Intermediate-term Functional Outcomes Research Articles

Propensity-Score Matched Analysis Between Extraperitoneal Single Port and Intraperitoneal Multiport Radical Prostatectomy: A Single-Institutional Experience

ObjectiveTo compare the perioperative results and intermediate-term functional outcomes of single port and multiport robotic-assisted laparoscopic prostatectomy by using a propensity-score analysis. Materials and MethodsWe evaluated all patients who underwent robotic prostatectomy by 3 urologic surgeons at our institution between January 2019 and October 2020. Demographic, intraoperative, and postoperative data were collected and assessed. Patients were matched based on body mass index, Gleason group, and prostate volume using the optimal matching method. ResultsOverall, 98 and 165 patients underwent single port and multiport robotic prostatectomy, respectively. Following propensity-score matching, 98 multiport cases were matched 1:1 to single port cases. The median operative time was lower for multiport (111.5 vs 147.0 minutes, P = .0000). Single port had a lower median estimated blood loss (50.0 vs 75.0 mL, P = .0006), pain score on postoperative day 0 (1.0 vs 2.0, P = .0004), opioid use at postoperative day 1 (0.0 [IQR 0.0-5.0] vs 0.0 MME [IQR 0.0-7.5], P = .0058), cumulative opioid use (2.0 vs 7.0 MME, P = .0008), and lymph node yield (4.0 vs 7.0 nodes, P = .0051). Single port had a greater percentage of men regain full erectile function by 6 months (23.8% vs 4.8%, P = .002). ConclusionThe single port robotic system is a safe option for localized prostate cancer treatment, offering superior pain control and comparable perioperative results and intermediate-term functional outcomes compared to the multiport robotic approach.

Synovial Fluid Cytokine Profile at the Time of Arthroscopy Explains Intermediate-Term Functional Outcomes

Background: The intra-articular immune response after ligamentous, meniscal, or focal chondral knee injuries likely plays a role in intra-articular healing and the onset and progression of posttraumatic osteoarthritis. Purpose: To evaluate the association of synovial fluid cytokine concentrations measured at the time of knee arthroscopy with intermediate-term functional outcomes after knee arthroscopy based on the Lysholm score. Study Design: Cohort study; Level of evidence, 2. Methods: This was a prospective cohort study of patients undergoing arthroscopic knee surgery. Synovial fluid was aspirated from the injured knee immediately before surgical incision, and the concentrations of 10 cytokines were analyzed using immunoassay. Principal component regression was used to create a model to predict patient-reported Lysholm score at a minimum of 5 years postoperatively. Hierarchical clustering was performed to identify groups of patients with similar synovial fluid inflammatory phenotypes. Lysholm scores and cytokine concentrations were compared between clusters. Results: A total of 26 patients (mean age, 40.33 ± 16.40 years) were included in the analysis. The mean duration between surgery and follow-up was 6.69 ± 0.72 years. A model consisting of 2 principal components (PC1, PC2) explained 62.48% of the variance in the cytokine data and 52.03% of the variance in intermediate-term Lysholm score. Hierarchical clustering resulted in 3 patient clusters based on the principal components used in the regression model. Despite no baseline differences in Lysholm score, cluster 3 demonstrated significantly greater intermediate-term Lysholm score compared with cluster 2 (94.33 vs 76.09, respectively; 95% CI, 5.96-30.52; P = .006) and cluster 1 (94.33 vs 52.33, respectively; 95% CI, 24.09-59.91; P = .003). Cluster 3, when compared with the overall means, was characterized by greater PC1 value (1.01 vs 0.00, respectively; P = .030) and greater PC2 value (0.86 vs 0.00, respectively; P = .002). Conclusion: The concentrations of select synovial fluid cytokines assessed at the time of knee arthroscopy can be used to explain more than half of the variance in intermediate-term functional outcomes.

Minimally invasive ileal ureter replacement: Comparative analysis of robot-assisted laparoscopic versus conventional laparoscopic surgery.

This study is an initial comparative analysis of perioperative and intermediate-term functional outcomes between patients who underwent robot-assisted laparoscopic (RALS) or conventional laparoscopic surgery (LS). A total of 25 patients who underwent ileal ureter replacement (10 RALS and 15 LS) were followed by functional cine magnetic resonance urography (MRU) combined with a modified Whitaker test. Also, the characteristics, perioperative data and functional outcomes of the patients were compared. The estimated blood loss, postoperative hospital stay and time to oral intake were significantly lower in the RALS group. At the median 14-month follow-up, all the patients showed improved renal function and were symptom-free, with no signs of leakage or stenosis observed by cine MRU combined with a modified Whitaker test. RALS with an extracorporeal bowel resection is feasible and appears to be safe, with quick postoperative recovery and encouraging outcomes.

Synovial Fluid Biomarkers at the Time of Arthroscopy Predict Five-Year Outcomes

Injury-induced molecular changes in the intra-articular microenvironment of the knee are thought to play a role in the development of post-traumatic osteoarthritis. The purpose of this study was to evaluate the association between post-traumatic synovial fluid biomarker concentrations and intermediate-term functional outcomes. Patients undergoing primary knee arthroscopy for ACL injury, meniscus injury, and/or focal chondral lesions were prospectively enrolled. Synovial fluid aspirate, collected immediately prior to surgical incision, was processed and analyzed using a multiplex magnetic bead immunoassay to determine the concentration of 10 pre-determined cytokines and chemokines. Patients with a minimum of five years of postoperative follow-up were surveyed with Visual Analog Pain Scale (VAS), Lysholm Knee Scoring Scale, and Knee Injury and Osteoarthritis Outcome Score Physical Function Shortform (KOOS-PS). Stepwise regression was used to fit a linear regression model and model accuracy was evaluated using k-fold cross validation. 39 patients (mean age: 41.56 +/- 15.98 years, mean postoperative follow-up: 6.79 +/- 0.72 years) were included in the study. Mean Lysholm, KOOS-PS, and VAS scores were 83.67 +/- 17.64, 88.37 +/- 12.79, and 11.03 +/- 19.84, respectively. 11 patients had undergone further ipsilateral knee surgery during the follow-up period. Of the remaining 28 patients, a model consisting of VEGF, TIMP-2, and MMP-3 was found to most accurately predict intermediate-term functional outcomes. Regardless of the type or extent of injury, these three biomarkers were able to explain 60.35%, 34.75%, and 39.38% of the variability in Lysholm, KOOS-PS, and VAS scores, respectively. By measuring the concentrations of MMP-3, TIMP-2, and VEGF at the time of surgery, functional outcomes and level of pain can be predicted at 5 years postoperatively with moderate accuracy. This suggests that these biomarkers may play an important role in the development of post-traumatic osteoarthritis and may serve as potential targets for therapeutic intervention.

Synovial Fluid Biomarkers at the Time of Arthroscopy Predict 5-Year Outcomes

Objectives:Injury-induced molecular changes in the intra-articular microenvironment of the knee are thought to play a role in the development of post-traumatic osteoarthritis. The purpose of this study was to evaluate the association between post-traumatic synovial fluid biomarker concentrations and intermediate-term functional outcomes.Methods:Patients undergoing primary knee arthroscopy for ACL injury, meniscus injury, and/or focal chondral lesions were prospectively enrolled. Synovial fluid aspirate, collected immediately prior to surgical incision, was processed and analyzed using a multiplex magnetic bead immunoassay to determine the concentration of 10 pre-determined cytokines and chemokines. Patients with a minimum of five years of postoperative follow-up were surveyed with Visual Analog Pain Scale (VAS), Lysholm Knee Scoring Scale, and Knee Injury and Osteoarthritis Outcome Score Physical Function Shortform (KOOS-PS). Stepwise regression was used to fit a linear regression model and model accuracy was evaluated using k-fold cross validation.Results:39 patients (mean age: 41.56 +/- 15.98 years, mean postoperative follow-up: 6.79 +/- 0.72 years) were included in the study. Mean Lysholm, KOOS-PS, and VAS scores were 83.67 +/- 17.64, 88.37 +/- 12.79, and 11.03 +/- 19.84, respectively. 11 patients had undergone further ipsilateral knee surgery during the follow-up period. Of the remaining 28 patients, a model consisting of VEGF, TIMP-2, and MMP-3 was found to most accurately predict intermediate-term functional outcomes. Regardless of the type or extent of injury, these three biomarkers were able to explain 60.35%, 34.75%, and 39.38% of the variability in Lysholm, KOOS-PS, and VAS scores, respectively.Conclusions:By measuring the concentrations of MMP-3, TIMP-2, and VEGF at the time of surgery, functional outcomes and level of pain can be predicted at 5 years postoperatively with moderate accuracy. This suggests that these biomarkers may play an important role in the development of post-traumatic osteoarthritis and may serve as potential targets for therapeutic intervention.Table 1.LysholmKOOS-PSVASβP-valueβP-valueβP-valuelog VEGF-6.370.038-6.780.024--log TIMP-29.77<0.0015.630.004-9.99<0.001log MMP-36.41<0.0014.320.0133.590.044Adj. R20.6035<0.0010.34750.0040.3938<0.001

Pilot Study to Assess Safety and Clinical Outcomes of Irreversible Electroporation for Partial Gland Ablation in Men with Prostate Cancer

Partial prostate gland ablation is a strategy to manage localized prostate cancer. Irreversible electroporation can ablate localized soft tissues. We describe 30 and 90-day complications and intermediate term functional outcomes in men undergoing prostate gland ablation using irreversible electroporation. We reviewed the charts of 25 patients with prostate cancer who underwent prostate gland ablation using irreversible electroporation as a primary procedure and who were followed for at least 6 months. Median followup was 10.9 months. Grade 3 complications occurred in 2 patients including epididymitis (1) and urinary tract infection (1). Fourteen patients experienced grade 2 or lower complications, mainly transient urinary symptoms, hematuria and urinary tract infections. Of 25 patients 4 (16%) had cancer in the zone of ablation on routine followup biopsy at 6 months. Of those with normal urinary function at baseline 88% and 94% reported normal urinary function at 6 and 12 months after prostate gland ablation, respectively. By 12 months only 1 patient with normal erectile function at baseline reported new difficulty with potency and only 2 patients (8%) required a pad for urinary incontinence. Prostate gland ablation with irreversible electroporation is feasible and safe in selected men with localized prostate cancer. Intermediate term urinary and erectile function outcomes appear reasonable. Irreversible electroporation is effective in the ablation of tumor bearing prostate tissue as a majority of men had no evidence of residual cancer on biopsy 6 months after prostate gland ablation.

PD5-06 EVALUATION OF LASER ENUCLEATION TECHNIQUES IN THE MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2015PD5-06 EVALUATION OF LASER ENUCLEATION TECHNIQUES IN THE MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS Sam Chopra, Cindy Garcia, Venu Chalasani, and Henry Woo Sam ChopraSam Chopra More articles by this author , Cindy GarciaCindy Garcia More articles by this author , Venu ChalasaniVenu Chalasani More articles by this author , and Henry WooHenry Woo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.305AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study was to conduct a systematic review and meta-analysis of available level 1 evidence studies, to evaluate the efficacy and safety of Laser enucleation techniques versus transurethral resection of prostate (TURP) and OP (open simple prostatectomy). Outcomes analysed were peri-operative complications, and functional outcomes at 12 months. METHODS A systematic literature search was performed using the electronic databases of EMBASE, Medline, and the Cochrane Central Register of Controlled Trials (1991to May2014) and American Urological Association and European Association of Urology conference proceedings from 2010 to 20114 were searched. There were no language restrictions. Trials were included if they were randomised controlled trials, had Laser enucleation (all power machines and any type of laser) as the intervention, and TURP or OP (standard group) as control. Meta-analysis was performed using a random effects model. Risk of bias of enrolled trials was assessed according to Cochrane Handbook. RESULTS A total of 15 RCTs (1628 enrolled patients) were included. Types of Laser used for enucleation included HOLEP, THULEP and Eraser enucleation (ELEP). Immediate complications were less numerous with Laser enucleation arm The rate of acute urinary retention, clot retention, re-catheterization, short-term reoperation, postoperative UTIs, post-operative storage symptoms, and urethral strictures were not significantly different in the two groups. Overall, length of stay was shorter in the laser group -47.8 hours [-59.19, -36.42]; p<00001 (favours Laser) and the rate of blood transfusion significantly less in this group as well (risk ratio: 0.23 [0.1-0.52]; p=0.0005). CONCLUSIONS The results of this systematic review have shown that perioperative outcomes, such as catheterisation time and length of hospital stay were significantly shorter in the laser enucleation arm in comparison to conventional TURP and OP. Postoperative complications of blood transfusion and clot retention were significantly less likely in laser arm. Overall, no difference was noted in intermediate-term functional outcomes. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e94 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sam Chopra More articles by this author Cindy Garcia More articles by this author Venu Chalasani More articles by this author Henry Woo More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Laparoscopic Anatrophic Nephrolithotomy for Management of Complete Staghorn Renal Stone: Clinical Efficacy and Intermediate-Term Functional Outcome

To report the clinical efficacy and intermediate-term functional outcome after laparoscopic anatrophic nephrolithotomy (LAN) as an alternative treatment modality for complete staghorn renal stone. The demographic and perioperative parameters as well as the intermediate outcome of 10 adults (9 men) who underwent transperitoneal LAN for complete staghorn renal stone were analyzed. Functional imaging studies consisted of intravenous urography (IVU) and technetium-99 dimercaptosuccinic acid scintigraphy (99Tc-DMSA) renal scan done before the operation and at the last follow-up visit. Mean age of patients was 48.7 years (range 37-64 years). Mean stone size was 67.3 mm (50-90 mm). Mean operative time was 192 minutes (110-240 min), and mean warm ischemia time was 32.8 minutes (15-40 min). A few hours after laparoscopy, one patient underwent splenectomy because of significant hemorrhage from a splenic laceration (grade IIIb complication). During the follow-up period early after the operation, we detected an 8-mm lower caliceal stone and a 25-mm midcaliceal stone in one patient each (stone-free rate: 80%). After a mean follow-up of 11.9 months (6-19 mos), 85.5% of corresponding renal unit function was preserved; however, there was a significant mean decrease in 99Tc-DMSA uptake from 48.4%±8.83 before surgery to 41.4%±13.98 afterward (-7%±6.53; P=0.008). Nevertheless, renal units were completely functional at follow-up IVU with a significant improvement in obstruction in all patients. LAN is an alternative minimally invasive approach for one-session management of patients with complete staghorn renal stone. It offers an acceptable rate of stone clearance and operative complications but does incur a minimal loss of function in the affected kidney.

Re: Laparoscopic Anatrophic Nephrolithotomy for Management of Complete Staghorn Renal Stone: Clinical Efficacy and Intermediate-Term Functional Outcome(From: Alireza Aminsharifi, Patris Hadian, and Kamran Bovei J Endourol 2013;27:000–000)

Re: Laparoscopic Anatrophic Nephrolithotomy for Management of Complete Staghorn Renal Stone: Clinical Efficacy and Intermediate-Term Functional Outcome(From: Alireza Aminsharifi, Patris Hadian, and Kamran Bovei J Endourol 2013;27:000–000)

Editorial Comment

The type of surgical treatment for benign prostatic hyperplasia is largely dependent on gland volume. This includes enucleation (open or Holmium [HoLEP]), transurethral resection of the prostate, or energy-based ablation. For larger glands, the enucleation procedures offer greater adenoma reduction with consequent long-term durable outcomes. Both single- and multi-port, transvesical and extravesical laparoscopic and robotic procedures have been reported as minimally invasive alternatives to open simple prostatectomy with encouraging results. Both require a substantial learning curve, comparable with that required of the HoLEP procedure. Preperitoneal Single-port Transvesical Enucleation of the Prostate (STEP) for Large-volume BPH: One-year Follow-up of Qmax, IPSS, and QoLUrologyVol. 80Issue 2PreviewTo evaluate the 1-year efficacy and safety of single-port transvesical enucleation of the prostate (STEP) for voluminous benign prostatic hyperplasia (BPH). Full-Text PDF ReplyUrologyVol. 80Issue 2PreviewWe really appreciate the editorial comment on our report regarding the intermediate-term functional outcomes of single-port transvesical enucleation of the prostate (STEP) for voluminous benign prostatic hyperplasia (BPH). Our study clearly shows that STEP can be performed safely in selected voluminous BPH patients, with a favorable functional efficacy in terms of Qmax, International Prostate Symptom Score and Quality of Life Index at 12 months postoperatively. STEP is still a technically demanding and challenging procedure. Full-Text PDF

Reply

We really appreciate the editorial comment on our report regarding the intermediate-term functional outcomes of single-port transvesical enucleation of the prostate (STEP) for voluminous benign prostatic hyperplasia (BPH). Our study clearly shows that STEP can be performed safely in selected voluminous BPH patients, with a favorable functional efficacy in terms of Qmax, International Prostate Symptom Score and Quality of Life Index at 12 months postoperatively. STEP is still a technically demanding and challenging procedure. A precise dissection and management of the apex is one of the most difficult surgical maneuvers to perform during STEP. The visibility can be to some extent improved by a stitch retraction, and we believe the digital assistance to reach the apex is useful. The STEP procedure still needs further refinements on instrumentation and surgical techniques. A combination of transurethral techniques or robotic assistance will ensure an adequate enucleation of the adenoma. Nevertheless, the point at which the advantages of STEP justify the increased overall cost (the TriPort, articulating instruments, robotic surgical system, etc.) should be evaluated in future study. Editorial CommentUrologyVol. 80Issue 2PreviewThe type of surgical treatment for benign prostatic hyperplasia is largely dependent on gland volume. This includes enucleation (open or Holmium [HoLEP]), transurethral resection of the prostate, or energy-based ablation. For larger glands, the enucleation procedures offer greater adenoma reduction with consequent long-term durable outcomes. Both single- and multi-port, transvesical and extravesical laparoscopic and robotic procedures have been reported as minimally invasive alternatives to open simple prostatectomy with encouraging results. Full-Text PDF

Surgery for tetralogy of Fallot - absent pulmonary valve syndrome. Technique of anterior translocation of the pulmonary artery

Patients with absent pulmonary valve syndrome (APVS) and tetralogy of Fallot represent a particular management's challenge. The distinctive feature of APVS is the airway obstruction caused by tracheobronchial compression that results from massive dilatation of the main pulmonary artery (PA) and its first- and second-order branches. Consequential tracheomalacia and bronchomalacia determine the timing and severity of respiratory compromise, as well as the morbidity and mortality of these patients. Although several techniques have been proposed for decompression of the airways, the method of choice is still controversial. Translocation of the PA anterior to the aorta and away from the airways has the potential to reduce or eliminate bronchial compression. Overall, the intermediate-term functional outcomes using this technique have been encouraging, with zero mortality even in the youngest age group of patients and the disappearance of respiratory symptoms in the majority of them. Nevertheless, failure of the treatment could be expected in symptomatic patients in whom the pathology of the airways extends beyond the proximal PAs.

The Hopkins Rehabilitation Engagement Rating Scale: Development and Psychometric Properties

Kortte KB, Falk LD, Castillo RC, Johnson-Greene D, Wegener ST. The Hopkins Rehabilitation Engagement Rating Scale: development and psychometric properties. Objective To conduct an initial investigation of the psychometric properties of the Hopkins Rehabilitation Engagement Rating Scale (HRERS), a 5-item, clinician-rated measure developed to quantify engagement in acute rehabilitation services. Design We used a cross-sectional design to conduct correlational and multivariate analyses to establish the measure’s internal consistency, interrater reliability, construct validity, and criterion validity. Setting Acute inpatient rehabilitation in 3 metropolitan hospitals. Participants A total of 206 subjects with spinal cord injury, ischemic or hemorrhagic stroke, amputation, or hip or knee replacement. Interventions Not applicable. Main Outcome Measures The HRERS, Positive and Negative Affect Schedule, Brief Symptom Inventory, Levine’s Denial of Illness Scale, Craig Handicap Assessment and Reporting Technique, and FIM instrument. Results The HRERS has good internal consistency (α=.91) and interrater reliability (intraclass correlation coefficient, .73) and represents a unidimensional construct. It correlated negatively with symptoms of depression ( r=−.24, P<.01), higher ratings of denial of illness ( r=−.30, P<.001), and self-rated negative affect ( r=−.23, P<.01), and correlated positively with self-rated positive affect ( r=.36, P<.001) and level of functioning 3 months postdischarge ( r=.22, P<.01). Conclusions The HRERS is a valid and reliable measure of rehabilitation engagement that relates to intermediate-term functional outcomes.

Augmentation of Intraarticular Calcaneal Fractures With Injectable Calcium Phosphate Cement: Densitometry, Histology, and Functional Outcome of 18 Patients

Eighteen patients with intraarticular calcaneal fractures treated with open reduction and internal fixation and augmentation with an injectable carbonated apatite cement. Functional follow-up studies using the Zwipp Foot Score and densitometry were performed at 6-month intervals postoperatively. Histological samples of biopsies obtained at the time of hardware removal (6 months postoperatively) were also analyzed. The use of bone cement led to intermediate-term functional outcomes that were no better than those reported with conventional surgical procedures using bone graft. Patients demonstrated postoperative difficulties similar to those seen in other studies of this fracture, including pain, subtalar motion restrictions, peroneal impingement, and difficulties on uneven terrain and with toe- and heel-walking. However, compared to patients treated surgically without injectable carbonated apatite cement, full weight bearing on the affected extremity was regained at an average 4 weeks postoperatively. In addition, autogenous bone graft was not required to fill the osseous defect using this technique, minimizing morbidity and discomfort. During the present observation period of 3 years, only a slight decrease in the density of the peripheral zones of the cement block was observed. Histological examination revealed fibrous bone formation resulting from remodelling processes. Complete resorption and remodeling of the bone cement were not complete at 3 years. One patient developed a postoperative wound infection. Another displayed cement loosening secondary to failure of bony ingrowth.

CLINICAL OUTCOME AT A MINIMUM OF FIVE YEARS AFTER RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT

Background: We are not aware of any previous studies in which independent measurements of function with validated outcome questionnaires such as the Knee Injury and Osteoarthritis Outcome Score and the International Knee Documentation Committee score were evaluated five years after reconstruction of the anterior cruciate ligament. We hypothesized that patient demographics, mechanism of injury, and intra-articular injuries and their treatment are factors associated with function five years after reconstruction of the anterior cruciate ligament. Methods: A consecutive series of unilateral, arthroscopically assisted primary reconstructions of the anterior cruciate ligament performed by one surgeon using a patellar tendon graft was evaluated. Data on patient demographics, injury variables, and intra-articular lesions noted at the time of surgery were collected prospectively. Multivariable regression analysis was used to identify independent predictors of outcomes as measured with five questionnaires. Results: Sixty-nine percent (217) of 314 knees with a reconstruction of the anterior cruciate ligament were followed for an average of 5.4 years. The average age at the time of the operation was twenty-seven years. Independent predictors of a worse outcome, which was measured with the overall Knee Injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee score, the Lysholm score, and the Western Ontario and McMaster Universities Osteoarthritis Index score, included the patient's recollection of hearing or feeling a pop at the time of the injury, a weight gain of >15 lb (6.8 kg), and no change in educational level since the surgery. There was a lack of association between the outcome and either the occurrence or the form of treatment of a meniscal tear or chondromalacia of the articular cartilage. Conclusions: To our knowledge, we performed the first prospective cohort study to evaluate the prognosis following reconstruction of the anterior cruciate ligament by identifying significant associations between multiple variables and clinical outcomes as measured with validated questionnaires. The clinician can counsel patients about the intermediate-term functional outcomes of reconstructions of the anterior cruciate ligament on the basis of these findings. Suggestions regarding weight control and future education may improve intermediate-term outcomes. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

Clinical Outcome at a Minimum of Five Years After Reconstruction of the Anterior Cruciate Ligament

We are not aware of any previous studies in which independent measurements of function with validated outcome questionnaires such as the Knee Injury and Osteoarthritis Outcome Score and the International Knee Documentation Committee score were evaluated five years after reconstruction of the anterior cruciate ligament. We hypothesized that patient demographics, mechanism of injury, and intra-articular injuries and their treatment are factors associated with function five years after reconstruction of the anterior cruciate ligament. A consecutive series of unilateral, arthroscopically assisted primary reconstructions of the anterior cruciate ligament performed by one surgeon using a patellar tendon graft was evaluated. Data on patient demographics, injury variables, and intra-articular lesions noted at the time of surgery were collected prospectively. Multivariable regression analysis was used to identify independent predictors of outcomes as measured with five questionnaires. Sixty-nine percent (217) of 314 knees with a reconstruction of the anterior cruciate ligament were followed for an average of 5.4 years. The average age at the time of the operation was twenty-seven years. Independent predictors of a worse outcome, which was measured with the overall Knee Injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee score, the Lysholm score, and the Western Ontario and McMaster Universities Osteoarthritis Index score, included the patient's recollection of hearing or feeling a pop at the time of the injury, a weight gain of >15 lb (6.8 kg), and no change in educational level since the surgery. There was a lack of association between the outcome and either the occurrence or the form of treatment of a meniscal tear or chondromalacia of the articular cartilage. To our knowledge, we performed the first prospective cohort study to evaluate the prognosis following reconstruction of the anterior cruciate ligament by identifying significant associations between multiple variables and clinical outcomes as measured with validated questionnaires. The clinician can counsel patients about the intermediate-term functional outcomes of reconstructions of the anterior cruciate ligament on the basis of these findings. Suggestions regarding weight control and future education may improve intermediate-term outcomes.

Repair of tetralogy of Fallot with absent pulmonary valve using a new approach

Although several techniques for the correction of tetralogy of Fallot (TOF) with absent pulmonary valve have been described, the method of choice is controversial. Symptomatic infants, in particular, have a poor prognosis because of severe central pulmonary artery dilatation and bronchial compression. An alternative technique for primary repair of TOF with absent pulmonary valve syndrome is suggested. Apart from correction of TOF, this approach includes translocation of the pulmonary artery anterior to the aorta and away from the airways. This technique has a potential to reduce or eliminate bronchial compression by the pulmonary artery. Insertion of valve homograft with anterior and/or posterior plication of the pulmonary artery is considered especially in symptomatic newborns and infants. The intermediate-term functional outcomes have been encouraging, with zero mortality events even in the youngest age group of patients and with the disappearance of respiratory symptoms in the majority of them.