Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part II: Assessing Patient-Reported Outcome Measures

Context: Assessing global, regional, and fear-of-reinjury outcomes in individuals with chronic ankle instability (CAI) is critical to understanding the effectiveness of clinical interventions. Objective: To determine the improvement of patient-reported outcomes after balance- and strength-training and control protocols among participants with CAI. Design: Randomized controlled clinical trial. Setting: Athletic training research laboratory. Patients or Other Participants: Thirty-nine volunteers with CAI who scored 11 or greater on the Identification of Functional Ankle Instability questionnaire were randomly assigned to 1 of 3 groups: balance-training protocol (7 males, 6 females; age = 23.5 ± 6.5 years, height = 175.0 ± 8.5 cm, mass = 72.8 ± 10.9 kg), strength-training protocol (8 males, 5 females; age = 24.6 ± 7.7 years, height = 173.2 ± 9.0 cm, mass = 76.0 ± 16.2 kg), or control (6 males, 7 females; age = 24.8 ± 9.0 years, height = 175.5 ± 8.4 cm, mass = 79.1 ± 16.8 kg). Intervention(s): Each group met for 20 minutes, 3 times each week, for 6 weeks. The control group completed a mild to moderately strenuous bicycle workout. Main Outcome Measure(s): Global patient-reported outcomes, regional ankle function, and perceived instability were measured using the Disablement in the Physically Active Scale, the Fear-Avoidance Beliefs Questionnaire, the Foot and Ankle Ability Measure, and a visual analog scale for perceived instability. Participants completed the questionnaires at pretest and 6 weeks posttest. A multivariate repeated-measures analysis of variance with follow-up univariate analysis was conducted. The α level was set a priori at .05. Results: No time-by-group interaction was found (P = .78, η2 = 0.09). However, we observed a main effect for time (P = .001, η2 = 0.49). Follow-up univariate analyses revealed differences between the pretest and posttest for the Disablement in the Physically Active Scale (P = .02, η2 = 0.15), Fear-Avoidance Beliefs Questionnaire (P = .001, η2 = 0.27), Foot and Ankle Ability Measure–Activities of Daily Living subscale (P = .003, η2 = 0.22), Foot and Ankle Ability Measure–Sport subscale (P = .001, η2 = 0.36), and visual analog scale (P = .008, η2 = 0.18). Conclusions: Statistically, after the 6-week intervention, all groups improved in global and regional health-related quality of life. Clinicians should compare patient-reported outcomes with clinical measures to have a better understanding of progression during rehabilitation.

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Isometric Hip Strength and Patient-Reported Outcomes of Individuals With and Without Chronic Ankle Instability

Journal of Sport Rehabilitation ◽

10.1123/jsr.2021-0111 ◽

2021 ◽

pp. 1-7

Author(s):

Katherine A. Bain ◽

Paige A. Clawson ◽

Stacey A. Slone ◽

Phillip A. Gribble ◽

Johanna M. Hoch ◽

...

Keyword(s):

Ankle Instability ◽

Peak Torque ◽

Group Differences ◽

Foot And Ankle ◽

Fear Avoidance ◽

Hip Strength ◽

Fear Avoidance Beliefs ◽

Patient Reported ◽

Ability Measure ◽

Fear Avoidance Beliefs Questionnaire

Context: Strength deficits and decreased scores on generic, dimension-specific, and region-specific health-related quality of life (HRQL) PRO measures are commonly documented among individuals with chronic ankle instability (CAI). However, it is unknown if there is a relationship between hip strength and self-reported patient-reported outcome (PRO) scores. Objective: To compare isometric peak torque for hip-extension (H-EXT) and hip-abduction (H-ABD), as well as PRO scores between CAI, lateral ankle sprain copers (LAS copers), and uninjured controls (UC). The secondary purpose was to examine the relationship between isometric hip peak torque and PROs in participants with CAI. Design: Cross-sectional. Setting: Laboratory. Participants: Sixty-three individuals, 45 women (23.02 [3.83] y, 165.91 [7.55] cm, 67.28 [11.95] kg) and 18 men (26.28 [5.43] y, 179.28 [9.01] cm, 83.87 [13.26] kg), grouped as uninjured control (n = 26), LAS coper (n = 15), or CAI (n = 22). Main Outcome Measures: The Foot and Ankle Ability Measure was used to assess region-specific HRQL. The Fear Avoidance Beliefs Questionnaire was used to assess injury-related fear. The Disablement in Physically Active was used to assess global HRQL. Isometric peak torque was measured with a handheld dynamometer for H-EXT and H-ABD. Results: No group differences were observed for H-ABD (P = .34) or H-EXT (P = .35). The CAI group had significantly worse scores on all PROs compared with LAS coper (P < .001) and HC (P < .001). Moderate–weak correlations were found between H-ABD and Foot and Ankle Ability Measure—activities of daily living (P = .047; ρ = .392) and Foot and Ankle Ability Measure-Sport (P = .013; ρ = .482) and H- EXT and Fear Avoidance Beliefs Questionnaire-Work (P = .007; ρ = −.517). Conclusions: Individuals with CAI displayed lower HRQL based on worse scores on generic, dimension-specific, and region-specific PROs compared with LAS copers and uninjured controls. There were no significant between-group differences for H-EXT and H-ABD isometric peak torque production, but there was a moderate positive relationship between isometric H-ABD and self-reported ankle disability in individuals with CAI.

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A 4-Week Multimodal Intervention for Individuals With Chronic Ankle Instability: Examination of Disease-Oriented and Patient-Oriented Outcomes

Journal of Athletic Training ◽

10.4085/1062-6050-344-17 ◽

2019 ◽

Vol 54 (4) ◽

pp. 384-396 ◽

Cited By ~ 4

Author(s):

Cameron J. Powden ◽

Johanna M. Hoch ◽

Beth E. Jamali ◽

Matthew C. Hoch

Keyword(s):

Effect Size ◽

Size Range ◽

Ankle Instability ◽

Foot And Ankle ◽

Fear Avoidance ◽

Balance Test ◽

Fear Avoidance Beliefs ◽

Ability Measure ◽

Fear Avoidance Beliefs Questionnaire

Context Individuals with chronic ankle instability (CAI) experience disease- and patient-oriented impairments that contribute to both immediate and long-term health detriments. Investigators have demonstrated the ability of targeted interventions to improve these impairments. However, the combined effects of a multimodal intervention on a multidimensional profile of health have not been evaluated. Objective To examine the effects of a 4-week rehabilitation program on disease- and patient-oriented impairments associated with CAI. Design Controlled laboratory study. Setting Laboratory. Patients or Other Participants Twenty adults (5 males, 15 females; age = 24.35 ± 6.95 years, height = 169.29 ± 10.10 cm, mass = 70.58 ± 12.90 kg) with self-reported CAI participated. Inclusion criteria were at least 1 previous ankle sprain, at least 2 episodes of “giving way” in the 3 months before the study, and a Cumberland Ankle Instability Tool score ≤24. Intervention(s) Individuals participated in 12 sessions over 4 weeks that consisted of ankle stretching and strengthening, balance training, and joint mobilizations. They also completed home ankle-strengthening and -stretching exercises daily. Main Outcome Measure(s) Dorsiflexion range of motion (weight-bearing–lunge test), isometric ankle strength (inversion, eversion, dorsiflexion, plantar flexion), isometric hip strength (abduction, adduction, flexion, extension), dynamic postural control (Y-Balance test), static postural control (eyes-open and -closed time to boundary in the anterior-posterior and medial-lateral directions), and patient-reported outcomes (Foot and Ankle Ability Measure–Activities of Daily Living and Foot and Ankle Ability Measure–Sport, modified Disablement in the Physically Active scale physical and mental summary components, and Fear-Avoidance Beliefs Questionnaire–Physical Activity and Fear-Avoidance Beliefs Questionnaire–Work) were assessed at 4 times (baseline, preintervention, postintervention, 2-week follow-up). Results Dorsiflexion range of motion, each direction of the Y-Balance test, 4-way ankle strength, hip-adduction and -extension strength, the Foot and Ankle Ability Measure–Activities of Daily Living score, the modified Disablement in the Physically Active scale–physical summary component score, and the Fear-Avoidance Beliefs Questionnaire–Physical Activity score were improved at postintervention (P < .001; effect-size range = 0.72–1.73) and at the 2-week follow-up (P < .001; effect-size range = 0.73–1.72) compared with preintervention. Hip-flexion strength was improved at postintervention compared with preintervention (P = .03; effect size = 0.61). Hip-abduction strength was improved at the 2-week follow-up compared with preintervention (P = .001; effect size = 0.96). Time to boundary in the anterior-posterior direction was increased at the 2-week follow-up compared with preintervention (P < .04; effect-size range = 0.61–0.78) and postintervention (P < .04) during the eyes-open condition. Conclusion A 4-week rehabilitation program improved a multidimensional profile of health in participants with CAI.

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Response Shift After a 4-Week Multimodal Intervention for Chronic Ankle Instability

Journal of Athletic Training ◽

10.4085/1062-6050-345-17 ◽

2019 ◽

Vol 54 (4) ◽

pp. 397-402 ◽

Cited By ~ 1

Author(s):

Cameron J. Powden ◽

Matthew C. Hoch ◽

Beth E. Jamali ◽

Johanna M. Hoch

Keyword(s):

Ankle Instability ◽

Response Shift ◽

Rehabilitation Program ◽

Foot And Ankle ◽

Fear Avoidance ◽

Fear Avoidance Beliefs ◽

Individual Level ◽

Ability Measure ◽

Fear Avoidance Beliefs Questionnaire

Context The accurate evaluation of self-reported changes in function throughout the rehabilitation process is important for determining patient progression. Currently, how a response shift (RS) may affect the accuracy of self-reported functional assessment in a population with chronic ankle instability (CAI) is unknown. Objective To examine the RS in individuals with CAI after a 4-week multimodal rehabilitation program. Design Controlled laboratory study. Setting Laboratory. Patients or Other Participants Twenty adults (5 men, 15 women; age = 24.35 ± 6.95 years, height = 169.29 ± 10.10 cm, mass = 70.58 ± 12.90 kg) with self-reported CAI participated. Inclusion criteria were at least 1 previous ankle sprain, at least 2 episodes of the ankle “giving way” in the 3 months before the study, and a score ≤24 on the Cumberland Ankle Instability Tool. Intervention(s) Individuals participated in 12 intervention sessions over 4 weeks and daily home ankle strengthening and stretching. Main Outcome Measure(s) Patient-reported outcomes (PROs) were assessed at 4 times (baseline, preintervention, postintervention, and 2-week follow-up). At the postintervention and 2-week follow-up, participants completed then-test assessments to measure RS. Then-test assessments are retrospective evaluations of perceived baseline function completed after an intervention. The PROs consisted of the Foot and Ankle Ability Measure-Activities of Daily Living and Sport subscales, the modified Disablement in the Physically Active scale physical and mental summary components, and the Fear-Avoidance Beliefs Questionnaire Physical Activity and Work subscales. We used repeated-measures analyses of variance to compare preintervention with then-test measurements. Individual-level RSs were examined by determining the number of participants who experienced preintervention to then-test differences that exceeded the calculated minimal detectable change. Results We did not identify an RS for any PRO (F > 2.338, P > .12), indicating no group-level differences between the preintervention and retrospective then-test assessments. Individual-level RS was most prominent in the Foot and Ankle Ability Measure-Sport subscale (n = 6, 30%) and the Fear-Avoidance Beliefs Questionnaire Physical Activity subscale (n = 9, 45%). Conclusions No group-level RS was identified for any PRO after a 4-week multimodal rehabilitation program in individuals with CAI. This finding indicates that traditional assessment of self-reported function was accurate for evaluating the short-term effects of rehabilitation in those with CAI. Low levels of individual-level RS were identified.

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PROMIS and FAAM Minimal Clinically Important Differences in Foot and Ankle Orthopedics

Foot & Ankle International ◽

10.1177/1071100718800304 ◽

2018 ◽

Vol 40 (1) ◽

pp. 65-73 ◽

Cited By ~ 21

Author(s):

Man Hung ◽

Judith F. Baumhauer ◽

Frank W. Licari ◽

Maren W. Voss ◽

Jerry Bounsanga ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Minimum Clinically Important Difference ◽

Measurement Information ◽

Diagnostic Study ◽

Foot And Ankle ◽

Meaningful Change ◽

Level Of Evidence ◽

Patient Reported ◽

Level I

Background: Establishing score points that reflect meaningful change from the patient perspective is important for interpreting patient-reported outcomes. This study estimated the minimum clinically important difference (MCID) values of 2 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments and the Foot and Ankle Ability Measure (FAAM) Sports subscale within a foot and ankle orthopedic population. Methods: Patients seen for foot and ankle conditions at an orthopedic clinic were administered the PROMIS Physical Function (PF) v1.2, the PROMIS Pain Interference (PI) v1.1, and the FAAM Sports at baseline and all follow-up visits. MCID estimation was conducted using anchor-based and distribution-based methods. Results: A total of 3069 patients, mean age of 51 years (range = 18-94), were included. The MCIDs for the PROMIS PF ranged from approximately 3 to 30 points (median = 11.3) depending on the methods being used. The MCIDs ranged from 3 to 25 points (median = 8.9) for the PROMIS PI, and from 9 to 77 points (median = 32.5) for the FAAM Sports. Conclusions: This study established a range of MCIDs in the PROMIS PF, PROMIS PI, and FAAM Sports indicating meaningful change in patient condition. MCID values were consistent across follow-up periods, but were different across methods. Values below the 25th percentile of MCIDs may be useful for low-risk clinical decisions. Midrange values (eg, near the median) should be used for high stakes decisions in clinical practice (ie, surgery referrals). The MCID values within the interquartile range should be utilized for most decision making. Level of Evidence: Level I, diagnostic study, testing of previously developed diagnostic measure on consecutive patients with reference standard applied.

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Responsiveness of the PROMIS and FAAM Instruments in Foot and Ankle Orthopedic Population

Foot & Ankle International ◽

10.1177/1071100718799758 ◽

2018 ◽

Vol 40 (1) ◽

pp. 56-64 ◽

Cited By ~ 9

Author(s):

Man Hung ◽

Judith F. Baumhauer ◽

Frank W. Licari ◽

Jerry Bounsanga ◽

Maren W. Voss ◽

...

Keyword(s):

T Test ◽

Measurement Information ◽

Foot And Ankle ◽

Level Of Evidence ◽

Paired Samples ◽

Level Ii ◽

Patient Reported ◽

Prospective Comparative Study ◽

Ability Measure

Background: Investigating the responsiveness of an instrument is important in order to provide meaningful interpretation of clinical outcomes. This study examined the responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), the PROMIS Pain Interference (PI), and the Foot and Ankle Ability Measure (FAAM) Sports subscale in an orthopedic sample with foot and ankle ailments. Methods: Patients presenting to an orthopedic foot and ankle clinic during the years 2014–2017 responded to the PROMIS and FAAM instruments prior to their clinical appointments. The responsiveness of the PROMIS PF v1.2, PROMIS PI v1.1, and FAAM Sports were assessed using paired samples t test, effect size (ES), and standardized response mean (SRM) at 4 different follow-up points. A total of 785 patients with an average age of 52 years (SD = 17) were included. Results: The PROMIS PF had ESs of 0.95 to 1.22 across the 4 time points (3, >3, 6, and <6 months) and SRMs of 1.04 to 1.43. The PROMIS PI had ESs of 1.04 to 1.63 and SRMs of 1.17 to 1.23. For the FAAM Sports, the ESs were 1.25 to 1.31 and SRMs were 1.07 to 1.20. The ability to detect changes via paired samples t test provided mixed results. But in general, the patients with improvement had statistically significant improved scores, and the worsening patients had statistically significant worse scores. Conclusion: The PROMIS PF, PROMIS PI, and FAAM Sports were sensitive and responsive to changes in patient-reported health. Level of Evidence: Level II, prospective comparative study.

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The Effect of Dry Needling on Patient-Reported Outcomes in Individuals With Chronic Ankle Instability: A Critically Appraised Topic

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2018-0075 ◽

2019 ◽

Vol 24 (5) ◽

pp. 186-192

Author(s):

Jennifer F. Mullins ◽

Arthur J. Nitz ◽

Matthew C. Hoch

Keyword(s):

Patient Reported Outcomes ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

The Other ◽

Clinical Scenario ◽

Clinical Question ◽

Dry Needling ◽

Bottom Line ◽

Patient Reported

Clinical Scenario: Chronic ankle instability (CAI) and its associated recurrent sprains, feelings of instability, and decreased function occur in approximately 40% of individuals that suffer an ankle sprain. Despite these continued deficits, more effective treatment has yet to be established. Decreased sensorimotor function has been associated with CAI and may be amenable to dry needling treatment, thereby improving patient-reported outcomes (PROs). Focused Clinical Question: Does dry needling improve PROs in individuals with CAI? Summary of Key Findings: Two studies were identified that examined dry needling in participants with CAI. One of the two studies reported improvements in PROs (PEDro score 7/10) while the other study did not identify any changes (PEDro score 9/10). The inconsistent results were likely related to different treatment durations and follow-up timelines across the included evidence. Clinical Bottom Line: Based on the included studies, there is inconsistent evidence that dry needling can improve PROs in individuals with CAI. Strength of Recommendation: Utilizing the Strength of Recommendation Taxonomy (SORT) guidelines, level B evidence exists to recommend dry needling treatment to improve PROs for individuals with CAI.

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Pain Assessment in Foot and Ankle Patients

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00067 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0006

Author(s):

Meghan Kelly ◽

David Bernstein ◽

Ashlee MacDonald ◽

John Ketz ◽

Adolph Flemister ◽

...

Keyword(s):

Pain Management ◽

Physical Function ◽

Patient Reported Outcomes ◽

Pearson Correlation ◽

Pain Level ◽

Foot And Ankle ◽

Moderate Correlation ◽

Patient Reported ◽

And Function

Category: Other Introduction/Purpose: The ability to accurately quantify a patient’s pain pre-operatively is advantageous in the preparation of post-operative expectations and pain management. The Numeric Pain Rating Scale (NPRS) is a popular method to identify patient pain level. Other patient reported outcomes are being collected, such as the Patient Reported Outcomes Measurement Information System (PROMIS) and has been suggested to be more accurate in measuring pain as well as physical function. The aim of this study was to 1) determine whether NPRS or PROMIS Pain Interference (PI) demonstrates a stronger association with physical function as determined by PROMIS Physical Function (PF) and 2) to determine which method better predicts post-surgical pain in a population of elective surgical foot and ankle patients. Methods: Prospective PROMIS PF, PI and NPRS (0-10) data was obtained for common foot and ankle elective surgical procedures (CPT codes 27698, 27870, 28285, 28289, 28300, 28705, 28730, 28750) from a multi-surgeon foot and ankle clinic between February 2015 until November 2017. Pearson correlation coefficients were used to determine the relationship between NPRS (0-10) and PROMIS domains (PI, PF) pre and post-operatively. Correlations were considered high (> 0.7), high moderate (0.6-0.69), moderate (0.4-0.6) or weak (<0.4). Results: A total of 502 patients found to have complete data sets and > 6 month follow up were evaluated (74% women, mean age 54+/- SD, mean follow-up 14.4 months, range 6-34 months). Pearson correlation evaluation of NPRS and PI revealed a moderate correlation in the pre- and postoperative setting. There was a high moderate negative correlation between PI and PF t-scores pre and postoperatively suggesting more pain and less function. However, the negative correlation between NPRS and PF pre- and postoperatively was weak indicating a poor relationship between NPRS pain assessment and function. There was a moderate correlation between pre- and postoperative scores in all domains of PROMIS while the correlation between pre- and postoperative NPRS scores was weak. Conclusion: In a population of elective surgical foot and ankle patients, the use of both NPRS and PROMIS can be utilized to assess pain level, however the PROMIS PI domain demonstrated a stronger relationship with PROMIS PF than NPRS. Furthermore, only the PROMIS domains demonstrated at least a moderate correlation between pre- and post-operative scores. PROMIS PI provides superior assessment of pre- and post-operative physical function and prediction of post-operative pain. PROMIS PI can be used to gauge a patient’s pre-operative level of pain and function and aid the surgeon in guiding post-operative patient expectations and pain management.

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Evaluating Patients for Elective Outpatient Foot and Ankle Surgery: Insurance as a Predictor of Patient Outcomes

Foot & Ankle Specialist ◽

10.1177/1938640018823070 ◽

2019 ◽

Vol 12 (6) ◽

pp. 522-529

Author(s):

Wajeeh Bakhsh ◽

Sean Childs ◽

Irvin Oh ◽

Sam Flemister ◽

Judy Baumhauer ◽

...

Keyword(s):

Patient Selection ◽

Patient Reported Outcomes ◽

Elective Surgery ◽

Pain Patient ◽

Trauma Patients ◽

Foot And Ankle ◽

Missed Appointments ◽

Ankle Surgery ◽

Patient Reported

Background. Elective surgical procedures necessitate careful patient selection. Insurance level has been associated with postoperative outcomes in trauma patients. This study evaluates the relationship insurance level has with outcomes from elective foot and ankle surgery. Methods. Retrospective chart review was performed on patients who underwent elective surgery at a single center with 1-year follow-up. Patients were classified by insurance: under-/uninsured (Medicaid, Option plans) versus fully insured. Outcomes included narcotic refills, patient-reported outcomes (PROMIS) of pain, function, and mood, and compliance with follow-up visits. Statistical analysis involved mean comparison and multivariate regression modeling, with significance P < .05. Results. Cohort groups included 220 insured and 47 under-/uninsured. Outcomes between the insured and under-/uninsured groups differed significantly in narcotic refills (0.72 vs 1.74 respectively, P < .01), missed appointments (0.13 vs 0.62, P < .01), and PROMIS results (pain 54.5 vs 60.2; function 44.3 vs 39.5; mood 44.6 vs 51.3; P < .01). The change in PROMIS scores from preoperative to 1-year postoperative were different in pain (−7.3 vs −2.5, P = .03) and function (+6.3 vs +1.3, P = .04). Regression results confirm insurance as a significant factor (coefficient 0.27, P < .01). Conclusion. These results establish that under-/uninsured patients have worse pain, patient-reported outcomes, and functional outcomes after elective foot and ankle surgery, which may inform patient selection. Levels of Evidence: Level III: Retrospective cohort study

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Early Functional and Patient Reported Outcomes following Suture Tape Augmented Brostrom

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00346 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0034

Author(s):

Kevin D. Martin ◽

Jeannie Huh ◽

William Robinson ◽

Kevin D. Martin

Keyword(s):

Patient Reported Outcomes ◽

Ankle Instability ◽

Active Duty ◽

Lateral Ligament ◽

Anterior Talofibular Ligament ◽

Foot And Ankle ◽

Military Population ◽

Functional Rehabilitation ◽

Patient Reported ◽

Suture Tape

Category: Ankle Introduction/Purpose: Immediately following a lateral ligament reconstruction the strength of the repair is far less than the native anterior talofibular ligament (ATFL). With early functional rehabilitation the repair has shown increased laxity. We hypothesized that a Brostrom augmented with a suture-tape construct would allow early functional rehabilitation while maintaining patient reported outcomes within a military population. Methods: This study is a retrospective cohort of 90 consecutive patients with chronic lateral ankle instability were treated with a Brostrom procedure augmented with a suture-tape construct. All had a preoperative MRI demonstrating ligament insufficiency, and was examined by an orthopaedic foot and ankle surgeon. Subjects were evaluated at 2, 6 and 12 weeks postoperatively. Demographics including Foot and Ankle Disability Index (FADI), Visual Analog Scale (VAS), and clinical measures including single- leg hop and single-leg heel raise were recorded. The population included (14 women [18%], 76 men [84%] mean age of 29.47, BMI 27.3) active duty service members. Results: The mean FADI score pre-operatively (67) improved to 86 and 89 at 6 and 12 weeks. The VAS scores pre-operatively (4.8) improved to 1.4 and 1.3 at 6 and 12 weeks respectively. 95.5% (86/90) of patients were able to complete a single-leg hop and single-leg heel raise at 6 and 12 weeks. Conclusion: Our results suggest that a Brostrom augmented with suture-tape can allow for early functional rehabilitation in an active duty Military population.

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Outcomes Following the Treatment of Talar Osteochondral Lesions with BioCartilage and Bone Marrow Aspirate Concentrate Mixture

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00049 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0004

Author(s):

Ashraf Fansa ◽

Mark Drakos ◽

Taylor Cabe ◽

Peter Fabricant

Keyword(s):

Bone Marrow ◽

Patient Reported Outcomes ◽

Bone Marrow Aspirate ◽

Statistical Significance ◽

Osteochondral Lesions ◽

Foot And Ankle ◽

Bone Marrow Aspirate Concentrate ◽

Patient Reported ◽

The Mean

Category: Arthroscopy Introduction/Purpose: With reported incidence rates ranging from 40% to 70% post ankle sprains and fractures, osteochondral lesions of the talus (OLT) are not uncommon. However, management of such defects remains challenging. Microfracturing is considered the standard treatment for symptomatic OLTs.Larger lesions however typically require more invasive restorative procedures such as autologous osteochondral transplantation. Microfracture results are variable due to the fact that the resulting reparative fibrocartilage is weaker and biomechanically inferior to native hyaline cartilage. In this study, we examine the functional and radiological outcomes following use of a new arthroscopic technique utilizing a mixture of micronized allograft cartilage matrix (BioCartilage) (Arthrex, Naples, FL) soaked in Bone Marrow Aspirate Concentrate (BMAC) to fill OLTs. Methods: Eighty-six consecutive patients treated for OLT using arthroscopic debridement and BioCartilage matrix soaked in BMAC were identified. All patients were treated by a single fellowship-trained sports medicine and foot and ankle surgeon. Functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS) and Patient-Reported Outcomes Measurement Information System (PROMIS). This information was obtained from a prospective registry at the authors’ institution. Wilcoxon signed rank tests were used to determine statistical significance between pre and postoperative clinical scores. Additionally, an attending radiologist assessed the reparative cartilage morphology on postoperative MRI scans. This was evaluated and scored using a modified magnetic resonance observation of cartilage tissue (MOCART) scoring system. Results: Thirty-one patients (19 Females; 12 Males) with a mean age of 37.8 years (Range 15–54) had a minimum follow-up duration of 12 months and were thus included in this review. Mean follow-up duration was 15.8 months (Range 12 –25.7). The mean patient BMI was 27.4 (Range 19.6 – 39.4), while the average osteochondral lesion size was 85.9 mm2 (Range 35 – 220). The Physical Function domain of the PROMIS score, demonstrated statistically significant change, improving from 40.63 ±8.31 to 48.31 ±10.07 (p=0.02). The Pain Intensity domain also improved significantly from 49.06 ±9.32 to 42.14 ±9.38 (p=0.03). The Pain Interference domain and FAOS scores did improve but not reaching statistical significance. The mean MRI MOCART score was 69 ±13.34 with 13.3 months average follow-up duration. Conclusion: Achieving the longest duration possible of symptom-free functioning postoperatively is the main goal of any cartilage repair procedure. Augmentation of an articular lesion’s infill with BioCartilage and BMAC may help enhance the biomechanical properties of the reparative fibrocartilage construct and its longevity. Our initial findings demonstrate favorable patient-reported outcomes. Moreover, postoperative MRIs demonstrate the majority of the lesions showed either complete or hypertrophic infill, complete or hypertrophic integration, homogenous repair tissue, and isointense signals. Long-term studies prospectively assessing the effectiveness of this technique in maintaining pain-free-function of the ankle joint are warranted.

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