المؤلفون: Freshman, Ryan, Zhang, Alan, Benjamin Ma, C, Feeley, Brian, Ortiz, Shannon, Patel, Jhillika, Dunn, Warren, Wolf, Brian, Hettrich, Carolyn, Lansdown, Drew, Baumgarten, Keith, Bishop, Julie, Bollier, Matthew, Brophy, Robert, Bravman, Jonathan, Cox, Charles, Cvetanovich, Gregory, Grant, John, Frank, Rachel, Jones, Grant, Kuhn, John, Mair, Scott, Marx, Robert, McCarty, Eric, Miller, Bruce, Seidl, Adam, Smith, Matthew, Wright, Rick

المصدر: Orthopaedic Journal of Sports Medicine. 11(10)

مصطلحات موضوعية: humeral avulsion of the glenohumeral ligament, magnetic resonance imaging, risk factors, shoulder instability

الوصف: BACKGROUND: Humeral avulsion of the glenohumeral ligament (HAGL) lesions are an uncommon cause of anterior glenohumeral instability and may occur in isolation or combination with other pathologies. As HAGL lesions are difficult to detect via magnetic resonance imaging (MRI) and arthroscopy, they can remain unrecognized and result in continued glenohumeral instability. PURPOSE: To compare patients with anterior shoulder instability from a large multicenter cohort with and without a diagnosis of a HAGL lesion and identify preoperative physical examination findings, patient-reported outcomes, imaging findings, and surgical management trends associated with HAGL lesions. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Patients with anterior glenohumeral instability who underwent surgical management between 2012 and 2020 at 11 orthopaedic centers were enrolled. Patients with HAGL lesions identified intraoperatively were compared with patients without HAGL lesions. Preoperative characteristics, physical examinations, imaging findings, intraoperative findings, and surgical procedures were collected. The Student t test, Kruskal-Wallis H test, Fisher exact test, and chi-square test were used to compare groups. RESULTS: A total of 21 HAGL lesions were identified in 915 (2.3%) patients; approximately one-third (28.6%) of all lesions were visualized intraoperatively but not identified on preoperative MRI. Baseline characteristics did not differ between study cohorts. Compared with non-HAGL patients, HAGL patients were less likely to have a Hill-Sachs lesion (54.7% vs 28.6%; P = .03) or an anterior labral tear (87.2% vs 66.7%; P = .01) on preoperative MRI and demonstrated increased external rotation when their affected arm was positioned at 90° of abduction (85° vs 90°; P = .03). Additionally, HAGL lesions were independently associated with an increased risk of undergoing an open stabilization surgery (odds ratio, 74.6 [95% CI, 25.2-221.1]; P < .001). CONCLUSION: Approximately one-third of HAGL lesions were missed on preoperative MRI. HAGL patients were less likely to exhibit preoperative imaging findings associated with anterior shoulder instability, such as Hill-Sachs lesions or anterior labral pathology. These patients underwent open procedures more frequently than patients without HAGL lesions.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/4cm554q4Test

المؤلفون: Wright, Rick, Huston, Laura, Haas, Amanda, Pennings, Jacquelyn, Allen, Christina, Cooper, Daniel, DeBerardino, Thomas, Dunn, Warren, Lantz, Brett, Spindler, Kurt, Stuart, Michael, Albright, John, Amendola, Annunziato, Andrish, Jack, Annunziata, Christopher, Arciero, Robert, Bach, Bernard, Baker, Champ, Bartolozzi, Arthur, Baumgarten, Keith, Bechler, Jeffery, Berg, Jeffrey, Bernas, Geoffrey, Brockmeier, Stephen, Brophy, Robert, Bush-Joseph, Charles, Butler, J, Campbell, John, Carey, James, Carpenter, James, Cole, Brian, Cooper, Jonathan, Cox, Charles, Creighton, R, Dahm, Diane, David, Tal, Flanigan, David, Frederick, Robert, Ganley, Theodore, Garofoli, Elizabeth, Gatt, Charles, Gecha, Steven, Giffin, James, Hame, Sharon, Hannafin, Jo, Harner, Christopher, Harris, Norman, Hechtman, Keith, Hershman, Elliott, Hoellrich, Rudolf, Johnson, David, Johnson, Timothy, Jones, Morgan, Kaeding, Christopher, Kamath, Ganesh, Klootwyk, Thomas, Levy, Bruce, Maiers, G, Marx, Robert, Matava, Matthew, Mathien, Gregory, McAllister, David, McCarty, Eric, McCormack, Robert, Miller, Bruce, Nissen, Carl, ONeill, Daniel, Owens, Brett, Parker, Richard, Purnell, Mark, Ramappa, Arun, Rauh, Michael, Rettig, Arthur, Sekiya, Jon, Shea, Kevin, Sherman, Orrin, Slauterbeck, James, Smith, Matthew, Spang, Jeffrey, Svoboda, Ltc, Taft, Timothy, Tenuta, Joachim, Tingstad, Edwin, Vidal, Armando, Viskontas, Darius, White, Richard, Williams, James, Wolcott, Michelle, Wolf, Brian, York, James, Ma, C Benjamin

المصدر: The American Journal of Sports Medicine. 51(3)

مصطلحات موضوعية: anterior cruciate ligament (ACL), knee articular cartilage, meniscus, outcomes, revision ACL reconstruction, Male, Humans, Adult, Follow-Up Studies, Cohort Studies, Cartilage, Articular, Anterior Cruciate Ligament Injuries, Menisci, Tibial, Osteoarthritis

الوصف: BACKGROUND: Meniscal and chondral damage is common in the patient undergoing revision anterior cruciate ligament (ACL) reconstruction. PURPOSE: To determine if meniscal and/or articular cartilage pathology at the time of revision ACL surgery significantly influences a patients outcome at 6-year follow-up. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients undergoing revision ACL reconstruction were prospectively enrolled between 2006 and 2011. Data collection included baseline demographics, surgical technique, pathology, treatment, and scores from 4 validated patient-reported outcome instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx Activity Rating Scale. Patients were followed up at 6 years and asked to complete the identical set of outcome instruments. Regression analysis assessed the meniscal and articular cartilage pathology risk factors for clinical outcomes 6 years after revision ACL reconstruction. RESULTS: An overall 1234 patients were enrolled (716 males, 58%; median age, 26 years). Surgeons reported the pathology at the time of revision surgery in the medial meniscus (45%), lateral meniscus (36%), medial femoral condyle (43%), lateral femoral condyle (29%), medial tibial plateau (11%), lateral tibial plateau (17%), patella (30%), and trochlea (21%). Six-year follow-up was obtained on 79% of the sample (980/1234). Meniscal pathology and articular cartilage pathology (medial femoral condyle, lateral femoral condyle, lateral tibial plateau, trochlea, and patella) were significant drivers of poorer patient-reported outcomes at 6 years (IKDC, KOOS, WOMAC, and Marx). The most consistent factors driving outcomes were having a medial meniscal excision (either before or at the time of revision surgery) and patellofemoral articular cartilage pathology. Six-year Marx activity levels were negatively affected by having either a repair/excision of the medial meniscus (odds ratio range, 1.45-1.72; P≤ .04) or grade 3-4 patellar chondrosis (odds ratio, 1.72; P = .04). Meniscal pathology occurring before the index revision surgery negatively affected scores on all KOOS subscales except for sports/recreation (P < .05). Articular cartilage pathology significantly impaired all KOOS subscale scores (P < .05). Lower baseline outcome scores, higher body mass index, being a smoker, and incurring subsequent surgery all significantly increased the odds of reporting poorer clinical outcomes at 6 years. CONCLUSION: Meniscal and chondral pathology at the time of revision ACL reconstruction has continued significant detrimental effects on patient-reported outcomes at 6 years after revision surgery.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/8f49341kTest

المؤلفون: Group, MARS, DeFroda, Steven F, Owens, Brett D, Wright, Rick W, Huston, Laura J, Pennings, Jacquelyn S, Haas, Amanda K, Allen, Christina R, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Lantz, Brett Brick A, Spindler, Kurt P, Stuart, Michael J, Albright, John P, Amendola, Annunziato, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R, Baker, Champ L, Bartolozzi, Arthur R, Baumgarten, Keith M, Bechler, Jeffery R, Berg, Jeffrey H, Bernas, Geoffrey A, Brockmeier, Stephen F, Brophy, Robert H, Bush-Joseph, Charles A, Butler, J Brad, Carey, James L, Carpenter, James E, Cole, Brian J, Cooper, Jonathan M, Cox, Charles L, Creighton, R Alexander, David, Tal S, Flanigan, David C, Frederick, Robert W, Ganley, Theodore J, Garofoli, Elizabeth A, Gatt, Charles J, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay, Hechtman, Keith S, Hershman, Elliott B, Hoellrich, Rudolf G, Johnson, David C, Johnson, Timothy S, Jones, Morgan H, Kaeding, Christopher C, Kamath, Ganesh V, Klootwyk, Thomas E, Levy, Bruce A, Benjamin, C, Maiers, G Peter, Marx, Robert G, Matava, Matthew J, Mathien, Gregory M, McAllister, David R, McCarty, Eric C, McCormack, Robert G, Miller, Bruce S, Nissen, Carl W, O’Neill, Daniel F, Parker, Richard D, Purnell, Mark L, Ramappa, Arun J, Rauh, Michael A, Rettig, Arthur C, Sekiya, Jon K, Shea, Kevin G, Sherman, Orrin H, Slauterbeck, James R, Smith, Matthew V, Spang, Jeffrey T, Svoboda, Steven J, Taft, Timothy N, Tenuta, Joachim J, Tingstad, Edwin M, Vidal, Armando F, Viskontas, Darius G, White, Richard A, Williams, James S, Wolcott, Michelle L, Wolf, Brian R, York, James J

المصدر: The American Journal of Sports Medicine. 50(9)

مصطلحات موضوعية: Transplantation, Clinical Research, Musculoskeletal, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Cohort Studies, Humans, Osteoarthritis, Quality of Life, Reoperation, bone graft, outcomes, revision anterior cruciate ligament reconstruction, tunnel lysis, MARS Group, Biomedical Engineering, Mechanical Engineering, Human Movement and Sports Sciences, Orthopedics

الوصف: BackgroundLytic or malpositioned tunnels may require bone grafting during revision anterior cruciate ligament reconstruction (rACLR) surgery. Patient characteristics and effects of grafting on outcomes after rACLR are not well described.PurposeTo describe preoperative characteristics, intraoperative findings, and 2-year outcomes for patients with rACLR undergoing bone grafting procedures compared with patients with rACLR without grafting.Study designCohort study; Level of evidence, 3.MethodsA total of 1234 patients who underwent rACLR were prospectively enrolled between 2006 and 2011. Baseline revision and 2-year characteristics, surgical technique, pathology, treatment, and patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale [Marx]) were collected, as well as subsequent surgery information, if applicable. The chi-square and analysis of variance tests were used to compare group characteristics.ResultsA total of 159 patients (13%) underwent tunnel grafting-64 (5%) patients underwent 1-stage and 95 (8%) underwent 2-stage grafting. Grafting was isolated to the femur in 31 (2.5%) patients, the tibia in 40 (3%) patients, and combined in 88 patients (7%). Baseline KOOS Quality of Life (QoL) and Marx activity scores were significantly lower in the 2-stage group compared with the no bone grafting group (P≤ .001). Patients who required 2-stage grafting had more previous ACLRs (P < .001) and were less likely to have received a bone-patellar tendon-bone or a soft tissue autograft at primary ACLR procedure (P≤ .021) compared with the no bone grafting group. For current rACLR, patients undergoing either 1-stage or 2-stage bone grafting were more likely to receive a bone-patellar tendon-bone allograft (P≤ .008) and less likely to receive a soft tissue autograft (P≤ .003) compared with the no bone grafting group. At 2-year follow-up of 1052 (85%) patients, we found inferior outcomes in the 2-stage bone grafting group (IKDC score = 68; KOOS QoL score = 44; KOOS Sport/Recreation score = 65; and Marx activity score = 3) compared with the no bone grafting group (IKDC score = 77; KOOS QoL score = 63; KOOS Sport/Recreation score = 75; and Marx activity score = 7) (P≤ .01). The 1-stage bone graft group did not significantly differ compared with the no bone grafting group.ConclusionTunnel bone grafting was performed in 13% of our rACLR cohort, with 8% undergoing 2-stage surgery. Patients treated with 2-stage grafting had inferior baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting. Patients treated with 1-stage grafting had similar baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/58w8r1d4Test

المؤلفون: Giri, Ayush, Freeman, Thomas H, Kim, Peter, Kuhn, John E, Garriga, Gustavo A, Khazzam, Michael, Higgins, Laurence D, Matzkin, Elizabeth, Baumgarten, Keith M, Bishop, Julie Y, Brophy, Robert H, Carey, James L, Dunn, Warren R, Jones, Grant L, Ma, C Benjamin, Marx, Robert G, McCarty, Eric C, Poddar, Sourav K, Smith, Matthew V, Spencer, Edwin E, Vidal, Armando F, Wolf, Brian R, Wright, Rick W, Jain, Nitin B

المصدر: Journal of Shoulder and Elbow Surgery. 31(4)

مصطلحات موضوعية: Nutrition, Obesity, Clinical Research, Prevention, Patient Safety, Adipose Tissue, Female, Humans, Male, Multicenter Studies as Topic, Orthopedics, Risk Factors, Rotator Cuff, Rotator Cuff Injuries, Sex Factors, Rotator cuff, fatty infiltration, obesity, body mass index, sex, cross-sectional study, Clinical Sciences

الوصف: BackgroundFatty infiltration (FI) is one of the most important prognostic factors for outcomes after rotator cuff surgery. Established risk factors include advancing age, larger tear size, and increased tear chronicity. A growing body of evidence suggests that sex and obesity are associated with FI; however, data are limited.MethodsWe recruited 2 well-characterized multicenter cohorts of patients with rotator cuff tears (Multicenter Orthopaedic Outcomes Network [MOON] cohort [n = 80] and Rotator Cuff Outcomes Workgroup [ROW] cohort [n = 158]). We used multivariable logistic regression to evaluate the relationship between body mass index (BMI) and the presence of FI while adjusting for the participant's age at magnetic resonance imaging, sex, and duration of shoulder symptoms, as well as the cross-sectional area of the tear. We analyzed the 2 cohorts separately and performed a meta-analysis to combine estimates.ResultsA total of 27 patients (33.8%) in the Multicenter Orthopaedic Outcomes Network (MOON) cohort and 57 patients (36.1%) in the Rotator Cuff Outcomes Workgroup (ROW) cohort had FI. When BMI < 25 kg/m2 was used as the reference category, being overweight was associated with a 2.37-fold (95% confidence interval [CI], 0.77-7.29) increased odds of FI and being obese was associated with a 3.28-fold (95% CI, 1.16-9.25) increased odds of FI. Women were 4.9 times (95% CI, 2.06-11.69) as likely to have FI as men.ConclusionsAmong patients with rotator cuff tears, obese patients had a substantially higher likelihood of FI. Further research is needed to assess whether modifying BMI can alter FI in patients with rotator cuff tears. This may have significant clinical implications for presurgical surgical management of rotator cuff tears. Sex was also significantly associated with FI, with women having higher odds of FI than men. Higher odds of FI in female patients may also explain previously reported early suboptimal outcomes of rotator cuff surgery and higher pain levels in female patients as compared with male patients.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/1fc7x0k1Test

المؤلفون: Gopinatth, Varun, Batra, Anjay K., Chahla, Jorge, Smith, Matthew V., Matava, Matthew J., Brophy, Robert H., Knapik, Derrick M.

المصدر: Arthroscopy, Sports Medicine, and Rehabilitation ; volume 6, issue 2, page 100916 ; ISSN 2666-061X

الإتاحة: https://doi.org/10.1016/j.asmr.2024.100916Test
https://api.elsevier.com/content/article/PII:S2666061X24000348?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S2666061X24000348?httpAccept=text/plainTest

المؤلفون: Cheema, Haadiya, Brophy, Robert, Collins, Jamie, Cox, Charles L., Guermazi, Ali, Kumara, Mahima, Levy, Bruce A., MacFarlane, Lindsey, Mandl, Lisa A., Marx, Robert, Selzer, Faith, Spindler, Kurt, Katz, Jeffrey N., Murray, Eleanor J.

المساهمون: National Institute of Arthritis and Musculoskeletal and Skin Diseases

المصدر: Osteoarthritis and Cartilage ; volume 32, issue 3, page 319-328 ; ISSN 1063-4584

مصطلحات موضوعية: Orthopedics and Sports Medicine, Biomedical Engineering, Rheumatology

الإتاحة: https://doi.org/10.1016/j.joca.2023.10.007Test
https://api.elsevier.com/content/article/PII:S1063458423009597?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S1063458423009597?httpAccept=text/plainTest

المؤلفون: Group, MARS, Wright, Rick W, Huston, Laura J, Haas, Amanda K, Pennings, Jacquelyn S, Allen, Christina R, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Lantz, Brett A, Spindler, Kurt P, Stuart, Michael J, Albright, John P, Amendola, Annunziato, Andrish, Jack T, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R, Baker, Champ L, Bartolozzi, Arthur R, Baumgarten, Keith M, Bechler, Jeffery R, Berg, Jeffrey H, Bernas, Geoffrey A, Brockmeier, Stephen F, Brophy, Robert H, Bush-Joseph, Charles A, Butler, J Brad, Campbell, John D, Carey, James L, Carpenter, James E, Cole, Brian J, Cooper, Jonathan M, Cox, Charles L, Creighton, R Alexander, Dahm, Diane L, David, Tal S, Flanigan, David C, Frederick, Robert W, Ganley, Theodore J, Garofoli, Elizabeth A, Gatt, Charles J, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay, Hechtman, Keith S, Hershman, Elliott B, Hoellrich, Rudolf G, Johnson, David C, Johnson, Timothy S, Jones, Morgan H, Kaeding, Christopher C, Kamath, Ganesh V, Klootwyk, Thomas E, Levy, Bruce A, Benjamin, C, Maiers, G Peter, Marx, Robert G, Matava, Matthew J, Mathien, Gregory M, McAllister, David R, McCarty, Eric C, McCormack, Robert G, Miller, Bruce S, Nissen, Carl W, O’Neill, Daniel F, Owens, Brett D, Parker, Richard D, Purnell, Mark L, Ramappa, Arun J, Rauh, Michael A, Rettig, Arthur C, Sekiya, Jon K, Shea, Kevin G, Sherman, Orrin H, Slauterbeck, James R, Smith, Matthew V, Spang, Jeffrey T, Svoboda, Steven J, Taft, Timothy N, Tenuta, Joachim J, Tingstad, Edwin M, Vidal, Armando F, Viskontas, Darius G, White, Richard A, Williams, James S, Wolcott, Michelle L, Wolf, Brian R, York, James J

المصدر: The American Journal of Sports Medicine. 49(10)

مصطلحات موضوعية: Transplantation, Clinical Research, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Musculoskeletal, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Autografts, Bone-Patellar Tendon-Bone Grafting, Cohort Studies, Humans, Male, Reoperation, Transplantation, Autologous, anterior cruciate ligament, ACL reconstruction, revision, outcomes, graft failure, MARS Group, Biomedical Engineering, Mechanical Engineering, Human Movement and Sports Sciences, Orthopedics

الوصف: BackgroundAlthough graft choice may be limited in the revision setting based on previously used grafts, most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome.HypothesisIn the ACL revision setting, there would be no difference between autograft and allograft in rerupture rate and patient-reported outcomes (PROs) at 6-year follow-up.Study designCohort study; Level of evidence, 2.MethodsPatients who had revision surgery were identified and prospectively enrolled in this cohort study by 83 surgeons over 52 sites. Data collected included baseline characteristics, surgical technique and pathology, and a series of validated PRO measures. Patients were followed up at 6 years and asked to complete the identical set of PRO instruments. Incidence of additional surgery and reoperation because of graft failure were also recorded. Multivariable regression models were used to determine the predictors (risk factors) of PROs, graft rerupture, and reoperation at 6 years after revision surgery.ResultsA total of 1234 patients including 716 (58%) men were enrolled. A total of 325 (26%) underwent revision using a bone-patellar tendon-bone (BTB) autograft; 251 (20%), soft tissue autograft; 289 (23%), BTB allograft; 302 (25%), soft tissue allograft; and 67 (5%), other graft. Questionnaires and telephone follow-up for subsequent surgery information were obtained for 809 (66%) patients, while telephone follow-up was only obtained for an additional 128 patients for the total follow-up on 949 (77%) patients. Graft choice was a significant predictor of 6-year Marx Activity Rating Scale scores (P = .024). Specifically, patients who received a BTB autograft for revision reconstruction had higher activity levels than did patients who received a BTB allograft (odds ratio [OR], 1.92; 95% CI, 1.25-2.94). Graft rerupture was reported in 5.8% (55/949) of patients by their 6-year follow-up: 3.5% (16/455) of patients with autografts and 8.4% (37/441) of patients with allografts. Use of a BTB autograft for revision resulted in patients being 4.2 times less likely to sustain a subsequent graft rupture than if a BTB allograft were utilized (P = .011; 95% CI, 1.56-11.27). No significant differences were found in graft rerupture rates between BTB autograft and soft tissue autografts (P = .87) or between BTB autografts and soft tissue allografts (P = .36). Use of an autograft was found to be a significant predictor of having fewer reoperations within 6 years compared with using an allograft (P = .010; OR, 0.56; 95% CI, 0.36-0.87).ConclusionBTB and soft tissue autografts had a decreased risk in graft rerupture compared with BTB allografts. BTB autografts were associated with higher activity level than were BTB allografts at 6 years after revision reconstruction. Surgeons and patients should consider this information when choosing a graft for revision ACL reconstruction.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/6031p4r6Test

المؤلفون: Brophy, Robert

المصدر: Military History. 04/2002 19(1):24

مصطلحات موضوعية: NAVY - United States - History, OFFICERS - Navy - United States - Biography

الوصف: por

الوصول الحر: http://www.dtic.mil/dtic/aulimp/citations/gsa/2002_112418/26766.htmlTest

المؤلفون: Houck, Darby A, Dunn, Robin H, Hettrich, Carolyn M, Wolf, Brian R, Frank, Rachel M, McCarty, Eric C, Group, MOON Shoulder, Bollier, Matthew J, Kuhn, John E, Cox, Charles L, Benjamin, C, Feeley, Brian T, Zhang, Alan L, Seidl, Adam J, Bishop, Julie Y, Jones, Grant L, Barlow, Jonathan D, Brophy, Robert H, Wright, Rick W, Smith, Matthew V, Marx, Robert G, Baumgarten, Keith M, Miller, Bruce S, Carpenter, James E, Grant, John A, Ortiz, Shannon F, Bravman, Jonathan T

المصدر: Arthroscopy Sports Medicine and Rehabilitation. 2(6)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, MOON Shoulder Group

الوصف: PurposeTo determine whether range of motion (ROM) varies with the location and extent of labral tear seen in patients undergoing arthroscopic anterior shoulder stabilization.MethodsConsecutive patients undergoing arthroscopic anterior shoulder stabilization who were enrolled in the Multicenter Orthopaedic Outcomes Network Shoulder Instability database underwent a preoperative physical examination and intraoperative examination under anesthesia in which ROM was recorded. Intraoperatively, the location and extent of the labral tear was recorded using conventional clock-face coordinates. Patients were grouped by combinations of quadrants involved in the labral tear (G1-G7): G1 = anterior only, G2 = anterior + inferior, G3 = anterior + inferior + posterior, G4 = all quadrants, G5 = superior + anterior, G6 = superior + anterior + inferior, and G7 = posterior + superior + anterior. Statistical analyses were performed with the Kruskal-Wallis rank-sum test. When P < .05, a post-hoc Dunn's test was performed. For categorical variables, the χ2 test was performed. We performed a series of bivariate negative binomial regression models testing pairwise combinations of ROM parameters predicting the count of labral tear locations (possible: 0-5) within each quadrant.ResultsA total of 467 patients were included, with 13 (2.8%) in G1, 221 (47.3%) in G2, 40 (8.6%) in G3, 51 (10.9%) in G4, 18 (3.9%) in G5, 121 (25.9%) in G6, and 3 (0.6%) in G7. Multiple statistically significant differences were noted in ROM, specifically active internal rotation at side (IRS) (P = .005), active abduction (P = .02), passive IRS (P = .02), and passive external rotation in abduction (P = .0007). Regression modeling revealed a positive correlation between passive abduction and predicted count of labral tear locations in the superior quadrant and between passive IRS and predicted count of labral tear location in the inferior quadrant.ConclusionsIn patients undergoing arthroscopic shoulder stabilization for anterior instability, ROM varies with location and extent of labral tear. However, the clinical relevance of such small ROM differences remains undetermined.Level of evidenceII, prospective comparative study.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/2cb7q2b4Test

المؤلفون: Wright, Rick W, Huston, Laura J, Haas, Amanda K, Allen, Christina R, Anderson, Allen F, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Lantz, Brett Brick A, Mann, Barton, Spindler, Kurt P, Stuart, Michael J, Nwosu, Samuel K, Pennings, Jacquelyn S, Albright, John P, Amendola, Annunziato Ned, Andrish, Jack T, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R, Baker, Champ L, Bartolozzi, Arthur R, Baumgarten, Keith M, Bechler, Jeffery R, Berg, Jeffrey H, Bernas, Geoffrey A, Brockmeier, Stephen F, Brophy, Robert H, Bush‐Joseph, Charles A, Butler, J Brad, Campbell, John D, Carey, James L, Carpenter, James E, Cole, Brian J, Cooper, Jonathan M, Cox, Charles L, Creighton, R Alexander, Dahm, Diane L, David, Tal S, Flanigan, David C, Frederick, Robert W, Ganley, Theodore J, Garofoli, Elizabeth A, Gatt, Charles J, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay, Hechtman, Keith S, Hershman, Elliott B, Hoellrich, Rudolf G, Hosea, Timothy M, Johnson, David C, Johnson, Timothy S, Jones, Morgan H, Kaeding, Christopher C, Kamath, Ganesh V, Klootwyk, Thomas E, Levy, Bruce A, Ma, C Benjamin, Maiers, G Peter, Marx, Robert G, Matava, Matthew J, Mathien, Gregory M, McAllister, David R, McCarty, Eric C, McCormack, Robert G, Miller, Bruce S, Nissen, Carl W, O'Neill, Daniel F, Owens, Brett D, Parker, Richard D, Purnell, Mark L, Ramappa, Arun J, Rauh, Michael A, Rettig, Arthur C, Sekiya, Jon K, Shea, Kevin G, Sherman, Orrin H, Slauterbeck, James R, Smith, Matthew V, Spang, Jeffrey T, Svoboda, LTC Steven J, Taft, Timothy N, Tenuta, Joachim J, Tingstad, Edwin M, Vidal, Armando F, Viskontas, Darius G, White, Richard A, Williams, James S, Wolcott, Michelle L, Wolf, Brian R, York, James J

المصدر: Journal of Orthopaedic Research®. 38(6)

مصطلحات موضوعية: Physical Injury - Accidents and Adverse Effects, Patient Safety, Clinical Research, Prevention, Comparative Effectiveness Research, Adult, Anterior Cruciate Ligament Reconstruction, Female, Humans, Male, ACL, clinical outcomes, knee, ligament, osteoarthritis, MARS Group, Biomedical Engineering, Clinical Sciences, Human Movement and Sports Sciences, Orthopedics

الوصف: The underlying theme throughout this series of studies authored by the Multicenter anterior cruciate ligament (ACL) Revision Study consortium has been to determine the modifiable predictors or risk factors of long-term outcomes of revision ACL reconstruction. The observational studies described and summarized in the manuscript are both clinically relevant and of great interest in finding out the long-term consequences of the intervention and its relationship to the original injury. The successful completion of these studies has important implications for both therapy and future clinical trials. The identification of modifiable risk factors will play an important role in secondary prevention, while the identification of nonmodifiable risk factors will aid us in counseling our patients and making surgical decisions. Thus, we expect a profound clinical impact on patients' care. More importantly, this project represents an important step forward in bringing evidence to bear in clinical decision making in orthopedic surgery.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/6wx0n3w1Test