Subsequent surgery after primary ACLR results in a significantly inferior subjective outcome at a 2-year follow-up

Purpose To analyze minimal important change (MIC), patient-acceptable symptom state (PASS) and treatment failure after reoperation within 2 years of primary ACL reconstruction and compare them with patients without additional surgery. Methods This is a retrospective follow-up study of a cohort from a single-clinic database with all primary ACLRs enrolled between 2005 and 2015. Additional surgery within 2 years of the primary ACLR on the ipsilateral knee was identified using procedural codes and analysis of medical records. Patients who completed the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire preoperatively and at the 2-year follow-up were included in the study. MIC, PASS and treatment failure thresholds were applied using the aggregate KOOS (KOOS4) and the five KOOS subscales. Results The cohort included 6030 primary ACLR and from this 1112 (18.4%) subsequent surgeries were performed on 1018 (16.9%) primary ACLRs. 24 months follow-up for KOOS was obtained on 523 patients (54%) in the reoperation group and 2084 (44%) in the no-reoperation group. MIC; the no-reoperation group had a significantly higher improvement on all KOOS subscales, Pain 70.3 vs 60.2% (p < 0.01), Symptoms 72.1 vs 57.4% (p < 0.01), ADL 56.3 vs 51.2% (p < 0.01), Sport/Rec 67.3 vs 54.4% (p < 0.01), QoL 73.9 vs 56.3% (p < 0.01). PASS; 62% in the non-reoperation group reported their KOOS4 scores to be satisfactory, while only 35% reported satisfactory results in the reoperated cohort (p < 0.05). Treatment failure; 2% in the non-reoperation group and 6% (p < 0.05) in the reoperation group considered their treatment to have failed. Conclusion Patients who underwent subsequent surgeries within 2 years of primary ACLR reported significantly inferior outcomes in MIC, PASS and treatment failure compared to the non-reoperated counterpart at the 2-year follow-up. This study provides clinicians with important information and knowledge about the outcomes after an ACLR with subsequent additional surgery. Level of evidence III.

Audiometric Characteristics and Tinnitus Features in a Cohort of 170 Spanish Patients

Background: Tinnitus is a rather prevalent, quite heterogeneous, and difficult to treat auditory disorder. The aim of this article is to provide the design and results of a cross-sectional study related to audiological and tinnitus features in a group of 170 Spanish patients. Methods: Audiometric characteristics were assessed on the basis of the pure-tone audiometry of both ears in 170 tinnitus patients and 85 control subjects. The audiometric status of each tinnitus participant was assessed on the basis of the average auditory threshold (AAT) in the whole frequency range (from 125 Hz to 8 kHz), and low (from 125 Hz to 2 kHz) and high (from 3 kHz to 8 kHz)-frequency intervals. Tinnitus features were evaluated through personal interview with patients and included tinnitus duration, laterality, pitch, sound, and distress (Tinnitus Handicap Inventory, THI). Correlational analysis was carried out between audiological (AAT) and tinnitus (THI) variables. Results: A very weak Spearman rank correlation factor is found between both variables. Conclusions: The subjective outcome of tinnitus distress (THI) was not correlated with the objective measure of hearing loss (AAT) in our cohort.

The Impact of Expectation for Pain Relief on Orofacial Pain Treatment Outcomes

Aims: To examine the effects of expectations for pain relief on the objective and subjective outcome of chronic orofacial pain (OFP) treatment.Materials and Methods: Sixty individuals referred to the Orofacial Pain Clinic at the Hebrew University-Hadassah School of Dental Medicine between 2015 and 2017 with OFP reported their expectation for pain relief upon initial consultation. They were also interviewed by telephone after treatment and asked to recall their expectations, referred to as “recalled expectations” (RE). Correlations between RE and treatment success were calculated from pain diaries, and from subjective pain improvement rates (PIR) reported by the patients.Results: 21 males (35.0%) and 39 females (65%), mean age of 46.90 ± 15.77 years and mean pain duration of 49.07 ± 51.95 months participated in the study. All participants rated their expectations as “10” on a 0 to 10 scale during their first visit. RE did not correlate with diary ratings, (P = 0.773) but inversely correlated (−0.3) with PIR (P = 0.020) treatment outcomes.Conclusions: Expectations for pain relief, reported as 10 on a 0–10 scale during the first appointment, may reflect the patient's desire for complete relief of their pain rather than their expectations. Clinicians should therefore be aware of the need for clear communication and wording when examining for expectations. Inverse correlation between recalled expectations and subjective outcome may be due to the nature of recalled expectations when patients already knew their treatment outcomes, and may be explained by the concept of cognitive dissonance.

Students’ Perceived Attributes and Benefits of a Leadership Course: Subjective Outcome Evaluation

Purpose: Using the client satisfaction approach, this study examined university students’ perceived attributes and benefits of a leadership subject which attempts to promote student well-being. We also studied the psychometric properties of the related evaluation tool. Method: Undergraduate students who enrolled in the course over 6 years (2013/14 to 2018/19) in a university in Hong Kong completed a subjective outcome evaluation tool ( N=10,484). Results: The evaluation tool possesses acceptable convergent validity, concurrent validity, and factorial validity. Students showed positive perceptions of the course, instructors, and benefits of the course. Conclusion: Findings suggest that university students had favorable perceptions of this credit-bearing leadership development subject based on the positive youth development approach. This subject serves as a good prototype for teachers, social workers, and allied professionals to develop and evaluate similar programs targeting university students. Social workers and teachers can also use the validated tool in research and evaluation contexts.

Good subjective outcome and low risk of revision surgery with a novel customized metal implant for focal femoral chondral lesions at a follow-up after a minimum of 5 years

Background and purpose Patients with focal cartilage lesions experience functional impairment. Results for biological treatments in the middle-aged patient is poor. Previous studies with focal prosthetic inlay resurfacing have shown a higher risk of conversion to total knee replacement at mid-term follow-up. A novel customized implant (Episealer, Episurf, Stockholm, Sweden) has been proposed to improve implant positioning and survival. The primary objective was to assess subjective-, objective function and implant survival at a minimum of five years after surgery. Materials and methods The inclusion criteria were patients aged 30–65 years with symptomatic focal chondral defects in the medial femoral condyle, International Cartilage Research Society grade 3 or 4 and failed conservative or surgical treatment. Minimum follow-up of 5 years. Clinical and radiologic assessments were made. Patient-reported outcome measurements at the latest follow-up were compared with the baseline data for the Knee injury and Osteoarthritis Outcome Score (KOOS), the EuroQoL (EQ-5D), the Tegner Activity Scale and a Visual Analog Scale of pain (VAS 0–10). Results Ten patients with the mean follow-up period of 75 months (60–86 months, SD 10) were included. Signs of osteoarthritis were seen in one patient (Ahlbäck 1). No cases with revision to knee replacement. VAS for pain and KOOS showed improvements that reached significance for VAS (p ≤ 0.001) and the KOOS subscores Pain (p = 0.01), ADL (p = 0.003), Sport and Recreation (p = 0.024) and Quality of Life (p = 0.003). Conclusion A good subjective outcome, a low risk of progression to degenerative changes and the need for subsequent surgery were seen at the mid-term follow-up with this customized focal knee-resurfacing implant. Level of evidence Prospective case series, level 4.

An intelligent system to identify coal maceral groups using markov-fuzzy clustering approach

Coal is the mixture of organic matters, called as macerals, and inorganic matters. Macerals are categorized into three major groups, i.e., vitrinite, inertinite, and liptinite. The maceral group identification serves an important role in coking and non-coking coal processes that are used mainly in steel and iron industries. Hence, it becomes important to efficiently characterize these maceral groups. Currently, industries use the optical polarized microscope to distinguish the maceral groups. However, the microscopical analysis is a manual method which is time-consuming and provides subjective outcome due to human interference. Therefore, an automated approach that can identify the maceral groups accurately in less processing time is strongly needed in industries. Computer-based image analysis methods are revolutionizing the industries because of its accuracy and efficacy. In this study, an intelligent maceral group identification system is proposed using markov-fuzzy clustering approach. This approach is an integration of fuzzy sets and the markov random field, which is employed towards maceral group identification in a clustering framework. The proposed model shows better results when compared with the standard cluster-based segmentation techniques. The results from the suggested model have also been validated against the outcome of manual methods, and the feasibility is tested using performance metrics.

Evaluation of Service-Learning in Project WeCan under COVID-19 in a Chinese Context

Service-learning is a widely adopted educational pedagogy and philosophy. With the support from the Wharf (Holdings) Limited (Group), service-learning was conducted in the “Project WeCan” in Hong Kong. Prior to COVID-19, traditional service-learning was implemented with students learning in the classroom and applying their knowledge and skills to the community through providing direct face-to-face service. With the COVID-19 outbreak in the 2019–20 academic year, school lockdown measures appeared. Students had to learn online and to design and implement service offsite. As the impacts of this rapid shift in paradigm remain unknown, this study examined changes in university students using a pretest–posttest design (n = 124) and perceptions of service-learning experience via the subjective outcome evaluation design (n = 192) under COVID-19. The authors also investigated service recipients’ (n = 56) satisfaction with service activities they participated in during the pandemic. Both objective outcome evaluation and subjective outcome evaluation findings revealed that service providers (university students) and recipients (secondary school students) experienced benefits from the Project. Findings support the benefits of online service-learning in “Project WeCan” even during unprecedented times such as COVID-19.

Mid-term outcome of bilateral fragility fractures of the sacrum after bisegmental transsacral stabilization versus spinopelvic fixation

Aims Minimally invasive fixation of pelvic fragility fractures is recommended to reduce pain and allow early mobilization. The purpose of this study was to evaluate the outcome of two different stabilization techniques in bilateral fragility fractures of the sacrum (BFFS). Methods A non-randomized, prospective study was carried out in a level 1 trauma centre. BFFS in 61 patients (mean age 80 years (SD 10); four male, 57 female) were treated surgically with bisegmental transsacral stablization (BTS; n = 41) versus spinopelvic fixation (SP; n = 20). Postoperative full weightbearing was allowed. The outcome was evaluated at two timepoints: discharge from inpatient treatment (TP1; Fitbit tracking, Zebris stance analysis), and ≥ six months (TP2; Fitbit tracking, Zebris analysis, based on modified Oswestry Disability Index (ODI), Majeed Score (MS), and the 12-Item Short Form Survey 12 (SF-12). Fracture healing was assessed by CT. The primary outcome parameter of functional recovery was the per-day step count; the secondary parameter was the subjective outcome assessed by questionnaires. Results Overall, no baseline differences were observed between the BTS and SP cohorts. In total, 58 (BTS = 19; SP = 39) and 37 patients (BTS = 14; SP = 23) could be recruited at TP1 and TP2, respectively. Mean steps per day at TP1 were median 308 (248 to 434) in the BTS group and 254 (196 to 446) in the SP group. At TP2, median steps per day were 3,759 (2,551 to 3,926) in the BTS group and 3,191 (2,872 to 3,679) in the SP group, each with no significant difference. A significant improvement was observed in each group (p < 0.001) between timepoints. BTS patients obtained better results than SP patients in ODI (p < 0.030), MS (p = 0.007), and SF-12 physical status (p = 0.006). In all cases, CT showed sufficient fracture healing of the posterior ring. Conclusion Both groups showed significant outcome improvement and sufficient fracture healing. Both techniques can be recommended for BFFS, although BTS was superior with respect to subjective outcome. Step-count tracking represents a reliable method to evaluate the mobility level. Cite this article: Bone Joint J 2021;103-B(3):462–468.