Patient Acceptable Symptom State Research Articles

Revision hip arthroscopy for hip synovial chondromatosis is effective despite inferior postoperative clinical outcomes compared to patients undergoing primary hip arthroscopy: a matched control study with minimum 2-year follow-up

Purpose(1) To determine the clinical outcomes following revision arthroscopy for patients with hip synovial chondromatosis (SC), and (2) to compare the clinical outcomes between patients undergoing revision hip arthroscopy and primary hip arthroscopy.MethodsPatients undergoing hip arthroscopy between December 2014 and January 2021 was reviewed. Patients treated for SC and confirmed by postoperative pathology were included. Exclusion criteria were age less than 18 years old, hip osteoarthritis (Tönnis grade > 1), history of autoimmune disease, avascular necrosis, and Legg–Calve–Perthes disease. Patients undergoing revision surgery were included in the revision group, while those undergoing primary surgery were matched in a 1:4 ratio and included in the primary group. Preoperative and postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and international Hip Outcome Tool, 12-component form (iHOT-12) were collected and compared. The PROs and percentage of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) of mHHS, iHOT-12, and NAHS were compared between the two groups.ResultsA total of 12 patients were included in the revision group, while 48 patients were included in the primary group. No significant difference was found in baseline characteristics (all with P > .05). No significant difference was found in the arthroscopic findings and procedures (all with P > .05). Both groups presented significant improvement of postoperative PROs compared to the preoperative PROs (all with P < .001). No significant difference was found in preoperative PROs between the two groups (all with P > .05). Postoperatively, the revision group presented inferior VAS (P = .007), mHHS (P = .007), iHOT-12 (P = .004), and NAHS (P = .028), as well as lower rate of achieving MCID of NAHS (P = .038), and PASS of mHHS (P = .003) compared to the primary group.ConclusionPatients undergoing revision arthroscopy for hip SC presented favorable clinical outcomes at minimum of 2-year follow-up, although the postoperative PROs, rate of achieving MCID, and PASS were lower compared to patients undergoing primary arthroscopy.Level of Evidence: III.

Is pre-operative block-test with lidocaine injection efficient in predicting the functional result of revision total hip arthroplasty?

BackgroundWhile performing a hip joint aspiration for culture, a lidocaine diagnostic injection called block test can be performed during the investigation of painful total hip arthroplasties (THA). This test was formerly applied to limited series in pre-operative and without assessing the predictive value on the results of THA revision. Therefore we investigated a consecutive series of THA revisions who underwent pre-operative aspiration-block test to determine if patients with pre-operative positive block test (disappearance of symptoms) have a better clinical improvement after revision. HypothesisThe positive pre-operative block test has a positive predictive value greater than 80% in predicting the favourable result of THA revisions. Materials and methodsWe reviewed 152 patients who had a hip aspiration associated with a block test before their THA revision. The patients were evaluated according to the Oxford hip score (OHS). The primary outcome was considered positive if the patient presented an improvement in the OHS greater than the Minimal Clinically Important Difference (MCID; 9 points) and/or if the postoperative OHS was higher than the Patient Acceptable Symptom State (PASS, defined as 39/48). ResultsBlock tests were positive for 61.2% (93/152) of patients. The median improvement in the OHS was 23.0 [IQR 16.0; 30.0] if the block test was positive versus 16.0 [IQR 4.0; 17.0] if negative (p = 0.002). The primary outcome after revision was strongly associated with block test positivity (p < 0.0001). The positive block test had a 67.7% sensitivity, 73.3% specificity, 91.4% Positive Predictive Value and 37.3% Negative Predictive Value for significant improvement after revision surgery. ConclusionHip joint aspiration for culture with concomitant block test seems to be an interesting tool in predicting outcomes of revision surgery for painful THA. Level of evidenceIV; retrospective study.

Pain Relief Survivorship: A Comparison of Exactech Equinoxe Anatomic and Reverse Total Shoulder Arthroplasty for Primary Osteoarthritis

BackgroundPain-relief plays a major deterministic role when assessing postoperative patient satisfaction; however, whether anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA) provides the most durable pain-relief has not been studied. The purpose of this study was to evaluate the durability of pain-relief after aTSA compared to rTSA in patients undergoing surgery for rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA). MethodsA retrospective review of a multicenter shoulder arthroplasty database (Exactech Equinoxe) was performed. We included 1,848 aTSAs and 1,464 rTSAs performed for RCI-GHOA between 2007 and 2023. Pain after surgery was assessed postoperatively at 3-months, 6-months, and yearly thereafter. Average postoperative pain on a daily basis and pain at worst were compared between aTSA and rTSA up to 8-years postoperatively. Kaplan-Meier survivorship analysis for pain-relief maintenance was performed to compare the maintenance of clinically-relevant pain-relief defined as pain scores that achieved the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS). Maintenance of favorable patient satisfaction over time was also evaluated. Multivariable cox regression was performed to determine whether the type of prosthesis (aTSA vs. rTSA) was independently associated with pain recurrence. ResultsMaintenance of achievement of the MCID and SCB for both daily pain and pain at worst as well as favorable patient satisfaction was similar between aTSAs and rTSAs. However, aTSA had longer maintenance of average daily pain below the PASS compared to rTSA (P=.024). This was confirmed on multivariable cox regression analysis which found that rTSAs had a 34% greater likelihood of recurrence of postoperative average daily pain exceeding the PASS (VAS rating 1/10) compared to aTSAs. ConclusionPatients that undergo either aTSA or rTSA for RCI-GHOA and achieve initial pain-relief postoperatively can expect to maintain their clinically-relevant pain improvement at similar rates up to 8-years postoperatively. However, recurrence of low levels of daily pain was significantly higher after rTSA.

Minimal clinically important difference in the Japanese Orthopedic Association Score and shoulder 36 after arthroscopic rotator cuff repair in a Japanese population: A retrospective cohort study

BackgroundIn Japan, the Japanese Orthopedic Association (JOA) score is widely used as a clinician-reported outcome after shoulder surgery. However, Shoulder36 is positioned as a general patient-reported outcome measure. This study aimed to determine the correlations between the JOA score and scores in the domains of the Shoulder36 and their minimal clinically important differences (MCIDs) and cutoff values for the patient-acceptable symptom state (PASS) after unilateral arthroscopic rotator cuff repair (ARCR). MethodsWe evaluated 145 patients using the JOA score and Shoulder36 before and 1 year after surgery. The MCID and PASS cutoff values were determined by patients’ responses to the following anchor item: A, none (“no good at all”); B, poor (“some effect but unsatisfactory”); C, good (“satisfactory effect with occasional episodes of pain or stiffness”); D, excellent (“ideal response, virtually pain-free”). The correlations between the JOA score and the domains of the Shoulder36 were statistically calculated. The border between B and C was defined as the threshold for PASS. ResultsThere were significant correlations between the JOA score and the Shoulder36 domains. The responses to the anchor item were as follows: A (n = 0), B (n = 21), C (n = 76), and D (n = 48). The MCID for the JOA score was 19.5 points and the MCIDs for Shoulder36 were 0.5 points for pain, 0.667 for range of motion, 0.67 for muscle strength, 0.3 for general health, 0.571 for activities of daily living, and 1.0 for sports ability. The PASS cutoff value was 89.0 points for the JOA score and 3.8 points for pain, 3.667 for range of motion, 3.0 for muscle strength, 3.7 for general health, 3.7 for activities of daily living, and 3.0 for sports ability in the Shoulder36. ConclusionsThe MCID and cutoff PASS values for the JOA score and Shoulder36 identified in this study will help to determine the effectiveness of multidisciplinary management after ARCR.

Higher isokinetic quadriceps peak force is associated with a patient-acceptable symptom-state 1 and 3 years after ACL reconstruction.

The main purpose was to determine cut-off values for absolute (QNm/kg) and relative (QLSI) isokinetic knee extensor (KE) strength for achieving a patient-acceptable symptom state (PASS) in the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and for different age groups to determine the association between QNm/kg and QLSI and PASS, at 1 and 3 years after an anterior cruciate ligament reconstruction (ACLR). PASS was defined as reaching cut-off values for all KOOS subscales. Data from follow-ups were extracted from a rehabilitation registry. Male and female patients were divided into two age groups based on their age at primary ACLR: 16-24 years and 25-65 years. Odds Ratios between the QNm/kg and QLSI cut-off values and achieving PASS were calculated. Receiver Operating Characteristic curves were constructed to determine the individual predictive capacity for achieving PASS of QNm/kg and of QLSI using the area under the curve (AUC). Results from 755 and 145 patients (females = 51% and 52%; preinjury Tegner Activity level ≥6 = 82% and 74%) were used in the 1- and 3-year follow-up analyses. Reaching the cut-off values for the QNm/kg, ranging between ≥2.1 and ≥2.7, entailed between 2.09 and 5.12 times the odds of achieving PASS, across all groups at the 1-year follow-up. At the 3-year follow-up, the cut-off values of ≥3.4 and ≥2.6QNm/kg were associated with patients achieving PASS with acceptable accuracy (AUC = 0.700-0.780) in 16-41 year-old males and females. At 1 year after ACLR, patients of both sexes and age groups reaching cut-off values for absolute KE strength had two to five times the odds, that were clinically relevant, to achieve PASS. Acceptable discriminative capacity was found for the absolute KE strength among male and female patients 16-24 years old, at 3 years after ACLR. Level III.

Establishment of Minimum Clinically Important Difference and Patient Acceptable Symptom State Thresholds for Foot and Ankle Ability Measure and Visual Analog Scale Scores After Hallux Valgus Surgery.

Although clinically relevant thresholds such as minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) have been widely described across orthopaedics, their application in hallux valgus surgery remains scarce. The purpose of this study was to determine the MCID and PASS thresholds for the visual analog scale (VAS) and Foot and Ankle Ability Measure (FAAM) scores after hallux valgus surgery. A retrospective review was performed in patients undergoing hallux valgus surgery at a single institution from January 2021 through December 2022. Patient-reported outcome measures (PROMs) were collected preoperatively and 1 year postoperatively. The specific PROMs used were the FAAM-activities of daily living (FAAM-ADL), Single Assessment Numeric Evaluation (SANE), and VAS scale. Two methods were used to calculate MCID and PASS thresholds: a distribution-based approach for MCID and an anchor-based approach using responses to a 1-year postoperative satisfaction question for PASS. The analysis identified optimal cutoff points that maximized sensitivity and specificity based on the Youden index. Overall, 86% (136/158) completed baseline PROMs, and 73% (99/136) completed 1-year PROMs. The distribution-based MCID for FAAM-ADL, SANE, and VAS were calculated to be 10.8, 14.1, and 1.2, respectively. The percentage of patients who achieved MCID thresholds was 54% for FAAM-ADL, 42% for SANE, and 96% for VAS. The PASS threshold for FAAM-ADL, SANE, and VAS were ≥78.5, ≥85, and ≤ 2, respectively. The percentage of patients who achieved PASS thresholds was 78% for FAAM-ADL, 72% for SANE, and 69% for VAS. This study identified useful values for the MCID and PASS thresholds of FAAM-ADL, SANE, and VAS scores at 1-year follow-up for patients undergoing hallux valgus surgery. Overall, despite not meeting the MCID thresholds, patients undergoing hallux valgus surgery were still likely to be satisfied with their surgery.

Effect of Patient Resilience on Functional Outcomes After Anterior Cruciate Ligament Reconstruction.

Previous studies have examined the relationship between patient resilience and functional outcome scores after anterior cruciate ligament reconstruction (ACLR). However, past studies have failed to explore the longitudinal relationship between preoperative resilience and functional outcomes 2 years after ACLR. To evaluate the relationship between preoperative patient resilience and functional outcomes 2 years after ACLR. Cohort study; Level of evidence, 3. Patients were identified who underwent ACLR for anterior cruciate ligament tears between January and June 2020 at a single institution. Those who completed the Brief Resilience Scale preoperatively as part of routine patient questionnaires were considered for inclusion. Patients were contacted a minimum of 2 years after ACLR to complete the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR), Single Assessment Numeric Evaluation (SANE), International Knee Documentation Committee (IKDC) Subjective Knee Form, and visual analog scale (VAS). Outcomes were compared among patients with low resilience (LR), normal resilience (NR), and high resilience (HR), as defined in a previous study.23. A total of 81 patients were included in the final analysis, with 14 patients in the low preoperative resilience group, 54 in normal, and 13 in high. The mean age of the cohort was 32.0 years, and there were no significant differences in age, sex, race, graft type, or psychiatric comorbidities among the resilience groups. Significantly increased postoperative KOOS-JR scores were observed in patients in the HR group as compared with those in the NR and LR groups (94.8, 86.7, and 79.6, respectively; P = .031). There were also significantly increased postoperative SANE scores in patients in the HR group versus those in the NR and LR groups (92.3, 83.5, and 69.2; P = .012). Patients with high preoperative resilience achieved the IKDC Patient Acceptable Symptom State at significantly higher rates (P = .003). No significant differences were observed in postoperative VAS (P = .364), IKDC (P = .072), or change in IKDC (P = .448) over time among resilience groups. Postoperatively, 30 patients (37.0%) changed resilience groups, with 13 moving down and 17 moving up in category (low, n = 12; normal, n = 55; high, n = 14). Preoperative resilience correlated with KOOS-JR and SANE scores 2 years after ACLR but did not correlate with VAS, IKDC, or change in IKDC over the same period. Resilience was not static, with changes in resilience observed from initial to final evaluations. Resilience is not a strong predictor of postoperative patient-reported outcomes after ACLR.

Psoriatic arthritis phenotype clusters and their association with treatment response: a real-world longitudinal cohort study from the psoriatic arthritis research consortium

ObjectivesTo identify phenotype clusters and their trajectories in psoriatic arthritis (PsA) and examine the association of the clusters with treatment response in a real-world setting.MethodsIn the multicentre PsA Research Consortium...

Low-constraint insert with a medial pivot design as a potential predictor of favourable outcomes in cruciate-retaining total knee arthroplasty: A propensity score-matched analysis.

The influence of polyethylene insert conformity on the outcomes of cruciate-retaining (CR) total knee arthroplasty (TKA) with a medial pivot design remains uncertain. Therefore, this study aimed to evaluate the effects of polyethylene insert conformity in CR-TKA on patient-reported outcomes. The data of 255 knees (FINE Total Knee System) from 255 patients were retrospectively analysed to compare outcomes for high- or low-constraint medial pivot inserts, as determined through historical controls, over an average follow-up period of 2.2 years (range, 2.0-5.5 years). Multivariate logistic regression analysis was used to identify predictors of achieving the patient-acceptable symptom state (PASS) for the Forgotten Joint Score-12 (FJS-12). Propensity score-matched cohorts for age, sex, body mass index, Kellgren-Lawrence grade, Charlson Comorbidity Index, knee flexion contracture, FJS-12 and follow-up duration were created for between-group comparison (n = 50 in each group). Low-constraint insert (p = 0.031) and age (p = 0.043) were independent predictors of achieving the PASS for the FJS-12 (>33, 153/255). After successful matching, compared to the high-constraint insert, the low-constraint insert improved patient satisfaction (p = 0.029 for pain on going up or downstairs, and p = 0.047 for the function of going upstairs) and increased the likelihood of achieving the minimal clinically important difference (p = 0.019) and PASS (p = 0.025) for the FJS-12. A significant correlation was observed between the posterior tibial slope and the FJS-12 in the low-constraint insert group (p < 0.001), indicating that a greater posterior tibial slope was associated with better functional outcomes in this group. Compared with high-constraint inserts, low-constraint medial pivot inserts yielded higher functional outcomes and patient satisfaction. Therefore, insert conformity may play a crucial role in CR-TKA outcomes. Level III.

Autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, osteochondral autograft transplantation and osteochondral allograft improve knee function and pain with considerations for patient and cartilage defects characteristics: A systematic review and meta-analysis.

Previous studies have reported on the outcomes of autologous chondrocyte implantation (ACI) versus matrix-induced ACI (MACI) and microfracture. Specific clinical outcomes of ACI, MACI, osteochondral autograft transplantation (OAT) and osteochondral allograft (OCA) have not been well studied. The purpose of this systematic review and meta-analysis was to analyze the outcomes of these regenerative surgical techniques with an emphasis on comparing their effectiveness using the International Knee Documentation Committee (IKDC) subjective score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and the Visual Analogue Scale (VAS) score for the surgical treatment of tibiofemoral joint cartilage defects. An electronic search of MEDLINE, Embase and Cochrane Library was performed to identify studies that reported clinical outcomes for ACI, MACI, OAT and OCA procedures. The literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and only studies involving cartilage defects in the tibiofemoral joint were included. Outcomes were measured with the IKDC evaluation, Lysholm Knee Scoring Scale, Tegner Activity Scale and the VAS. Outcomes were compared to the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). The methodological quality of the included studies was analyzed by the Methodological Index for Nonrandomized Studies and the Jadad scale. Forty-seven studies were included representing a total of 1993 patients with a mean follow-up time of 57.2 ± 40.3 months (range: 4.0-160.0 months). The location of cartilage defects was reported in 46 studies, with a total of 1922 cartilage defects. There were 1277 medial femoral condyle cartilage defects, 488 lateral femoral condyle cartilage defects, 139 unspecified femoral condyle cartilage defects and 18 tibial plateau cartilage defects. All four procedures reported significant improvements in the Lysholm, IKDC, Tegner and VAS scores with no significant differences between them. The OAT technique surpassed the PASS threshold for the IKDC score while all four techniques surpassed the PASS threshold for Tegner and Lysholm scores. Additionally, all procedures met the MCID for each clinical outcome. This systematic review and meta-analysis indicate that ACI, MACI, OAT and OCA all result in significant improvements in knee function and pain for cartilage defects of the tibiofemoral joint. When selecting a procedure, patient and cartilage defect characteristics should be assessed to determine the best technique for each individual patient. Systematic review and meta-analysis. Level III.

Establishing Clinically Significant Improvement for Patients After Arthroscopic Surgery for Shoulder Instability With Large Labral Tears.

Patients with large labral tears represent a subset of traumatic shoulder instability cases. Outcomes after arthroscopic stabilization in these patients have been studied less compared with other tears. To establish minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) thresholds for patients after arthroscopic repair of labral tears ≥270°. Patient-reported outcome measures (PROMs) included the Rowe instability score, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain. Case-control study; Level of evidence, 3. A total of 52 arthroscopic large labral repairs (52 patients, mean age 28.7 years) performed in male active-duty military patients with a mean follow-up of 79.2 months (range, 24-117 months) met inclusion criteria and were included in the final analysis. All included patients completed the Rowe, ASES, SANE, and VAS pain preoperatively and at final follow-up, and the MCID, PASS, and SCB were calculated for each PROM score. Factors associated with achieving clinically relevant improvement were also calculated. The MCID, PASS, and SCB, respectively, for each PROM were as follows: 10.4 points, 90, and 35 points for the Rowe; 9.7 points, 80, and 43 points for the ASES; 9.9 points, 87, and 65 points for the SANE; and 1.1 points, 3, and 6 points for VAS pain. More than 90% of patients improved according to the MCID for each PROM, while >75% achieved the PASS threshold for each score. The percentage of patients who improved according to the SCB ranged from 9.6% for the ASES to 75% for the SANE. Maintenance of active-duty status was associated with achieving the MCID for the ASES and SANE, while recurrent instability was associated with lower rates of Rowe MCID achievement and SANE PASS achievement. Higher preoperative scores were also associated with lower rates of achieving clinical improvement. Thresholds found for the MCID, PASS, and SCB in active-duty patients undergoing surgery for shoulder instability with labral tears ≥270° were similar to those for all-comers with anterior instability. Factors associated with achieving success or lack thereof on PROMs included maintenance of active-duty status and lower preoperative PROM scores.

Establishing Clinical Significance for Patients Undergoing Arthroscopic Repair of Type II SLAP Lesions.

Type II superior labrum anterior to posterior (SLAP) lesions may be treated with either arthroscopic repair or biceps tenodesis. There are no previous reports of measures of clinically significant improvement after arthroscopic repair of SLAP lesions. To establish the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) for patients undergoing arthroscopic repair for type II SLAP lesions. Case series; Level of evidence, 4. A total of 69 arthroscopic repair procedures for isolated type II SLAP lesions were performed in a military population. The mean age was 28.1 ± 4.7 years, 97.1% were male, and the mean follow-up was 99.5 ± 19.7 months. The MCID, PASS, and SCB were calculated for each patient-reported outcome measure, consisting of the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain, using anchor- and distribution-based models. Factors associated with achieving a clinically relevant improvement were also determined. The MCID, PASS, and SCB for each measure were as follows: 7.7, 70, and 34 for the ASES score, respectively; 10.4, 80, and 45 for the SANE, respectively; and 1.0, 4, and 6 for the VAS pain, respectively. At least 85% of patients achieved the MCID for each measure; however, PASS rates were lower, with 50.7% for the SANE and 69.6% for both the ASES score and VAS pain. The ASES score had the highest percentage of patients achieving the SCB at 44.9%, followed by the SANE (26.1%) and VAS pain (10.1%). Greater forward flexion at final follow-up was associated with achieving the MCID and PASS for both the ASES score and SANE. Internal rotation stiffness at final follow-up was negatively associated with achieving the PASS for the VAS pain. Combat arms military occupational specialty was associated with a lesser likelihood of achieving the SCB for the ASES score. Clinical metrics of improvement were defined for the ASES score, SANE, and VAS pain using the MCID, PASS, and SCB for patients undergoing arthroscopic repair of type II SLAP lesions. Better final range of motion was positively associated with achieving improvement, while high-intensity military duty was negatively associated.

Time Required to Achieve Clinically Significant Outcomes After Anteroinferior Arthroscopic Capsular Release for Shoulder Adhesive Capsulitis.

The specific time required to reach clinically significant outcomes for patient-reported outcome measures (PROMs) after arthroscopic capsular release (ACR) for the treatment of shoulder adhesive capsulitis remains unknown. To determine the time required to achieve the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) score thresholds after ACR for visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons score (ASES), Single Assessment Numeric Evaluation (SANE), and Constant score and to identify patient factors associated with delayed achievement of these clinical benchmarks. Case series; Level of evidence, 4. A prospective analysis was performed of patients who underwent ACR for the treatment of idiopathic shoulder adhesive capsulitis between October 2019 and October2020. Patients completed PROMs preoperatively and at 1, 2, 4, 6, and 12 months postoperatively. Threshold values for MCID and PASS were obtained from previous literature for the VAS, ASES, SANE, and Constant scores. A total of 73 patients were included (mean age, 55.5 ± 9.3 years; body mass index [BMI], 26.6 ± 4.6 kg/m2). By 1-year follow-up, the cumulative percentage of patients achieving the MCID and PASS for VAS, ASES, SANE, and Constant scores was 98.6%, 100%, 100%, and 98.6%, and 95.8%, 91.7%, 98.6%, and 84.9%, respectively. The median time required to reach the MCID thresholds for VAS, ASES, SANE, and Constant scores was 1, 1, 2, and 1 month, respectively. The median time required to reach the PASS thresholds for VAS, ASES, SANE, and Constant scores was 4, 4, 4, and 2 months, respectively. Factors associated with delayed achievement of MCID for SANE included higher BMI (hazard ratio [HR], 0.94; 95% CI, 0.88-0.99) and diabetes (HR, 0.49; 95% CI, 0.2-0.99). Age was associated with delayed achievement of the PASS for VAS. Most patients undergoing ACR achieved clinically significant outcomes within a 4-month timeframe. The majority of patients reached MCID thresholds on outcome measures within 1 to 2 months and achieved satisfactory symptom states within 2 to 4 months postoperatively. By delineating the timeline of patient-perceived benefits, these results provide useful data to set appropriate expectations, guide rehabilitation, and optimize outcomes after ACR.

Defining Clinically Significant Outcome Thresholds for the Patient-Reported Outcomes Measurement Information System (PROMIS) at 2 Years After Gluteus Medius and/or Minimus Repair.

Clinically significant outcome (CSO) thresholds are invaluable to the interpretation of patient-reported outcomes (PROs). The Patient-Reported Outcomes Measurement Information System (PROMIS) is gaining popularity among the orthopaedic community; however, CSO thresholds for PROMIS are yet to be defined for outcomes after gluteus medius and/or minimus (GM) repair. To (1) define CSO thresholds for PROMIS-Pain Interference (PROMIS-PI) and PROMIS-Physical Function (PROMIS-PF) after GM repair, (2) correlate these PROMIS scores with legacy hip-specific PROs, and (3) quantify their floor and ceiling effects. Case series; Level of evidence, 4. Consecutive patients who underwent primary GM repair between September 2017 and June 2021 with completed PROMIS at minimum 2-year follow-up were evaluated. The minimal clinically important difference, Patient Acceptable Symptom State, and substantial clinical benefit thresholds were defined for the PROMIS-PI and PROMIS-PF as well as for legacy PROs: Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Hip Outcome Score-Sports Subscale (HOS-SS); modified Harris Hip Score (mHHS); 12-item International Hip Outcome Tool (iHOT-12); and the visual analog scale (VAS) for pain and satisfaction. Pearson correlations were performed between PROMIS scores and legacy PROs. Rates of floor and ceiling effects were quantified. Overall, 107 patients (81.7% follow-up compliance; mean age, 59.8 ± 8.8 years; 92.5% female; mean body mass index, 28.6 ± 6.3 kg/m2) were included in the analysis. GM tears were partial thickness in 56.1% of cases and treated endoscopically in 64.5% of cases. The minimal clinically important difference, Patient Acceptable Symptom State, and substantial clinical benefit thresholds, respectively, were as follows: PROMIS-PI (-4.6, 56.0, 52.6), PROMIS-PF (3.5, 42.7, 43.7), HOS-ADL (10.7, 68.2, 78.6), HOS-SS (16.5, 58.6, 60.6), mHHS (9.0, 64.3, 71.5), iHOT-12 (14.2, 63.6, 69.4), VAS pain (-16.1, 34.9, 28.1), and VAS satisfaction (not applicable, 70.9, 93.6). Moderate to strong correlations were observed between the PROMIS and legacy PROs. The PROMIS-PI showed a significant postoperative floor effect of 18.7%. Study findings indicated that the PROMIS is effective for use in GM repair patients, given the moderate-to-strong correlations between the PROMIS and legacy hip-specific PROs, the mostly limited floor and ceiling effects, and large effect sizes. Use of PROMIS instead of legacy PROs may aid in limiting survey burden.

Multiportal Arthroscopy-assisted Surgical Resection of Diffuse-type Tenosynovial Giant Cell Tumors in the Ankle Joint Yields Favorable Clinical Outcomes: A Retrospective Study.

Diffuse-type tenosynovial giant cell tumors (Dt-TGCTs) commonly occur in the knee joint and tend to recur postoperatively. However, limited clinical data are available on ankle joint involvement especially associated multiportal arthroscopic treatment outcomes. The purpose of this study was to report the clinical results of multiportal arthroscopy-assisted resection of Dt-TGCTs of the ankle. We retrospectively reviewed the clinical data of 33 patients with Dt-TGCT of the ankle who underwent multiportal arthroscopic treatment between August 2011 and December 2020. Clinical follow-up included the visual analogue scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) score, Kofoed score, and recurrence rate to assess surgical outcomes. The number of patients who achieved the patient acceptable symptom state (PASS) based on the AOFAS score was also examined. Additionally, the patients were categorized into two groups based on the final surgical approach: Group A who underwent multiportal arthroscopic synovectomy and Group AO who underwent combined arthroscopic and open surgical excision. Intergroup comparisons were conducted. Intraoperative characteristics, such as the number of patients with involvement of the tarsal tunnel and fibularis tendon and the Outerbridge grading of cartilage damage, were recorded to assess the selection of surgical procedures. Among the 33 patients, 15 were assigned to Group A, and 18 were in Group AO. The median follow-up duration for the 33 patients was 77 months (range, 28-142 months). The median VAS score was 1 (range, 0-4), the AOFAS score was 96 (range, 65-100), and the Kofoed score was 96 (range, 67-100). A total of 27 patients (82%) achieved PASS based on AOFAS scores, while five patients (15%) had recurrence. No statistically significant difference was observed between the two groups in recurrence rate, follow-up VAS score, AOFAS score, Kofoed score, or number of patients who reached the PASS (p > 0.05). In the AO group, 16 cases of Dt-TGCT involved the tarsal tunnel, and 11 cases involved the fibularis tendon. All these patients exhibited extension beyond the joint. In contrast, only one patient in Group A had involvement of the tarsal tunnel. Statistically significant differences were observed between the groups (p < 0.001). This study demonstrated that, with the assistance of a multiportal arthroscopic approach, surgical excision of Dt-TGCT in the ankle resulted in favorable clinical outcomes with a relatively low recurrence rate. Additionally, patients with extra-articular involvement were more likely to require concomitant open surgery.

Patients Have Acceptable Patient-Reported Outcome Measures After Medial Unicompartmental Knee Arthroplasty Regardless of Age

BackgroundContemporary evidence-based indications no longer consider age regarding eligibility for medial unicompartmental knee arthroplasty (mUKA). This has led to more surgical candidates; however, whether patients still have satisfactory outcomes lacks evidence. This study examined the association between age and change in patient-reported outcome measures (PROMs) after mUKA as well as the achievement of Patient Acceptable Symptom State (PASS) and Minimal Important Change (MIC). MethodsWe included 782 mUKAs performed between February 1, 2016, and April 26, 2023. The mean change from preoperative Oxford Knee Score (OKS), Forgotten Joint Score (FJS), and Activity and Participation Questionnaire (APQ) was assessed at three, 12, and 24 months after surgery. The achievement of 12-month PASS (OKS ≥ 30) and MIC (changes in OKS ≥ 8; FJS ≥ 14) was also assessed. Patients were divided into age groups: < 55, 55 to < 65, 65 to < 75 years (reference group), and ≥ 75 years. There were 432 women (55%), patients had a mean age of 67 years (range, 29 to 93) and a mean BMI of 30 (range, 20 to 53). ResultsMedian OKS, youngest to eldest, were 34, 35, 36, and 35 (three months); 40, 39, 41, and 43 (12 months); 42, 41, 43, and 42 (24 months). We found no differences in change in OKS between groups. Patients aged 55 to < 65 years had lower changes in FJS at 24 months and APQ at 12 and 24 months. Patients ≥ 75 years had lower 24-month change in APQ. We found no association between age and the fraction achieving either PASS or MIC (youngest to eldest, 90, 90, 94, and 95%). ConclusionWe found good PROM improvements and satisfactory outcomes after mUKA in all age groups; however, patients aged 55 to < 65 years had worse changes in FJS and APQ. Results support contemporary indications for mUKA, and applying an age cutoff is unwarranted.

Functional outcome after arthroscopic mosaicplasty for localised osteochondral defects in the knee

Background: Knee injuries are commonly encountered in active sports persons as well as nonathletes, with approximately 60% of patients having cartilage damage with or without associated ligament and meniscal injuries. In this study, we report on the functional outcome of autologous osteochondral grafting in localised cartilage lesions of the knee. MethodsA longitudinal follow-up study was conducted on 50 patients aged between 18-55 years with symptomatic focal cartilage defect in the knee of size less than 2.0 cm2 after necessary inclusion/exclusion criteria. Management involved arthroscopic autologous osteochondral grafting. The donor cartilage was from the non–weight-bearing region of the ipsilateral knee. Other associated intra-articular injuries were addressed in the same sitting. The patients were followed up after 6 weeks, 3 months and 6 months and clinical status documented by the Lysholm Knee Function Scale (LKFS). ResultsMost patients were young active males. Clinical presentation involved pain in all participants, followed by joint line tenderness. There was at least one associated injury to other intra-articular structures in 52% of the patients. The commonest associated injury was anterior cruciate ligament (ACL) tear followed by meniscus tear. The mean size of the focal cartilage defect was 1.013 cm2, ranging from 0.8 cm2 to 1.6 cm2. The mean preoperative LKFS was 56.97 ± 1.38 (standard error). There was a statistically (p < 0.001) as well as clinically significant (clinically important difference >13.0 and patient acceptable symptomatic state >70.0) improvement in the mean Lysholm score, which was 70 ± 1.32, 81.3 ± 1.12 and 92.1 ± 1.11 at the end of 6 weeks, 3 months and 6 months respectively. Eighty-four percent of the patients showed excellent functional outcome at 6 months (LKFS >90), whereas 8% and 4% had good and fair outcomes, respectively, at 6 months (LKFS: 70–90). Two patients (4%) who had failed ACL reconstruction had poor outcome (LKFS <70)at 6 months. ConclusionMosaicplasty is an excellent procedure for managing cartilage defects of small to medium sizes, less than 2.0 cm2. The short-term results are satisfying and can accelerate rehabilitation of sports injuries. It is noteworthy that instability is a contra-indication for the procedure to succeed.

Inferior Clinical Outcomes Following Endoscopic Proximal Hamstring Repair in Patients with Chronic Degenerative Tears Despite the use of Dermal Allograft Augmentation

PurposeTo compare clinical outcomes in patients undergoing endoscopic proximal hamstring repair with and without dermal allograft augmentation. MethodsA retrospective review of prospectively collected data was performed on patients undergoing endoscopic proximal hamstring repair (PHR) and proximal hamstring repair with dermal allograft augmentation (PHR-A) by a single surgeon between 2016 and 2023. Augmentation was utilized for cases of chronic degenerative tears (> 6 weeks from the time of initial injury) where hamstring tissue quality was deemed poor intraoperatively. A survey of patient-reported outcome measures (PROMs) was completed at a minimum of 1 year postoperatively. PROMs included a Visual Analogue Scale (VAS) for pain; University of California, Los Angeles (UCLA) Activity Scale; modified Harris Hip Score (mHHS); Hip Outcome Score-Sports-Specific Subscale (HOS-SSS); and a Single Assessment Numeric Evaluation (SANE). The proportion of patients achieving the minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) for PROMs were compared between groups. ResultsSixty-four patients were included (42 PHR, 22 PHR-A). No differences were seen between the PHR and PHR-A groups in terms of age at surgery (49 ± 12 vs. 54 ± 9, p=0.08), sex, or body-mass index (BMI). There was a significantly longer time to follow-up (41.5±23.4 vs. 20.1±10.2 months, p<0.001) in the PHR group. There were significantly greater postoperative mHHS (82.7±15.1 vs. 72.0±18.0, p=0.02) and SANE (89.6±9.9 vs. 73.6±22.5, p=0.002) scores in the PHR group. There were no significant differences in postoperative VAS, UCLA, or HOS-SSS between groups. A greater proportion of patients in the PHR group achieved a SCB for mHHS (71% vs. 36%, p=0.008). ConclusionsOur study demonstrates inferior clinical outcomes in patients undergoing endoscopic proximal hamstring repair with dermal allograft augmentation compared to patients undergoing endoscopic proximal hamstring repair without augmentation. Level of EvidenceIII, retrospective comparative case series

Anterior Cruciate Ligament Reconstruction With The Rectus Femoris Autograft – Results From The First 80 Patients

Objectives To report on the clinical outcomes and complications following anterior cruciate ligament (ACL) reconstruction using a novel rectus femoris autograft, including its clinical efficacy and safety. Methods Retrospective case series of patients undergoing isolated primary anatomic ACL reconstruction, with an outside-in technique, using a novel a rectus femoris autograft. Non-inclusion criteria consisted of partial tears; prior ipsilateral knee surgery; concomitant ligament, meniscus or cartilage procedures; follow-up shorter than 6 months. The primary clinical outcome measure was Lysholm score, including the percentage of patients achieving a previously published patient acceptable symptom state (PASS). Secondary outcomes included the observed rates for complications, as well as graft failure rate. Results 80 patients (53% male; mean age 28.95 ± 8,04 years) were included, with a mean follow up of 18.03 months (± 6,94; min 6, max 28). The mean postoperative Lysholm was 97.08 (± 2.63; min 90, max 100), with 100% of patients achieving PASS. There were three instances of graft amputation during harvest (3/83 = 3.61%), all of which occurred within the first 10 cases. An overall post-operative complication rate of 6.25% was observed, with 4 instances of hematoma at the graft harvest site (4/80 = 5%), one infection (1/80 = 1.25%) and no instances of graft failure (0/80 = 0%) at final follow-up. Conclusion The rectus femoris autograft is a suitable graft option for ACL reconstruction, with demonstrated clinical efficacy and safety in this initial case series. Potential benefits include a minimally invasive harvest technique without the need for additional instruments, and an observed length of around 30cm, which can be tailored to multiligament or revision cases. Longer follow-up and comparative studies are needed in the future in order to assess the long-term efficacy and failure rates.

Association between acute pain trajectory and patient-reported outcomes at 6-months following lumbar surgery for patients with lumbar degenerative disease.

To investigate the association between acute pain trajectory over one week and patient-reported outcomes (PRO) at 6-months following lumbar surgery in patients with lumbar degenerative disease (LDD). Two hundred and fifty-five subjects with LDD who received surgical treatment at our hospital between April 2019 and March 2022. Acute pain trajectory was measured using a pain trajectory calculator to determine an approximate line using the linear least squares method based on pain intensity on postoperative days 1, 3, 5, and 7. The pain trajectory-slope, which represents the change in postoperative pain intensity of the calculated approximation line, was evaluated as the main exposure for the present study. The PRO was assessed using the Oswestry Disability Index (ODI) measured at 6 ± 1 months postoperatively. Poor PRO scores in this study were defined using a threshold of an ODI of 22% or greater, which represents the patient acceptable symptomatic state after lumbar spine surgery. Multivariable logistic regression analysis including covariates was performed to investigate the association between pain trajectory-slope and PRO at 6-months following lumbar surgery. In this study, 101 (39.6%) had poor PRO scores. Multivariable logistic regression analysis adjusted for covariates showed that pain trajectory-slope was associated with the poor PRO scores (odd ratios; 1.203, 95% confidence intervals; 1.130-1.288). The results of this study show that acute pain trajectory is significantly associated with poor PRO scores 6-months after lumbar surgery. Patients with slower pain relief or worsening pain were associated with poor PRO scores.