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Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses

Campbell, Kirk A; Saltzman, Bryan M; Mascarenhas, Randy; Khair, M Michael; Verma, Nikhil N; Bach, Bernard R Jr; Cole, Brian J
PURPOSE: The aims of this study were (1) to perform a systematic review of meta-analyses evaluating platelet-rich plasma (PRP) injection in the treatment of knee joint cartilage degenerative pathology, (2) to provide a framework for analysis and interpretation of the best available evidence to provide recommendations for use (or lack thereof) of PRP in the setting of knee osteoarthritis (OA), and (3) to identify literature gaps where continued investigation would be suggested. METHODS: Literature searches were performed for meta-analyses examining use of PRP versus corticosteroids, hyaluronic acid, oral nonsteroidal anti-inflammatory drugs, or placebo. Clinical data were extracted, and meta-analysis quality was assessed. The Jadad algorithm was applied to determine meta-analyses that provided the highest level of evidence. RESULTS: Three meta-analyses met the eligibility criteria and ranged in quality from Level II to Level IV evidence. All studies compared outcomes of treatment with intra-articular platelet-rich plasma (IA-PRP) versus control (intra-articular hyaluronic acid or intra-articular placebo). Use of PRP led to significant improvements in patient outcomes at 6 months after injection, and these improvements were seen starting at 2 months and were maintained for up to 12 months. It is unclear if the use of multiple PRP injections, the double-spinning technique, or activating agents leads to better outcomes. Patients with less radiographic evidence of arthritis benefit more from PRP treatment. The use of multiple PRP injections may increase the risk of self-limited local adverse reactions. After application of the Jadad algorithm, 3 concordant high-quality meta-analyses were selected and all showed that IA-PRP provided clinically relevant improvements in pain and function compared with the control treatment. CONCLUSIONS: IA-PRP is a viable treatment for knee OA and has the potential to lead to symptomatic relief for up to 12 months. There appears to be an increased risk of local adverse reactions after multiple PRP injections. IA-PRP offers better symptomatic relief to patients with early knee degenerative changes, and its use should be considered in patients with knee OA. LEVEL OF EVIDENCE: Level IV, systematic review of Level II through IV studies.
PMID: 26033459
ISSN: 1526-3231
CID: 1667252

Increasing patient-reported allergies are not associated with pain, functional outcomes, or satisfaction following medial patellofemoral ligament reconstruction: a retrospective comparative cohort study

Bi, Andrew S; Shankar, Dhruv S; Vasavada, Kinjal D; Fisher, Nina D; Strauss, Eric J; Alaia, Michael J; Campbell, Kirk A
BACKGROUND:Patient-reported allergies (PRAs) are often stigmatized as a potential nonmodifiable risk factor for increased pain and worse functional outcomes following surgery. However, there is a dearth of literature directly assessing the impact of PRAs on outcomes in sport surgeries such as medial patellofemoral ligament reconstruction (MPFLR). The purpose of our study was to determine whether PRAs were associated with worse outcomes following MPFLR. METHODS:We conducted a retrospective review of patients who underwent MPFLR at our institution from 2011 to 2019. Patients were included if they had at least 12 months of follow-up. PRAs were obtained from preoperative medical assessments and categorized by drug class. Demographic and perioperative data were obtained from electronic medical records. Postoperative outcomes were measured using a telephone survey and included recurrent instability, Visual analog scale (VAS) for pain, VAS for sports, Kujala score, MPFL-Return to Sport after Injury (MPFL-RSI) score, and overall satisfaction score. Multiple linear regression was used to determine association between PRAs and outcome measures, and p-values less than 0.05 were considered significant. RESULTS:The cohort included 141 MPFLR. Most patients were female (98, 70%) with an average age of 25 years (range 12-56 years). Average follow-up time was 47 months. Forty-seven patients (33%) reported at least one PRA. There were no significant differences in postoperative pain, functional outcomes, satisfaction, or return to sport between patients with or without PRAs (all p > 0.05). Absence of antibiotic PRAs was predictive of higher VAS (p < 0.007), but there were no other differences. There were no significant differences in outcomes between patients without PRAs, PRAs without a concomitant psychiatric disorder, or PRAs with a concomitant psychiatric disorder (all p > 0.05). CONCLUSIONS:In conclusion, PRAs with or without concomitant psychiatric diagnoses are not associated with worse postoperative pain, functional outcomes, or satisfaction following MPFLR with allograft, dispelling common misconceptions that increased number of allergies or psychiatric diagnoses lead to inferior surgical outcomes. Presence of antibiotic allergies was associated with lower VAS postoperative pain score. Future research should investigate the relationship between PRAs and other surgeries in the field of sports medicine.
PMCID:8981631
PMID: 35382898
ISSN: 2234-0726
CID: 5219602

Return to Play After Biceps Tenodesis for Isolated SLAP Tears in Overhead Athletes

Lorentz, Nathan A; Hurley, Eoghan T; Colasanti, Christopher A; Markus, Danielle H; Alaia, Michael J; Campbell, Kirk A; Strauss, Eric J; Jazrawi, Laith M
BACKGROUND/UNASSIGNED:Performing open subpectoral biceps tenodesis in overhead athletes with a superior labrum anterior to posterior (SLAP) tear may affect their ability to return to overhead sports. PURPOSE/UNASSIGNED:To investigate clinical outcomes in overhead athletes undergoing biceps tenodesis for the treatment of symptomatic, isolated SLAP tears involving the biceps-labral complex. STUDY DESIGN/UNASSIGNED:Case series; Level of evidence, 4. METHODS/UNASSIGNED:value of <.05 was considered to be statistically significant. RESULTS/UNASSIGNED:The current study included 44 overhead athletes. The mean age was 34.9 years (range, 16-46 years), 79.5% were male, and the mean follow-up was 49.0 months (range, 18-107 months). Overall, 81.8% of patients returned to play their overhead sport after biceps tenodesis, and 59.1% of patients returned to the same or higher level of play. It took patients, on average, 8.7 months to return to play after biceps tenodesis. The mean SLAP-RSI score was 69.4, and 70.5% of patients passed the SLAP-RSI threshold of 56. The mean ASES score, VAS score, SSV, and satisfaction were 92.0, 0.8, 80.6, and 87.9%, respectively. No patients in our cohort required revision surgery. CONCLUSION/UNASSIGNED:This study found that athletes undergoing biceps tenodesis for the treatment of a symptomatic, isolated SLAP tear had a high rate of return to play, good functional outcomes, and a low rate of revision surgery.
PMID: 35341336
ISSN: 1552-3365
CID: 5200822

Quadriceps tendon has a lower re-rupture rate than hamstring tendon autograft for anterior cruciate ligament reconstruction - A meta-analysis

Hurley, Eoghan T; Mojica, Edward S; Kanakamedala, Ajay C; Meislin, Robert J; Strauss, Eric J; Campbell, Kirk A; Alaia, Michael J
IMPORTANCE/OBJECTIVE:There have been several recent systematic reviews of quadriceps tendon autografts (QT), which have not shown any significant difference in outcomes between QT and hamstring tendon autograft (HS) for ACL reconstruction (ACLR). However, several recent comparative studies have been published comparing QT to HS for ACLR. AIM/OBJECTIVE:The purpose of this study is to perform a systematic review and meta-analysis of the studies comparing QT to HS for ACLR. EVIDENCE REVIEW/METHODS:Two independent reviewers performed the literature search based on the PRISMA guidelines, with a senior author arbitrating discrepancies. Cohort studies comparing QT with HS were included. FINDINGS/RESULTS:There were 15 studies comparing 611 patients with QT to 543 patients with HS, with a mean of 27.4 months follow-up. QT resulted in a significantly lower rate of graft re-rupture (2.5% vs 8.7%, p = 0.01), and donor site morbidity (17.6% vs 26.2%, p = 0.02). There was a significant difference in favour of QT for the positive pivot shift test (Grade I/II: 15.8% vs 23.0%, p = 0.02), but not in the rate of the positive Lachman test (Grade I/II: 18.3% vs 26.7%, p = 0.16). Additionally, there was no difference in the side to side difference in knee stability (1.8 mm vs 2.0 mm, p = 0.48). Functionally, both grafts had similar functional outcomes in terms of the IKDC score (88.0 vs 87.9, p = 0.69), and Lysholm score (89.3 vs 87.6, p = 0.15). CONCLUSIONS AND RELEVANCE/CONCLUSIONS:Our study showed that QT has a lower re-rupture rate than HS in ACLR, with lower donor site morbidity. QT appeared to be slightly better for residual pivot shift, but there was no difference in patient-reported outcomes. LEVEL OF EVIDENCE/METHODS:III.
PMID: 35543668
ISSN: 2059-7762
CID: 5214432

Female Gender Is Associated with Lower Satisfaction with Postoperative Telemedicine Visits in Sports Medicine

Mojica, Edward S; Hurley, Eoghan T; Markus, Danielle H; Bloom, David A; Mannino, Brian J; Stein, Spencer M; Jazrawi, Laith M; Campbell, Kirk A
PMID: 35333658
ISSN: 1556-3669
CID: 5205882

Estimated Time to Maximum Medical Improvement of Intra-articular Injections in the Treatment of Knee Osteoarthritis-A Systematic Review

Mojica, Edward S; Markus, Danielle H; Hurley, Eoghan T; Blaeser, Anna M; Jazrawi, Laith M; Campbell, Kirk A; Strauss, Eric J
PURPOSE/OBJECTIVE:The purpose of the current study is to perform a systematic review of the literature and evaluate maximum medical improvement and minimal clinically important difference (MCID) of different injectables in the treatment of symptomatic knee osteoarthritis. METHODS:A systematic review was performed to evaluate maximum medical improvement and MCID in patients undergoing injections of different modalities for knee osteoarthritis. Demographic factors of the patients being reviewed were analyzed, with patient-reported outcomes as reported by visual analog scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) being used to evaluate the clinical trajectory of patients receiving intra-articular injections. RESULTS:Overall, 79 (level of evidence I: 79) studies met inclusion criteria, with 8761 patients. Corticosteroid (CS) injections, middle molecular weight hyaluronic acid (MMW-HA), and leukocyte-rich platelet rich plasma (LR-PRP) injections reached their maximum pain control at 4 to 6 weeks after injection, as measured by VAS. The lowest VAS scores were reached for low molecular weight hyaluronic acid (LMW-HA), high molecular weight hyaluronic acid (HMW-HA), and leukocyte-poor platelet rich plasma (LP-PRP) by 3 months after injection. Similarly, the WOMAC scores were lowest at 4 to 6 weeks after CS and MMW-HA injections, and at 3 months after HMW-HA and LP-PRP injections. LR-PRP demonstrated the most prolonged pain relief relative to the other injection types, with the lowest VAS score of all groups measured at final follow-up. LP-PRP showed the lowest WOMAC scores at final follow-up, one year post-injection. CONCLUSION/CONCLUSIONS:PRP injections provide continued pain relief at up to 1 year after injection. Corticosteroids and hyaluronic acid have good efficacy and are suitable for many patients but lack this longevity. LEVEL OF EVIDENCE/METHODS:Level I, a systematic review of Level I studies.
PMID: 34461219
ISSN: 1526-3231
CID: 5061132

High Rate of Satisfaction and Return to Play at 5-Year Following Arthroscopic Superior-Labrum Anterior-Posterior Repairs

Hurley, Eoghan T; Mojica, Edward S; Markus, Danielle H; Lorentz, Nathan A; Colasanti, Christopher A; Campbell, Kirk A; Alaia, Michael J; Jazrawi, Laith M
PURPOSE/OBJECTIVE:The purpose of this study was to evaluate the outcomes of patients 5-years post-operatively following arthroscopic superior-labrum anterior-posterior (SLAP) repair, and to evaluate factors associated with satisfaction. METHODS:A retrospective review of patients who underwent SLAP repair with a minimum of 5-year follow-up was performed. Recurrence, Visual Analogue Scale (VAS) score, Subjective Shoulder Value (SSV), American Shoulder & Elbow Surgeons (ASES) score, satisfaction, whether they would undergo the same surgery again, and the rate, level and timing of return to play (RTP) were evaluated. Multi-linear regression models were used to evaluate factors affecting postoperative satisfaction. RESULTS:Overall, 122 patients who underwent SLAP repair were included, with a mean age of 33.4 years. 81% were males, and 58.2% were participating in sport pre-operatively. The mean follow-up was 86.4 ± 14.4 months. At final follow up, the mean satisfaction was 87.7%, and the mean SSV was 82.9. Overall, the rate of RTP was 85.9%, with 64.8% returning at the same level at a mean of 10.5 ± 8 months. Ultimately, 13 (10.7%) patients had a further surgery, including 10 (8.2%) patient that had a biceps tenodesis. VAS during sport (p = 0.025), SSV (p < 0.001), and time to RTP (p = 0.0056), were associated with higher satisfaction. CONCLUSION/CONCLUSIONS:There was a high rate of satisfaction at 5-year follow-up, with excellent patient reported outcomes but with a tenth of patients requiring revision surgeries. Additionally, while there was an overall high rate of RTP, there was only a modest rate of RTP at their pre-injury level and overhead athletes took longer to RTP.
PMID: 35124221
ISSN: 1526-3231
CID: 5156592

Open Subpectoral Biceps Tenodesis May Be an Alternative to Arthroscopic Repair for SLAP Tears in Patients Under 30

Hurley, Eoghan T; Colasanti, Christopher A; Lorentz, Nathan A; Campbell, Kirk A; Alaia, Michael J; Strauss, Eric J; Matache, Bogdan A; Jazrawi, Laith M
PURPOSE/OBJECTIVE:The purpose of the current study is to compare the outcomes of open subpectoral biceps tenodesis (BT) to arthroscopic repair (AR) for SLAP tears in patients under the age of 30 years. METHODS:A retrospective review of patients under the age of 30 years who underwent either isolated BT or AR for a diagnosis of a SLAP tear between 2011 and 2019 was performed. Patients were included if they were >16 years old at the time of surgery, had an isolated SLAP tear involving instability of the biceps-labral anchor (types II-IV), were skeletally mature, and had a minimum follow-up of 12 months. The American Shoulder & Elbow Surgeons score, visual analog scale, Subjective Shoulder Value, patient satisfaction, willingness to undergo surgery again, revisions, and return to play (RTP) were evaluated. A P value of <.05 was considered statistically significant. RESULTS:Our study included 103 patients in total; 29 patients were treated with BT, and 74 were treated with AR. The mean age was 24.8 years, and the mean follow-up duration was 60 months. At final follow-up, there was no difference between treatment groups in any of the functional outcome measures assessed (P > .05). Overall, there was no significant difference in the total rate of RTP (BT: 76.3%, AR: 85%; P = .53), timing of RTP (BT: 8.8 months, AR: 9.4 months; P = .61), and total rate of RTP among overhead athletes (BT: 84.2%, AR: 83.3%; P > .99). Among those undergoing AR, 9 required a revision procedure (11.5%) compared to none treated with BT (P = .11). CONCLUSIONS:In patients under the age of 30 years with a symptomatic isolated SLAP tear, BT may be a reliable alternative to AR. LEVEL OF EVIDENCE/METHODS:Level III, retrospective comparative study.
PMID: 34343624
ISSN: 1526-3231
CID: 5005922

Adding a tibial tubercle osteotomy with anteromedialisation to medial patellofemoral ligament reconstruction does not impact patient-reported outcomes in the treatment of patellar instability

Markus, Danielle H; Hurley, Eoghan T; Gipsman, Aaron; Campbell, Kirk A; Jazrawi, Laith M; Alaia, Michael J; Strauss, Eric J
OBJECTIVES/OBJECTIVE:An isolated medial patellofemoral ligament (MPFL) reconstruction (MPFLR) has been demonstrated to be an effective treatment option in the prevention of patellar instability, but there is growing support for performing a tibial tubercle osteotomy (TTO) in patients with an elevated tibial tubercle-trochlear groove distance. The purpose of this study was to evaluate the impact of adding a TTO to MPFLR on patient-reported outcomes. METHODS:A retrospective review of patients who underwent MPFLR with or without TTO with a minimum of 12-month follow-up was performed. Patients in both groups were matched based on age, gender, and follow-up time. Recurrent instability (including redislocation and subluxation), visual analogue scale (VAS) score, Kujala score, and satisfaction were evaluated. RESULTS:There were 59 patients who underwent MPFLR with concomitant TTO performed at our institution and met our inclusion and exclusion criteria. These patients were then matched to patients undergoing isolated MPFLR based on demographics and follow-up time. The mean age was 25.0 years, 76.3% were female, and the mean follow-up time was 49 months. There was a significant difference in mean tibial tubercle-trochlear groove distance (19.8 ± 3.9 vs. 14.1 ± 2.8) between groups. There was no significant difference in VAS (1.48 ± 2.0 vs. 1.49 ± 2.1, p = 0.972), satisfaction (86.1% ± 24.2% vs. 81.2% ± 27.9, p = 0.311) or revision surgeries (10.2% vs. 10.2%) between groups. CONCLUSION/CONCLUSIONS:Matched patients undergoing MPFLR with TTO compared with isolated MPFLR demonstrate no statistically significant difference in patient-reported outcomes, levels of pain, and satisfaction postoperatively. Furthermore, the addition of a TTO does not increase the risk of further surgery or complications. LEVEL OF EVIDENCE/METHODS:III, retrospective comparative study.
PMID: 35543657
ISSN: 2059-7762
CID: 5214422

Platelet-Rich Plasma Outcomes Do Not Correlate with Patient Satisfaction or Perceived Cost-Effectiveness

Mojica, Edward Stephan; Lin, Charles; Kirschner, Noah; Ortega, Paola; Hurley, Eoghan T; Campbell, Kirk; Alaia, Michael; Jazrawi, Laith
BACKGROUND/UNASSIGNED:As platelet-rich plasma injection for knee osteoarthritis (OA) has increased in popularity, it has become more important to assess its effectiveness and satisfaction with its use in the context of its high cost. The purpose of this study was to determine satisfaction, commercial appeal, and effectiveness of platelet-rich plasma (PRP) for the treatment of knee OA. METHODS/UNASSIGNED:A retrospective review of patients who underwent PRP injection in the knee from 2016 to 2019 was performed. Satisfaction with the PRP injection (out of 100), whether the patient would want to undergo PRP injection again, whether they would recommend the injection and whether they felt that the injection was worth the cost was collected. VAS pain scores were collected and measured out of 100. RESULTS/UNASSIGNED:Overall, 114 patients were included. The mean pre-injection pain score was 70.4, and the mean pain level decreased after injection to 36.8. Patients rated their satisfaction on average at 49.2, 50.9% stated that they would get the PRP injection again, 60.5% would recommend to a friend, and 50.9% felt the injection was worth the cost. Younger age and improved post-injection pain correlated with increasing likelihood of desiring further PRP injection. CONCLUSIONS/UNASSIGNED:Patients on average rated satisfaction slightly below average, indicating net indifference skewing towards dissatisfaction with their injection, and only half indicated that it was worth the cost and that they would receive it again. Younger age and pain relief increased desire for further injection, but efficacy did not correlate with patients saying that the injection was worth the cost.
PMID: 34985383
ISSN: 2326-3660
CID: 5107132