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: Jones, Morgan H., Gottreich, Julia R., Jin, Yuxuan, Kattan, Michael W., Spindler, Kurt P., Farrow, Lutul D., Frangiamore, Salvatore J., Gilot, Gregory J., Hampton, Robert J., Leo, Brian M., Nickodem, Robert J., Parker, Richard D., Rosneck, James T., Saluan, Paul M., Scarcella, Michael J., Serna, Alfred, Stearns, Kim L.

المصدر: Orthopaedic Journal of Sports Medicine ; volume 12, issue 4 ; ISSN 2325-9671 2325-9671

الوصف: Background: Surgeon performance has been investigated as a factor affecting patient outcomes after orthopaedic procedures to improve transparency between patients and providers. Purpose/Hypothesis: The purpose of this study was to identify whether surgeon performance influenced patient-reported outcomes (PROMs) 1 year after arthroscopic partial meniscectomy (APM). It was hypothesized that there would be no significant difference in PROMs between patients who underwent APM from various surgeons. Study Design: Case-control study; Level of evidence, 3. Methods: A prospective cohort of 794 patients who underwent APM between 2018 and 2019 were included in the analysis. A total of 34 surgeons from a large multicenter health care center were included. Three multivariable models were built to determine whether the surgeon—among demographic and meniscal pathology factors—was a significant variable for predicting the Knee injury and Osteoarthritis Outcome Score (KOOS)-Pain subscale, the Patient Acceptable Symptom State (PASS), and a 10-point improvement in the KOOS-Pain at 1 year after APM. Likelihood ratio (LR) tests were used to determine the significance of the surgeon variable in the models. Results: The 794 patients were identified from the multicenter hospital system. The baseline KOOS-Pain score was a significant predictor of outcome in the 1-year KOOS-Pain model (odds ratio [OR], 2.1 [95% CI, 1.77-2.48]; P < .001), the KOOS-Pain 10-point improvement model (OR, 0.57 [95% CI, 0.44-0.73), and the 1-year PASS model (OR, 1.42 [95% CI, 1.15-1.76]; P = .002) among articular cartilage pathology (bipolar medial cartilage) and patient-factor variables, including body mass index, Veterans RAND 12-Item Health Survey–Mental Component Score, and Area Deprivation Index. The individual surgeon significantly impacted outcomes in the 1-year KOOS-Pain mixed model in the LR test ( P = .004). Conclusion: Patient factors and characteristics are better predictors for patient outcomes 1 year after APM than surgeon characteristics, ...

الإتاحة: https://doi.org/10.1177/23259671231204014Test

المؤلفون: Gottreich, Julia R., Katz, Jeffrey N., Jones, Morgan H.

المصدر: Orthopaedic Journal of Sports Medicine ; volume 12, issue 3 ; ISSN 2325-9671 2325-9671

مصطلحات موضوعية: Orthopedics and Sports Medicine

الوصف: Background: Biomarkers collected in synovial tissue and fluid have been identified as potential predictors of outcomes after arthroscopy. Purpose: To provide a narrative review of the current literature that assesses the associations between preoperative biomarkers in the synovial fluid or synovial tissue and patient outcomes after knee arthroscopy. Study Design: Narrative review. Methods: We searched the PubMed database with keywords, “biomarkers AND arthroscopy,” “biomarkers AND anterior cruciate ligament reconstruction,” and “biomarkers AND meniscectomy.” To be included, studies must have collected synovial fluid or synovial tissue from patients before or during arthroscopic knee surgery and analyzed the relationship of biomarkers to postoperative patient outcomes. Biomarkers were classified into 4 main categories: metabolism of aggrecan in cartilage, metabolism of collagen in cartilage (type II collagen), noncollagenous proteins in the knee, and other. When biomarker levels and outcomes were expressed with continuous variables, we abstracted the Pearson or Spearman correlation coefficients as the effect measure. If the biomarker values were continuous and the outcomes binary, we abstracted the mean or median biomarker values in those with favorable versus unfavorable outcomes. We calculated effect sizes as the difference between means of both groups divided by the standard deviation from the mean in the group with better outcomes. Results: Eight studies were included in the review. Each study reported different patient outcomes. Biomarkers associated with metabolism of aggrecan, type II collagen metabolism, and noncollagenous proteins as well as inflammatory biomarkers had statistically significant associations with a range of patient outcomes after knee arthroscopy. Difference across studies in sample size and outcome measures precluded choosing a single biomarker that best predicted patient outcomes. Conclusion: The findings suggest that biomarkers associated with metabolism of aggrecan, type II collagen ...

الإتاحة: https://doi.org/10.1177/23259671231193370Test

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: 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

المؤلفون: Group, The MARS, 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 A, Mann, Barton, Spindler, Kurt P, Stuart, Michael J, Nwosu, Samuel K, 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, Hosea, Timothy M, 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. 47(10)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Arthritis, Patient Safety, Clinical Research, Musculoskeletal, Adolescent, Adult, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Cartilage Diseases, Cohort Studies, Female, Humans, Knee Joint, Male, Meniscectomy, Middle Aged, Patient Reported Outcome Measures, Reoperation, Surveys and Questionnaires, Young Adult, ACL reconstruction, revision, outcomes, IKDC, KOOS, Marx, MARS Group, Biomedical Engineering, Mechanical Engineering, Human Movement and Sports Sciences, Orthopedics, Clinical sciences, Allied health and rehabilitation science, Sports science and exercise

الوصف: BackgroundPatient-reported outcomes (PROs) are a valid measure of results after revision anterior cruciate ligament (ACL) reconstruction. Revision ACL reconstruction has been documented to have worse outcomes when compared with primary ACL reconstruction. Understanding positive and negative predictors of PROs will allow surgeons to modify and potentially improve outcome for patients.Purpose/hypothesisThe purpose was to describe PROs after revision ACL reconstruction and test the hypothesis that patient- and technique-specific variables are associated with these outcomes.Study designCohort study; Level of evidence, 2.MethodsPatients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons over 52 sites. Data included baseline demographics, surgical technique and pathology, and a series of validated PRO 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. Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Multivariate regression models were used to control for a variety of demographic and surgical factors to determine the positive and negative predictors of PRO scores at 2 years after revision surgery.ResultsA total of 1205 patients met the inclusion criteria and were successfully enrolled: 697 (58%) were male, with a median cohort age of 26 years. The median time since their most recent previous ACL reconstruction was 3.4 years. Two-year questionnaire follow-up was obtained from 989 patients (82%). The most significant positive predictors of 2-year IKDC scores were a high baseline IKDC score, high baseline Marx activity level, male sex, and having a longer time since the most recent previous ACL reconstruction, while negative predictors included having a lateral meniscectomy before the revision ACL reconstruction or having grade 3/4 chondrosis in either the trochlear groove or the medial tibial plateau at the time of the revision surgery. For KOOS, having a high baseline score and having a longer time between the most recent previous ACL reconstruction and revision surgery were significant positive predictors for having a better (ie, higher) 2-year KOOS, while having a lateral meniscectomy before the revision ACL reconstruction was a consistent predictor for having a significantly worse (ie, lower) 2-year KOOS. Statistically significant positive predictors for 2-year Marx activity levels included higher baseline Marx activity levels, younger age, male sex, and being a nonsmoker. Negative 2-year activity level predictors included having an allograft or a biologic enhancement at the time of revision surgery.ConclusionPROs after revision ACL reconstruction are associated with a variety of patient- and surgeon-related variables. Understanding positive and negative predictors of PROs will allow surgeons to guide patient expectations as well as potentially improve outcomes.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/8rc6d7rsTest

المؤلفون: Group, MARS, Bigouette, John P, Owen, Erin C, Lantz, Brett A, Hoellrich, Rudolf G, Huston, Laura J, Haas, Amanda K, Allen, Christina R, Anderson, Allen F, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Mann, Barton, Spindler, Kurt P, Stuart, Michael J, Wright, Rick W, 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, Hosea, Timothy M, 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. 47(9)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Clinical Research, Arthritis, Physical Injury - Accidents and Adverse Effects, Musculoskeletal, Adolescent, Adult, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Athletic Injuries, Child, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Reported Outcome Measures, Quality of Life, Reoperation, Return to Sport, Self Report, Surveys and Questionnaires, Young Adult, anterior cruciate ligament, outcomes, revision ACL, sports participation, MARS Group, Biomedical Engineering, Mechanical Engineering, Human Movement and Sports Sciences, Orthopedics, Clinical sciences, Allied health and rehabilitation science, Sports science and exercise

الوصف: BackgroundAnterior cruciate ligament (ACL) revision cohorts continually report lower outcome scores on validated knee questionnaires than primary ACL cohorts at similar time points after surgery. It is unclear how these outcomes are associated with physical activity after physician clearance for return to recreational or competitive sports after ACL revision surgery.HypothesesParticipants who return to either multiple sports or a singular sport after revision ACL surgery will report decreased knee symptoms, increased activity level, and improved knee function as measured by validated patient-reported outcome measures (PROMs) and compared with no sports participation. Multisport participation as compared with singular sport participation will result in similar increased PROMs and activity level.Study designCross-sectional study; Level of evidence, 3.MethodsA total of 1205 patients who underwent revision ACL reconstruction were enrolled by 83 surgeons at 52 clinical sites. At the time of revision, baseline data collected included the following: demographics, surgical characteristics, previous knee treatment and PROMs, the International Knee Documentation Committee (IKDC) questionnaire, Marx activity score, Knee injury and Osteoarthritis Outcome Score (KOOS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A series of multivariate regression models were used to evaluate the association of IKDC, KOOS, WOMAC, and Marx Activity Rating Scale scores at 2 years after revision surgery by sports participation category, controlling for known significant covariates.ResultsTwo-year follow-up was obtained on 82% (986 of 1205) of the original cohort. Patients who reported not participating in sports after revision surgery had lower median PROMs both at baseline and at 2 years as compared with patients who participated in either a single sport or multiple sports. Significant differences were found in the change of scores among groups on the IKDC (P < .0001), KOOS-Symptoms (P = .01), KOOS-Sports and Recreation (P = .04), and KOOS-Quality of Life (P < .0001). Patients with no sports participation were 2.0 to 5.7 times more likely than multiple-sport participants to report significantly lower PROMs, depending on the specific outcome measure assessed, and 1.8 to 3.8 times more likely than single-sport participants (except for WOMAC-Stiffness, P = .18), after controlling for known covariates.ConclusionParticipation in either a single sport or multiple sports in the 2 years after ACL revision surgery was found to be significantly associated with higher PROMs across multiple validated self-reported assessment tools. During follow-up appointments, surgeons should continue to expect that patients who report returning to physical activity after surgery will self-report better functional outcomes, regardless of baseline activity levels.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/8v6653n3Test

المؤلفون: Wright, Rick W, Huston, Laura J, Nwosu, Samuel K, Allen, Christina R, Anderson, Allen F, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Haas, Amanda K, Lantz, Brett Brick A, Mann, Barton, Spindler, Kurt P, Stuart, Michael J, Albright, John P, Amendola, Annunziato Ned, Andrish, Jack T, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R Jr, Baker, Champ LIII, 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 Jr, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay Jr, 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 II, 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 Jr, Wolcott, Michelle L, Wolf, Brian R, York, James J

المصدر: Journal of Bone and Joint Surgery. 101(9)

مصطلحات موضوعية: Behavioral and Social Science, Patient Safety, Physical Injury - Accidents and Adverse Effects, Clinical Research, Arthritis, Physical Rehabilitation, Aging, Bioengineering, Rehabilitation, Musculoskeletal, Adult, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Braces, Cohort Studies, Early Ambulation, Female, Humans, Male, Patient Reported Outcome Measures, Range of Motion, Articular, Recovery of Function, Reoperation, Weight-Bearing, Young Adult, MARS Group, Biomedical Engineering, Clinical Sciences, Orthopedics

الوصف: BackgroundRevision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes than primary ACL reconstruction. The reasons remain varied and not completely understood.MethodsPatients undergoing revision ACL reconstruction were prospectively enrolled. Data collected included baseline demographics, surgical technique and pathological condition, prescribed rehabilitation instructions, and a series of validated patient-reported outcome instruments. Patients were followed for 2 years and asked to complete a set of outcome instruments identical to those completed at baseline. Subsequent surgical procedures on the ipsilateral knee were recorded. Regression analysis was used to control for age, sex, activity level, baseline outcome scores, and the above-mentioned rehabilitation-related variables in order to assess the factors affecting clinical outcomes 2 years after revision ACL reconstruction.ResultsA total of 843 patients met the inclusion criteria and were successfully enrolled, and 82% (695) were followed for 2 years. Two rehabilitation-related factors were found to influence outcome. First, patients who were prescribed an ACL brace for their return to sports had a significantly better Knee injury and Osteoarthritis Outcome Score (KOOS) for sports and recreational activities at 2 years (odds ratio [OR] =1.50, 95% confidence interval [CI] = 1.07 to 2.11; p = 0.019). Second, patients prescribed an ACL brace for the postoperative rehabilitation period were 2.3 times more likely to have subsequent surgery by 2 years (OR = 2.26, 95% CI = 1.11 to 4.60; p = 0.024). The odds of a graft rerupture were not affected by any type of brace wear.ConclusionsRehabilitation-related factors that the physician can control at the time of an ACL reconstruction have the ability to influence clinical outcomes at 2 years. Weight-bearing and motion can be initiated immediately postoperatively. Bracing during the early postoperative period is not helpful. Use of a functional brace early in the postoperative period was associated with an increased risk of a reoperation. Use of a functional brace for a return to sports improved the KOOS on the sports/recreation subscale.Level of evidencePrognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/8197p0dzTest

المؤلفون: Group, The MARS, Cooper, Daniel E, Dunn, Warren R, Huston, Laura J, Haas, Amanda K, Spindler, Kurt P, Allen, Christina R, Anderson, Allen F, DeBerardino, Thomas M, Lantz, Brett A, Mann, Barton, 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, Hosea, Timothy M, 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, Wright, Rick W

المصدر: The American Journal of Sports Medicine. 46(12)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Prevention, Transplantation, Clinical Research, Adolescent, Adult, Anterior Cruciate Ligament, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Female, Humans, Knee Joint, Male, Preoperative Care, Prognosis, Prospective Studies, Range of Motion, Articular, Reoperation, Risk Factors, Rupture, Transplantation, Autologous, Young Adult, anterior cruciate ligament, knee hyperextension, graft failure, graft tensioning, MARS Group, Biomedical Engineering, Mechanical Engineering, Human Movement and Sports Sciences, Orthopedics, Clinical sciences, Allied health and rehabilitation science, Sports science and exercise

الوصف: BackgroundThe occurrence of physiologic knee hyperextension (HE) in the revision anterior cruciate ligament reconstruction (ACLR) population and its effect on outcomes have yet to be reported. Hypothesis/Purpose: The prevalence of knee HE in revision ACLR and its effect on 2-year outcome were studied with the hypothesis that preoperative physiologic knee HE ≥5° is a risk factor for anterior cruciate ligament (ACL) graft rupture.Study designCohort study; Level of evidence, 2.MethodsPatients undergoing revision ACLR were identified and prospectively enrolled between 2006 and 2011. Study inclusion criteria were patients undergoing single-bundle graft reconstructions. Patients were followed up at 2 years and asked to complete an identical set of outcome instruments (International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, WOMAC, and Marx Activity Rating Scale) as well as provide information regarding revision ACL graft failure. A regression model with graft failure as the dependent variable included age, sex, graft type at the time of the revision ACL surgery, and physiologic preoperative passive HE ≥5° (yes/no) to assess these as potential risk factors for clinical outcomes 2 years after revision ACLR.ResultsAnalyses included 1145 patients, for whom 2-year follow-up was attained for 91%. The median age was 26 years, with age being a continuous variable. Those below the median were grouped as "younger" and those above as "older" (age: interquartile range = 20, 35 years), and 42% of patients were female. There were 50% autografts, 48% allografts, and 2% that had a combination of autograft plus allograft. Passive knee HE ≥5° was present in 374 (33%) patients in the revision cohort, with 52% being female. Graft rupture at 2-year follow-up occurred in 34 cases in the entire cohort, of which 12 were in the HE ≥5° group (3.2% failure rate) and 22 in the non-HE group (2.9% failure rate). The median age of patients who failed was 19 years, as opposed to 26 years for those with intact grafts. Three variables in the regression model were significant predictors of graft failure: younger age (odds ratio [OR] = 3.6; 95% CI, 1.6-7.9; P = .002), use of allograft (OR = 3.3; 95% CI, 1.5-7.4; P = .003), and HE ≥5° (OR = 2.12; 95% CI, 1.1-4.7; P = .03).ConclusionThis study revealed that preoperative physiologic passive knee HE ≥5° is present in one-third of patients who undergo revision ACLR. HE ≥5° was an independent significant predictor of graft failure after revision ACLR with a >2-fold OR of subsequent graft rupture in revision ACL surgery. Registration: NCT00625885 ( ClinicalTrials.gov identifier).

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/73r538zkTest

المؤلفون: Sullivan, James K., Gottreich, Julia R., Imrey, Peter B., Winalski, Carl S., Li, Xiaojuan, Spindler, Kurt P., Tomko, Patrick M., Cox, Charles L., Wright, Rick W., Jones, Morgan H.

المصدر: Orthopaedic Journal of Sports Medicine ; volume 11, issue 4, page 232596712311508 ; ISSN 2325-9671 2325-9671

مصطلحات موضوعية: Orthopedics and Sports Medicine

الوصف: Background: Meniscal tear in older adults often accompanies knee osteoarthritis and is commonly treated with arthroscopic partial meniscectomy (APM) when patients have persistent pain after a trial of physical therapy. Cross-sectional evidence suggests that synovitis is associated with baseline pain in this patient population, but little is known about the relationship between synovitis and postoperative recovery or progression of knee osteoarthritis. Purpose/Hypothesis: Intra-articular extended-release triamcinolone may reduce inflammation and thereby improve outcomes and slow disease progression. This article presents the rationale behind the Corticosteroid Meniscectomy Trial (CoMeT) and describes its study design and implementation strategies. Study Design: Randomized controlled trial. Methods: CoMeT is a 2-arm, 3-center, randomized placebo-controlled trial designed to establish the clinical efficacy of extended-release triamcinolone administered via intra-articular injection immediately after APM. The primary outcome is change in Knee injury and Osteoarthritis Outcome Score Pain subscore at 3-month follow-up. Synovial biopsy, joint fluid aspirate, and urine and blood sample analyses will examine the associations between various objective measures of baseline inflammation and pre- and postoperative outcome measures and clinical responses to triamcinolone intervention. Quantitative 3-T magnetic resonance imaging will evaluate cartilage and meniscal composition and 3-dimensional bone shape to detect early joint degeneration. Results: We discuss methodologic innovations and challenges. Conclusion: To our knowledge, this is the first randomized double-blind clinical trial that will analyze the effect of extended-release triamcinolone acetonide on pain, magnetic resonance imaging measures of structural change and effusion/synovitis, soluble biomarkers, and synovial tissue transcriptomics after APM.

الإتاحة: https://doi.org/10.1177/23259671231150812Test