Patient-reported Functional Outcomes Research Articles

Quantifying the Relationship Between Clinician-Administered Measures of Vestibulo-Ocular Reflex and Oculomotor Function and Patient-Reported Outcome After Pediatric Mild Traumatic Brain Injury.

In pediatric mild traumatic brain injury (mTBI), high rates of abnormalities are observed in vestibulo-ocular reflex (VOR) and oculomotor (OM) function, but there is a lack of understanding of how these impairments may affect daily functioning. To determine the extent to which clinician-administered measures of VOR and OM function are associated with patient-reported levels of activity limitations and participation restriction in children and adolescents within 31days post-mTBI. Cross-sectional design. Tertiary care pediatric hospital. Participants with mTBI aged 7 to 17.99years. Participants were assessed on a battery of VOR and OM tests within 31days of injury. The Dizziness Handicap Inventory (DHI) and Cardiff Visual Ability Questionnaire (CVAQ) measured patient-reported dizziness and visual disability. The vestibular/ocular motor screening tool (VOMS), Head Thrust Test, computerized Dynamic Visual Acuity (DVA) Test, and video Head Impulse Test were administered to assess VOR and OM function. Linear regression examined the associations between clinician-administered measures of VOR and OM function and patient-reported functional outcomes. The sample consisted of 100 youth (54.4% female; mean age 13.92 [2.63]; mean time since injury: 18.26 [6.16] days). Associations were found between (1) DHI score and age (1.773 [0.473-3.073], P =.01), VOR symptom provocation (18.499 [11.312-25.686], P ≤.001), and DVA (-29.433 [-59.206 to -2.60], P =.03); and (2) CVAQ score and version symptom provocation (0.796 [0.185-1.406], P =.01). High abnormal proportions (up to 56.7%) were found in VOMS performance. The symptom provocation induced by VOR and OM tasks was associated with patient-reported dizziness and visual disability outcomes, highlighting the detrimental impact of symptoms on daily functioning. The findings of this study will assist clinicians when interpreting patient-reported measures of activity limitation and participation restriction.

What Functional Outcomes Can Be Expected With Osseointegrated Prostheses in Transfemoral Amputations?

Individuals who have undergone transfemoral amputation often have difficulty donning and utilizing a conventional socket prosthesis. Osseointegrated prostheses may alleviate certain issues, potentially resulting in better outcomes, but few prospective studies have either evaluated these outcomes or quantified the purported benefits. (1) Did patient-reported outcome measures improve between baseline and 2-year follow-up among those who underwent osseointegration surgery after transfemoral amputation? (2) What was the frequency and severity of early complications related to the osseointegration procedures? (3) What was the minimum clinically important difference (MCID) in a global patient-reported outcome measure in this patient population? Between October 2017 and October 2023, we recruited 41 participants to undergo transfemoral osseointegration surgery treated with the Osseointegrated Prostheses for the Rehabilitation of Amputees implant system for patients who had trouble utilizing traditional, socket-based prostheses. Of those, 5% (2 of 41) did not undergo surgery, 2% (1 of 41) were lost to follow-up, and 2% (1 of 41) died before the final 2-year follow-up, leaving 90% (37 of 41) for analysis in this prospective, observational trial. Participants were asked to complete the validated Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) and the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire before surgery as well as 3, 6, 12, and 24 months after the two-stage procedure. Thirty-seven participants (three women and 34 men; mean ± SD age 38 ± 10 years) reached the 24-month follow-up visit, and four patients were withdrawn. We tabulated the frequency and types of surgical complications that patients experienced and calculated the anchored-based MCID for the Q-TFA global score (0 to 100 maximum). The Q-TFA's global score is generated based on answers to three questions: "How would you summarize your level of function with your current prosthesis?", "How would you summarize the problems you experience with your current prosthesis?", and "How would you summarize your overall situation as an amputee?" Using the sum of the numerical scores for the three questions, we found the difference between the baseline and the final follow-up for the participants. Then, we took the first quartile of the difference to represent the median change in the lower 25% of the data and used this value as our MCID. Scores in the study group improved in nearly all domains of the Q-TFA and PROMIS, including those related to prosthetic use, prosthetic mobility, and physical function (all p < 0.05). Patients developed superficial infections in 29% (15 of 51) of implanted limbs, all of which were treated successfully with antibiotics alone; 7 patients developed deep infections, only 1 of which involved the bone and implant. The anchor-based MCID in the Q-TFA global score was calculated as 17 of 100 for this study population. Functional patient-reported outcomes improved in multiple domains among our patient cohort who underwent osseointegration surgery after transfemoral amputation, demonstrating the promise of this technology for patients with unsatisfactory function using conventional, socket-based prostheses. Infections and other complications were lower than in prior studies of osseointegration following limb loss. The novel MCID that we report can be used to determine whether patients have clinically important improvement in future osseointegration surgery studies comparing results between different implants, surgical techniques, and patient populations. Level II, therapeutic study.

Patient-reported outcomes of esthetics, function and oral hygiene with single dental implants 10-15 years after placement: a cross-sectional study.

Little attention has been paid to patients' perception of function and esthetics with single dental implants. The aim of this study was therefore to describe patient-reported function and esthetic outcomes in single dental implants. A second aim was to study the objective esthetics in single dental implants. Patients with one single dental implant in the esthetic zone were selected. Two questionnaires with visual analog scales (VAS) were filled in by the patients, and intraoral photographs were taken. One of the questionnaires related to satisfaction with cleaning and function, and the other involved the esthetics of the single dental implant. One dentist reviewed the photographs using the pink esthetic score/white esthetic score (PES/WES) index. Results: For chewing and for speaking, the scores were 8.8 and 9.9 respectively on a VAS (best 10). The overall esthetic score on a VAS was 8.6 (best 10). The PES/WES in the present study was 14.6 (standard deviation [SD] ± 1.9), and 3/45 (6.7%) of the single dental implants never reached clinical acceptability. Conclusions: Patients reported high satisfaction with both the function and the esthetics of single dental implants. Both subjectively and objectively, the peri-implant mucosa was less favorable compared with the crown.

Refinement of post-COVID condition core symptoms, subtypes, determinants, and health impacts: A cohort study integrating real-world data and patient-reported outcomes

Post-COVID-19 condition (PCC) affects millions of people, and is an essential component of the long-term impact of COVID-19 during the post-pandemic era. Yet, consensus on clinical case definition and core components of PCC remains lacking, affecting our ability to inform research and evidence-based management. Our study aims 1) to identify the most specific symptoms for PCC, and identify clinical subtypes; 2) to evaluate both virus- and host-related determinants of PCC, and 3) assess the impact of PCC on physical and mental health. We studied participants from UK Biobank who completed a health and wellbeing survey between June and September 2022. Participants reported the current conditions of the presence, duration, and functional limitations of 45 symptoms, using an online questionnaire designed specifically for COVID-19 research. SARS-CoV-2 infection status and disease history were obtained through linkage to surveillance data and electronic medical records, respectively. Participants reporting symptoms within 30 days after infection (acute phase) were excluded. The most specific PCC symptoms were defined using two criteria: statistical significance (P<0.05 after Bonferroni correction) and clinical relevance (absolute risk increase > 5%). Propensity score weighting was used to control for confounding. Subtypes of PCC were then defined based on the specific symptoms among the COVID-19 infected individuals. A multivariable regression was used to study pathogen- and host-related risk factors for PCC, and its impact on 13 physical and 4 mental health patient-reported functional outcomes. 172,303 participants (mean age 68.9, 57.4% female) were included in the analysis, of whom 43,395 had PCR-confirmed COVID-19. We identified 10 most specific symptoms and classified four PCC subtypes: ENT subtype (30.1%), characterized by alterations in smell, taste, and hearing loss; cardiopulmonary subtype (10.4%), characterized by shortness of breath, postural tachycardia, chest tightness, and chest pressure; neurological subtype (23.5%), characterized by brain fog and difficulty speaking; and general fatigue subtype (38.0%), characterized by mild fatigue. A higher PCC risk was observed for patients with Wild-type variant, multiple infections, and severe acute COVID-19 illness, consistently across the four PCC subtypes. In addition, a range of factors, including socioeconomic deprivation, higher BMI, unhealthy lifestyle, and multiple chronic health conditions, were associated with increased PCC risk, except for age and sex. Conversely, vaccination was associated with a largely reduced PCC risk, particularly for the cardiopulmonary subtypes. Individuals with PCC experienced a much worse physical and mental health. Specifically, the cardiopulmonary subtype had the most pronounced adverse impact on function impairments, followed by neurological, mild fatigue, and ENT subtype. The most affected functions included the ability to concentrate, participate in day-to-day work, and emotional vulnerability to health problems. PCC can be categorized into four distinct subtypes based on ten core symptoms. These subtypes appeared to share a majority of pathogen and host-related risk factors, but their impact on health varied markedly by subtype. Our findings could help refine current guidelines for precise PCC diagnosis and progression, enhance the identification of PCC subgroups for targeted research, and inform evidence-based policy making to tackle this new and debilitating condition. NIHR Senior Research Fellowship (grant SRF-2018-11-ST2-004).

Patient-Reported Outcomes in Children Undergoing the Modified Green Procedure for Treating Sprengel's Deformity: Results from a Multicentric Study.

Sprengel's Deformity (SD) is a rare condition of the shoulder girdle, appearing as the principal congenital anomaly of the shoulder in paediatric patients. The aim of this study is to document the combined experience of two paediatric orthopaedic departments in managing SD using the modified Green Procedure, with a specific emphasis on the clinical and functional outcomes reported by patients; Methods: from June 2010 to February 2023, 42 shoulders in 40 paediatric patients were surgically treated for SD at two paediatric orthopaedic departments. All patients were treated using the modified Green Procedure with or without clavicle osteotomy. To better evaluate the deformity, the Cavendish's classification for aesthetic appearance and the Rigault's classification for radiological aspect were used, while movements of abduction and flexion were quantified to assess shoulder mobility. Several dedicated questionnaires such as QuickDASH, the Shoulder Pain Index and the Shoulder Disability Index (SPADI) and finally the UCLA Shoulder Scale were submitted to assess the quality of life of the subjects and the ability to practice certain activities, including work and sports. Complications were evaluated according to the modified Clavien-Dindo-Sink classification; Results: The mean follow-up was 5 years (range, 1.0-13.6). Clavicular osteotomy, performed in 15 patients, improved post-operative abduction by a mean of 25° (95% CI: 11-39°; p = 0.001). Three patients had complications (7.1%), with two requiring re-operation. At follow-up, 67.5% of patients had a qDASH score < 7, highlighting excellent functional outcomes. Shoulder function showed moderate correlation with pre- and post-operative flexion. The SPADI and UCLASS scores indicated significant improvement, with 70.0% reporting high satisfaction. Factors like sex, associated anomalies, and surgical technique did not impact patient-reported outcomes or satisfaction; Conclusions: The modified Green's technique has proven to be a safe procedure with a low rate of complications and satisfactory clinical and functional patient-reported outcomes.

A Prospective Study on Gait Impairment in Patients With Symptomatic Lumbar Canal Stenosis and Impact of Surgical Intervention on Gait Function.

Prospective observational cohort study. To analyze the effect of decompression surgery on gait characteristics in patients with stenosis. Also, to test the hypothesis that patient-reported functional outcomes and gait parameters (spatiotemporal, kinetic, and kinematic measures) will improve postoperatively and achieve normal values when compared with matched healthy controls. Lumbar spinal stenosis is one of the leading causes of disability among elderly population. Gait impairment is one of the primary symptoms of degenerative conditions involving lumbar spine. Research suggests that decompressive surgery can positively influence gait parameters in patients with spinal stenosis. Studies have shown improvements in walking speed, stride length, and balance post-surgery. Thirty-two patients with single-level lumbar stenosis and 32 healthy volunteers were prospectively recruited. All patients underwent gait analysis preoperatively and 6 months postoperatively as per standard protocol. Spatiotemporal, kinematic, and kinetic parameters were analyzed. Stepwise linear regression models were used to detect significant relationships between changes in functional score (Visual Analogue Scale/Oswestry Disability Index) and gait parameters. Significant improvement was noted in functional scores(P<0.05) 6 months post-surgery. Spatiotemporal (swing phase, mean velocity, cadence, stride length, step length, and step width) and kinetic parameters (hip, knee, and ankle power) were significantly better after surgery, reaching normal levels. Kinematic parameters significantly improved after surgery but did not reach normal levels when compared with controls. A significant correlation was found between changes in functional scores with changes in certain kinematic parameters (knee-power, ankle plantarflexion, swing time, peak ankle dorsiflexion in swing, peak-hip, and knee flexor moment). Decompression surgery in lumbar stenosis produces improvement in gait parameters, pain scores, and functional outcomes that significantly improve gait posture and speed.

Reverse Shoulder Arthroplasty in the Setting of Massive Proximal Humeral Bone Loss: A Systematic Review

Massive proximal humeral bone loss (PHBL) poses a technical challenge during reverse shoulder arthroplasty (RSA). Surgical treatment strategies include allograft-prosthetic composite (APC) reconstructions, endoprostheses, and other reverse shoulder arthroplasty constructs, however, there is a paucity of literature summarizing the outcomes and complications unique to this complex patient population. This study aimed to systematically review the literature to evaluate (1) patient-reported outcome measures (PROMs), (2) functional outcomes, and (3) complications according to surgical treatment strategy for patients with massive PHBL who undergo primary or revision shoulder arthroplasty. A systematic review of the PubMed/MEDLINE, Embase, and Cochrane databases was performed to identify studies reporting clinical outcomes and complications of reverse shoulder arthroplasty in patients with significant PHBL. Methodological quality was assessed for included studies. PROMs, radiographic outcomes, and postoperative functional outcomes were collected. Eleven studies evaluating clinical outcomes and complications of reverse shoulder arthroplasty in the setting of PHBL comprising 277 patients were included for review. The mean age was 66 years (range, 60-79 years). American Shoulder and Elbow Surgeons (ASES) score, Visual Analog Scale (VAS), and range of motion (ROM) were the most common outcomes collected, and patients exhibited significant improvements in mean scores postoperatively. Of the types of prostheses reported, there were 155 reverse shoulder arthroplasty (RSA) with allograft-prosthetic composite (APC) reconstructions, 48 proximal humeral replacement (PHR) endoprostheses, 41 RSA, 15 custom RSA, and 2 RSA with fibular strut allografts. The overall pooled complication rate was 30.1% (82/272) with revision/reoperation as the most common complication at 21% (57/272). The overall complication rate for RSA-APC reconstructions was 51% (79/155). The overall complication rate for PHR endoprostheses was 64.6% (31/48). Revision/reoperation rates were the most complication for both RSA-APC and PHR endoprostheses with rates of 20% and 31.3%, respectively. Treatment by APC reconstruction is the most common surgical technique described in the setting of massive PHBL. While shoulder arthroplasty can yield acceptable results for patients with substantial PHBL, such patients are at increased risk for complications and revision surgery.

Protected Early Mobilization Using Buddy Taping Versus Splint Immobilization for Fifth Metacarpal Neck Fractures: A Meta-Analysis

Metacarpal fractures are one of the more common fractures of the hand, with the fifth metacarpal neck fractures, commonly referred to as boxer’s fractures, comprising around 20% of all hand fractures. Currently, a variety of surgical treatment methods may be used for management, such as wire or plate fixations. Although these methods provide stable reduction, they are limited by higher costs and their invasive nature. Therefore, boxer's fractures have traditionally been treated conservatively with cast or splint immobilization, with these methods showing good functional outcomes. Recently, however, there have been studies showing similar results with the use of protected early mobilization with the use of soft wraps and buddy taping. This study aims to compare the patient-reported functional outcomes of treating undisplaced fifth metacarpal neck fractures with protected early mobilization using buddy taping versus cast/splint immobilization with the use of the Shortened Disability of the Arm, Shoulder and Hand Score (quickDASH). This study will be conducted with a comprehensive literature search from PubMed, Cochrane Library, Embase, Google Scholar and ScienceDirect from inception to October 2022. All randomized control trials comparing protected early mobilization with buddy taping and cast/splint immobilization of the fifth metacarpal neck fractures will be included.

Acellular Particulated Costal Allocartilage Improves Cartilage Regeneration in High Tibial Osteotomy: Data From a Randomized Controlled Trial.

This study aimed to compare short-term arthroscopic and clinical outcomes between microfractures with (treatment group) and without (control group) acellular particulated costal allocartilage in patients undergoing concurrent high tibial osteotomy (HTO). This retrospective cohort study enrolled 19 and 21 patients in the treatment and control groups, respectively, and reviewed them at a minimum 2-year follow-up after HTO. Cartilage regeneration status was evaluated according to the International Cartilage Repair Society-Cartilage Repair Assessment (ICRS-CRA) grading and Koshino's macroscopic staging systems during medial locked plate removal. Patient-reported measures, including the visual analog scale pain score, Knee Injury and Osteoarthritis Outcome Score, and International Knee Documentation Committee score, assessed clinical outcomes. The total points of the ICRS-CRA grading system were significantly higher in the treatment group than in the control group (7.7 ± 3.8 vs 4.2 ± 3.0, respectively; P = 0.007). Likewise, the cartilage status according to Koshino's macroscopic staging system was better in the treatment group (P = 0.022). Patient-reported functional outcomes significantly improved postoperatively but were equivalent between the study groups at the final follow-up. Microfractures augmented with acellular particulated costal allocartilage resulted in better repair quality than microfractures alone at a minimum 2-year follow-up after HTO, but functional outcomes improved similarly for both treatment approaches.

Comparison of pericapsular nerve group and lateral quadratus lumborum blocks on cumulative opioid consumption after primary total hip arthroplasty: a randomized controlled trial

IntroductionBoth the quadratus lumborum block (QLB) and the pericapsular nerve group (PENG) block provide effective postoperative analgesia after hip surgery while minimizing the impact on motor function. This study aimed...

Comparison of Percutaneous Repair and Open Repair for Delayed Treatment of Achilles Tendon Rupture

Category: Sports; Hindfoot Introduction/Purpose: Delays in diagnosis or treatment of acute Achilles tendon rupture are relatively frequent either due to the injury being misdiagnosed or the patient disregarding its severity. In the delayed presentation of Achilles tendon rupture, open repair is generally recommended for mobilization of the adherent and retracted tendons from the thickened paratenon layer repair although this introduces the risk of wound complications. Although a minimally invasive technique for acute Achilles tendon rupture has demonstrated lower infection rates, with functional results equivalent to those of open repair, their use in patients presenting in a delayed fashion has not been thoroughly investigated. The objective of this study is to compare the outcomes of percutaneous and open repair in cases of delayed presentation of acute Achilles tendon rupture. Methods: This was a retrospective study of prospectively collected data on consecutive patients who underwent either percutaneous or open repair for delayed presentation of Achilles tendon rupture and were followed up for at least one year. Delayed Achilles tendon rupture was defined as if patients underwent surgery 14 to 30 days after the injury and had received no treatment before surgery. The percutaneous repair was a modified Bunnell suture with an additional incision enough to permit mobilization of the tendon ends and core suture. An identical postoperative rehabilitation protocol was implemented in both groups: with below-knee cast in maximum plantarflexion, full weightbearing on the metatarsal heads was immediately allowed as tolerated. Postoperatively, the AT Resting Angle (ATRA), patient-reported functional outcomes using the AT Rupture Score (ATRS), and Calf circumference difference were evaluated. Postoperative complications, including re-rupture, wound infection, and sural nerve injury, were assessed. Results: There were no significant differences in demographic data between the percutaneous repair group (N =23) and the open repair group (N =23). The elapsed time from injury to surgical treatment and the gap between the proximal and distal stumps assessed on the MRI between the groups were similar. there were no statistically significant differences observed in ATRA (-2.9 ± 1.8 vs -2.1 ± 1.7, p = 0.687), ATRS (92.2 ± 2.5 vs 93.1 ± 2.6, p = 0.814), or calf circumference difference. Additionally, there were no cases of re-rupture in either group. A deep wound infection occurred in one patient in the open repair group. Symptoms related to sural nerve injury were observed in two patients in the percutaneous repair group, which resolved with conservative treatment. Conclusion: In cases of delayed presentation of Achilles tendon rupture, the percutaneous tendon repair technique is considered to yield comparable outcomes to the open tendon repair technique.

Comparison of Clinical Outcomes Between Cheilectomy and Proximal Phalangeal Dorsiflexion Osteotomy with and without Bone Marrow Aspirate Concentrate and Particulated Cartilage for Hallux Rigidus

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: Cheilectomy in conjunction with a proximal phalangeal dorsal closing wedge (Moberg) osteotomy is a popular strategy to manage early- to moderate-stage hallux rigidus. While the cheilectomy and Moberg osteotomy procedure has demonstrated good results, there are questions concerning how articular cartilage damage or an accompanying osteochondral lesion of the first MTP joint should be addressed, which could lead to persistent symptoms despite a technically well-performed operation. We propose that bone marrow aspirate concentrate (BMAC) combined with Biocartilage can be a viable adjunct that has demonstrated excellent outcomes in the treatment of OCLs in other joints. The purpose of this study was to compare clinical and patient-reported functional outcomes for patients who underwent cheilectomy and Moberg osteotomy with those who underwent cheilectomy and Moberg with BMAC. Methods: This was a single-center retrospective study conducted from the institutional review board-approved Foot and Ankle Registry data, and the protocol was approved by the steering committee at the investigators’ institution. Patients who received open cheilectomy with first proximal phalangeal dorsal closing wedge osteotomy with or without BMAC between 2016 to 2023. Inclusion criteria included patients aged 18 or older who underwent cheilectomy with Moberg osteotomy for a primary diagnosis of moderate to advanced hallux rigidus and had preoperative PROMIS scores. Excluded were patients without preoperative radiographs and patients with histories of previous ipsilateral forefoot surgeries, rheumatoid arthritis, or gout. Retrospective review of the registry was performed, and 137 patients were included. 71 treated with cheilectomy and Moberg osteotomy alone (CM) and 66 treated with cheilectomy and Moberg osteotomy with Biocartilage and BMAC (CMB). Results: Both CM and CMB cohorts demonstrated significant improvement in Physical Function, Pain Interference, Pain Intensity, and Global Physical Health. Preoperatively, there were no significant differences in PROMIS domains between the two cohorts. Postoperatively, there were no significant differences in PROMIS between the CM and CMB cohorts. There were no significant differences in the incidence of subsequent procedures on the ipsilateral first ray, revisions, conversions to first MTP arthrodesis, infections, progression to arthritis, and persistent pain. The rate of revision between the CM and CMB groups was not significantly different. Conclusion: This study compared short- to medium-term patient-reported clinical outcomes and complications of cheilectomy and Moberg osteotomy with and without BMAC for hallux rigidus. The addition of BMAC did not increase the incidence of postoperative complications while producing similar PROMIS scores at 1-year minimum followup. This study suggests that any potential differences in outcomes between groups are not large enough to be clinically meaningful in the short term and that other factors may be more relevant in determining the best course of treatment. A longer follow-up is required to warrant if the use of biologics in this procedure is necessary.

Can a New, Satellite Inpatient Hospital Maintain the Efficiency of an Ambulatory Surgery Center with No Difference in Patient-reported Outcomes? A Prospective Study

BackgroundPrevious research has found that anterior cruciate ligament (ACL) reconstructions performed at ambulatory surgery centers (ASCs) are more time-efficient. However, recent literature investigating this phenomenon within the pediatric population is limited and primarily retrospective. The goal of this study was to prospectively compare the operating room (OR) efficiency of pediatric ACL reconstructions performed across different surgical settings. MethodsAdolescent patients (12–18 years) undergoing ACL reconstruction by a single surgeon were prospectively enrolled from 2020 to 2024. Patients were cohorted based on the location of their surgery at one of three sites: 1) a traditional, tertiary care academic hospital, 2) hospital-owned ASCs, or 3) a satellite inpatient hospital that was built and connected to an ASC in January 2022. Patient preoperative, surgical, and postoperative data were collected, and surgical efficiency was compared across surgical sites using a variety of metrics. Patient-reported outcomes (PROMs) were collected using the Pedi-FABS and Pediatric International Knee Documentation Committee questionnaires. ResultsA total of 115 patients (56.5% female, mean age: 15.4 ​± ​1.7 years) met inclusion criteria and were enrolled. Thirty-one patients (27.0%) had ACL reconstructions at the main inpatient hospital, 36 (31.3%) at hospital-owned ASCs, and 48 (41.7%) at the new satellite inpatient hospital. When controlling for concomitant procedures, regional anesthesia type, and staff, there was a significant difference in total OR in-room, anesthesia induction, surgery preparation, surgery duration, and dressing application/wake-up times among the three cohorts (P ​< ​.001). Both the ASCs and the satellite inpatient hospital had shorter total OR in-room and surgery duration times than the main inpatient hospital (P ​< ​.001). There were no differences in PROMs among the three cohorts (P ​> ​.05). ConclusionsAdolescent ACL reconstructions performed at either an ASC or a satellite inpatient hospital were more time-efficient than those performed at a traditional, main inpatient hospital, with no differences in PROMs. Institutions should consider implementing strategies used at ASCs, such as standardized surgical teams, at main hospitals to increase efficiency. Key Concepts(1)A satellite inpatient hospital and ambulatory surgery centers are more time-efficient for adolescent ACL reconstruction than a main, inpatient hospital.(2)There were no differences in patient-reported functional outcomes after adolescent ACL reconstruction among ASCs, a main inpatient hospital, and a satellite inpatient hospital.(3)A satellite inpatient hospital can be as efficient as an ASC, with no significant difference in quality. Level of EvidenceII (Prospective Cohort Study)

Rehabilitation to Improve Outcomes after Cervical Spine Surgery: Narrative Review.

The increasing elderly patient population is contributing to the rising worldwide load of cervical spinal disorders, which is expected to result in a global increase in the number of surgical procedures in the foreseeable future. Cervical rehabilitation plays a crucial role in optimal recovery after cervical spine surgeries. Nevertheless, there is no agreement in the existing research regarding the most suitable postsurgical rehabilitation program. Consequently, this review assesses the ideal rehabilitation approach for adult patients following cervical spine operations. This review covers activities of daily living and encompasses diverse treatment methods, including physiotherapy, specialized tools, and guidance for everyday activities. The review is organized under three headings: (1) historical perspectives, (2) patient-reported functional outcomes, and (3) general and disease-specific rehabilitation. Rehabilitation programs are determined on the basis of patient-reported outcomes, performance tests, and disease prognosis. CSM requires strengthening of the neck and shoulder muscles that have been surgically invaded. In contrast, the CCI requires mobility according to the severity of the spinal cord injury and functional prognosis. The goal of rehabilitation for CCTs, as for CCIs, is to achieve ambulation, but the prognosis and impact of cancer treatment must be considered. Rehabilitation of the cervical spine after surgery is essential for improving physical function and the ability to perform daily activities and enhancing overall quality of life. The rehabilitation process should encompass general as well as disease-specific exercises. While current rehabilitation protocols heavily focus on strengthening muscles, they often neglect the crucial aspect of spinal balance. Therefore, giving equal attention to muscle reinforcement and the enhancement of spinal balance following surgery on the cervical spine is vital.

FDA Approval Summary: Belzutifan for Patients with Advanced Renal Cell Carcinoma.

On December 14, 2023, the U.S. FDA approved belzutifan (Welireg, Merck & Co., Inc.) for patients with advanced renal cell carcinoma (RCC) following treatment with a PD-1/PD-L1 inhibitor and a VEGF tyrosine kinase inhibitor. The FDA granted traditional approval based on LITESPARK-005 (NCT04195750), an open-label, randomized, head-to-head trial of 746 patients with advanced RCC that progressed following treatment with both a PD-1/PD-L1 inhibitor and a VEGF tyrosine kinase inhibitor. Patients were randomized (1:1) to receive belzutifan or everolimus. The primary endpoints were progression-free survival (PFS) assessed by blinded independent central review and overall survival. A statistically significant improvement in PFS was demonstrated for belzutifan compared with everolimus [HR = 0.75; 95% confidence interval (CI), 0.63-0.90; one-sided P value = 0.0008]. Kaplan-Meier curves reflected nonproportional hazards with similar median PFS estimates of 5.6 months (95% CI, 3.9-7.0) in the belzutifan arm and 5.6 months (95% CI, 4.8-5.8) in the everolimus arm. Although not reaching full maturity, the overall survival results seemed to show a favorable trend in the belzutifan arm compared with the everolimus arm (HR, 0.88; 95% CI, 0.73-1.07). The confirmed objective response rate by blinded independent central review was 22% and 3.6% in the belzutifan and everolimus arms, respectively. Observed toxicities differed between treatment arms, but drug discontinuations and interruptions due to treatment-emergent adverse events were lower in the belzutifan arm compared with the everolimus arm, and a descriptive analysis of patient-reported symptom and functional outcomes was suggestive of favorable tolerability for belzutifan compared with everolimus.

Nonoperative Management of High Ankle Sprains: A Case Series With ≥18-Year Follow-up

Background: High ankle sprains are common athletic injuries and can be associated with long-term sequelae. Regardless of operative or nonoperative treatment, there is a paucity of data in the literature about the long-term outcomes of high ankle sprains. Hypothesis: Nonoperative treatment of high ankle sprains utilizing a standardized protocol will result in good long-term outcomes. Study Design: Case series; Level of evidence, 4. Methods: Patients who experienced a high ankle sprain without radiographic diastasis of the syndesmosis were identified from a previous study database and contacted for long-term follow-up. All patients were high school or National Collegiate Athletic Association Division IA athletes at initial injury and were treated nonoperatively with the same standardized protocol. Patients completed a questionnaire that included documentation of any interim ankle injuries, 2 different patient-reported outcome scores, and ankle radiographs to conduct Kellgren-Lawrence scoring for ankle osteoarthritis. Results: In total, 76 cases in 74 patients were identified in the database. A total of 40 patients were successfully contacted, and 31 patients (24 collegiate and 7 high school athletes) with 33 high ankle sprains completed the survey (31/40; 77.5%). The mean age at follow-up was 45 years (range, 34-50 years), with a mean time from injury to follow-up of 25 years. Overall, 93.5% (n = 29) of the respondents were male, and 42% (n = 13) of the respondents reported an ipsilateral ankle injury since their initial injury, with 16% (n = 5) having ankle or Achilles surgery. The mean Patient-Reported Outcomes Measurement Information System-10 score was 53.4 (SD, 8.3; range, 37.4-67.7), PROMIS median (IQR), 54.1 (39.9, 68.3), and the mean Self-reported Foot and Ankle Score score was 42.7 (SD, 5.86). Follow-up ankle radiographs were obtained in 11 (35%) of the respondents; 27% had Kellgren-Lawrence grade >2 osteoarthritis, and 36% had signs of heterotopic ossification on imaging. The mean tibiofibular clear space was 4.5 mm, and the mean tibiofibular overlap was 7.15 mm, with 27% of patients demonstrating some tibiotalar narrowing. Conclusion: At long-term follow-up, nonoperative management of high ankle sprains without diastasis on imaging was associated with acceptable patient-reported functional outcomes and low rates of subsequent ankle injuries. There was a high incidence of arthritis, but most cases were not clinically significant. This case series shows the natural history of nonoperatively treated high ankle sprains and may serve as a comparison for different management techniques in the future.

Above-Knee Amputation Following Chronically Infected Total Knee Arthroplasty: Patient-Reported Satisfaction and Functional Outcomes

BackgroundPeriprosthetic joint infection (PJI) that arises following total knee arthroplasty (TKA) can usually be resolved through surgical and antimicrobial therapy. However, in approximately 5% of cases, an infection that is chronic and persistent will require treatment by above-knee amputation (AKA). This study seeks to provide an enhanced understanding of patient functionality and satisfaction following this devastating complication of one of the most commonly performed surgeries in the world. MethodsA retrospective chart review of all patients who underwent an AKA as a result of PJI following TKA at our center between January 2000 and November 2023 was performed. Patients completed a post-TKA AKA functionality and satisfaction questionnaire, as well as the 12-item short form survey. Of 27 eligible patients, 14 were contacted by phone for follow-up, six were deceased, six could not be reached, and one declined participation. The mean age at AKA was 62 years old (range, 43 to 85). Patients had an average of 5.5 procedures (range, 3 to 8) between primary TKA and AKA. The average follow-up time post-AKA was 38.5 months (range, 12 to 102). ResultsOf the patients, 85.7% were satisfied with their AKA, 85.7% would choose AKA again, and 71.4% would have proceeded with AKA earlier in retrospect. The average 12-item short form survey physical and mental component scores were 37.1 and 50.6, respectively. ConclusionsDespite important limitations in functional and ambulatory status, the vast majority of patients who underwent an AKA following an infected TKA are satisfied with their amputation and would choose this treatment modality again if necessary, with many indicating they would do so at an earlier time point. In light of these results, the option of amputation should, when medically indicated, be discussed in a sensitive, but timely manner with patients undergoing treatment for recalcitrant PJI.

Targeted Ablation Using Ultrasound-Guided Irreversible Electroporation of Index Tumors (TARGET Study): Prospective Development Study Evaluating Safety, Patient-Reported Outcomes, and Oncologic Efficacy.

We studied patient-reported functional outcomes, safety, and oncologic efficacy of focal irreversible electroporation as a primary treatment for intermediate-risk prostate cancer. Between February 2015 and April 2017, 20 consecutive patients elected irreversible electroporation and underwent 22 treatments. All underwent MRI-targeted and systematic transrectal biopsies. Eligibility criteria were grade group 2/3 prostate cancer in a maximum of 2 adjacent sextant prostate sectors in 1 hemigland without extraprostatic extension on MRI. Ablation was performed with a 5-mm cancer margin. Any grade group 1 cancer outside mapped index lesion was untreated. Outcome measures were based on the Prostate Quality of Life Survey, Male Sexual Health Questionnaire, and MRI-targeted and systematic biopsies at 3 and 12 months. Nineteen patients completed irreversible electroporation. One had electrocardiographic changes, and irreversible electroporation was aborted. No deterioration was detected in urinary or sexual domains (-0.2, 95% CI -1.4, 0.9, P = .7, and -1.9, 95% CI -10.1, 6.4, P = .6, respectively) or health-related quality of life (-0.2, 95% CI -1.4, 1.0, P = .7) at 6 months post ablation. Ejaculation volume decreased at 12 months (-1.5 points, 95% CI -2.4, -0.5, P = .003). At 12 months of follow-up, 14/19 patients (74%, 95% CI 49%, 91%) had no clinically significant cancer anywhere in the prostate. Radical treatment-free survival was 79% at 2 years (95% CI 53%, 92%) and 73% at 4 years (95% CI 47%, 88%). Our data show promising oncologic and functional outcomes following focal irreversible electroporation treatment for carefully selected patients with intermediate-risk prostate cancer. Further research should compare irreversible electroporation with active surveillance.

Both Hamstring and Quadriceps Tendon Autografts Offer Similar Functional Outcomes After Arthroscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 50 Years or Older

PurposeThe purpose of this study was to compare the outcomes of hamstring tendon (HT) and quadriceps tendon (QT) autografts for anterior cruciate ligament (ACL) reconstruction in patients older than 50 years in terms of patient-reported functional outcomes, graft failure rates, complications, return to sports activity and the preference for sports. MethodsBetween 2010 and 2022, prospectively collected data were obtained from an institutional database. Patients older than 50 years with primary arthroscopic ACL reconstruction using either HT or QT autograft and a minimum of 2 years of follow-up were included. Patients with concomitant meniscus, cartilage and MCL injury were also included. Patients undergoing a revision ACL reconstruction or undergoing a primary ACL reconstruction using a graft other than HT or QT autograft, and patients with a contralateral knee injury or ipsilateral osteoarthritis (Ahlback stage 2 or higher) were excluded. Patients were evaluated for pre-injury and 2-year follow-up Lysholm knee score, Tegner activity level, Visual Analog Scale (VAS) for pain, graft failure, quadriceps tendon rupture, and return to sport. Mann-Whitney test was used for unpaired samples, whereas the Friedman test was used for analyzing variables over time. The chi-square statistic test was used to determine differences in categorical data between groups ResultsThe number of patients in the QT and HT groups was 85 and 143 respectively. The mean age was 54.4 [50-65] and 56.4 [50-65] for the QT and HT groups respectively, 49% and 51% were males in the QT and HT groups respectively. The two groups did not differ significantly in terms of age, gender, time from injury to surgery and concomitant injuries. No significant differences were found in the pre-injury patient-reported outcome scores (PROMs) as Lysholm, Tegner activity level and VAS for pain between the two groups (p>0.05). At the 2-year follow-up, Lysholm knee score, Tegner activity level and VAS for pain improved to pre-injury level and no significant difference was noted between pre-injury and 2-year follow-up functional scores between the two groups (p>0.05).Furthermore, at the 2-year follow-up, Lysholm score, and VAS didn't show significant differences between QT and HT groups. (p=.390; p= .131). Similarly, no differences have been reported in Tegner activity level scores between HT and QT groups at 2 years of follow-up. No significant differences in terms of minimal clinically important difference (MCID) have been detected between the two groups for Lysholm and Tegner activity scores (p = 0.410 and p = 0.420 for Lysholm score and Tegner activity level score respectively).The two groups did not differ in terms of patient’s percentage of sports participation at baseline, and 2 years of follow-up (p>0.05). A significant decrease (p=0.01) in skiing/snowboarding was reported in the HT group at a 2-year follow-up compared to baseline [116 (81%) vs 98 (69%)]. No case of graft failures and quadriceps tendon rupture was reported in either of the groups. ConclusionArthroscopic ACL reconstruction by using HT or QT autograft in athletically active older than 50 years patients provide satisfactory patient-reported functional outcomes and allows recovery of the pre-injury level of activity.

Is casting of displaced paediatric distal forearm fractures non-inferior to reduction under general anaesthesia? Study protocol for a pragmatic, randomized, controlled non-inferiority multicentre trial (the casting trial)

BackgroundTreatment of displaced distal forearm fractures in children has traditionally been closed reduction and pin fixation, although they might heal and remodel without surgery with no functional impairment. No randomized controlled trials have been published comparing the patient-reported functional outcome following non-surgical or surgical treatment of displaced paediatric distal forearm fractures.MethodsA multicentre non-inferiority randomized controlled trial. Children aged 4–10 years with a displaced distal forearm fracture will be offered inclusion, if the on-duty orthopaedic surgeon finds indication for surgical intervention. They will be allocated equally to non-surgical treatment (intervention) or surgical treatment of surgeon’s choice (comparator). Follow-up will be 4 weeks and 3, 6, and 12 months. The primary outcome is the between-group difference in 12 months QuickDASH score. We will need a sample of 40 patients to show a 15-point difference with 80% power.DiscussionThe results of this trial may change our understanding of the healing potential of paediatric distal forearm fractures. If non-inferiority of non-surgical treatment is shown, the results may contribute to a reduction in future surgeries on children, who in turn can be treated without the risks and psychological burdens associated with surgery.Trial registrationwww.clinicaltrials.gov (ID: NCT05736068). Date of registry: 17 February 2023.