scholarly journals Ultrasound-based evaluation revealed reliable postoperative knee stability after combined acute ACL and MCL injuries

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Patricia M. Lutz ◽  
Louisa S. Höher ◽  
Matthias J. Feucht ◽  
Jan Neumann ◽  
Daniela Junker ◽  
...  
Keyword(s):  
Clinical Examination ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Knee Stability ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Grade Ii ◽  
Group 2 ◽  
Group 1

Abstract Purpose Anterior cruciate ligament (ACL) injuries are often combined with lesions of the medial collateral ligament (MCL). The aim of this study was to evaluate treatment outcome of combined acute ACL and MCL lesions using functional US and clinical examination. Methods Patients aged > 18 years undergoing primary ACL reconstruction with concomitant operative (group 1) or non-operative treatment of the MCL (group 2) between 2014 and 2019 were included after a minimum follow-up of 12 months. Grade II MCL injuries with dislocated tibial or femoral avulsions and grade III MCL ruptures underwent ligament repair whereas grade II injuries without dislocated avulsions were treated non-operatively. Radiological outcome was assessed with functional US examinations. Medial knee joint width was determined in a supine position at 0° and 30° of knee flexion in unloaded and standardized loaded (= 15 Dekanewton) conditions using a fixation device. Clinical examination was performed and patient-reported outcomes were assessed by the use of the subjective knee form (IKDC), Lysholm score, and the Tegner activity scale. Results A total of 40 patients (20 per group) met inclusion criteria. Mean age of group 1 was 40 ± 12 years (60% female) with a mean follow-up of 33 ± 17 months. Group 2 showed a mean age of 33 ± 8 years (20% female) with a mean follow-up of 34 ± 15 months. Side-to-side differences in US examinations were 0.4 ± 1.5 mm (mm) in 0° and 0.4 ± 1.5 mm in 30° knee flexion in group 1, and 0.9 ± 1.1 mm in 0° and 0.5 ± 1.4 mm in 30° knee flexion in group 2, with no statistically significant differences between both groups. MCL repair resulted in lower Lysholm scores (75 ± 19 versus 86 ± 15; p < 0.05). No significant differences could be found for subjective IKDC or Tegner activity scores among the two groups. Conclusion A differentiated treatment concept in combined ACL and MCL injuries based on injury patterns leads to reliable postoperative ligamentous knee stability in US-based and clinical examinations. However, grade II and III MCL lesions with subsequent operative MCL repair (group 1) result in slightly poorer subjective outcome scores. Level of evidence Retrospective cohort study; Level III

scholarly journals Effects of posterior tibial slope on the mid-term results of medial unicompartmental knee arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Zhijie Chen ◽  
Kaizhe Chen ◽  
Yufei Yan ◽  
Jianmin Feng ◽  
Yi Wang ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Tibial Slope ◽  
Posterior Tibial ◽  
Significant Difference ◽  
Medial Unicompartmental Knee Arthroplasty ◽  
Group 3 ◽  
Group 2 ◽  
Postoperative Knee ◽  
Group 1

Abstract Objective To evaluate the effect of medial posterior tibial slope (PTS) on mid-term postoperative range of motion (ROM) and functional improvement of the knee after medial unicompartmental knee arthroplasty (UKA). Methods Medical records of 113 patients who had undergone 124 medial UKAs between April 2009 through April 2014 were reviewed retrospectively. The mean follow-up lasted 7.6 years (range, 6.2–11.2 years). Collected were demographic data, including gender, age, height, weight of the patients. Anteroposterior (AP) and lateral knee radiographs of the operated knees were available in all patients. The knee function was evaluated during office follow-up or hospital stay. Meanwhile, postoperative PTS, ROM, maximal knee flexion and Hospital for Special Surgery (HSS) knee score (pre−/postoperative) of the operated side were measured and assessed. According to the size of the PTS, patients were divided into 3 groups: group 1 (<4°), group 2 (4° ~ 7°) and group 3 (>7°). The association between PTS and the knee function was investigated. Results In our cohort, the average PTS was 2.7° ± 0.6° in group 1, 5.6° ± 0.9° in group 2 and 8.7° ± 1.2° in group 3. Pairwise comparisons showed significant differences among them (p < 0.01). The average maximal flexion range of postoperative knees in each group was 112.4° ± 5.6°, 116.4° ± 7.2°, and 117.5° ± 6.1°, respectively, with significant difference found between group 1 and group 2 (p < 0.05), and between group 1 and group 3 (p < 0.05). However, the gender, age, and body mass index (BMI) did not differ between three groups and there was no significant difference between groups in terms of pre−/postoperative HSS scores or postoperative knee ROM. Conclusion A mid-term follow-up showed that an appropriate PTS (4° ~ 7°) can help improve the postoperative flexion of knee. On the other hand, too small a PTS could lead to limited postoperative knee flexion. Therefore, the PTS less than 4° should be avoided during medial UKA.

Equality in Hip Arthroscopy Outcomes Can Be Achieved Regardless of Patient Socioeconomic Status

2021 ◽  
pp. 036354652110469
Author(s):  
Benjamin R. Saks ◽  
Vivian W. Ouyang ◽  
Elijah S. Domb ◽  
Andrew E. Jimenez ◽  
David R. Maldonado ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Hip Arthroscopy ◽  
Labral Tear ◽  
Harris Hip Score ◽  
Group 4 ◽  
Patient Reported ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Background: Access to quality health care and treatment outcomes can be affected by patients’ socioeconomic status (SES). Purpose: To evaluate the effect of patient SES on patient-reported outcome measures (PROMs) after arthroscopic hip surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Demographic, radiographic, and intraoperative data were prospectively collected and retrospectively reviewed on all patients who underwent hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral tear between February 2008 and September 2017 at one institution. Patients were divided into 4 cohorts based on the Social Deprivation Index (SDI) of their zip code. SDI is a composite measure that quantifies the level of disadvantage in certain geographical areas. Patients had a minimum 2-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), International Hip Outcome Tool—12, and visual analog scale (VAS) for both pain and satisfaction. Rates of achieving the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated for the mHHS, NAHS, and VAS pain score. Rates of secondary surgery were also recorded. Results: A total of 680 hips (616 patients) were included. The mean follow-up time for the entire cohort was 30.25 months. Division of the cohort into quartiles based on the SDI national averages yielded 254 hips (37.4%) in group 1, 184 (27.1%) in group 2, 148 (21.8%) in group 3, and 94 (13.8%) in group 4. Group 1 contained the most affluent patients. There were significantly more men in group 4 than in group 2, and the mean body mass index was greater in group 4 than in groups 1 and 2. There were no differences in preoperative radiographic measurements, intraoperative findings, or rates of concomitant procedures performed. All preoperative and postoperative PROMs were similar between the groups, as well as in the rates of achieving the MCID or PASS. No differences in the rate of secondary surgeries were reported. Conclusion: Regardless of SES, patients were able to achieve significant improvements in several PROMs after hip arthroscopy for FAIS and labral tear at the minimum 2-year follow-up. Additionally, patients from all SES groups achieved clinically meaningful improvement at similar rates.

Septic Arthritis After Anterior Cruciate Ligament Reconstruction: How Important Is Graft Salvage?

2018 ◽  
Vol 46 (10) ◽  
pp. 2376-2383 ◽  
Author(s):  
Jonas Pogorzelski ◽  
Alexander Themessl ◽  
Andrea Achtnich ◽  
Erik M. Fritz ◽  
Klaus Wörtler ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Resonance Imaging ◽  
Kt 1000 ◽  
Graft Removal ◽  
Group 2 ◽  
Anterior Cruciate ◽  
Group 1

Background: Septic arthritis (SA) of the knee after anterior cruciate ligament reconstruction (ACLR) is a rare but potentially devastating condition. In certain cases, graft removal becomes necessary. Purpose: To evaluate clinical, subjective, and radiologic outcomes of patients with SA after ACLR and assess whether graft retention has superior clinical results as compared with graft removal. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who were at least 12 months out from arthroscopic treatment of SA after isolated ACLR at our institution were eligible for inclusion. Patients were categorized into 2 groups: group 1, patients with initial graft retention; group 2, patients with initial graft removal. Group 2 was subdivided into 2 groups: group 2a, patients with graft reimplantation; group 2b, patients without graft reimplantation. Objective and subjective assessments were obtained at follow-up, including the International Knee Documentation Committee (IKDC) knee examination form, KT-1000 arthrometer measurements, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score, Lysholm score, and IKDC subjective evaluation. Radiologic assessment was performed with pre- and postoperative magnetic resonance imaging. Results: Of the 41 patients included, 33 (81%) were available for follow-up at a mean ± SD 54.7 ± 24.4 months at an age of 28.4 ± 9.3 years. When compared with patients from group 2 (n = 12), patients from group 1 (n = 21) obtained significantly better results on the objective IKDC score (normal or nearly normal: group 1, 66.6%; group 2, 36.4%; P = .047) and KT-1000 measurements (group 1, 1.3 ± 1.0 mm; group 2, 2.9 ± 1.5 mm; P = .005). Group 1 also scored better than group 2 on the Lysholm ( P = .007), IKDC subjective ( P = .011), and WOMAC ( P = .069) measures. Between groups 2a (n = 4) and 2b (n = 8), no significant differences in outcomes could be detected ( P values, .307-.705), although patients with anterior cruciate ligament graft reimplantation showed a clear tendency toward better results in objective and not subjective parameters. Magnetic resonance imaging evaluation showed higher rates of cartilage damage and meniscal tears among patients with graft resection versus graft retention. Conclusion: Patients with graft retention showed superior postoperative results when compared with patients who underwent initial graft resection, although subanalysis showed comparable outcomes between graft retention and reimplantation. Thus, while graft-retaining protocols should have the highest priority in the treatment of SA after ACLR, graft reimplantation should be performed in cases where graft resection becomes necessary, to avoid future cartilage and meniscal lesions. Finally, further studies with larger numbers of patients are needed to gain a better understanding of the outcomes of patients with SA after ACLR.

scholarly journals Double-Layered Quadriceps Tendon Autografts Provide Lower Failure Rates and Improved Clinical Results Compared With Hamstring Tendon Grafts in Revision ACL Reconstruction

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110469
Author(s):  
Lena Eggeling ◽  
Stefan Breer ◽  
Tobias Claus Drenck ◽  
Karl-Heinz Frosch ◽  
Ralph Akoto
Keyword(s):  
Cruciate Ligament ◽  
Case Series ◽  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Failure Rates ◽  
Level Of Evidence ◽  
Quadriceps Tendon Graft ◽  
Patient Reported

Background: We developed a quadriceps-tendon graft technique using a double-layered, partial-thickness, soft tissue quadriceps tendon graft (dlQUAD) for anterior cruciate ligament reconstruction (ACLR). This technique allows simple femoral loop button fixation and a limited harvest depth of the quadriceps tendon. Purpose: To evaluate the outcome of patients undergoing revision ACLR using the dlQUAD technique compared with a hamstring tendon graft (HT). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 114 patients who underwent revision ACLR between 2017 and 2018 were included in this retrospective case series. At a mean follow-up of 26.9 ± 3.7 months (range, 24-36), 89 patients (dlQUAD: n = 43, HT: n = 46) were clinically examined. In addition, patients completed the Lysholm score, Tegner activity scale, subjective International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score, and visual analog scale (VAS) for pain. Postoperative failure of the revision ACLR was defined as a side-to-side difference (SSD) in Rolimeter testing ≥5 mm or a pivot-shift grade of 2 or 3. Results: Nine patients (10.1%) were identified with a failed revision ACLR. There was a significantly lower failure rate with dlQUAD versus the HT group (2.3% vs 17.4%; P = .031). The mean postoperative SSD was significantly less in the dlQUAD group (1.3 ± 1.3 mm [range, 0-5] vs 1.8 ± 2.2 mm [range, 0-9]; P = .043). At the latest follow-up, Tegner and IKDC scores significantly improved in the dlQUAD group compared with the HT group (Tegner: 5.8 ± 1.8 vs 5.6 ± 1.5; P = .043; IKDC: 83.8 ± 12.2 vs 78.6 ± 16.8; P = .037). The pain VAS score was also significantly reduced in the dlQUAD group compared with the HT group (0.9 ± 1.1 vs 1.6 ± 2.0; P = .014). Conclusion: The dlQUAD and HT techniques both demonstrated significant improvement of preoperative knee laxity and satisfactory patient-reported outcome measures after revision ACLR. Compared with the HT grafts, the dlQUAD technique showed lower failure rates and small increases in Tegner and IKDC scores.

Cytokine Induced Killer Cells Are Feasible and Safe for Both Autologous and Allogeneic Applications in Patients with Haematological Malignancies

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2917-2917
Author(s):  
Yeh Ching Linn ◽  
Tsyr jong Lim ◽  
Madelaine Niam ◽  
Garnet Suck ◽  
Yeow Tee Goh ◽  
...  
Keyword(s):  
Salvage Chemotherapy ◽  
Allogeneic Transplant ◽  
Autologous Transplant ◽  
Cik Cells ◽  
Donor Cells ◽  
Grade Ii ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Introduction: Cytokine-induced killer ( CIK) cells are polyclonal non-MHC restricted T cells with potent cytotoxicity against acute myeloid leukemia (AML) cells in vitro. We have established culture of CIK cells with GMP compliance and infused into patients with various haematological malignancies. These include group 1, as adjuvant therapy post autologous transplant for acute myeloid leukaemia (AML), group 2, in untreated disease and group 3, for relapse post allogeneic transplant (NCT 00460694, NCT 00394381). Patients, Methods and Results: A total of 39 CIK cultures was produced over a 2 year period which resulted in 65 infusions given to 21 patients. We have demonstrated that it is feasible to expand CIK in large scale culture from both patients and allogeneic stem cell donors. The CD3+CD56+ subset expanded a median of 42.7 fold from 1.3% (0.2–5.3%) to 31.1% (10.4–76.9%) post culture for CIK derived from patients’s leukapheresis product, which is comparable with that derived from healthy haemopoietic stem cell donors. The cytotoxicity of these CIK against a panel of allogeneic AML targets showed variable potency (0% to 69%), with a median of 38%. Self limiting fever was the only infusion related side effect. Patients In group 1 received an autologous transplant as consolidation for AML followed by adjuvant infusions of CIK cells., These were successfully cultured for 9 of 11 patients and infused into all 9 in aliquots of between 1–4 infusions. Follow up is short and a comparison against historical autologous transplant results are similar. Group 2 consisted of patients with overt leukemia who have failed or are unfit for chemotherapy. All 4 had CIK cells successfully cultured from a product containing variable % of leukemic cells, 3 of the patients who survived to receive CIK infusion did not have any response. However one of them had an incidental regression of basal cell carcinoma after 2 infusions. In group 3, 6 patients who relapsed after an allogeneic transplant received allogeneic CIK after failing donor lymphocyte infusions (DLI). Another 3 patients had CIK generated from their own leukapheresis product due to donor unavailability (1 post cord blood and 2 post MUD transplant). Amongst the 8 patients who have received CIK infusion, two with overt refractory relapse (1 AML and 1 Hodgkin’s disease) did not respond to 3 and 4 infusions respectively. Four patients (2 AML and 2 ALL) had CIK infusion post salvage chemotherapy and therefore remission could not be entirely attributed to CIK infusion. Two patients had measurable responses attributable solely to CIK infusion. One was a post-transplant relapsed T cell ALL refractory to 5 different salvage regimen and repeated DLI. A marrow remission was achieved after one further Gemcitabin/Mitoxantrone salvage chemotherapy followed by CIK infusion. Marrow remission was maintained for 10 months with 4–6 weekly infusion of CIK while extramedullary (EM) disease progressed, suggesting control of marrow leukemia by CIK while leukemia evolution manifested at EM sites, known to be less susceptible to immunotherapy. A second patient had refractory Hodgkin’s disease in the lungs and vertebrae. A partial reduction in the size of lung nodules was achieved after the second CIK infusion but this was not sustainable. The dose of allo- CIK ranged from 10 – 200 million CD34/kg given as a step-wise increment for each patient. Three patients developed acute GVHD, one grade II liver, one grade II skin andgut, and a third patient had grade I upper gut GVHD, at doses of 50, 100 and 10 million CD3/kg respectively. All responded promptly to prednisolone at 1mg/kg. Conclusion: We have shown that CIK infusion is feasible and safe in both the autologous and allogeneic setting, and GVHD that occurs is easily controlled. It is unlikely that CIK is effective against a large tumour burden. Its efficacy as an adjuvant therapy to eradicate minimal residual disease requires larger patient numbers and longer follow up. For allogeneic transplant, CIK culture has an additional advantage of expanding unrelated donor cells where availability is a problem by harvesting donor cells from patients for expansion. Further numbers are needed to compare against unmanipulated DLI in terms of efficacy and reduced GVHD severity.

Arthroscopic Surgery for Primary Traumatic Patellar Dislocation

2008 ◽  
Vol 36 (12) ◽  
pp. 2301-2309 ◽  
Author(s):  
Petri J. Sillanpää ◽  
Heikki M. Mäenpää ◽  
Ville M. Mattila ◽  
Tuomo Visuri ◽  
Harri Pihlajamäki
Keyword(s):  
Patellar Dislocation ◽  
Functional Limitations ◽  
Arthroscopic Surgery ◽  
Activity Level ◽  
Loose Bodies ◽  
Level Of Evidence ◽  
Group 2 ◽  
Patellar Stability ◽  
Group 1

Background No data exist whether patients with primary traumatic patellar dislocation benefit from initial arthroscopic medial repair surgery. Purpose To compare long-term outcomes of patients treated with acute arthroscopic stabilization for patellar dislocation with those treated nonoperatively except for removal of loose bodies. Study Design Cohort study; Level of evidence, 2. Methods The study group included 76 consecutive military recruits (72 men, 4 women), with a median age of 20 years (range, 19–22) at the time of dislocation. Thirty patients (group 1) underwent initial arthroscopic medial retinacular repair, and 46 patients (group 2) were treated without stabilizing surgery, including 11 who had osteochondral fragments arthroscopically removed. Patients with previous patellar dislocations or instability were excluded. Aftercare was identical in both groups. Redislocations, subjective symptoms, and functional limitations were evaluated after a median 7-year follow-up. Results Sixty-one (80%) patients participated in a follow-up examination. At final follow-up, 8 (23%) redislocations occurred in group 2 and 5 (19%) in group 1 ( P = .84). Eight (23%) patients in group 2 and 3 (12%) in group 1 reported patellar subluxations ( P = .18). In group 1, 81% regained their preinjury activity level compared with 56% in group 2 ( P = .05). Functional outcomes were good in both groups (Kujala scores: 87 for group 1 and 90 for group 2) ( P = .22). Regarding the presence of osteoarthritic characteristics in the patellofemoral joint, no statistically significant differences were found between the groups. Conclusions Initial arthroscopic medial retinacular repair was not followed by improved patellar stability nor reduced incidence of redislocations compared with nonoperative (except for removal of loose bodies) treatment. Acute arthroscopic medial retinacular repair allowed patients to better regain preinjury activity level than in patients not undergoing retinacular repair. The decision to stabilize the patella by initial arthroscopic surgery should be made with caution.

scholarly journals Anterior Cruciate Ligament Reconstruction with LARS Artificial Ligament—Clinical Results after a Long-Term Follow-Up

Joints ◽  
2018 ◽  
Vol 06 (02) ◽  
pp. 075-079 ◽  
Author(s):  
Paolo Parchi ◽  
Gianluca Ciapini ◽  
Carlo Paglialunga ◽  
Michele Giuntoli ◽  
Carmine Picece ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Rating Scale ◽  
Cruciate Ligament ◽  
Case Series ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Anterior Cruciate

Purpose The aim of this retrospective study was to evaluate the subjective and functional outcome of anterior cruciate ligament (ACL) reconstruction with the synthetic Ligament Advanced Reinforcement System (LARS) ligament. Methods Twenty-six patients were reviewed at an average follow-up of 11.6 years. Objective clinical evaluation was performed with stability tests. Patient-reported outcomes (Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score, and Cincinnati Knee Rating Scale) were used to assess subjective and functional outcomes. Results Overall satisfactory results were obtained in 22 cases (84.6%). Four patients (15.4%) showed mechanical failure of the graft. No cases of synovitis or infection were reported. Conclusion LARS ligament can be considered a safe and suitable option for ACL reconstruction in carefully selected cases, especially elderly patients needing a rapid postoperative recovery. Level of Evidence Level IV, retrospective case series.

scholarly journals Vaginal pH Measurement as a Strategy for the Early Diagnosis of Vulvovaginal Atrophy in the Development of Menopause

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Silva TRC ◽  
◽  
Oliveira PR ◽  
Batista ML ◽  
Oliveira AB ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Clinical Examination ◽  
Ph Measurement ◽  
Vaginal Atrophy ◽  
Vaginal Ph ◽  
Group 2 ◽  
Hormonal Cytology ◽  
Symptoms And Signs ◽  
Group 1

Objective: Most studies use clinical examination and evaluation of symptoms as subjective forms for the diagnosis of vaginal atrophy. Vaginal hormonal cytology and vaginal pH are objective forms commonly used, however, mainly for treatment control purposes. Despite the relevance of the early diagnosis of vaginal atrophy, we are not aware of studies that objectively or subjectively evaluate the evolution of the parameters with this intention. The aim of the study was to assess if the instruments most used in scientific studies for indication and follow-up of AVV therapy could be used for the early diagnosis of AVV. Methods: The sample consisted of 40 women, 21 in the menopausal/ premenopausal transition (Group 1) and 19 in the postmenopausal (Group 2), between 40 and 65 years old. Results: It was observed that the set of parameters evaluated, such as: symptoms, clinical examination, vaginal pH, cell maturation value and questionnaire, mainly when used in an associated way, suggest being efficient for the diagnosis of AVV. In general, the observed changes in pH measurement show a good association with cell cytology, which was very characteristic in the two experimental groups (pre and postmenopausal). In addition, pH also showed good association with clinical examination parameters and the main symptoms and signs of menopause. Conclusion: Finally, the results herein shown seems to be promising in relation to the use of vaginal pH measurement as a “tool” for the early diagnosis of AVV.

The Relationship Between Polyethylene Insert Size and Complications in Total Ankle Replacement

2018 ◽  
Vol 12 (3) ◽  
pp. 253-257
Author(s):  
James M. Cottom ◽  
Steven M. Douthett ◽  
Kelly K. McConnell ◽  
Britton S. Plemmons
Keyword(s):  
Statistical Significance ◽  
Total Ankle Replacement ◽  
Complication Rates ◽  
Polyethylene Insert ◽  
Insert Size ◽  
Ankle Replacement ◽  
Patient Reported ◽  
Group 2 ◽  
Group 1

The purpose of this study was to compare complication rates after total ankle replacement in 2 groups of patients based on polyethylene insert size. The total cohort was divided into 2 groups based on insert size. Group 1 included patients with polyethylene insert size less than 10 mm in thickness. Group 2 included patients with polyethylene insert sizes 10 mm and larger. Available charts were reviewed for patients who underwent primary total ankle arthroplasty by one surgeon. Patient demographics, polyethylene insert size, implant used, concomitant procedures, postoperative complications, and patient-reported outcome scores were recorded. One hundred patients were available for follow-up and were included in this study, which ranged from March 2012 to July 2017. The average follow-up was 31.3 months (range = 10-60 months). Forty-eight females and 52 males were included in this study. There were a total of 63 patients in group 1 and 47 patients in group 2. The total complication rate for patients in group 1 was 11.1% (7/63), and in group 2 it was 16.2% (6/32). There was no statistical significance in complication rates when comparing the 2 groups (P = 0.5427). All patients underwent at least one concomitant procedure at the time of initial ankle replacement. Our findings show that total ankle replacement complication rates are equal when comparing large polyethylene inserts commonly utilized to correct deformities, versus small polyethylene inserts commonly utilized in primary resurfacing. Levels of Evidence: Level IV, Retrospective comparative study

Differences in Baseline Characteristics and Outcome Among Responders, Late Responders, and Never-Responders After Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110478
Author(s):  
Per-Henrik Randsborg ◽  
Dakota Adamec ◽  
Nicholas A. Cepeda ◽  
Andrew Pearle ◽  
Anil Ranawat
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Patient Characteristics ◽  
International Knee Documentation Committee ◽  
Patient Reported Outcome Measures ◽  
Return To Sports ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Anterior Cruciate

Background: Loss to follow-up in registry studies might affect generalizability and interpretation of results. Purpose: To evaluate the effect of nonresponder bias in our anterior cruciate ligament (ACL) registry. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 2042 patients with ACL reconstruction in the Hospital for Special Surgery ACL Registry between 2009 and 2013 were included in the study. Patients who completed the patient-reported outcome measures at 2 or 5 years were considered responders (n = 808). Baseline data and patient characteristics were compared between responders and nonresponders (n = 1234). Both responders and nonresponders were contacted and invited to complete the International Knee Documentation Committee (IKDC) and Marx scores electronically and respond to questions regarding return to sports and subsequent surgeries. Nonresponders who completed the questionnaires after reminders were considered late responders. The remaining nonresponders were considered never-responders. The late responders (n = 367) completed the questionnaires after a mean follow-up of 7.8 years (range, 6.7-9.6 years), while follow-up for the responders was 6.8 years (range, 5.0-9.7 years). Responders and late responders were then compared in terms of differences in IKDC and Marx scores from baseline to final follow-up. Results: Nonresponders were younger (28.5 vs 31.5 years; P < .001) and more often male (60% vs 53%; P = .003) compared with responders. Responders had a higher level of education and were more likely to be White (79% vs 74%; P = .04). There were no substantial differences in patient characteristics or baseline IKDC and Marx scores between the late responders and never-responders. There were no statistically significant differences in patient-reported outcomes, return to sports, or subsequent surgeries between responders and late responders at a mean follow-up time of 8.8 years (range, 6.7-9.7 years). Repeat email reminders and telephone calls increased response rate by 18% (from 40% to 58%). Conclusion: There was no difference in clinical outcome as evaluated using IKDC and Marx scores between responders and late responders.

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