scholarly journals THE BENEFITS CONFERRED BY MULTI-SPORT PARTICIPATION MAY NOT INCLUDE IMPROVED FUNCTIONAL AND PSYCHOLOGICAL READINESS FOLLOWING INJURY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0016
Author(s):  
Craig Kemper ◽  
K. John Wagner ◽  
Connor M. Carpenter ◽  
Philip L. Wilson ◽  
Henry B. Ellis
Keyword(s):  
Acl Reconstruction ◽  
Sports Medicine ◽  
Sport Participation ◽  
Patient Reported Outcome Measures ◽  
Return To Play ◽  
Concomitant Injuries ◽  
Psychological Recovery ◽  
Patient Reported ◽  
Surgical Data ◽  
Athletic Development

Background: Multi-sport participation has been advocated for youth as a means to foster athletic development and reduce over-use injury. Whether this sport variety may influence functional and psychological readiness after injury is unclear. Purpose: The purpose of this study was to compare presentation, and functional and psychological recovery between single sport and multi-sport pediatric athletes following an ACL reconstruction (ACLR). Methods: Following IRB approval, prospectively collected data in consecutive patients treated for ACL injury (1/2015-2/2017) in a pediatric sports medicine clinic was reviewed. Inclusion required primary ACLR. Injury and surgical data, patient reported outcome measures (PROM) including both functional (Pedi-IKDC) and psychological PROM (ACSI-28 and ACL-RSI), functional clearance data (Y balance testing), timing of return to play clearance, and any re-injuries were reviewed. Comparison of multi-sport and single sport athletes was performed using a Kruskal-Wallis test and ANOVA analysis followed by T-tests for multiple comparisons. Results: 81.5% of patients who underwent an ACL reconstruction were single sport athletes. Single sport athletes presented with a higher initial BMI (24.47 ± 5.67 vs 22.45 ± 3.81, p = 0.03) than multi-sport athletes. In this cohort, soccer players (89%) were more likely to be specialized compared to football (61%) or basketball players (69%, p<0.01). No differences between groups were noted regarding surgical procedures or concomitant injuries. While no significant differences were found between the groups in time to functional clearance or clearance scores, it was noted that only ¾ of single sport athletes returned to sports (74.0% vs 92.3%, p = 0.06). Reported confidence in functional and psychological recovery improved in both groups throughout rehabilitation (see Table 1). Multi-sport athletes in this cohort demonstrated no advantage in either phase of recovery. Conclusion: Although multi-sport participation has been established to improve athletic development, and decrease burnout and over-use injury; it may not confer advantages in comparison to the specialized athlete for functional or psychological recovery following ACL reconstruction. [Table: see text]

scholarly journals VALIDATION OF A COMPUTER-BASED SYSTEM FOR THE COLLECTION OF PATIENT REPORTED OUTCOME MEASURES IN PEDIATRIC SPORTS MEDICINE

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0003
Author(s):  
Meagan J. Sabatino ◽  
Catherine V. Gans ◽  
Aaron J. Zynda ◽  
Chan-Hee Jo ◽  
Jane Chung ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Sports Medicine ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Electronic Format ◽  
Pediatric Sports Medicine ◽  
Patient Reported ◽  
Computer Based ◽  
Activity Scale ◽  
Tegner Activity Scale

Background: In orthopedics, patient reported outcome measures (PROMs) have become popularized due to an increase in patient-centered research and pay for performance reimbursement models. Most pediatric PROMs have been utilized and validated in paper format. However, the use of a computer-based system may improve patient and physician efficiency, decrease cost, ensure completion, provide instantaneous information, and minimize inconvenience. The purpose of the study is to validate the use, evaluate patient satisfaction, and review differences of electronic compared to paper PROMs in a pediatric sports medicine practice. Methods: New patients between 12 – 19 years of age with a knee-related primary complaint were identified prior to their appointment. Patients were then randomized into two groups to complete standard clinical PROMs; including the Pedi-IKDC, HSS Pedi-FABS, Tegner Activity Scale, Visual Analogue Scale (VAS) and PedsQL-Teen. Group 1 completed paper forms followed by electronic, while Group 2 received the electronic format followed by paper, with a 10-minute break between formats in each group. Following the completion of PROMs, subjects completed a satisfaction survey. A Pearson’s correlation was used to calculate the association between the measures and a paired t-test to compare means between electronic and paper forms. Reliability analysis was conducted using an ICC calculation. Results: 87 subjects were enrolled with one excluded due to incomplete PROMs, for a total of 86. 54 subjects were female and 32 were male with an average age of 14.3 years (range 12-18). A high degree of reliability was found when comparing the paper and electronic versions of the Pedi-IKDC, HSS Pedi-FABS, PedsQL 13-18 and the Tegner activity scale (Figure 1). Differences were noted between the VAS scores, with paper scores being significantly higher than electronic (5.3 vs 4.6, p<0.001). Excluding the 10-minute break, it took subjects an average of 21.3 minutes to complete the PROMs. Although not significant, electronic PROMs took less time than paper on average (10.0 min vs 11.2 min, p=0.096). All subjects endorsed that PROMs captured on paper were the same as electronic with 69.8% of subjects preferring the electronic PROMs. 67.4% of subjects reported they felt the electronic format was faster, with only 5.8% of patients reporting the electronic forms were hard or confusing. 93.0% stated they would complete forms at home prior to appointments if it were an option and 91.8% were not concerned about the safety/privacy of electronic forms. Conclusion/Significance: PROMs captured electronically were reliable and valid when compared to paper, with differences noted only on the VAS. Electronic PROMs may be quicker, will not require manual scoring, and are preferred by patients. Electronic PROMs will improve the clinician’s ability to collect complete and validated data while reducing the burden on the clinical staff and patients. [Figure: see text]

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.

scholarly journals Return-to-Play Considerations Following a COVID-19 Infection in Elite Athletes

2021 ◽  
Author(s):  
Ryan Ross ◽  
Laura Irvin ◽  
Rich Severin ◽  
Brian Ellis
Keyword(s):  
Sports Medicine ◽  
Sport Participation ◽  
Elite Athletes ◽  
Return To Play ◽  
Strength And Conditioning ◽  
Unique Challenge ◽  
Orthopedic Injuries ◽  
High Level ◽  
Isolation Period ◽  
Prolonged Absence

Abstract The COVID-19 pandemic has created a unique challenge for sports medicine staffs as they are attempting to safely transition elite athletes into sport participation after a COVID-19 infection. Athletes must isolate for a period of time after testing positive for COVID-19 to prevent the spread of the virus within a community. After an isolation period, a battery of cardiac tests must be given to assess whether or not an athlete is ready to begin a reconditioning protocol. A return-to-play plan should be established to safely re-integrate high-level athletes into strength and conditioning, sport-specific drill work, and contact drill work. Elite athletes should also be gradually eased back into full training loads in order to avoid increases in orthopedic injuries after a prolonged absence from training.

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 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 Changes in Patient-Reported Outcome Measures From the Time of Injury to Return to Play in Adolescent Athletes at Secondary Schools With an Athletic Trainer

2019 ◽  
Vol 54 (2) ◽  
pp. 170-176 ◽  
Author(s):  
Janet E. Simon ◽  
Alison R. Snyder Valier ◽  
Zachary Y. Kerr ◽  
Aristarque Djoko ◽  
Stephen W. Marshall ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Knee Injury ◽  
Outcome Measure ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Return To Play ◽  
Foot And Ankle ◽  
Adolescent Athletes ◽  
Patient Reported ◽  
Ability Measure

Context Typically, athletic trainers rely on clinician-centered measures to evaluate athletes' return-to-play status. However, clinician-centered measures do not provide information regarding patients' perceptions. Objective To determine whether clinically important changes in patient-reported outcomes were observed from the time of lower extremity injury to the time of return to play in adolescent athletes. Design Cross-sectional study. Setting The National Athletic Treatment, Injury and Outcomes Network (NATION) program has captured injury and treatment data in 31 sports from 147 secondary schools across 26 states. A subsample of 24 schools participated in the outcomes study arm during the 2012−2013 and 2013−2014 academic years. Patients or Other Participants To be included in this report, student-athletes must have sustained a knee, lower leg, ankle, or foot injury that restricted participation from sport for at least 3 days. A total of 76 initial assessments were started by athletes; for 69 of those, return-to-play surveys were completed and analyzed. Main Outcome Measure(s) All student-athletes completed generic patient-reported outcome measures (Patient-Reported Outcomes Measurement Information System [PROMIS] survey, Global Rating of Change scale, and Numeric Pain Rating Scale) and, depending on body region, completed an additional region-specific measure (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure). All applicable surveys were completed at both the initial and return-to-play time points. Means and standard deviations for the total scores of each patient-reported outcome measure at each time point were calculated. Change scores that reflected the difference from the initial to the return-to-play time points were calculated for each participant and compared with established benchmarks for change. Results The greatest improvement in patient-reported outcomes was in the region-specific forms, with scores ranging from 9.92 to 37.73 on the different region-specific subscales (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure; scores range from 0−100). The region-specific subscales on average still showed a 21.8- to 37.5-point deficit in reported health at return to play. The PROMIS Lower Extremity score increased on average by 13 points; all other PROMIS scales were within normative values after injury. Conclusions Adolescent athletes who were injured at a high school with an athletic trainer may have shown improvement in patient-reported outcomes over time, but when they returned to play, their outcome scores remained lower than norms from comparable athlete groups.

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.

Validation and Implementation of 4-domain Patient-reported Outcome Measures (PROMs) Tailored for Orthopedic Sports Medicine

2021 ◽  
Author(s):  
Sérgio Rocha Piedade ◽  
Mark R. Hutchinson ◽  
Daniel Miranda Ferreira ◽  
Mario Ferretti ◽  
Nicola Maffulli
Keyword(s):  
Sports Medicine ◽  
Sports Injuries ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Validity And Reliability ◽  
Sports Activity ◽  
Physical Demands ◽  
High Performing ◽  
Patient Reported ◽  
Surgical Treatments

AbstractThe validation of a 4-domain PROM tailored to orthopedic sports medicine was performed through item generation, item scaling, validity and reliability testing, statistical analysis, as well as item reduction. Conbrach's alpha was used to verify item homogeneity, i. e. their accuracy or consistency. This PROM showed acceptable statistical accuracy and clinical applicability for a variety of surgical treatments, regardless of the anatomical injury sites. Moreover, this PROM considers the athletes’ primary physical demands in an non-injured baseline condition, their motivation to continue sports practice and participation, and the influence of sports practice on their quality of life. This 4-domain PROM tailored for orthopedic sports medicine appears to be a valid tool to assess athletes and high-performing practitioners with sports injuries, recording their perception of injury, expectations of treatment; evaluation of postoperative care and treatment received, and perceived outcomes compared to their pre-injury status of physical demands in sports activity. The tool is unique, allowing direct comparisons between athletes’ perception of pre-injury baseline, injury, treatment, and outcome. It will be a welcome adjunct to the sports medicine professional’s tool box when assessing athlete’s status and outcome after injury and intervention.

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