported ◽  
Equinus Deformity ◽  
Clinical Records

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has been shown to be an effective treatment for end stage ankle arthritis. Achieving normal anatomical alignment has been shown to be important in long term outcomes and revision rates. Recent data from the British NJR has shown that revision rates are higher in patients with pre-operative fixed equinus. Although there is literature about surgical techniques to deal with pre-operative equinus we are not aware of any papers presenting patient outcomes. We present patient reported outcomes for our cohort of patients with pre-operative fixed equinus compared to those able to achieve a plantigrade ankle. Methods: This is a single surgeon, retrospective cohort study of consecutive cases. A mobile bearing prosthesis was used (Mobility TAA system, DePuy, Raynham, Massachusetts, USA). Cases were identified from a locally held joint registry which routinely records PROMS data pre-operatively and at annual intervals post-operatively. Patients undergoing primary TAA between March 2006 and June 2014 were included, revision procedures along with those with inadequate PROMS data were excluded. PROMS scores used were FAOS (WOMAC Pain, Function and Stiffness), SF-36 scores and patient satisfaction. All pre-operative lateral weight bearing xrays were reviewed to screen for potential fixed equinus deformity (tibia-sole angle >90 degrees). Clinical records were then reviewed to confirm clinical diagnosis of fixed equinus deformity. Results: 259 cases were identified, 95 cases were excluded based on our criteria leaving 164 cases for analysis (mean follow up 61.6 months). 144 were classified as neutral and 20 as fixed equinus. The fixed equinus group were significantly younger (neutral 64.2 vs equinus 53.9, p=0.0002), there was no difference in BMI or length of follow up. There was no difference in baseline scores except WOMAC stiffness, with the fixed equinus group significantly worse (36.9 vs 25.6, p=0.0014). Final PROMS score, change from baseline and patient satisfaction was the same in all domains for both groups. There was no difference in revision rates. Conclusion: A pre-operative fixed equinus deformity does not negatively impact on clinical outcomes in patients undergoing TAA. We are not aware of any previous studies to compare results. As expected the equinus group showed higher levels of stiffness pre-operatively. Contrary to the British NJR dataset we did not find a difference in revision rates.

scholarly journals Effect of Concomitant Cartilage Lesions on Patient-Reported Outcome After ACL-Reconstruction-A Nationwide Cohort Study from Norway and Sweden of 8470 Patients With 5-Year Follow-Up

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0005
Author(s):  
Svend Ulstein ◽  
Asbjorn Aroen ◽  
Magnus L. Forssblad ◽  
Lars Engebretsen ◽  
Jan Harald Røtterud
Keyword(s):  
Surgical Treatment ◽  
Cruciate Ligament ◽  
Cartilage Lesion ◽  
Patient Reported Outcome ◽  
Full Thickness ◽  
Knee Ligament ◽  
Cartilage Lesions ◽  
Partial Thickness ◽  
Patient Reported

Objectives: To evaluate (1) the effect of concomitant partial-thickness (International Cartilage Repair Society [ICRS] grades 1-2) and full-thickness (ICRS grades 3-4) cartilage lesions on patient-reported outcome 5 years after Anterior Cruciate Ligament Reconstruction (ACLR), and (2) the effect of debridement or microfracture (MF) compared with no treatment of concomitant full-thickness cartilage lesions on patient-reported outcome 5 years after ACLR. Methods: All patients that underwent unilateral primary ACLR registered in the Norwegian and Swedish National Knee Ligament Registries from 2005 through 2008 (n = 15,783) were included the study. At the 5-year follow-up, 8470 (54%) patients completed The Knee Injury and Osteoarthritis Outcome Score (KOOS). A subgroup of all patients with concomitant full-thickness cartilage lesions (n = 644), treated with debridement (n = 129), or MF (n = 164), or no surgical treatment (n = 351) at the time of ACLR, was included in the treatment component of the study. At the 5-year follow-up, 368 (57%) patients completed the KOOS. Linear regression models were used to estimate the effect of concomitant focal cartilage lesions on the patient-reported outcome (KOOS) 5 years after ACLR, and to estimate the effect of surgical debridement or MF of concomitant full-thickness cartilage lesions, on patient-reported outcome 5 years after ACLR. Results: Of the 8470 patients available for follow-up at 5 years, 2248 (27%) had 1 or more concomitant cartilage lesions at the time of ACLR, comprised of 1685 (20%) patients with 1 or more partial-thickness cartilage lesions and 563 (7%) patients with 1 or more full-thickness cartilage lesions. Of the 368 patients available for the 5-year follow-up in the treatment component of the study, 203 (55%) patients received no surgical treatment to their full-thickness cartilage lesion at the time of ACLR, 70 (19%) were treated with debridement and 95 (26%) with MF. In the adjusted analyses, partial-thickness cartilage lesions showed significant associations with inferior KOOS scores at follow-up in all subscales. Full-thickness cartilage lesions were significantly associated with inferior KOOS scores in all subscales, both in the unadjusted and the adjusted analyses. With no treatment of the concomitant cartilage lesion as the reference, no significant effects of debridement or MF were detected in the unadjusted or adjusted regression analyses in any of the KOOS subscales at the 5-year follow-up. However, there was a trend in both the unadjusted and adjusted analyses towards negative effects of MF in the KOOS subscales Sport/Rec and QoL with regression coefficient (β) of -5; 95% CI, -12.3-2.2 and -5.7; 95% CI, -12.5-1.1, respectively. Conclusion: ACL-injured patients with concomitant full-thickness cartilage lesions reported worse outcomes and less improvement than those without cartilage lesions 5 years after ACLR. Compared to leaving concomitant full-thickness cartilage lesions untreated at the time of ACLR, debridement and MF showed no effect on patient-reported outcome at 5-year follow-up.

scholarly journals Long-Term Sports Participation and Satisfaction After UCL Reconstruction in Amateur Baseball Players

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110275
Author(s):  
Robert A. Jack ◽  
Somnath Rao ◽  
Taylor D’Amore ◽  
Donald P. Willier ◽  
Robert Gallivan ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Case Series ◽  
Sports Participation ◽  
High Rate ◽  
Return To Play ◽  
Baseball Players ◽  
Patient Reported ◽  
Rate Of Progression

Background: While the incidence of ulnar collateral ligament reconstruction (UCLR) has increased across all levels of play, few studies have investigated the long-term outcomes in nonprofessional athletes. Purpose: To determine the rate of progression to higher levels of play, long-term patient-reported outcomes (PROs), and long-term patient satisfaction in nonprofessional baseball players after UCLR. Study Design: Case series; Level of evidence, 4. Methods: We evaluated UCLR patients who were nonprofessional baseball athletes aged <25 years at a minimum of 5 years postoperatively. Patients were assessed with the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), the Timmerman-Andrews (T-A) Elbow score, the Mayo Elbow Performance Score (MEPS), and a custom return-to-play questionnaire. Results: A total of 91 baseball players met the inclusion criteria, and 67 (74%) patients were available to complete the follow-up surveys at a mean follow-up of 8.9 years (range, 5.5-13.9 years). At the time of the surgery, the mean age was 18.9 ± 1.9 years (range, 15-24 years). Return to play at any level was achieved in 57 (85%) players at a mean time of 12.6 months. Twenty-two (32.8%) of the initial cohort returned to play at the professional level. Also, 43 (79.1%) patients who initially returned to play after surgery reported not playing baseball at the final follow-up; of those patients, 12 reported their elbow as the main reason for eventual retirement. The overall KJOC, MEPS, and T-A scores were 82.8 ± 18.5 (range, 36-100), 96.7 ± 6.7 (range, 75-100), and 91.9 ± 11.4 (range, 50-100), respectively . There was an overall satisfaction score of 90.6 ± 21.5 out of 100, and 64 (95.5%) patients reported that they would undergo UCLR again. Conclusion: In nonprofessional baseball players after UCLR, there was a high rate of progression to higher levels of play. Long-term PRO scores and patient satisfaction were high. The large majority of patients who underwent UCLR would undergo surgery again at long-term follow-up, regardless of career advancement.

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