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: Kim, Jason S, Borges, Silvana, Clauw, Daniel J, Conaghan, Philip G, Felson, David T, Fleming, Thomas R, Glaser, Rachel, Hart, Elizabeth, Hochberg, Marc, Kim, Yura, Kraus, Virginia B, Lapteva, Larissa, Li, Xiaojuan, Majumdar, Sharmila, McAlindon, Timothy E, Mobasheri, Ali, Neogi, Tuhina, Roemer, Frank W, Rothwell, Rebecca, Shibuya, Robert, Siegel, Jeffrey, Simon, Lee S, Spindler, Kurt P, Nikolov, Nikolay P

مصطلحات موضوعية: Medical Biotechnology, Biomedical and Clinical Sciences, Osteoarthritis, Aging, Arthritis, Clinical Research, Clinical Trials and Supportive Activities, Musculoskeletal, Good Health and Well Being, Biomarkers, Disease Progression, Drug Development, Humans, Structure-modifying therapy, Regulatory approval, Drug development, Disease-modifying therapy, Clinical benefit, Long-term benefit, Clinical Sciences, Public Health and Health Services, Arthritis & Rheumatology, Clinical sciences

الوصف: ObjectiveTo summarize proceedings of a workshop convened to discuss the current state of science in the disease of osteoarthritis (OA), identify the knowledge gaps, and examine the developmental and regulatory challenges in bringing these products to market.DesignSummary of the one-day workshop held virtually on June 22nd, 2021.ResultsSpeakers selected by the Planning Committee presented data on the current approach to assessment of OA therapies, biomarkers in OA drug development, and the assessment of disease progression and long-term benefit.ConclusionsDemonstrated by numerous failed clinical trials, OA is a challenging disease for which to develop therapeutics. The challenge is magnified by the slow time of onset of disease and the need for clinical trials of long duration and/or large sample size to demonstrate the effect of an intervention. The OA science community, including academia, pharmaceutical companies, regulatory agencies, and patient communities, must continue to develop and test better clinical endpoints that meaningfully reflect disease modification related to long-term patient benefit.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/2cf6v3kpTest

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: Messier, Stephen P., Callahan, Leigh F., Losina, Elena, Mihalko, Shannon L., Guermazi, Ali, Ip, Edward, Miller, Gary D., Katz, Jeffrey N., Loeser, Richard F., Pietrosimone, Brian G., Soto, Sandra, Cook, James L., Newman, Jovita J., DeVita, Paul, Spindler, Kurt P., Runhaar, Jos, Armitano-Lago, Cortney, Duong, Vicky, Selzer, Faith, Hill, Ryan, Love, Monica, Beavers, Daniel P., Saldana, Santiago, Stoker, Aaron M., Rice, Paige E., Hunter, David J.

المصدر: Messier , S P , Callahan , L F , Losina , E , Mihalko , S L , Guermazi , A , Ip , E , Miller , G D , Katz , J N , Loeser , R F , Pietrosimone , B G , Soto , S , Cook , J L , Newman , J J , DeVita , P , Spindler , K P , Runhaar , J , Armitano-Lago , C , Duong , V , Selzer , F , Hill , R , Love , M , Beavers , D P , ....

مصطلحات موضوعية: /dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being, name=SDG 3 - Good Health and Well-being

الوصف: Background: Osteoarthritis (OA), the leading cause of disability among adults, has no cure and is associated with significant comorbidities. The premise of this randomized clinical trial is that, in a population at risk, a 48-month program of dietary weight loss and exercise will result in less incident structural knee OA compared to control. Methods/design: The Osteoarthritis Prevention Study (TOPS) is a Phase III, assessor-blinded, 48-month, parallel 2 arm, multicenter randomized clinical trial designed to reduce the incidence of structural knee OA. The study objective is to assess the effects of a dietary weight loss, exercise, and weight-loss maintenance program in preventing the development of structural knee OA in females at risk for the disease. TOPS will recruit 1230 ambulatory, community dwelling females with obesity (Body Mass Index (BMI) ≥ 30 kg/m 2 ) and aged ≥50 years with no radiographic (Kellgren-Lawrence grade ≤1) and no magnetic resonance imaging (MRI) evidence of OA in the eligible knee, with no or infrequent knee pain. Incident structural knee OA (defined as tibiofemoral and/or patellofemoral OA on MRI) assessed at 48-months from intervention initiation using the MRI Osteoarthritis Knee Score (MOAKS) is the primary outcome. Secondary outcomes include knee pain, 6-min walk distance, health-related quality of life, knee joint loading during gait, inflammatory biomarkers, and self-efficacy. Cost effectiveness and budgetary impact analyses will determine the value and affordability of this intervention. Discussion: This study will assess the efficacy and cost effectiveness of a dietary weight loss, exercise, and weight-loss maintenance program designed to reduce incident knee OA. Trial registration: ClinicalTrials.gov Identifier: NCT05946044.

وصف الملف: application/pdf

العلاقة: https://pure.eur.nl/en/publications/4f47dedb-a38f-4ef4-8b6f-9146d78ba487Test

الإتاحة: https://doi.org/10.1016/j.ocarto.2023.100418Test
https://pure.eur.nl/en/publications/4f47dedb-a38f-4ef4-8b6f-9146d78ba487Test
https://pure.eur.nl/ws/files/124162103/The_osteoarthritis_prevention_study_TOPS_-_A_randomized_controlled_trial_of_diet_and_exercise_to_prevent_Knee_Osteoarthritis.pdfTest
http://www.scopus.com/inward/record.url?scp=85179044965&partnerID=8YFLogxKTest

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: Sahoo, Sambit, Entezari, Vahid, Ho, Jason C., Jun, Bong-Jae, Spindler, Kurt P., Seitz, William H., Gilot, Gregory J., Miniaci, Anthony, Evans, Peter J., Sabesan, Vani J., Strnad, Greg, Jin, Yuxuan, Imrey, Peter B., Derwin, Kathleen A., Iannotti, Joseph P., Ricchetti, Eric T.

المساهمون: National Institutes of Health, NIAMS

المصدر: Journal of Shoulder and Elbow Surgery ; ISSN 1058-2746

مصطلحات موضوعية: Orthopedics and Sports Medicine, General Medicine, Surgery

الإتاحة: https://doi.org/10.1016/j.jse.2024.01.028Test
https://api.elsevier.com/content/article/PII:S1058274624001423?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S1058274624001423?httpAccept=text/plainTest

المؤلفون: Dakkak, Michael, Saleem, Arhum, Patel, Dev, Yeager, Matthew, Oliveira, Leonardo, Gilot, Gregory, Spindler, Kurt P.

المصدر: JSES International ; ISSN 2666-6383

مصطلحات موضوعية: Orthopedics and Sports Medicine, Surgery

الإتاحة: https://doi.org/10.1016/j.jseint.2024.01.003Test
https://api.elsevier.com/content/article/PII:S2666638324000331?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S2666638324000331?httpAccept=text/plainTest

المؤلفون: Jacobs, Cale A, Conley, Caitlin EW, Kraus, Virginia Byers, Lansdown, Drew A, Lau, Brian C, Li, Xiaojuan, Majumdar, Sharmila, Spindler, Kurt P, Lemaster, Nicole G, Stone, Austin V

المصدر: Trials. 23(1)

مصطلحات موضوعية: Humans, Sulfides, Acetates, Cyclopropanes, Quinolines, Adult, Middle Aged, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, Anterior Cruciate Ligament Reconstruction, Anterior cruciate ligament, Biomarker, MRI, Montelukast, Posttraumatic osteoarthritis, Arthritis, Prevention, Clinical Research, Injury (total) Accidents/Adverse Effects, Patient Safety, Clinical Trials and Supportive Activities, Osteoarthritis, Aging, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Musculoskeletal, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Cardiovascular System & Hematology, General & Internal Medicine

الوصف: BackgroundAfter anterior cruciate ligament (ACL) reconstruction, patient-reported outcomes are improved 10 years post-surgery; however, cytokine concentrations remain elevated years after surgery with over 80% of those with combined ACL and meniscus injuries having posttraumatic osteoarthritis (PTOA) within 10-15 years. The purpose of this multicenter, randomized, placebo-controlled trial is to assess whether a 6-month course of oral montelukast after ACL reconstruction reduces systemic markers of inflammation and biochemical and imaging biomarkers of cartilage degradation.MethodsWe will enroll 30 individuals undergoing primary ACL reconstruction to participate in this IRB-approved multicenter clinical trial. This trial will target those at greatest risk of a more rapid PTOA onset (age range 25-50 with concomitant meniscus injury). Patients will be randomly assigned to a group instructed to take 10 mg of montelukast daily for 6 months following ACL reconstruction or placebo. Patients will be assessed prior to surgery and 1, 6, and 12 months following surgery. To determine if montelukast alters systemic inflammation following surgery, we will compare systemic concentrations of prostaglandin E2, monocyte chemoattractant protein-1, and pro-inflammatory cytokines between groups. We will also compare degradative changes on magnetic resonance imaging (MRI) collected 1 and 12 months following surgery between groups with reductions in early biomarkers of cartilage degradation assessed with urinary biomarkers of type II collagen breakdown and bony remodeling.DiscussionThere is a complex interplay between the pro-inflammatory intra-articular environment, underlying bone remodeling, and progressive cartilage degradation. PTOA affects multiple tissues and appears to be more similar to rheumatoid arthritis than osteoarthritis with respect to inflammation. There is currently no treatment to delay or prevent PTOA after ACL injury. Since there is a larger and more persistent inflammatory response after ACL reconstruction than the initial insult of injury, treatment may need to be initiated after surgery, sustained over a period of time, and target multiple mechanisms in order to successfully alter the disease process. This study will assess whether a 6-month postoperative course of oral montelukast affects multiple PTOA mechanisms. Because montelukast administration can be safely sustained for long durations and offers a low-cost treatment option, should it be proven effective in the current trial, these results can be immediately incorporated into clinical practice.Trial registrationClinicalTrials.gov NCT04572256 . Registered on October 1, 2020.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0gb1j640Test

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: Svantesson, Eleonor, Hamrin Senorski, Eric, Webster, Kate E, Karlsson, Jón, Diermeier, Theresa, Rothrauff, Benjamin B, Meredith, Sean J, Rauer, Thomas, Irrgang, James J, Spindler, Kurt P, Ma, C Benjamin, Musahl, Volker, Panther Symposium ACL Injury Clinical Outcomes Consensus Group

المصدر: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 28(8)

مصطلحات موضوعية: Panther Symposium ACL Injury Clinical Outcomes Consensus Group, Humans, Osteoarthritis, Knee, Athletic Injuries, Recurrence, Postoperative Complications, Treatment Outcome, Graft Survival, Quality of Life, Anterior Cruciate Ligament Reconstruction, Surveys and Questionnaires, Anterior Cruciate Ligament Injuries, Patient Reported Outcome Measures, ACL, Anterior cruciate ligament, Consensus statement, Outcome, Reconstruction, Osteoarthritis, Knee, Clinical Sciences, Human Movement and Sports Sciences, Orthopedics

الوصف: PurposeA stringent outcome assessment is a key aspect for establishing evidence-based clinical guidelines for anterior cruciate ligament (ACL) injury treatment. The aim of this consensus statement was to establish what data should be reported when conducting an ACL outcome study, what specific outcome measurements should be used and at what follow-up time those outcomes should be assessed.MethodsTo establish a standardized approach to assessment of clinical outcome after ACL treatment, a consensus meeting including a multidisciplinary group of ACL experts was held at the ACL Consensus Meeting Panther Symposium, Pittsburgh, PA; USA, in June 2019. The group reached consensus on nine statements by using a modified Delphi method.ResultsIn general, outcomes after ACL treatment can be divided into four robust categories-early adverse events, patient-reported outcomes, ACL graft failure/recurrent ligament disruption and clinical measures of knee function and structure. A comprehensive assessment following ACL treatment should aim to provide a complete overview of the treatment result, optimally including the various aspects of outcome categories. For most research questions, a minimum follow-up of 2 years with an optimal follow-up rate of 80% is necessary to achieve a comprehensive assessment. This should include clinical examination, any sustained re-injuries, validated knee-specific PROs and Health-Related Quality of Life questionnaires. In the mid- to long-term follow-up, the presence of osteoarthritis should be evaluated.ConclusionThis consensus paper provides practical guidelines for how the aforementioned entities of outcomes should be reported and suggests the preferred tools for a reliable and valid assessment of outcome after ACL treatment.Level of evidenceV.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/95t3f66kTest