Improvement In Functional Outcome Research Articles

Anterior Subtenon Triamcinolone Injection for Refractory Macular Edema: A Retrospective Case Series.

To evaluate the effectiveness of anterior subtenon triamcinolone (AST) injections in the management of refractory macular edema. This is a retrospective case series of consecutive eyes with refractory macular edema treated with AST at a single vitreoretinal surgeon's practice at Toronto Western Hospital, University of Toronto, Canada in 2018-2023. Refractory was defined as persistent macular edema with a central subfield thickness of 250μm or greater over a 24-week period, receiving at least four intravitreal anti-VEGF injections. Vision outcomes and optical coherence tomography features for all eyes were compared for three visits pre-AST treatment and two visits post-AST treatment. Ninety-three patients (119 eyes; diabetic macular edema (26%), and pseudophakic CME (74%), with a mean follow-up duration of 161 days were included. The presence of subretinal fluid (p=0.0013), central subfield macular thickness (p<0.0001), cube average thickness (p=0.0024) and macular cube volume (p= 0.0017) significantly improved from pre-AST to post-AST treatment. Visual acuity also significantly improved from pre-AST treatment to post-AST treatment (p<0.0001). There was no significant change in the intraocular pressures from pre-AST to post-AST (p=0.7920) and no complications were noted throughout the follow-up period. The findings from this study suggest that AST injections show modest improvement in anatomical and functional outcomes, and are safe for the treatment and management of refractory macular edema.

Thrombectomy for Stroke With Large Infarct on Noncontrast CT

Recent large infarct thrombectomy trials used heterogeneous imaging modalities and time windows for patient selection. Noncontrast computed tomographic (CT) scan is the most common stroke imaging approach. It remains uncertain whether thrombectomy is effective for patients with large infarcts identified using noncontrast CT alone within 24 hours of stroke onset. To evaluate the effect of thrombectomy in patients with a large infarct on a noncontrast CT scan within 24 hours of onset. Open-label, blinded-end point, bayesian-adaptive randomized trial with interim analyses for early stopping (futility or success) or population enrichment, which was conducted at 47 US academic and community-based stroke thrombectomy centers. Three hundred patients presenting within 24 hours with anterior-circulation, large-vessel occlusion and large infarct on noncontrast CT scan, with Alberta Stroke Program Early CT Scores of 2 to 5, were randomized to undergo thrombectomy or usual care. Enrollment occurred July 16, 2019 to October 17, 2022; final follow-up, January 25, 2023. The intervention patients (n = 152) underwent endovascular treatment using standard thrombectomy devices and usual medical care. Control patients (n = 148) underwent usual medical care alone. The primary efficacy end point was improvement in 90-day functional outcome measured using mean utility-weighted modified Rankin Scale (UW-mRS) scores (range, 0 [death or severe disability] to 10 [no symptoms]; minimum clinically important difference, 0.3). A bayesian model determined the posterior probability that the intervention would be superior to usual care; statistical significance was a 1-sided posterior probability of .975 or more. The primary adverse event end point was 90-day mortality; secondary adverse event end points included symptomatic intracranial hemorrhage and radiographic intracranial hemorrhage. The trial enrolled 300 patients (152 intervention, 148 control; 138 females [46%]; median age, 67 years), without early stopping or enrichment; 297 patients completed the 90-day follow-up. The mean (SD) 90-day UW-mRS score was 2.93 (3.39) for the intervention group vs 2.27 (2.98) for the control group with an adjusted difference of 0.63 (95% credible interval [CrI], -0.09 to 1.34; posterior probability for superiority of thrombectomy, .96). The 90-day mortality was similar between groups: 35.3% (53 of 150) for the intervention group vs 33.3% (49 of 147) for the control group. Six of 151 patients (4.0%) in the intervention group and 2 of 149 (1.3%) in the control group experienced 24-hour symptomatic intracranial hemorrhage. Fourteen patients of 148 (9.5%) in the intervention group vs 4 of 146 (2.7%) in the control group experienced parenchymal hematoma type 1 hemorrhages; 14 (9.5%) in the intervention group vs 5 (3.4%) in the control group experienced parenchymal hematoma type 2 hemorrhages; and 24 (16.2%) in the intervention group vs 9 (6.2%) in the control group experienced subarachnoid hemorrhages. Among patients with a large infarct on noncontrast CT within 24 hours, thrombectomy did not demonstrate improvement in functional outcomes. But the width of the credible interval around the effect estimate includes the possibility of both no important effect and a clinically relevant benefit, so the potential role of thrombectomy with this imaging approach and time window will likely require additional study. ClinicalTrials.gov Identifier: NCT03805308.

The Influence of Resilience on Outcomes After Total Ankle Arthroplasty.

Resiliency is the ability to recover from stressful events and has been shown to correlate with patient outcomes following certain orthopaedic procedures. The purpose of this study was to determine the relationship between resiliency and outcomes following TAA. A retrospective analysis of patients undergoing primary TAA between April 2015 and September 2022 was performed (N = 83). Data included demographics, comorbidities, complications, preoperative and postoperative visual analog scale (VAS) pain and Foot and Ankle Ability Measure (FAAM) functional scores, Brief Resilience Scale (BRS) scores, and surgical satisfaction. Patients were defined as having low resilience (LR), normal resilience (NR), or high resilience (HR) based on a BRS score of <3, 3-4.30, and >4.3, respectively. High resilience patients had significantly higher postoperative FAAM ADL, Sports, and Overall scores as well as a significantly greater increase from preoperative scores compared with LR and NR patients. Low resilience patients had significantly lower FAAM Sports and Overall scores compared with normal and high resilience patients. BRS scores positively correlated with postoperative FAAM scores. We found no difference in satisfaction or VAS between the 3 cohorts. Multivariate regression analysis identified BRS scores to be an independent predictor for greater changes in FAAM scores following TAA. Although functional improvements following TAA are expected, patients with higher resilience at baseline are more likely to experience greater improvements in functional outcomes following surgery. Level III.

Effect of knee strengthening exercises and lifestyle modifications through mobile phone support in people suffering from knee osteoarthritis.

The study aimed to evaluate the effectiveness of mobile phone-based support in improving exercise adherence and outcomes in knee OA. A prospective comparative cohort study was conducted with a follow-up at 3, 6, and 12 weeks, involving 210 participants allocated into intervention and control groups. The intervention group received knee exercise flyers and mobile phone-based adherence support, while the control group received only standard instructions after physiotherapy. Outcome measures included Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, numeric rating scale pain scores, and quality of life assessments at baseline and follow-ups at 3, 6 and 12 weeks. The intervention group exhibited significant reductions in WOMAC scores, pain scores and improvement in quality of life over the 12-week follow-up compared to baseline. The intervention group exhibited significantly greater improvements in the outcomes as compared to control group. A combined intervention of knee exercises leaflets and SMS/phone-call adherence support led to significant improvements in pain, functional outcomes and quality of life among individuals with knee OA. These findings underscore the potential of mobile phone-based interventions as effective adjuncts to traditional therapies for knee OA.

Professor Klaus Fassbender: The Father of Mobile Stroke Units.

Professor Klaus Fassbender is a distinguished neurologist from Germany, widely recognized for his groundbreaking contributions to the fields of neurology and neurodegenerative disease. His work has been pivotal in advancing our understanding of the pathophysiological mechanisms underlying neurodegenerative disorders, including Alzheimer's and Parkinson's disease, as well as in refining therapeutic strategies for their treatment. His studies in cerebrovascular disease have elucidated the complex molecular and cellular processes involved in ischemic and hemorrhagic stroke, leading to the development of novel therapeutic interventions, often bridging the gap between laboratory discoveries and their application in clinical settings. Professor Klaus Fassbender is "the father" of the mobile stroke unit (MSU). With the "time is brain" concept in mind, he proposed and developed the MSU concept for the first time, allowing prehospital stroke imaging, diagnosis, and treatment directly at the site of emergency.This concept reduced times between symptoms onset and treatment, resulting in an increased proportion of patients receiving treatment within "the golden hour" and leading to the improvement of functional outcomes at 90 days. Professor Fassbender's work has been instrumental in shaping contemporary approaches to diagnosing and managing stroke and neurodegenerative disease, making him a leading figure in modern neurology.

Trends in sex differences of functional outcome after intravenous thrombolysis in patients with acute ischemic stroke.

Intravenous thrombolysis (IVT) is an approved treatment for patients with acute ischemic stroke irrespective of sex. However, the current literature on sex differences in functional outcomes following IVT is inconsistent. So far, a number of studies-including a previous analysis based on data from the Austrian Stroke Unit Registry (ASUR)-detected significant sex-related differences in functional outcome, while others did not report any differences between women and men. In addition, currently there is a lack of data on how sex-related differences evolve over time. To assess time trends of sex-related differences in functional outcome of ischemic stroke in a large nationwide cohort and to investigate associations of patient characteristics with functional outcome post thrombolysis in women and men. These data will offer crucial insights into whether sex differences in functional outcome persist despite the large advances in acute stroke treatment. We analyzed retrospective data of consecutive patients with acute ischemic stroke treated with IVT in 39 stroke centers contributing to the ASUR between 2006 and 2021. We included patients over 18 years of age diagnosed with an acute ischemic stroke who received IVT and with available data on functional outcome at 3 months after treatment. The primary outcome parameter was favorable functional outcome (modified Rankin Scale (mRS) of 0-2) at 3 months. Multivariable logistic regression analysis was performed in the overall population and stratified by sex to assess associations of baseline characteristics with functional outcome. Among 11,840 patients receiving IVT, 2489 of 5503 (45.4%) women achieved favorable functional outcome compared to 3787 of 6337 (59.8%) men. Overall, female sex was a statistically significant predictor of functional outcome after thrombolysis, but additional predictors of outcome differed between women and men. Female sex was independently associated with decreased chances of achieving functional independency (adjusted odds ratio (adjOR) = 0.87, 95% confidence interval (CI) = 0.79-0.96, p = 0.005) and we detected a statistically significant improvement in functional outcome over time only in men (year of treatment, adjOR (per year) = 1.04, 95% CI = 1.02-1.06, p < 0.001) but not in women (adjOR (per year) = 1.01, 95% CI = 0.99-1.03, p = 0.280). Hypertension, smoking, and longer or unknown onset-to-door times were statistically significant predictors of outcome only in male patients, whereas atrial fibrillation, prior myocardial infarction, and longer door-to-needle times were significantly associated with outcome only in women. Sex differences in functional outcome after IVT for acute ischemic stroke are persisting over the past years. Results of our analysis can increase awareness and a resulting focus on sex differences in predictors of outcome could be helpful in mitigating these differences in the future by supporting a more individualized patient care in clinical routine. Follow-up analyses are needed to assess this potential impact and its effect in the future. Data from the Austrian Stroke Unit Registry can only be accessed by the employed statistician (D.M.), access inquiries have to be addressed to the registry's academic review board.

Cardiac contractility modulation in heart failure with reduced ejection fraction patients with QRS duration 120–149 ms: Reduction in heart failure hospitalizations and improvement in functional outcome

BackgroundA subset of heart failure (HF) patients qualifies for cardiac resynchronization therapy (CRT). However, a 30% CRT nonresponder rate persists, with patients having narrower QRS durations (ie, QRSd 120–149 ms) receiving less or inconsistent benefit. Cardiac contractility modulation (CCM) may be an important alternative therapy option but has largely been evaluated only in HF patients with QRSd <120 ms. ObjectivesThe purpose of this study was to evaluate the impact of CCM on HF-related hospitalizations and on left ventricular ejection fraction (LVEF) as well as quality of life in HF patients with QRSd 120–149 ms compared to QRSd <120 ms. MethodsThe CCM-REG Registry enrolled 503 HF patients with follow-up up to 2 years. Hospitalization rates were available for 1 year preimplant. Safety was assessed by comparison of actual vs Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score– or Seattle Heart Failure Model (SHFM)–predicted mortality. ResultsAmong 111 of 455 subjects with QRSd 120–149 ms (mean QRSd 130 ± 8 ms; age 68 ± 10 years; 20% female; LVEF 29% ± 9%; 82% New York Heart Association [NYHA] class III), CCM diminished HF-related hospitalization rate by 72% (pre- vs postimplant 0.90 vs 0.25 events per patient-year over 2 years; P <.001). LVEF improved by 7% ± 8% (P = .01 vs baseline), Minnesota Living with Heart Failure Questionnaire score by 10 ± 23 points (P = .01 vs baseline), and NYHA class by 0.5 ± 0.7 classes (<0.001 vs baseline). The effect size was similar to that in QRSd <120 ms patients. Mortality within the first year was 19% in QRSd 120–149 ms patients (ie, not significantly different from the MAGGIC score or SHFM prediction). ConclusionsCCM significantly improved HF control in NYHA class III HF with reduced ejection fraction patients with moderately prolonged QRSd 120–149 ms. The effect was similar to that in patients with QRSd <120 ms.

Functional Outcomes of Gap Non-Union Humerus Fractures Treated with Fibular Strut Graft, Iliac Crest Graft, and Locking Compression Plate.

The humeral shaft gap non-union treatment surgically after unsuccessful fixation is difficult. In this study, the functional outcome of unsuccessful fixation of humeral shaft gap non-unions using a locking compression plate (LCP), fibular strut graft, and iliac bone graft was evaluated. After taking ethical approval, we studied 10 patients with humeral shaft gap non-unions with unsuccessful surgical fixation treated with open reduction and internal fixation using LCP with fibular strut graft and iliac cancellous bone graft. The study duration was from January 2022-January 2024. The mean time from non-union was 7 months. Disabilities of the arm, shoulder, and hand (DASH) scores improved significantly from a pre-operative average of 59.2 ± 7.3 to a mean final score of 24.6 ± 4.8 reflecting a mean improvement of 34.6 with no complications. This study shows that LCP with fibular strut graft and iliac bone grafts is a good alternative for diaphyseal humerus gap non-union along with statistically significant improvement in functional outcome, with union seen in all cases. This construct augments biomechanical stability and good biological healing in these gap non-unions.

Gene therapy using retrovirally transduced human chondrocytes expressing TGF-β1: a systematic review of early results are not promising!

Background: Gene therapy is a promising ortho-biologic product for Osteoarthritis (OA) knee with some level 2 and 3 studies. There is a need to evaluate the safety and efficacy of this therapy with a systematic review by pooling the data from the limited clinical trials to give an early idea of the product. Methods: Pubmed, Embase, and Scopus were searched for articles related to gene therapy use in human trials for osteoarthritis using mesh terms. After screening, seven RCTs were included in this review. Clinical outcomes with IKDC scores, VAS, and adverse effects were analyzed. Results: All studies reported significant improvement in functional outcomes measured with IKDC scores. VAS scores showed mixed results. WOMAC scores and WORMS scoring reported no significant difference between the treatment and placebo groups, but the progression of OA was decreased in the treatment group. Conclusion: Gene therapy could potentially improve knee-related functional outcomes and alleviate pain. While some studies indicate positive effects on knee morphology, further research is needed in this regard. Adverse events, though generally manageable, require ongoing vigilance. Gene therapy holds the potential to enhance the quality of life for individuals with osteoarthritis knee.

Is Restoration of Sagittal Spinopelvic Parameters Necessary in Spinal Tuberculosis of Lumbar and Lumbosacral Spine? Conservative versus Operative Management

The relationship of spinopelvic parameters with spondylolisthesis is widely explored. However, there is scarce evidence on correlation of tuberculosis of lumbar spine with respect to spinopelvic harmony. The current study aims to find the association between functional outcomes and spinopelvic parameters in lumbar spine tuberculosis treatment. A total of 47 patients with active tuberculosis confined to lumbar spine were prospectively analyzed and divided into 2 groups according to mode of intervention. Group A included 26 operatively managed patients and group B had 21 conservatively managed cases. Functional parameters comprising Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) along with spinopelvic radiologic parameters (pelvic incidence [PI], pelvic tilt [PT], sacral slope [SS], lumbar lordosis [LL], PI-LL, sagittal vertical axis) in both groups were analyzed at 0 and 6 months of follow-up. Both the groups showed significant improvement from initial presentation to final follow-up in ODI (Group A: 85.4 ± 12.1-12.3 ± 3.2, P= 0.02; Group B: 82.5 ± 10.06-36.8 ± 11.9, P= 0.04) and VAS (Group A: 8.1 ± 1.2-1.4 ± 0.9, P= 0.02; Group B: 8.5 ± 0.09-3.5 ± 1.1, P=0.02). Statistically significant (P < 0.05) difference was observed in both functional outcome parameters between the 2 groups at 2-month and 6-month follow-up, compared with nonsignificant difference (P > 0.05) at presentation. Better improvements of spinopelvic parameters of PT, SS, LL, PI-LL were observed in Group A and in both groups the difference of these parameters correlated with differences of functional outcome parameters, though PI showed no correlation. The spinopelvic parameters played significant role in functional outcome. There is better functional outcome when LL is adequately restored. Surgical correction offered betterment of spinopelvic parameters like PT, SS, an sagittal vertical axis, which in turn leads to improvement in functional outcome.

Robotic exoskeleton-assisted gait training in patients with motor incomplete myelopathy

Objectives: To assess the effect of gait training with robotic exoskeleton-assisted rehabilitation systems on gait parameters, balance, and overall disability in motor incomplete myelopathy. Design: Prospective pre-post study. Setting: Neurological rehabilitation unit in a tertiary university teaching hospital. Participants: Thirty-four motor incomplete myelopathy patients [22 males, mean age 36.7 y (12.7)] were included in this prospective, pre-post study. Twenty-two had nontraumatic etiology, and 17 had tetraplegia. American Spinal Injury Association impairment scale suggested 23 as C and 11 as American Spinal Injury Association impairment scale-D. The mean duration of the lesion was 333 days. Intervention: Twenty-four sessions of robotic gait training (1-h session, 5–6 sessions/wk) for 4–6 weeks. Outcome measures: Gait speed was assessed using a 10-meter walk test (10MWT), endurance with a 2-minute walk test (2MWT) and 6-minute walk test (6MWT), walking ability by Walking Index in Spinal Cord Injury-walking index for spinal cord injury II, functionality using Spinal cord Independence Measure-SCIM III, and balance by Timed-up-and-go (TUG) test. Results: At baseline, 20 patients were nonwalkers-NWB, and 14 were walkers-WB. The walking index for spinal cord injury II and SCIM III suggested significant improvement in both groups by the end of the study (P&lt;0.05). Among the WB group, 10MWT, 2MWT, and TUG showed significant improvement (P=0.004, 0.02, and 0.01, respectively) with training. Patients in NWB group were able to perform 10MWT, 2MWT, 6MWT, and TUG by the end of the study. Conclusions: Gait training with robotic exoskeleton-assisted rehabilitation systems can lead to a significant improvement in gait endurance, speed, balance, and functional outcomes in individuals with incomplete myelopathy. The effect is more pronounced among already ambulatory patients.

Reverse Total Shoulder Arthroplasty in the Setting of an Intramuscular Lipoma With Extension Into the Glenoid: A Case Report.

Glenoid bone loss from an infiltrating intramuscular lipoma causing erosive changes is a rare occurrence. A 71-year-old woman with symptomatic rotator cuff arthropathy in the setting of an intramuscular infiltrating lipoma and secondary glenoid bone loss was treated with single-stage tumor excision and reverse total shoulder arthroplasty (rTSA) using an injectable, hard self-setting calcium phosphate as structural bone graft substitute. The patient demonstrated excellent clinical and radiographic outcomes at 2-year follow-up. Infiltrating lipomas resulting in functional rotator cuff arthropathy and erosive osseous glenoid changes are exceedingly rare, yet significant glenoid bony defects present a challenge in the setting of shoulder arthroplasty. This report describes the use of structural bone graft substitute for the management of a glenoid bone defect from a rare case of an intramuscular infiltrating lipoma, while maintaining excellent improvement in functional outcomes and pain after rTSA.

Patella is rarely resurfaced during primary total knee arthroplasty in clinical trials conducted in Greece: a systematic review.

The aim of the present study was to report the approach of Greek surgeons regarding patellar management and provide the outcomes and the rate of the need for secondary patella resurfacing. Following the PRISMA guidelines, PubMed, Scopus, and The Cochrane Central Register of Controlled Trials (CENTRAL) databases were accessed in January 2024. Clinical studies evaluating the outcomes of patients undergoing primary TKA were considered eligible for this systematic review if the following predefined criteria were fulfilled: (1) published in English, (2) were conducted in Greece, and had a minimum of 2-year follow-up. The methodological quality and publication bias were assessed using the Modified Coleman Methodology Score (mCMS) and ROBIS tool, respectively. Data was presented in tables using absolute values from individual studies. Pooled data were presented as means, ranges, and percentages. Six clinical studies with a total of 1084 TKAs were included. Four studies were retrospectives, and two studies were prospective. Patella was only resurfaced in 0.6% of total TKAs. TKA without patellar resurfaced, which resulted in an improvement in functional outcome. Among studies, the overall need for revision incidence was 7.6% (68 out of 892 TKAs). Additionally, Aseptic loosening (2.4%) was the most common reason for revision due to patellofemoral joint complications, followed by secondary patellar resurfacing (2.1%) and deep infection (1.3%). The mean mCMS demonstrated a fair methodological quality level, and the ROBIS toll a low risk of bias in all four domains. The available evidence supports that Greek surgeons mainly do not resurface the patella. However, patellar non-resurfacing yields good functional outcomes and presents relatively low revision rates for secondary patellar resurfacing. IV.

Point of Care Ultrasound Guided Management of Lateral Ankle Sprains: A Case Series.

Lateral ankle sprain (LAS) is a common injury with incidence rates reported at 7.2 per 1000 person-years. Physical examination strategies provide limited information to guide rehabilitation that can maximize clinical outcomes. Early and accurate diagnostic information using ultrasound imaging enables individualized care and the ability to monitor healing along with its response to activity and rehabilitation. The purpose of this study was to describe and observe the outcomes associated with Point of Care Ultrasound (POCUS) guided early management of acute and sub-acute lateral ankle sprains. Case series. Individuals with a LAS within the prior 28 days underwent a clinical evaluation to include a POCUS exam to assess ligamentous integrity. Objective and POCUS findings were integrated to classify each LAS into one of four categories. Each grade of ankle sprain corresponded to levels of bracing for the protection of injured structures with each patient receiving physical therapy care based on rehabilitation guidelines. Participants completed the Foot and Ankle Ability Measure (FAAM) activities of daily living and Sports subscale, the Foot and Ankle Outcome Score (FAOS), Patient Reported Outcomes Measurement Information Systems Global Health, Tampa Scale of Kinesiophobia (TSK-11), Cumberland Ankle Instability Tool (CAIT), and the Numeric Pain Rating Scale as well as the Ankle Lunge Test and Figure 8 measurements at baseline, 4 weeks, 8 weeks and 12 weeks post enrollment. The FAAM Sport subscale, all FAOS subscales, and the TSK-11 were also collected at 24 weeks while the CAIT was collected at baseline and 24 weeks. Fourteen participants were enrolled with 11 participants completing all data collection. FAAM Sport scores significantly improved at 4, 8, 12 and 24 weeks. All components of the FAOS significantly increased except for Sport scores at four weeks and Quality of Life scores at four and eight weeks. POCUS guided early management and ligamentous protection of LASs resulted in significant short and long-term improvement in function and return to sporting activity. This case series highlights the feasibility of using ultrasound imaging to assess the severity of ligamentous injury and align bracing strategies for ligamentous protection. The observations from this case series suggest that functional bracing strategies focused on ligamentous protection to promote healing and reduce re-injury rates does not delay improvement in functional outcomes. Level IV, Case Series.

Improved Acromiohumeral Distance Independently Predicts Better Outcomes After Arthroscopic Superior Capsular Reconstruction Graft Tears

PurposeTo identify independent factors responsible for the poor outcomes after a graft tear after arthroscopic superior capsular reconstruction (ASCR). MethodsPatients who underwent ASCR for massive rotator cuff tears between January 2013 and July 2021were reviewed. Based on the achievement of the minimal clinically important differences for clinical outcome measures at the final follow up, patients were divided into the good outcome (GO) and poor outcome (PO) groups. The minimal clinically important differences were calculated as the values equal to one‐half of the standard deviation of the changes in outcome scores between the preoperative baseline and the latest follow‐up. Pre- and final follow-up variables included demographics, American Shoulder and Elbow Surgeons (ASES) score, Constant score, visual analog scale (VAS) score, range of motion, Preoperative and postoperative 1-year radiological variables were analyzed using MRIs, including anteroposterior (AP) and mediolateral (ML) tear sizes, subscapularis tear, acromiohumeral distance (AHD), and degree of fatty degeneration. Logistic regression analysis was performed to identify the significant predictors of poor outcomes. ResultsA total of 33 patients who underwent ASCR presented with graft tears, which were confirmed by postoperative 1-year magnetic resonance imaging (MRI), and had a minimum follow-up duration of 2 years after surgery were enrolled. The GO group demonstrated significantly greater improvements in functional outcomes compared with the PO group (ASES: 83.5 ± 11.8 vs. 64.0 ± 20.4, P = 0.004; Constant: 67.6 ± 5.7 vs. 57.1 ± 9.8, P <0.001; and VAS: 0.9 ± 1.2 vs. 2.4 ± 2.0, P = 0.026). The postoperative 1-year AHD showed significant improvement in the GO group (3.1 ± 1.2 vs. 6.1 ± 1.4, P <0.001) but no change in the PO group (3.4 ± 1.3 vs. 4.2 ± 0.9, P = 0.074) postoperatively. Multivariate logistic regression analysis indicated that a decreased postoperative 1-year AHD (OR, 0.145; P = 0.019) was associated with a poor outcome after a graft tear. ConclusionA narrow postoperative 1-year AHD was identified as the most importantindependent risk factor indicating poor clinical outcomes after a graft tear post-ASCR, which was related to a larger tear and loss of integrity between the grafts and infraspinatus at 1 year postoperatively. Level of evidenceLevel IV.

Association Between Spinopelvic Parameters and Clinical Outcomes of Patients Treated With Transforaminal Platelet-Rich Plasma Injections for Lumbar Disc Prolapse.

Introduction Lumbar disc prolapse mainly occurs in the regions involving the L4-L5 and L5-S1 vertebrae. In this context, the significance of spinopelvic parameters becomes notably prominent. Non-invasive management of lumbar disc prolapse encompasses medicinal therapy, physical therapy, exercise, and epidural injections. Because of its autologous blood origin, platelet-rich plasma (PRP) therapy has minimal risks associated with immunogenic reactions and side consequences. We evaluated the extent of pain reduction and improvement of functional outcomes in patients having discogenic low back pain with modified spinopelvic parameters before and after undergoing transforaminal autologous PRP injection interventions. Methodology An observational study was conducted between September 2022 and August 2023 on 100 patients with low back pain for six months.The study populationcomprised patients whodid not respond to conservative treatment; they were recruited from the orthopaedicward of the emergency medicine department and outpatient department at the RLJalappa Hospital and Research Centre affiliated with Sri Devaraj Urs Medical College in Kolar, India. Every patient received a thorough evaluation that comprised an extensive medical history, a clinical examination, and imaging of the lumbosacral spine from both the front and side views. After obtaining the patient's consent and confirming their readiness for surgery, a PRPinjection was administered. The injection technique followed the standardized protocol and was performed by an experienced spine surgeon in collaboration with orthopaedic residents. Pain evaluations utilizing the Visual Analog Scale (VAS) and assessment of functional outcomes using the Oswestry Disability Index (ODI) scale were conducted before and after PRPinjections at the one- and six-month follow-ups. Results The average age of the study participants was 41.82 ± 5.0 years, with 55% of them being male. A total of 39% of study samples exhibited an increased angle in spinopelvic parameters. The independent t-test revealed a statistically significant difference in the mean score of back pain, limb pain, and ODI score between patients with increased and decreased angles of spinopelvic parameters before and after injection (p=0.0001). The severity of back pain, leg pain, and functional disability was significantly reduced in patients with increased angles of spinopelvic parameters following PRP injections at the one-month follow-up (p=0.0001). However, at the six-month follow-up, patients encountered recurring symptoms and worsening back pain, leg pain, and functional disability compared to the one-month follow-up. Conversely, the severity of back pain, leg pain, and functional disability has been markedly reduced in the patients with lower spinopelvic parameter angles following PRP injections at one month (p=0.0001) and six months (p=0.0001) compared to pre-injections. Conclusion During the long-term follow-up, subjects with elevated spinopelvic parameter angles reported a lower level of improvement in functional outcome, leg pain, and back pain. The impact of spinopelvic parameterson back pain severity and functional disability is substantial, significantly affecting the functional outcome of patients with lumbar disc prolapse.

Subacromial injection of platelet-rich plasma provides greater improvement in pain and functional outcomes compared to corticosteroids at 1-year follow-up: a double-blinded randomized controlled trial

BackgroundStudies evaluating the results of platelet-rich plasma (PRP) for the treatment of rotator cuff tendinopathy (RCT) have demonstrated conflicting results and have been confounded by small patient samples, the absence of a control group, the combined analysis of isolated tendinopathies and rotator cuff tears, insufficient reporting of PRP preparations, The purpose of this study was to perform a randomized controlled trial comparing platelet-rich plasma (PRP) with standard corticosteroid (CS) injections in providing pain relief and improved function in patients with rotator cuff tendinopathy. MethodsThis was a double-blind RCT at a single center. We evaluated patients between 18 and 50 years old who had both a clinical and magnetic resonance (MRI) diagnosis of supraspinatus tendinopathy refractory to conservative treatment. A total of 50 patients received PRP treatment, whereas 50 patients received a corticosteroid, as a control group. Patients completed patient-reported outcome assessments at baseline and at 1, 3, 6 and 12 months after injection. The primary outcome was improvement in the VAS score for pain. Secondary outcomes included changes in ASES score, SANE score and the Pittsburgh Sleep Quality Index (PSQI). Treatment failure was defined as persistent pain at 3 months which required a subsequent injection. ResultsThe mean age was 27.7 (±7.4). All the patients completed 12 months clinical follow-up. At 12 months, patients in the PRP group showed a significantly greater improvement in the VAS than patients in the CS group 1.68(0.6) vs 2.3(1.0) (p<0.001). As well, at 12 months follow-up, the 3 scores evaluated were significantly higher in patients treated with PRP than in patients treated with CS ASES 89.8 (6.3) vs 78.0 (8.6) (p<.001); SANE 89.2 (6.3) vs 80.5 (9.6) (p< .001) and PSQI 2.72 (0.6) vs 4.02 (1.7) (p< .001)The overall failure rate, was significantly higher in the CS group (30%) than in the PRP group (12%) (p<0.01) ConclusionOne subacromial PRP injection in patients with rotator cuff tendinopathy showed significantly superior and sustained pain-relieving and functional improvements compared with one corticosteroid subacromial injection assessed by 4 patient-reported outcome scales at 12 months of follow-up. Moreover, the overall failure rate, was significantly higher in the CS group than in the PRP group.

An evaluation of the total ankle replacement in the modern era: a narrative review.

Total ankle replacement has become an increasingly popular surgical procedure for treatment of end-stage ankle arthritis. Though ankle arthrodesis has historically been considered the gold standard treatment, advancements in implant design, functional outcomes, and survivorship have made total ankle replacement a compelling alternative. Particularly, in the past 20 years, total ankle replacement has undergone tremendous innovation, and the field of research in this procedure continues to grow. In this review, we aim to summarize the history, evolution, advancements, and future directions of total ankle replacement as described through implant design, indications, surgical procedures, complications, and outcomes. Literature searches were conducted in PubMed to identify relevant articles published prior to March 2023 using the following keywords: "total ankle replacement", "total ankle arthroplasty", and "total ankle". Total ankle replacement has demonstrated significant improvements in surgical technique, implant design, survivorship, and clinical and functional outcomes in the modern era. The procedure reports high patient satisfaction, low complication rates, and improved functional abilities that challenge the current gold standard treatment for ankle arthritis. Though there are areas of improvement for total ankle replacement, the procedure demonstrates promising outcomes for patients with end-stage ankle arthritis to improve pain and functional abilities. Research studies continue to explore various the facets of total ankle replacement, including outcomes, risk factors, novel techniques and modalities, and complications, to direct future innovation and to optimize patient results.

Unraveling the gait dynamics - A comparative study of iASSIST and conventional total knee replacement techniques in osteoarthritic elderly patients

BackgroundOsteoarthritis (OA) stands as the most prevalent disability among the elderly population. Assessing functional outcomes after Total Knee Replacement (TKR) typically involves Gait analysis along with other evaluation methods. The objective of this study was to compare Gait results, including temporospatial parameters, joint angles, gait profile score (GPS), and movement analysis profiles (MAP), between conventional and iASSIST TKR techniques. MethodThe study involved 21 participants (mean age 68.4 ± 4.2 years), with 16 females and 5 males. Among them, 11 patients had traditional surgery (15 TKR), and 10 patients had iASSIST surgery (13 TKR), totaling 28 knees (7 bilateral). The pre-operative Gait analysis was conducted one day before the surgical procedure, whereas the postoperative Gait analysis was performed, on average, 210 ± 20 days after surgery. Gait analysis was conducted using the Qualisys Motion capture system, operating at a rate of 120 Hz. The data were thoroughly analyzed using Visual 3D C-Motion Software. ResultsAn analysis of gait biomechanics metrics, encompassing temporospatial parameters, joint angles, GPS, and MAP, was undertaken. Significant differences were observed in sagittal plane joint angles of the pelvis and hip, transverse plane joint angles of the knee, cadence, and MAP of foot internal/external rotation. However, there were no statistically significant differences between the two TKR techniques in the remaining temporospatial variables, joint angles, GPS, or MAP. ConclusionThis study revealed a significant difference between iASSIST-guided TKR and conventional TKR, demonstrating that the iASSIST procedure led to improvements in walking biomechanics. Findings hold potential utility for orthopedic surgeons in their decision-making processes, ultimately contributing to the improvement of functional outcomes following TKR.

PL-TOSP, the Novel Entry Point in Transforaminal Endoscopic Spine Surgery: Radiological Analysis with Prospective Surgical Evaluation and Review of Literature of Various Skin Entry Points

Abstract Purpose Aim of this study was to analyze variation in angulation of trajectories of various skin entry points in transforaminal endoscopic spine surgery with change in the physical parameters, namely, weight, abdominal girth, and body mass index and to validate our hypothesis that posterolateral (PL)-tip of spinous process (TOSP) entry has minimal variation in the angle of trajectory as compared with currently available skin entry points. The study included an analysis of the functional outcomes of these patients who underwent transforaminal endoscopy using the novel PL-TOSP technique, assessing improvements in pain and disability. Overview Entry point in transforaminal endoscopic lumbar discectomy (TELD) was taken as a rough distance of 10 to 12 cm from midline as proposed by Kambin whereas Yeung and Tsou advised entry point as distance between the center of the disc space and the posterior skin line measured on lateral. But entry points cannot be static as they tend to change according to changes in physical parameters. Materials and Methods This study comprises of radiological analysis and a prospective evaluation of these patients operated on using the PL-TOSP entry point. Radiological analytic study was performed on 50 symptomatic preoperative patients who underwent transforaminal endoscopy using the novel PL-TOSP entry point. A lumbar spine magnetic resonance imaging (MRI) field of vision (MRI-FOV) was performed for the patients including the abdominal perimeter. Weight, height, and abdominal girth of the patients were noted prior to MRI. Angulation of trajectory made by four standard entry points used in TELD, namely, 45–45, PL, TOSP), dorsum of facet joint, and our proposed entry point PL-TOSP (which is a midpoint between PL and TOSP entry), were calculated using MRI-FOV at L45 and L5S1 level. For the functional outcome analysis of these 50 patients, preoperative Visual Analogue Score (VAS) for lower limb pain and Oswestry Disability Index (ODI) were recorded. Postoperative VAS and ODI scores were reassessed at 2, 6, and 12 weeks. Statistical analysis was conducted to evaluate the significance of changes in VAS scores and ODI preoperative versus postoperative. A p-value of &lt; 0.05 was considered statistically significant. Results Angle of trajectory with the horizontal for all five entry points varies with physical parameters. PL-TOSP entry point has the least variation with change in physical parameters as compared with other entry points. The range of angle for PL-TOSP entry was 21 to 29 degrees. In our study, there was improvement in postoperative VAS and ODI scoring systems which was statistically significant (p-value &lt; 0.05). This suggests reliability of our proposed entry point with consistent postoperative improvement. Conclusion The novel PL-TOSP entry point for transforaminal endoscopy demonstrates superior stability in trajectory angle despite variations in physical parameters, and is associated with significant improvements in functional outcomes and pain reduction for patients with lower limb radiculopathy. Angulation of PL-TOSP trajectory with horizontal also corresponds to current generation of endoscopes (25 or 30 degrees).