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Patient-reported outcomes and return to pre-injury activities after surgical treatment of multi-ligamentous knee injuries in patients over 40-years-old: Average 5-years follow-up

Li, Zachary I; Green, Joshua S; Chalem, Isabel; Triana, Jairo; Rao, Naina; Hughes, Andrew J; Campbell, Kirk A; Jazrawi, Laith M; Medvecky, Michael J; Alaia, Michael J
BACKGROUND:Multi-ligamentous knee injuries (MLKI) are potentially devastating injuries, though existing prognostic research among older patients who sustain MLKI is limited. The purpose was to investigate clinical outcomes and rates of return to pre-injury activities following surgical treatment of MLKI in patients at least 40 years old. METHODS:This study was a multi-center retrospective case series of patients who underwent surgical treatment for MLKI from 2013-2020 and were ≥ 40 years old at time of injury. Outcomes were assessed via e-mail and telephone using the International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner activity scale, a satisfaction rating, and return to pre-injury sport and work surveys. Stepwise linear regression was used to assess the impact of preoperative characteristics on IKDC and Lysholm scores. RESULTS:Of 45 patients eligible for inclusion, 33 patients (mean age: 48.6 years [range: 40-72]) were assessed at a mean follow-up of 59.1 months (range 24-133). The cohort reported a mean IKDC of 63.4 ± 23.5, Lysholm of 72.6 ± 23.6, and Tegner of 3.8 ± 2.0. There was a 41.2% rate of return to sports, and 82.1% returned to work. Documented knee dislocation was predictive of poorer IKDC (β:-20.05, p = 0.025) and Lysholm (β:-19.99, p = 0.030). Patients aged > 50 were more satisfied compared to those 40-50 years old (96.2 ± 4.9 vs 75.6 ± 23.3, p = 0.012). CONCLUSIONS:Patients who sustained MLKI aged at least 40 at injury demonstrated fair clinical outcomes at a mean 5-year follow-up. Older patients who sustained MLKI reported a relatively high rate of return to work but were less likely to return to sports. LEVEL OF EVIDENCE/METHODS:IV, Case series.
PMID: 38070381
ISSN: 1873-5800
CID: 5589802

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

Kinesiophobia and Pain Catastrophizing Leads to Decreased Return to Sport Following Autologous Chondrocyte Implantation but Does Not Affect Return to Work

Triana, Jairo; Rao, Naina; Buldo-Licciardi, Michael; Lott, Ariana; Rynecki, Nicole D; Eskenazi, Jordan; Alaia, Michael J; Jazrawi, Laith M; Strauss, Eric J; Campbell, Kirk A
OBJECTIVE:To evaluate the effect of fear of reinjury on return to sport (RTS), return to work (RTW), and clinical outcomes following autologous chondrocyte implantation (ACI). DESIGN/METHODS:A retrospective review of patients who underwent ACI with a minimum of 2 years in clinical follow-up was conducted. Patient-reported outcomes collected included the Visual Analog Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Kinesiophobia and pain catastrophizing was assessed using the Tampa Scale of Kinesiophobia-11 (TSK-11) and Pain Catastrophizing Scale (PCS), respectively. Patients were surveyed on their RTS and RTW status. RESULTS:= 0.003). CONCLUSION/CONCLUSIONS:Fear of reinjury decreases the likelihood that patients will return to sport after ACI. Patients that do not return to sport report significantly greater levels of fear of reinjury and pain catastrophizing and lower clinical knee outcomes. Nearly all patients were able to return to work after surgery. LEVEL OF EVIDENCE/METHODS:IV case series.
PMID: 37815311
ISSN: 1947-6043
CID: 5604942

Patients who undergo bilateral medial patellofemoral ligament reconstruction return to sport at a similar rate as those that undergo unilateral reconstruction

Li, Zachary I; Triana, Jairo; Lott, Ariana; Rao, Naina; Jazrawi, Taylor; Montgomery, Samuel R; Buldo-Licciardi, Michael; Alaia, Michael J; Strauss, Eric J; Jazrawi, Laith M; Campbell, Kirk A
PURPOSE/OBJECTIVE:Lateral patellar instability is a debilitating condition not only to athletes, but also to a wide range of highly active individuals. Many of these patients experience symptoms bilaterally, though it is unknown how these patients fair with return to sports following a second medial patellofemoral ligament reconstruction (MPFLR). The purpose of this study is to evaluate the rate of return to sport following bilateral MPFLR compared to a unilateral comparison group. METHODS:Patients who underwent primary MPFLR with minimum 2-year follow-up were identified from 2014 to 2020 at an academic center. Those who underwent primary MPFLR of bilateral knees were identified. Pre-injury sport participation and Tegner score, Kujala score, Visual Analog Score (VAS) for pain, satisfaction, and MPFL-Return to Sport after Injury (MPFL-RSI) scale were collected. Bilateral and unilateral MPFLRs were matched in a 1:2 ratio based on age, sex, body mass index, and concomitant tibial tubercle osteotomy (TTO). A sub-analysis was performed regarding concomitant TTO. RESULTS:The final cohort consisted of 63 patients, including 21 patients who underwent bilateral MPFLR, matched to 42 unilateral patients at mean follow-up of 47 ± 27 months. Patients who underwent bilateral MPFLR returned to sport at a rate of 62% at a mean of 6.0 ± 2.3 months, compared to a unilateral rate of 72% at 8.1 ± 4.2 months (n.s.). The rate of return to pre-injury level was 43% among bilateral patients and 38% in the unilateral cohort. There were no significant differences in VAS pain, Kujala, current Tegner, satisfaction, and MPFL-RSI scores between cohorts. Approximately half of those (47%) who failed to return to sport cited psychological factors and had significantly lower MPFL-RSI scores (36.6 vs 74.2, p = 0.001). CONCLUSION/CONCLUSIONS:Patients who underwent bilateral MPFLR returned to sports at a similar rate and level compared to a unilateral comparison group. MPFL-RSI was found to be significantly associated with return to sport. LEVEL OF EVIDENCE/METHODS:III.
PMID: 37219546
ISSN: 1433-7347
CID: 5508312

Gender does not impact clinical outcomes following SLAP repair

Markus, Danielle H; Hurley, Eoghan T; Lorentz, Nathan; Colasanti, Christopher A; Campbell, Kirk A; Carter, Cordelia W; Strauss, Eric J
BACKGROUND/UNASSIGNED:The purpose of the current study was to investigate whether pain, function, satisfaction, return to play (RTP), or psychological readiness to RTP differ between sexes post-operatively following SLAP repair. METHODS/UNASSIGNED:A retrospective review of patients who underwent arthroscopic repair of a SLAP tear was performed. The American Shoulder & Elbow Surgeons (ASES) score, Visual Analogue Scale (VAS), Subjective Shoulder Value (SSV), patient satisfaction, willingness to undergo surgery again, revisions, and return to play (RTP) were evaluated. Clinical outcomes were compared between male and female patients. RESULTS/UNASSIGNED:> 0.05). CONCLUSION/UNASSIGNED:There is no difference in clinical outcomes, function, satisfaction, or revision procedures in mid- to long-term follow-up after SLAP repair between male and female patients. This data is useful in the preoperative counselling of patients undergoing arthroscopic management of symptomatic superior labral pathology. LEVEL OF EVIDENCE/UNASSIGNED:III.
PMCID:10557936
PMID: 37811383
ISSN: 1758-5732
CID: 5604572

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