Try a new search

Format these results:

Searched for:

person:gonzag07

Total Results:

65


Patient Satisfaction with Postoperative Telemedicine Versus In-Office Visits Following Primary Hip Arthroscopy: A Prospective Observational Study Before and During the COVID-19 Pandemic

Shankar, Dhruv S; Li, Zachary I; Hoberman, Alexander R; Blaeser, Anna M; Gonzalez-Lomas, Guillem; Youm, Thomas
PMID: 37585554
ISSN: 1556-3669
CID: 5635342

Cannabidiol for Postoperative Pain Control After Arthroscopic Rotator Cuff Repair Demonstrates No Deficits in Patient-Reported Outcomes Versus Placebo: 1-Year Follow-up of a Randomized Controlled Trial

Alaia, Michael J; Li, Zachary I; Chalem, Isabel; Hurley, Eoghan T; Vasavada, Kinjal; Gonzalez-Lomas, Guillem; Rokito, Andrew S; Jazrawi, Laith M; Kaplan, Kevin
BACKGROUND/UNASSIGNED:Cannabidiol (CBD) has been shown recently to positively affect patient pain and satisfaction immediately after arthroscopic rotator cuff repair (ARCR). However, it is unclear whether the addition of CBD to a perioperative regimen could affect postoperative outcomes. PURPOSE/UNASSIGNED:To evaluate patient-reported outcomes among patients who underwent ARCR and received buccally absorbed CBD or an identical placebo for early postoperative pain management at 1-year follow-up. STUDY DESIGN/UNASSIGNED:Randomized controlled trial; Level of evidence, 2. METHODS/UNASSIGNED:test and Fisher exact test, respectively. RESULTS/UNASSIGNED: = .79). CONCLUSION/UNASSIGNED:Perioperative use of CBD for pain control among patients undergoing ARCR did not result in any significant deficits in pain, satisfaction, or patient-reported outcomes at 1-year postoperatively compared with a placebo control group. These findings suggest that CBD can be considered in a postoperative multimodal pain management regimen without detrimental effects on outcome. REGISTRATION/UNASSIGNED:NCT04672252 (ClinicalTrials.gov identifier).
PMCID:10846110
PMID: 38322981
ISSN: 2325-9671
CID: 5632632

Patient-Reported Hip Pain and Function are Worse Among Elite Nordic Ski Athletes Competing in Ski Jumping Versus Nordic Combined: A Cross-Sectional Analysis

Vasavada, Kinjal D; Shankar, Dhruv S; Ross, Keir A; Avila, Amanda; Buzin, Scott; Jazrawi, Isabella B; Carter, Cordelia W; Chen, Andrew L; Borowski, Lauren E; Milton, Heather A; Gonzalez-Lomas, Guillem
OBJECTIVES/OBJECTIVE:Nordic ski athletes are at increased risk of developing hip pain and dysfunction secondary to femoroacetabular impingement syndrome (FAIS), but it is unclear whether hip symptomatology differs between ski jumping (SJ) and Nordic combined (NC) athletes. The purpose of this study was to compare patient-reported hip pain and dysfunction between elite Nordic ski athletes participating in SJ versus NC. METHODS:A cross-sectional study was conducted involving SJ and NC athletes who competed at the international and U.S. national level during the 2021-2022 season. Subjects were excluded if they had hip surgery within two years prior to enrollment. Subjects were asked to undergo diagnostic workup for FAIS including physical examination and plain radiographic imaging. Subjects were asked to complete a survey that collected information on athletic and training history and to complete the Hip Disability and Osteoarthritis Outcome Score (HOOS). Demographics, athletic/training history, and HOOS sub-scores were compared between the SJ and NC groups using Student's t-test, Wilcoxon rank-sum test, or Fisher's exact test, as appropriate. P-values <0.05 were considered significant. RESULTS:Twenty-four athletes (13 SJ, 11 NC) were included in the study. There were no statistically significant differences in age, sex, BMI, or age of menarche between the two groups (all p>0.05). There were also no statistically significant differences in the number of prior sports participated in, total hours of participation in prior sports, or total hours of training in Nordic specialization (all p>0.05). Among the 18 athletes who underwent physical examination (9 SJ, 9 NC), there were no statistically significant inter-group differences in hip range of motion or incidence of positive impingement tests (all p>0.05). Among the 19 athletes who underwent imaging (9 SJ, 10 NC), there were no statistically significant inter-group differences in the incidence of cam or pincer morphology in at least one hip (all p>0.05). SJ athletes had statistically significantly worse HOOS sub-scores for hip symptoms and stiffness, hip function in sports/recreational activities, and hip-related quality of life compared to NC athletes (all p<0.05). CONCLUSION/CONCLUSIONS:Elite SJ athletes have worse self-reported hip function compared to elite NC athletes despite comparable demographics, athletic history, and duration of ski training. LEVEL OF EVIDENCE/METHODS:IV.
PMID: 38278215
ISSN: 2059-7762
CID: 5625472

Acceptable clinical outcomes despite high reoperation rate at minimum 12-month follow-up after concomitant arthroscopically assisted anterior cruciate ligament reconstruction and medial meniscal allograft transplantation

Shankar, Dhruv S.; Vasavada, Kinjal D.; Avila, Amanda; DeClouette, Brittany; Aziz, Hadi; Strauss, Eric J.; Alaia, Michael J.; Jazrawi, Laith M.; Gonzalez-Lomas, Guillem; Campbell, Kirk A.
Background: Single-stage medial meniscus allograft transplantation (MAT) with concomitant anterior cruciate ligament reconstruction (ACLR) is a technically challenging procedure for management of knee pain and instability in younger patients, but clinical and functional outcomes data are sparse. The purpose of this study was to assess surgical and patient-reported outcomes following concomitant ACLR and medial MAT. Methods: We conducted a retrospective case series of patients who underwent medial MAT with concomitant primary or revision ACLR at our institution from 2010 to 2021 and had minimum 12-month follow-up. Complications, reoperations, visual analog scale (VAS) pain, satisfaction, Lysholm score, return to sport, and return to work outcomes were assessed. Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, Pain Intensity, and Physical Function Scores were used to measure patients"™ functional status relative to the US population. P-values < 0.05 were considered significant. Results: The cohort consisted of 17 knees of 16 individual patients. The cohort was majority male (82.4%) with mean age of 31.9 years (range 19"“49 years) and mean body mass index (BMI) of 27.9 kg/m2 (range 22.5"“53.3 kg/m2). Mean follow-up time was 56.8 months (range 13"“106 months). Most patients underwent revision ACLR (64.7%). The 1-year reoperation rate was high (23.5%), with two patients (11.8%) tearing their meniscus graft. Patient-reported outcomes indicated low VAS pain (mean 2.2), high satisfaction (mean 77.9%), and fair Lysholm score (mean 81.1). Return to work rate was high (92.9%), while return to sport rate was low (42.9%). Postoperative PROMIS scores were comparable or superior to the national average and correlated significantly with patient satisfaction (p < 0.05). Conclusions: The concomitant ACLR and MAT procedure is associated with excellent knee pain and functional outcomes and high rate of return to work after surgery, though the 1-year reoperation rate is high and rate of return to sport is low. Level of evidence: IV.
SCOPUS:85146131298
ISSN: 2234-0726
CID: 5408462

A modified Delphi consensus statement on patellar instability: part II

Hurley, Eoghan T; Sherman, Seth L; Chahla, Jorge; Gursoy, Safa; Alaia, Michael J; Tanaka, Miho J; Pace, J L; Jazrawi, Laith M; ,; Hughes, Andrew J; Arendt, Elizabeth A; Ayeni, Olufemi R; Bassett, Ashley J; Bonner, Kevin F; Camp, Christopher L; Campbell, Kirk A; Carter, Cordelia W; Ciccotti, Michael G; Cosgarea, Andrew J; Dejour, David; Edgar, Cory M; Erickson, Brandon J; Espregueira-Mendes, João; Farr, Jack; Farrow, Lutul D; Frank, Rachel M; Freedman, Kevin B; Fulkerson, John P; Getgood, Alan; Gomoll, Andreas H; Grant, John A; Gwathmey, F W; Haddad, Fares S; Hiemstra, Laurie A; Hinckel, Betina B; Savage-Elliott, Ian; Koh, Jason L; Krych, Aaron J; LaPrade, Robert F; Li, Zachary I; Logan, Catherine A; Gonzalez-Lomas, Guillem; Mannino, Brian J; Lind, Martin; Matache, Bogdan A; Matzkin, Elizabeth; Mandelbaum, Bert; McCarthy, Thomas F; Mulcahey, Mary; Musahl, Volker; Neyret, Philippe; Nuelle, Clayton W; Oussedik, Sam; Verdonk, Peter; Rodeo, Scott A; Rowan, Fiachra E; Salzler, Matthew J; Schottel, Patrick C; Shannon, Fintan J; Sheean, Andrew J; Strickland, Sabrina M; Waterman, Brian R; Wittstein, Jocelyn R; Zacchilli, Michael; Zaffagnini, Stefano
AIMS/UNASSIGNED:The aim of this study was to establish consensus statements on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy, trochleoplasty, and rehabilitation and return to sporting activity in patients with patellar instability, using the modified Delphi process. METHODS/UNASSIGNED:This was the second part of a study dealing with these aspects of management in these patients. As in part I, a total of 60 surgeons from 11 countries contributed to the development of consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered unanimous. RESULTS/UNASSIGNED:Of 41 questions and statements on patellar instability, none achieved unanimous consensus, 19 achieved strong consensus, 15 achieved consensus, and seven did not achieve consensus. CONCLUSION/UNASSIGNED:Most statements reached some degree of consensus, without any achieving unanimous consensus. There was no consensus on the use of anchors in MPFL reconstruction, and the order of fixation of the graft (patella first versus femur first). There was also no consensus on the indications for trochleoplasty or its effect on the viability of the cartilage after elevation of the osteochondral flap. There was also no consensus on postoperative immobilization or weightbearing, or whether paediatric patients should avoid an early return to sport.
PMID: 38035602
ISSN: 2049-4408
CID: 5590422

A modified Delphi consensus statement on patellar instability: part I

Hurley, Eoghan T; Hughes, Andrew J; Savage-Elliott, Ian; Dejour, David; Campbell, Kirk A; Mulcahey, Mary K; Wittstein, Jocelyn R; Jazrawi, Laith M; ,; Alaia, Michael J; Arendt, Elizabeth A; Ayeni, Olufemi R; Bassett, Ashley J; Bonner, Kevin F; Camp, Christopher L; Carter, Cordelia W; Chahla, Jorge; Ciccotti, Michael G; Cosgarea, Andrew J; Edgar, Cory M; Erickson, Brandon J; Espregueira-Mendes, João; Farr, Jack; Farrow, Lutul D; Frank, Rachel M; Freedman, Kevin B; Fulkerson, John P; Getgood, Alan; Gomoll, Andreas H; Grant, John A; Gursoy, Safa; Gwathmey, F W; Haddad, Fares S; Hiemstra, Laurie A; Hinckel, Betina B; Koh, Jason L; Krych, Aaron J; LaPrade, Robert F; Li, Zachary I; Logan, Catherine A; Gonzalez-Lomas, Guillem; Mannino, Brian J; Lind, Martin; Matache, Bogdan A; Matzkin, Elizabeth; McCarthy, Thomas F; Mandelbaum, Bert; Musahl, Volker; Neyret, Philippe; Nuelle, Clayton W; Oussedik, Sam; Pace, J L; Verdonk, Peter; Rodeo, Scott A; Rowan, Fiachra E; Salzler, Matthew J; Schottel, Patrick C; Shannon, Fintan J; Sheean, Andrew J; Sherman, Seth L; Strickland, Sabrina M; Tanaka, Miho J; Waterman, Brian R; Zacchilli, Michael; Zaffagnini, Stefano
AIMS/UNASSIGNED:The aim of this study was to establish consensus statements on the diagnosis, nonoperative management, and indications, if any, for medial patellofemoral complex (MPFC) repair in patients with patellar instability, using the modified Delphi approach. METHODS/UNASSIGNED:A total of 60 surgeons from 11 countries were invited to develop consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest within patellar instability. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered to be unanimous. RESULTS/UNASSIGNED:Of 27 questions and statements on patellar instability, three achieved unanimous consensus, 14 achieved strong consensus, five achieved consensus, and five did not achieve consensus. CONCLUSION/UNASSIGNED:The statements that reached unanimous consensus were that an assessment of physeal status is critical for paediatric patients with patellar instability. There was also unanimous consensus on early mobilization and resistance training following nonoperative management once there is no apprehension. The statements that did not achieve consensus were on the importance of immobilization of the knee, the use of orthobiologics in nonoperative management, the indications for MPFC repair, and whether a vastus medialis oblique advancement should be performed.
PMID: 38037678
ISSN: 2049-4408
CID: 5590442

Force plate jump testing metrics are predictive of performance on a multimodal return to sport testing protocol among anterior cruciate ligament reconstruction patients at minimum six-month follow-up

Shankar, Dhruv S; Milton, Heather A; Mojica, Edward S; Buzin, Scott; Strauss, Eric J; Campbell, Kirk A; Alaia, Michael J; Gonzalez-Lomas, Guillem; Jazrawi, Laith M
BACKGROUND:Force plate-based jump testing may serve as a potential alternative to traditional return to sport (RTS) testing batteries. The purpose of our study was to identify force plate jump metrics that were predictive of RTS test findings in patients who were at least six months postoperative following anterior cruciate ligament reconstruction (ACLR). METHODS:We conducted a cross-sectional study of patients who underwent ACLR at our center and were at least six months postoperative. Subjects completed a multimodal Institutional RTS (IRTS) testing battery which included range of motion (ROM) testing and isokinetic quadriceps strength testing. Subjects also completed a countermovement jump testing protocol on a commercially-available force plate. Jump metrics predictive of IRTS test findings were identified using multivariable linear and logistic regression with stepwise selection. Model significance was assessed at α=0.002. RESULTS:Sixteen patients (7M, 9F) were enrolled in our study with median age of 29 years (range 20-47). Relative concentric impulse was positively predictive of knee flexion active ROM (β=7.07, P=0.01) and passive ROM (β=9.79, P=0.003). Maximum power was positively predictive of quadriceps strength at 60 deg/s (β=3.27, P<0.001) and 180 deg/s (β=2.46, P<0.001). Center-of-pressure (COP) shift acceleration along the force plate X-axis was negatively predictive of Bunkie lateral test score (β=-945, P<0.001) and medial test score (β=-839, P=0.03). CONCLUSIONS:Force plate-derived vertical jump testing metrics are predictive of certain components of a multimodal RTS physical assessment for ACLR patients, including knee flexion ROM, quadriceps strength on isokinetic testing, and Bunkie Test performance.
PMID: 37526491
ISSN: 1827-1928
CID: 5613982

The Minimal Clinically Important Difference: Response [Comment]

Bloom, David A; Kaplan, Daniel J; Mojica, Edward; Strauss, Eric J; Gonzalez-Lomas, Guillem; Campbell, Kirk A; Alaia, Michael J; Jazrawi, Laith M
PMID: 37917815
ISSN: 1552-3365
CID: 5606652

Patient-reported allergies are associated with increased rate of postoperative stiffness after arthroscopic rotator cuff repair

Morgan, Allison M; Li, Zachary I; Garra, Sharif; Bi, Andrew S; Gonzalez-Lomas, Guillem; Jazrawi, Laith M; Campbell, Kirk A
BACKGROUND:Several risk factors have been identified for the development of postoperative shoulder stiffness, and there has been increasing interest in orthopedic literature regarding patient-reported allergy (PRA) as an identifiable risk factor for adverse outcomes. The purpose of this study is to determine whether PRAs are associated with subsequent rates of diagnosis of adhesive capsulitis (AC) or return to the operating room for postoperative shoulder stiffness within 2 years after arthroscopic rotator cuff repair (ARCR). METHODS:Current Procedural Terminology surgical billing codes were used to retrospectively identify patients who underwent ARCR at a single urban academic institution from January 2012 to December 2020 with minimum 2-year follow-up. Lysis of adhesions (LOA), manipulation under anesthesia (MUA), and AC of the shoulder were further queried within 2 years postoperatively for the ipsilateral shoulder. Patients were excluded if they had undergone ipsilateral MUA/LOA or received a diagnosis of AC before the index procedure. Demographic characteristics and medical comorbidities (hypertension, diabetes, hyperlipidemia, and hypothyroidism) were extracted from electronic medical records. Baseline characteristics were compared between patients with and without PRAs. Multivariate logistic regression analyses were performed to determine the association of the presence of PRAs overall, as well as the presence of 1, 2, or 3 or more PRAs, with subsequent MUA/LOA or diagnosis of AC within 2 years postoperatively. RESULTS:Of 7057 patients identified in the study period, 6583 were eligible for the final analysis. The mean age was 56.6 ± 11.7 years, and the mean body mass index was 29.1 ± 5.6. Overall, 19.3% of patients (n = 1271) reported at least 1 allergy, and 7.1% (n = 469) had >1 PRA. A total of 44 patients (0.7%) underwent subsequent ipsilateral MUA/LOA within 2 years postoperatively, whereas 93 patients (1.4%) received a diagnosis of ipsilateral AC in the same time frame. PRAs were significantly associated with subsequent diagnosis of AC (odds ratio [OR]: 2.39; 95% confidence interval [CI]: 1.45-3.92; P < .001), but not MUA/LOA (OR: 1.97, 95% CI: 1.26-3.61; P = .133). Patients with 2 PRAs had greater odds of being diagnosed with AC than patients with 1 PRA (OR: 2.74; 95% CI: 1.14-5.99; P = .012). Although this association was nonsignificant for MUA/LOA, patients with 2 PRAs (OR: 2.67; 95% CI: 0.96-8.80; P = .059) demonstrated a similar statistical trend. CONCLUSION/CONCLUSIONS:PRAs are associated with increased odds of receiving a diagnosis of AC within 2 years after ARCR but were not found to be associated with return to the operating room for postoperative stiffness.
PMID: 37839628
ISSN: 1532-6500
CID: 5620412

After Anterior Cruciate Ligament Injury, Patients With Medicaid Insurance Experience Delayed Care and Worse Clinical Outcomes Than Patients With Non-Medicaid Insurance

Kingery, Matthew T; Kaplan, Daniel; Resad, Sehar; Strauss, Eric J; Gonzalez-Lomas, Guillem; Campbell, Kirk A
PURPOSE/UNASSIGNED:To evaluate the effects of socioeconomic factors on the operative treatment of anterior cruciate ligament injuries and outcomes following surgical reconstruction. METHODS/UNASSIGNED:A retrospective cohort study of primary anterior cruciate ligament reconstruction surgeries at a single institution performed from 2011 to 2015 with minimum 2-year follow-up was conducted. Patient demographics, insurance type, workers' compensation status, surgical variables, International Knee Documentation Committee score, and failure were recorded from chart review. Education level and income were obtained via phone interview. Differences between functional outcome were compared between Medicaid and non-Medicaid groups. RESULTS/UNASSIGNED: = .036). CONCLUSIONS/UNASSIGNED:Patients with Medicaid insurance were seen in the clinic significantly later after initial injury and had worse outcomes compared with patients with other insurance types. Also, patients in higher annual income brackets had significantly better clinical outcomes scores at a minimum of 2 years postoperatively. LEVEL OF EVIDENCE/UNASSIGNED:Level III, retrospective cohort study.
PMCID:10498400
PMID: 37711162
ISSN: 2666-061x
CID: 5593532