scholarly journals ANTERIOR CRUCIATE LIGAMENT RECONSRUCTION IN CHILDREN: OUTCOMES OF QUADRICEPS VERSUS HAMSTRING AUTOGRAFTS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0006
Author(s):  
Joshua T. Bram ◽  
Itai Gans ◽  
Robert Parisien ◽  
Elliot Greenberg ◽  
Theodore J. Ganley
Keyword(s):  
Pediatric Patients ◽  
Cruciate Ligament ◽  
Cohort Analysis ◽  
Donor Site ◽  
Peak Torque ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Donor Site Pain ◽  
Patient Reported ◽  
Torque Values

Background: Emerging evidence has suggested reduced donor site pain and equivalent/improved functional outcomes in adults undergoing ACL reconstruction (ACLR) with quadriceps (QT) autograft versus hamstrings (HT) grafts. No studies in children comparing QT versus HT autografts have assessed postoperative strength or active range of motion (AROM) in addition to more commonly accepted patient-reported outcome measures (PROMs). Hypothesis/Purpose: The purpose of this study was to directly compare clinical and patient-reported outcomes of pediatric patients undergoing QT and HT autograft ACL reconstructions. We hypothesized that use of QT autografts would result in similar clinical and PROMs to HT autografts. Methods: A retrospective cohort analysis of pediatric patients (≤18 years) undergoing primary transphyseal ACLR from 1/2018-12/2019 without concomitant multiligamentous reconstruction was conducted. Outcomes at 3 and 6 months, including isokinetic strength testing, PROMIS and IKDC scores, and AROM were compared between patients receiving either HT or QT autografts. Hamstrings to quadriceps (H/Q) ratios were calculated using the ratio of the respective peak torque values normalized to body weight. Multiple imputation was utilized to minimize bias resulting from missed follow-up appointments. Results: 84 patients met inclusion criteria (Table 1). The 40 patients receiving QT were more often male (62.5% vs 34.1%, p=0.009). There were no differences in operative time (p=0.053) or proportion of patients requiring meniscus repair (p=0.958). At 3 months postoperative, those with HT had lower H/Q ratios (62.2 ± 15.8 vs 78.6 ± 19.9, p<0.001) and limb symmetry index (LSI) in flexion (86.1 ± 17.1 vs 94.3 ± 17.6, p=0.042), while patients with QT had lower LSI in extension (66.8 ± 13.2 vs 77.3 ± 12.6, p=0.001). The H/Q ratio was also lower at 6 months among patients receiving HT (59.7 ± 11.2 vs 66.3 ± 8.2, p=0.004). IKDC, PROMIS physical function, and PROMIS pain interference scores were not different between cohorts at either 3 or 6 months. There was no difference in AROM in flexion or extension between groups at all postoperative visits. Patients with QT were more likely to have a postoperative wound issue (20.0% vs 2.3%, p=0.012). Conclusion: Significant differences in quadriceps and hamstrings strength at 3 months were observed for ACLR patients by graft type. This contributed to higher H/Q ratios at 3 and 6 months postoperatively for patients receiving QT. QT grafts appear to have a higher rate of postoperative infection/wound issues. Tables/Figures: [Table: see text]

scholarly journals Sex differences in postural orientation errors and association with objective and patient-reported function in patients with ACL injury: an exploratory cross-sectional study

2021 ◽  
Vol 7 (2) ◽  
pp. e001045
Author(s):  
Jenny Nae ◽  
Mark W Creaby ◽  
Anna Cronström ◽  
Eva Ageberg
Keyword(s):  
Sex Differences ◽  
Physical Function ◽  
Cruciate Ligament ◽  
Visual Assessment ◽  
Patient Reported Outcome Measures ◽  
Cross Sectional Study ◽  
Patient Reported Outcome ◽  
Cross Sectional ◽  
Patient Reported ◽  
Postural Orientation

ObjectivesThere is limited research on sex differences in postural orientation (ie, alignment between body segments) in people with knee injury measured with a clinically applicable method. An understanding of the relationship between postural orientation and physical function may help guide decision making in rehabilitation. The aims were to evaluate (1) sex differences in visual assessment of Postural Orientation Errors (POEs) and (2) the association between POEs and objective and patient-reported physical function, in men and women with anterior cruciate ligament reconstruction (ACLR).MethodsTwenty-four women and 29 men (mean 26.7 (SD 6.5) years) with ACLR were included. Six POEs (lower extremity and trunk) were scored from a video of five tasks with varying difficulty to compute POE scores (total and subscores). Objective physical function was evaluated with the single-leg hop for distance and side hop. Patient-reported physical function was evaluated using patient-reported outcome measures (PROMs).ResultsWomen had significantly more POEs than men (median difference 5.5–25, p≤0.028). More POEs were associated with shorter hop distance and fewer side hops in women (rs= −0.425 to −0.518, p<0.038), but not in men (rs<0.301, p>0.05). No associations were found between POE scores and PROMs, in either sex (rs< –0.246, p>0.05).ConclusionsWomen with ACLR seem to have more POEs compared with men, indicating worse postural orientation. More POEs were associated with worse hop performance, suggesting that POE scores may be used as criteria for rehabilitation progression. The lack of associations between POE scores and PROMs indicate that these measures complement each other.

scholarly journals Patient-Reported Outcome Measures in Cystic Fibrosis: Protocol for a Systematic Review (Preprint)

2019 ◽  
Author(s):  
Irushi Ratnayake ◽  
Susannah Ahern ◽  
Rasa Ruseckaite
Keyword(s):  
Systematic Review ◽  
Cystic Fibrosis ◽  
Outcome Measures ◽  
Systematic Reviews ◽  
Pediatric Patients ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Cochrane Library ◽  
Patient Reported

BACKGROUND Patients with cystic fibrosis (CF) can struggle with burdensome symptoms and treatment regimens that negatively affect every aspect of their life. As physiological parameters can fail to capture these complications, the assessment of health-related quality of life (HRQOL) has gained prominence. HRQOL can be measured using standardized patient questionnaires called patient-reported outcome measures (PROMs). The Australian Cystic Fibrosis Data Registry (ACFDR) collects clinical data on adult and pediatric patients with CF. The incorporation of PROMs into the ACFDR would enable monitoring of HRQOL trends, benchmarking of HRQOL outcomes, and support of HRQOL research in CF. OBJECTIVE Prior to incorporation of a PROM in the ACFDR, this systematic review was planned to evaluate whether any suitable PROMs are currently being used for CF. METHODS This systematic review will be conducted in compliance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. MEDLINE, EMBASE, Scopus, CINAHL (Cumulative Index of Nursing and Allied Health Literature), PsycINFO, and Cochrane Library databases were searched for articles published between January 2009 and February 2019 on the use of PROMs to measure HRQOL in adult and pediatric patients with CF. Study designs such as observational studies, reviews and validation studies were included. Studies describing randomized controlled trials, dissertations, books, guideline statements, and abstracts were excluded. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist was used to assess the methodological quality of included studies. A descriptive synthesis of the results will be undertaken in line with the outcomes of this study. RESULTS As of July 2019, the search has been conducted and 4530 records were screened. After two phases of screening, 97 studies were included in the final review and subjected to data extraction. Reviewers are currently in the process of critical appraisal. CONCLUSIONS This review will identify any PROM(s) that may be used to measure HRQOL in the ACFDR. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD42019126931; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=126931

scholarly journals Baseline Analysis of Patients Presenting for Surgical Review of Anterior Cruciate Ligament Rupture Reveals Heterogeneity in Patient-Reported Outcome Measures

2020 ◽  
Author(s):  
Chee Han Ting ◽  
Corey Scholes ◽  
David Zbrojkiewicz ◽  
Christopher Bell
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Outcome Measures ◽  
Cruciate Ligament ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Cluster Membership ◽  
Patient Reported ◽  
Rehabilitation Protocols ◽  
Anterior Cruciate

AbstractDespite the establishment of successful surgical techniques and rehabilitation protocols for anterior cruciate ligament (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 patient-reported outcome measures (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 Veterans RAND 12-item Health Survey (VR-12) Physical Component Summary and Mental Component Summary scores, Tegner activity scale, and International Knee Documentation Committee (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 analysis of variance (ANOVA; Kruskal–Wallis) and nominal logistic regression was performed to determine relationships between cluster membership and patient age, gender, body mass index (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 patient acceptable symptom state for the IKDC score for ACL reconstruction (70.1, interquartile range: 59–78). Significant (p < 0.05) differences in PROMs between clusters were observed using ANOVA, with variance explained ranging from 40 to 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.

Patient-reported outcome measures following anterior cruciate ligament reconstruction are not related to dynamic knee extension angle

2018 ◽  
Vol 3 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Kanto Nagai ◽  
Elmar Herbst ◽  
Tom Gale ◽  
Yasutaka Tashiro ◽  
James J Irrgang ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Patient Reported Outcome Measures ◽  
Knee Extension ◽  
Patient Reported Outcome ◽  
Cruciate Ligament Reconstruction ◽  
Knee Hyperextension ◽  
Patient Reported ◽  
Anterior Cruciate

ObjectivesControversy still exists on whether knee hyperextension affects the outcome following anterior cruciate ligament reconstruction (ACL-R). Therefore, the purpose of the present study was to determine if maximum knee extension angle of ACL-R knees and contralateral uninjured knees during walking is related to the clinical outcome following ACL-R. It was hypothesised that maximum knee extension angle would not be significantly correlated with patient-reported outcome measures (PROMs) following ACL-R.MethodsForty-two patients (age at surgery: 23±9 years, 23 male and 19 female) underwent unilateral ACL-R. Twenty-four months after surgery, subjects performed level walking on a treadmill while biplane radiographs were acquired at 100 Hz. Three-dimensional tibiofemoral motion was determined using a validated model-based tracking process. Tibiofemoral rotations were calculated from foot strike through early stance. The primary kinematic outcome measure was maximum knee extension angle of ACL-R and contralateral uninjured knees during walking, with positive values indicating hyperextension. The side-to-side difference (SSD) in maximum knee extension angle was calculated by subtracting the angle of the contralateral uninjured knee from that of the ACL reconstructed knee. PROMs (International Knee Documentation Committee Subjective Knee Form, Knee Injury and Osteoarthritis Score and Marx Activity Rating Scale) were obtained at 24 months after surgery. Correlations between PROMs and maximum dynamic knee extension angle in ACL-R and contralateral knee were evaluated (P<0.05).ResultsMaximum knee extension angle during walking was 2.3±4.5° in ACL-R knees and 4.3±4.2° in contralateral uninjured knees at 24 months after surgery, indicating hyperextension during walking on average. SSD in maximum knee extension angle was −2.0±3.7°. No significant correlation was observed between maximum knee extension angle and the PROMs.ConclusionMaximum knee extension angle during walking was not significantly correlated with PROMs, suggesting that clinically, physiologic knee hyperextension can be restored after ACL-R and not adversely affect PROMs.Level of evidenceLevel III.

scholarly journals Relationship Between Sports Participation After Revision Anterior Cruciate Ligament Reconstruction and 2-Year Patient-Reported Outcome Measures

2019 ◽  
Vol 47 (9) ◽  
pp. 2056-2066
Author(s):  
◽  
John P. Bigouette ◽  
Erin C. Owen ◽  
Brett (Brick) A. Lantz ◽  
Rudolf G. Hoellrich ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Cruciate Ligament ◽  
Sports Participation ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Activity Level ◽  
Acl Revision ◽  
Patient Reported ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) revision cohorts continually report lower outcome scores on validated knee questionnaires than primary ACL cohorts at similar time points after surgery. It is unclear how these outcomes are associated with physical activity after physician clearance for return to recreational or competitive sports after ACL revision surgery. Hypotheses: Participants who return to either multiple sports or a singular sport after revision ACL surgery will report decreased knee symptoms, increased activity level, and improved knee function as measured by validated patient-reported outcome measures (PROMs) and compared with no sports participation. Multisport participation as compared with singular sport participation will result in similar increased PROMs and activity level. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 1205 patients who underwent revision ACL reconstruction were enrolled by 83 surgeons at 52 clinical sites. At the time of revision, baseline data collected included the following: demographics, surgical characteristics, previous knee treatment and PROMs, the International Knee Documentation Committee (IKDC) questionnaire, Marx activity score, Knee injury and Osteoarthritis Outcome Score (KOOS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A series of multivariate regression models were used to evaluate the association of IKDC, KOOS, WOMAC, and Marx Activity Rating Scale scores at 2 years after revision surgery by sports participation category, controlling for known significant covariates. Results: Two-year follow-up was obtained on 82% (986 of 1205) of the original cohort. Patients who reported not participating in sports after revision surgery had lower median PROMs both at baseline and at 2 years as compared with patients who participated in either a single sport or multiple sports. Significant differences were found in the change of scores among groups on the IKDC ( P < .0001), KOOS-Symptoms ( P = .01), KOOS–Sports and Recreation ( P = .04), and KOOS–Quality of Life ( P < .0001). Patients with no sports participation were 2.0 to 5.7 times more likely than multiple-sport participants to report significantly lower PROMs, depending on the specific outcome measure assessed, and 1.8 to 3.8 times more likely than single-sport participants (except for WOMAC-Stiffness, P = .18), after controlling for known covariates. Conclusion: Participation in either a single sport or multiple sports in the 2 years after ACL revision surgery was found to be significantly associated with higher PROMs across multiple validated self-reported assessment tools. During follow-up appointments, surgeons should continue to expect that patients who report returning to physical activity after surgery will self-report better functional outcomes, regardless of baseline activity levels.

Prospective Evaluation of the Patient Acceptable Symptom State to Identify Clinically Successful Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 47 (5) ◽  
pp. 1159-1167 ◽  
Author(s):  
José F. Vega ◽  
Cale A. Jacobs ◽  
Gregory J. Strnad ◽  
Lutul Farrow ◽  
Morgan H. Jones ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Cruciate Ligament ◽  
High Sensitivity ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Related Quality ◽  
Patient Acceptable Symptom State ◽  
Anterior Cruciate

Background: The length of most patient-reported outcome measures creates significant response burden, which hampers follow-up rates. The Patient Acceptable Symptom State (PASS) is a single-item, patient-reported outcome measure that asks patients to consider all aspects of life to determine whether the state of their joint is satisfactory; this measure may be viable for tracking outcomes on a large scale. Hypothesis: The PASS question would identify clinically successful anterior cruciate ligament reconstruction (ACLR) at 1-year follow-up with high sensitivity and moderate specificity. We defined “clinically successful” ACLR as changes in preoperative to postoperative scores on the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale and the KOOS knee-related quality of life subscale in excess of minimal clinically important difference or final KOOS pain or knee-related quality of life subscale scores in excess of previously defined PASS thresholds. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients enrolled in a prospective longitudinal cohort completed patient-reported outcome measures immediately before primary ACLR. At 1-year follow-up, patients completed the same patient-reported outcome measures and answered the PASS question: “Taking into account all the activity you have during your daily life, your level of pain, and also your activity limitations and participation restrictions, do you consider the current state of your knee satisfactory?” Results: A total of 555 patients enrolled in our cohort; 464 were eligible for this study. Of these, 300 patients (64.7%) completed 1-year follow-up, of whom 83.3% reported satisfaction with their knee after surgery. The PASS question demonstrated high sensitivity to identify clinically successful ACLR (92.6%; 95% CI, 88.4%-95.6%). The specificity of the question was 47.1% (95% CI, 35.1%-59.5%). The overall agreement between the PASS and our KOOS-based criteria for clinically successful intervention was 81.9%, and the kappa value indicated moderate agreement between the two methods (κ = 0.44). Conclusion: The PASS question identifies individuals who have experienced clinically successful ACLR with high sensitivity. The limitation of the PASS is its low specificity, which we calculated to be 47.1%. Answering “no” to the PASS question meant that a patient neither improved after surgery nor achieved an acceptable final state of knee health. The brevity, interpretability, and correlation of the PASS question with significant improvements on various KOOS subscales make it a viable option in tracking ACLR outcomes on a national or global scale.

Effects of Surgical Factors on Cartilage Can Be Detected Using Quantitative Magnetic Resonance Imaging After Anterior Cruciate Ligament Reconstruction

2017 ◽  
Vol 45 (5) ◽  
pp. 1075-1084 ◽  
Author(s):  
Keiko Amano ◽  
Alan K. Li ◽  
Valentina Pedoia ◽  
Matthew F. Koff ◽  
Aaron J. Krych ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Cruciate Ligament ◽  
Relaxation Times ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Meniscal Tears ◽  
T2 Relaxation ◽  
Patient Reported ◽  
Anterior Cruciate

Background: Quantitative magnetic resonance (qMR) can be used to measure macromolecules in tissues and is a potential method of observing early cartilage changes in the development of posttraumatic osteoarthritis. Hypothesis/Purpose: We hypothesized that specific patient and surgical factors affecting cartilage matrix composition after anterior cruciate ligament (ACL) reconstruction (ACLR) can be detected using T1ρ and T2 relaxation times. Our purpose was to demonstrate this ability in a multicenter feasibility study. Study Design: Case series; Level of evidence, 4. Methods: A total of 54 patients who underwent ACLR underwent bilateral MRI at baseline before surgery and 6 months postoperatively. Operative findings were recorded. T1ρ and T2 relaxation times were calculated for 6 cartilage regions: the medial femur, lateral femur, medial tibia, lateral tibia, patella, and trochlea. A paired t test compared relaxation times at baseline and 6 months, univariate regression identified regions that influenced patient-reported outcome measures, and analysis of covariance was used to determine the surgical factors that resulted in elevated relaxation times at 6 months. Results: The injured knee had significantly prolonged T1ρ and T2 relaxation times in the tibiofemoral compartment at baseline and 6 months but had shorter values in the patellofemoral compartment compared with the uninjured knee. Prolonged T1ρ and T2 times at 6 months were noted for both the injured and uninjured knees. At 6 months, prolongation of T1ρ and T2 times in the tibial region was associated with lower patient-reported outcome measures. ACLR performed within 30 days of injury had significantly shorter T1ρ times in the tibial regions, and lateral meniscal tears treated with repair had significantly shorter T1ρ times than those treated with excision. Conclusion: Prolonged relaxation times in multiple regions demonstrate how the injury affects the entire joint after an ACL tear. Changes observed in the uninjured knee may be caused by increased loading during rehabilitation, especially in the patellofemoral articular cartilage and distal femur. Relaxation times in the tibial regions may be predictive of patient symptoms at 6 months. These same regions are affected by surgical timing as early as 30 days after injury, but this may partially be reflective of the severity of the preoperative injury and the choice of treatment of meniscal tears.

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