scholarly journals Neighborhood Socioeconomic Status Affects Patient-Reported Outcome 2 Years After ACL Reconstruction

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985107 ◽  
Author(s):  
Morgan H. Jones ◽  
Emily K. Reinke ◽  
Alexander Zajichek ◽  
Jessica A. Kelley-Moore ◽  
M. Michael Khair ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Acl Reconstruction ◽  
Patient Reported Outcome ◽  
Education Level ◽  
Patient Age ◽  
Patient Âgé ◽  
Patient Reported ◽  
Multivariable Models ◽  
Us Census ◽  
Neighborhood Ses

Background: Lower socioeconomic status (SES) is associated with worse patient-reported outcome (PRO) after orthopaedic procedures. In patients with anterior cruciate ligament (ACL) reconstruction, evaluating SES by use of traditional measures such as years of education or occupation is problematic because this group has a large proportion of younger patients. We hypothesized that lower education level and lower values for SES would predict worse PRO at 2 years after ACL reconstruction and that the effect of education level would vary with patient age. Purpose: To compare the performance of multivariable models that use traditional measures of SES with models that use an index of neighborhood SES derived from United States (US) Census data. Study Design: Cohort study; Level of evidence, 3. Methods: A cohort of 675 patients (45% female; median age, 20 years), were prospectively enrolled and evaluated 2 years after ACL reconstruction with questionnaires including the International Knee Documentation Committee (IKDC) questionnaire, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Marx activity rating scale (Marx). In addition, a new variable was generated for this study, the SES index, which used geocoding performed retrospectively to identify the census tract of residence for each participant at the time of enrollment and extract neighborhood SES measures from the 2000 US Census Descriptive Statistics. Multivariable models were constructed that included traditional measures of SES as well as the SES index, and the quality of models was compared through use of the likelihood ratio test. Results: Lower SES index was associated with worse PRO for all measures. Models that included the SES index explained more variability than models with traditional SES. In addition, a statistically significant variation was found regarding the impact of education on PRO based on patient age for the IKDC score, the Marx scale, and 4 of the 5 KOOS subscales. Conclusion: This study demonstrates that lower neighborhood SES is associated with worse PRO after ACL reconstruction and that age and education have a significant interaction in this patient population. Future studies in patients who have undergone ACL reconstruction should attempt to account for neighborhood SES when adjusting for confounding factors; further, targeting patients from areas with lower neighborhood SES with special interventions may offer an opportunity to improve their outcomes.

scholarly journals Baseline analysis of patients presenting for surgical review of ACL rupture reveals heterogeneity in patient-reported outcome measures

2020 ◽  
Author(s):  
Chee Han Ting ◽  
Corey Scholes ◽  
David Zbrojkiewicz ◽  
Christopher Bell
Keyword(s):  
Acl Reconstruction ◽  
Surgical Techniques ◽  
Acl Rupture ◽  
Activity Levels ◽  
Physical And Mental Health ◽  
Patient Age ◽  
Cluster Membership ◽  
Patient Âgé ◽  
Patient Reported ◽  
Rehabilitation Protocols

AbstractDespite establishment of successful surgical techniques and rehabilitation protocols for ACL reconstruction, published return to sport rates are less than satisfactory. This has led orthopaedic surgeons and researchers to develop more robust patient selection methods and investigate prognostic patient characteristics. No previous studies have integrated baseline characteristics and responses to PROMs of patients with ACL rupture presenting for surgical review.Patients electing to undergo ACL reconstruction under the care of a single orthopaedic surgeon at a metropolitan public hospital were enrolled in a clinical quality registry. Patients completed VR-12 PCS and MCS scores, Tegner activity scale and IKDC questionnaires at presentation. Total scores were extracted from the electronic registry, and a machine learning approach (k-means) was used to identify subgroups based on similarity of questionnaire responses. The average scores in each cluster were compared using ANOVA (Kruskal-Wallis) and nominal logistic regression was performed to determine relationships between cluster membership and patient age, gender, BMI and injury-to-examination delay.A sample of 107 patients with primary ACL rupture were extracted, with 97 (91%) available for analysis with complete datasets. Four clusters were identified with distinct patterns of PROMs responses. These ranged from lowest (Cluster 1) to highest scores for VR-12 and IKDC (Cluster 4). In particular, Cluster 4 returned median scores within 6 points of the PASS for the IKDC score for ACL reconstruction (70.1, IQR 59 - 78). Significant (p<0.05) differences in PROMs between clusters was observed using ANOVA, with variance explained ranging from 40-69%. However, cluster membership was not significantly associated with patient age, gender, BMI or injury-to-examination delay.Patients electing to undergo ACL reconstruction do not conform to a homogenous group but represent a spectrum of knee function, general physical and mental health, and preinjury activity levels, which may not lend itself to uniform treatment and rehabilitation protocols. The factors driving these distinct responses to PROMs remain unknown, but are unrelated to common demographic variables.

Knowledge of Cystic Fibrosis in Patients and Their Parents

PEDIATRICS ◽  
1986 ◽  
Vol 77 (2) ◽  
pp. 229-235
Author(s):  
Terry Nolan ◽  
Katharine Desmond ◽  
Roberta Herlich ◽  
Susan Hardy
Keyword(s):  
Cystic Fibrosis ◽  
Socioeconomic Status ◽  
Male Sterility ◽  
Educational Level ◽  
Detailed Knowledge ◽  
Patient Knowledge ◽  
Parental Age ◽  
Patient Age ◽  
Parent Knowledge ◽  
Patient Âgé

A standardized questionnaire was used to assess knowledge about cystic fibrosis in 28 patients with cystic fibrosis (aged 10 to 21 years) and in the parents of 25 of these patients. Knowledge of disease pathophysiology and treatment was generally comprehensive and detailed; knowledge of the genetics was fair. However, there were conspicuous deficits in the awareness of reproductive risks and of male sterility. Significant predictors of patient knowledge were patient age, sex, and educational level and parental age. Predictors of parent knowledge were Shwachman score, socioeconomic status, and sex of responding parent. Patients rely heavily on parents for information about cystic fibrosis. More than one third of both patients and parents sought more information about the disease and its implications.

scholarly journals Neighborhood Socioeconomic Status in Relation to All-cause, Cancer, and Cardiovascular Mortality in the Black Women’s Health Study

2016 ◽  
Vol 26 (2) ◽  
pp. 157 ◽  
Author(s):  
Traci N. Bethea ◽  
Julie R. Palmer ◽  
Lynn Rosenberg ◽  
Yvette C. Cozier
Keyword(s):  
Socioeconomic Status ◽  
Black Women ◽  
Cardiovascular Mortality ◽  
Health Study ◽  
Block Group ◽  
Census Block ◽  
Census Block Group ◽  
Neighborhood Socioeconomic Status ◽  
Us Census ◽  
Neighborhood Ses

<p><strong>Background</strong>: Neighborhood socioeconomic status (SES) is associated with adverse health outcomes, but longitudinal data among Black Americans, who tend to live in more deprived neighborhoods, is lacking. <br />Objectives: We prospectively assessed the relation of neighborhood SES to mortality in the Black Women’s Health Study.</p><p><strong>Design</strong>: A prospective cohort of 59,000 Black women was followed from 1995-2011. Participant addresses were geocoded and US Census block group was identified. Neighborhood SES was measured by a score based on US Census block group data for six indicators of income, education and<br />wealth.</p><p><strong>Main outcome measures:</strong> Deaths were identified through the National Death Index. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs with control for covariates.</p><p><strong>Results</strong>: Based on 2,598 deaths during 1995-2011, lower neighborhood SES was associated with increased all-cause and cancer mortality irrespective of individual education: among those with 16 or more years of education, HRs for lowest relative to highest neighborhood SES quartile were 1.42 (95% CI 1.18-1.71) for all-cause and 1.54 (95% CI 1.14-2.07) for cancer mortality. Neighborhood SES was associated with cardiovascular mortality among lesseducated women.</p><p><strong>Conclusions</strong>: Lower neighborhood SES is associated with greater risk of mortality among Black women. The presence of the association even among women with high levels of education suggests that individual<br />SES may not overcome the unfavorable influence of neighborhood deprivation. <em>Ethn Dis</em>. 2016;26(2):157-164; doi:10.18865/<br />ed.26.2.157</p>

scholarly journals Reoperation and Failure Rate at Six Years Following Revision ACL Reconstruction: A MARS Cohort Study

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0029
Author(s):  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Reoperation Rate ◽  
Patient Reported Outcome ◽  
Young Cohort ◽  
Revision Procedure ◽  
Revision Acl Reconstruction ◽  
Patient Reported ◽  
Surgical Data

Objectives: Revision anterior cruciate ligament (ACL) reconstruction remains a challenge for orthopaedic surgeons, as results are persistently inferior to those of primary reconstructions. There is very limited data regarding outcomes at 6 years following revision ACL surgery. The purpose of this study was to report the rate of reoperation, further revision, and conversion to total knee arthroplasty (TKA) in a large cohort of revision ACL reconstructions Methods: Patients undergoing revision ACL reconstructions were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, intraoperative surgical technique, and a series of validated patient-reported outcome instruments. Patients were followed up by questionnaire and telephone at 6 years following index revision surgery and asked if they had undergone any further surgical procedures to either knee. If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Results: Six-year follow-up subsequent surgical data was available for 951/1234 patients (77%). In this available cohort, 556 (58%) were male, mean age was 28 years (range 12-61 years) and mean BMI was 26.1 (range 17.1-47.5). Allograft was used in 510 (54%) cases, BTB autograft in 234 (25%), soft tissue autograft in 174 (18%) and other grafts were used in the remaining 33 (3%). Their index surgery was their first revision ACL reconstruction in 822 (86.4%), in 108 (11.4%) it was their second, and in 21 (2.2%) it was their third or greater. This revision procedure was a mean of 5.7 years (range 0.1-26 years) from their prior ACL reconstruction. At six years following the index revision procedure, 16.2% of the cohort underwent at least 1 subsequent surgical procedure on their index knee. Of the reoperations, 29% were meniscal procedures (71% meniscectomy, 18% repair), 21% were articular cartilage procedures (79% chondroplasty, 15% microfracture, 3% OATS, 3% ACI), 11% were for arthrofibrosis, 9% for hardware removal, and 6% were for a subsequent revision ACL reconstruction. Surprisingly, only 5% reported having undergone a subsequent TKA on their ipsilateral knee. During this same 6-year follow-up period, 6% of the cohort (n=53 patients) underwent a subsequent surgery on their contralateral knee, of which 36 were ACL reconstructions. Conclusion: Our data shows that there is a reoperation rate of greater than 15% following ACL revision, which is an important point of discussion between surgeons and their patients. Of particular interest is that there was a 6% rate of recurrent ACL failure and 5% rate of subsequent TKA in this young cohort 6 years following a revision ACL reconstruction.

No negative effect on patient-reported outcome of concomitant cartilage lesions 5–9 years after ACL reconstruction

2016 ◽  
Vol 25 (5) ◽  
pp. 1482-1488 ◽  
Author(s):  
Svend Ulstein ◽  
Karin Bredland ◽  
Asbjørn Årøen ◽  
Lars Engebretsen ◽  
Jan Harald Røtterud
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcome ◽  
Cartilage Lesions ◽  
Patient Reported ◽  
Negative Effect

scholarly journals Predictors of Pain and Function Before Knee Arthroscopy

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984426 ◽  
Author(s):  
◽  
Matthew C. Bessette ◽  
Robert W. Westermann ◽  
Alan Davis ◽  
Lutul Farrow ◽  
...  
Keyword(s):  
Mental Health ◽  
Outcome Measures ◽  
Knee Arthroscopy ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Education Level ◽  
Smoking History ◽  
Female Sex ◽  
Patient Reported ◽  
Surgical Data

Background: Patient-reported outcome measures are commonly used to measure knee pain and functional impairment. When structural abnormality is identified on examination and imaging, arthroscopic partial meniscectomy and chondroplasty are commonly indicated for treatment in the setting of pain and decreased function. Purpose: To evaluate the relationship between patient characteristics, mental health, intraoperative findings, and patient-reported outcome measures at the time of knee arthroscopy. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Between February 2015 and October 2016, patients aged 40 years and older who were undergoing routine knee arthroscopy for meniscal and cartilage abnormality, without reconstructive or restorative procedures, were prospectively enrolled in this study. Routine demographic information was collected, and the Knee injury and Osteoarthritis Outcome Score (KOOS) Pain, Quality of Life (QoL), and Physical Function Short Form (PS) subscales and the mental and physical component subscales of the Veterans RAND 12-Item Health Survey (VR-12 MCS and VR-12 PCS) were administered preoperatively on the day of surgery. Intraoperative findings were collected in a standardized format. Patient demographics, intraoperative findings, and the VR-12 MCS were used as predictor values, and a multivariate analysis was conducted to assess for relationships with the KOOS and VR-12 as dependent variables. Results: Of 661 eligible patients, baseline patient-reported outcomes and surgical data were used for 638 patients (97%). Lower scores on both subscales of the VR-12 were predicted by female sex, positive smoking history, fewer years of education, and higher body mass index (BMI). All KOOS subscales were negatively affected by lower VR-12 MCS scores, female sex, lower education level, and higher BMI in a statistically meaningful way. Positive smoking history was associated with worse scores on the KOOS-PS. Abnormal synovial status was associated with worse KOOS-Pain. Conclusion: The demographic factors of sex, smoking status, BMI, and education level had an overwhelming impact on preoperative KOOS and VR-12 scores. Of interest, mental health as assessed by the VR-12 MCS was also a consistent predictor of KOOS scores. The only intraoperative finding with a significant association was abnormal synovial status and its effect on KOOS-Pain scores.

scholarly journals Current Return to Sport Criteria after ACL Reconstruction Fail to Identify Increased Risk of Second ACL Injury in Young Athletes

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0006 ◽  
Author(s):  
Mark V. Paterno ◽  
Mitchell Rauh ◽  
Staci Thomas ◽  
Timothy E. Hewett ◽  
Laura Schmitt
Keyword(s):  
Acl Reconstruction ◽  
Group Analysis ◽  
Return To Sport ◽  
Acl Injury ◽  
Quadriceps Strength ◽  
Patient Reported Outcome ◽  
Young Athletes ◽  
Increased Risk ◽  
Significant Difference ◽  
Patient Reported

Objectives: The incidence of 2nd anterior cruciate ligament (ACL) injury after ACL reconstruction (ACLR) and return to sport (RTS) ranges from 25%-33% in young, active populations; with the greatest risk in the first 12 months after RTS. Recent data indicate that failure to successfully meet traditional RTS criteria, inclusive of strength, functional hop testing and patient reported outcome scores, may identify athletes at increased risk of future injury after ACLR. However, these studies have focused on adult populations and it is unknown if similar RTS criteria apply to young, adolescent, pivoting/cutting athletes. The purpose of this study was to determine if meeting all current, standard RTS criteria would identify young athletes at risk for future ACL injury after primary ACLR and RTS. The tested hypothesis was the likelihood of 2nd ACL injury in the first 2 years after RTS would be lower in patients who met all RTS criteria prior to initiation of pivoting and cutting activity compared to patients who failed to meet all RTS criteria prior to RTS. Methods: One hundred fifty-nine subjects (112 female, 47 male) with a mean age of 17.2±2.6 years old (range: 13-25 y.o.) underwent ACLR and were released to return to pivoting/cutting sport. These patients were enrolled in a prospective, observational cohort study, completed a RTS assessment and were then tracked for occurrence of 2nd ACL after ACLR for 24 months. The RTS assessment included 6 tests: isometric quadriceps strength, 4 functional hop tests and the International Knee Documentation Committee (IKDC) patient reported outcome survey. Limb symmetry index (LSI) was calculated for strength and hop test assessments [(involved/uninvolved)*100]. The IKDC was reported on a 0-100 scale with 100 representing a perfect score. Subjects were classified into groups that successfully passed all 6 RTS tests at a level of 90 and again at 95 compared to those that failed to meet all 6 criteria. Chi Square tests were used to determine if successfully passing all 6 RTS measures at various levels of symmetry resulted in a reduced risk of 2nd ACL injury in the first 24 months after RTS. Results: Thirty-five (22.0%) patients suffered a 2nd ACL injury, with 26 occurring in the first 12 months after RTS. At the time of RTS, 42 patients (26%) achieved LSI values of 90 or greater on all testing as well as an IKDC value of 90 or greater. The remaining 117 subjects (74%) scored below 90 on at least 1 of the 6 assessments. At this level, there was no difference in 2nd ACL injury prevalence between patients who passed all RTS criteria (12/42; 28.6%) and those who failed at least 1 criteria (23/117; 19.7%) (p=0.23). When the passing criteria was elevated to 95 on all RTS testing, only 15 subjects (9%) successfully passed all 6 tests. There was no significant difference in 2nd ACL injury prevalence between patients who passed all RTS criteria (5/15; 33%) and those who failed at least 1 test (30/144; 20.8%) (p=0.32). Sub-group analysis which evaluated the group by graft type, also indicated no significant differences between groups (p>0.05). Conclusion: Current criteria to evaluate readiness to return young athletes to pivoting and cutting sports, using quadriceps strength symmetry, functional hop performance symmetry and patient reported outcomes, may not identify young, active patients at high risk for 2nd ACL injury. Future work must identify more appropriate criteria to assess readiness to RTS in the young, athletic population and incorporate these findings into practice.

scholarly journals Functional and Patient-Reported Outcomes Improve Over the Course of Rehabilitation: A Secondary Analysis of the ACL-SPORTS Trial

2018 ◽  
Vol 10 (5) ◽  
pp. 441-452 ◽  
Author(s):  
Amelia J.H. Arundale ◽  
Jacob J. Capin ◽  
Ryan Zarzycki ◽  
Angela Smith ◽  
Lynn Snyder-Mackler
Keyword(s):  
Randomized Controlled Trial ◽  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Controlled Trial ◽  
Return To Sport ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Men And Women ◽  
Randomized Controlled ◽  
Patient Reported

Background: The Anterior Cruciate Ligament–Specialized Post-Operative Return to Sports (ACL-SPORTS) randomized controlled trial was designed to address deficits in functional and patient-reported outcomes. The trial examined the effects of a secondary ACL prevention program that included progressive strengthening, agility training, plyometrics (SAP), and other components of current primary prevention protocols, with perturbation training (SAP + PERT group) and without PERT (SAP group). A secondary purpose of this study was to examine whether study outcomes differed between men and women. Hypotheses: (1) Athletes in both the SAP and SAP + PERT groups will have improved knee function and patient-reported outcome measures from pre- to posttraining, (2) the SAP + PERT group would have higher outcome scores than the SAP group, and (3) outcomes will differ by sex. Study Design: Randomized controlled trial (NCT01773317). Level of Evidence: Level 2. Methods: A total of 79 athletes (39 women) were randomized into the SAP and SAP + PERT groups. All athletes had undergone primary ACL reconstruction and achieved 80% quadriceps strength limb symmetry (QI), full range of motion, had minimal effusion, and had no pain. Additionally, all had begun running again. Prior to and after the training program, athletes’ QI, hopping, and patient-reported outcomes were assessed. Repeated-measures analyses of variance were used to determine whether there were differences between groups. Subsequently, the SAP and SAP + PERT groups were collapsed to analyze differences between sexes. Results: There were significant increases for all variables, with the exception of QI. There were no differences between the SAP and SAP + PERT groups. Both men and women made significant improvements in all knee function and patient-reported outcome measures except QI. Men made significant improvements in QI, whereas women did not. Conclusion: The common elements of the training program that all athletes received (10 sessions of progressive strengthening, agility training, plyometrics, and secondary prevention) may be a beneficial addition to the return-to-sport phase of ACL reconstruction rehabilitation. The results suggest that women may require further quadriceps strengthening to maintain and improve QI, an important focus given the relationship between QI and risk for reinjury. Clinical Relevance: During the return-to-sport phase of ACL reconstruction rehabilitation, clinicians tend to shift their focus away from strengthening toward more advanced sports-related tasks. These results indicate that women in particular need continued focus on quadriceps strengthening.

scholarly journals Comparison of concomitant injuries and patient-reported outcome in patients that have undergone both primary and revision ACL reconstruction—a national registry study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Eleonor Svantesson ◽  
Eric Hamrin Senorski ◽  
Frida Kristiansson ◽  
Eduard Alentorn-Geli ◽  
Olof Westin ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcome ◽  
Concomitant Injuries ◽  
Knee Ligament ◽  
Acl Revision ◽  
Revision Acl Reconstruction ◽  
Patient Reported ◽  
Cartilage Injuries ◽  
One Year ◽  
Primary Acl Reconstruction

Abstract Background Anterior cruciate ligament (ACL) revision surgery has been associated with inferior outcome compared with primary ACL reconstruction. However, this has rarely been investigated in a consecutive cohort limited to patients that have undergone both primary and revision ACL reconstruction. This study aimed to assess differences in outcome and concomitant injuries between primary and revision ACL reconstruction in such a cohort, and to identify predictors of the patient-reported outcome after ACL revision. Methods Patients who had undergone both primary and revision ACL reconstruction were identified in the Swedish National Knee Ligament Registry. Patients aged 13–49 years with hamstring tendon primary ACL reconstruction and data on the Knee Injury and Osteoarthritis Outcome Score (KOOS) on at least one occasion (preoperative or one year postoperatively) at both surgeries were eligible. Concomitant injuries and the KOOS were compared between each patient’s primary and revision ACL reconstruction. Linear regression analyses were performed to determine predictors of the one-year KOOS after ACL revision. Results A total of 1014 patients were included. Cartilage injuries increased at ACL revision (p < 0.001), as 23.0% had a cartilage injury at ACL revision that was not present at primary ACL reconstruction. The 1-year KOOS was lower after ACL revision compared with primary ACL reconstruction, with the largest difference in the KOOS sports and recreation (5.2 points, SD 32.2, p = 0.002). A posterolateral corner (PLC) injury at ACL revision was a negative predictor of KOOS, with the largest effect on the sports and recreation subscale (β = − 29.20 [95% CI − 50.71; − 6.69], p = 0.011). The use of allograft for ACL revision was an independent predictor of a poorer KOOS QoL (β = − 12.69 [95% CI − 21.84; − 3.55], p = 0.0066) and KOOS4 (β = − 11.40 [95% CI − 19.24; − 3.57], p = 0.0044). Conclusion Patients undergoing ACL revision reported a 1-year outcome that was slightly inferior to the 1-year outcome after their primary ACL reconstruction. An ACL revision was associated with an increase in cartilage injuries. A PLC injury at ACL revision and the use of allograft for ACL revision predicted a clinically relevant poorer KOOS one year after ACL revision.

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