Postoperative Outcome Measures Research Articles

Long-term Postural Stability Changes After Correction of Spinal Deformity: A prospective, controlled pilot study.

Prospective cohort study. This study aimed to investigate the durability of postural stability after ASD correction surgery and its' association with clinical outcomes. The prevalence of symptomatic adult spinal deformity (ASD) necessitates surgical intervention, aiming to correct global spinal balance and spinopelvic parameters. Short-term studies have shown improvements in postural control following surgery, but the long-term impact remains unclear. This single-center prospective cohort study included adult patients undergoing long-segment fusion surgery between November 2019 and July 2021. Preoperative and postoperative balance assessments, radiographic analyses, and patient-reported outcome measures (PROMs) were conducted. Statistical analyses evaluated changes in postural stability and clinical outcomes. Fifteen ASD patients were analyzed. Significant improvements were observed in the early postoperative period in coronal center of pressure (COP) sway (P=0.048) and amplitude (P=0.027), total COP sway (P=0.042), coronal center of gravity (COG) amplitude (P=0.013), total COG sway (P=0.044), and head sway in the coronal plane (P=0.025). These improvements were maintained at the final postoperative visit for all measurements except coronal COG amplitude (early vs. last postoperative visit, P=0.040). Radiographic parameters, including pelvic incidence - lumbar lordosis mismatch (P=0.041) and sagittal vertical axis (P=0.032), also significantly improved postoperatively. PROMs revealed significant enhancements in VAS back pain (P=0.045), RAND SF-36 pain (P=0.016), RAND SF-36 physical functioning (P=0.008), and PROMIS pain interference (P=0.032) scores at the last follow-up. These results demonstrate that the postural stability improvements seen after ASD correction are durable and correlate with enhanced clinical outcomes, such as reduced back pain and improved physical functioning. These findings underscore the clinical importance of achieving sagittal alignment in ASD patients. Further research with larger cohorts and extended follow-up periods is warranted to confirm these associations and establish postural stability assessment as a vital parameter in evaluating patients' quality of life postoperatively. Level 3.

Early Impact of Hip Arthroscopy on the Resolution of Symptom Burden in Athletes With Femoroacetabular Impingement.

Coexisting symptoms can confound outcomes after arthroscopic correction of femoroacetabular impingement (FAI). Symptom burden (SB) represents the cumulative load of patient-reported symptoms. To quantify the prevalence of symptoms in athletes before and after arthroscopic correction of FAI and evaluate the impact of independent and cumulative SB resolution on outcomes. Case series; Level of evidence, 4. Included were 509 hips of 386 athletes (89% men; age, 26.4 ± 6.1 years) who underwent primary hip arthroscopy for FAI between 2011 and 2020. Symptom prevalence was assessed preoperatively and 1 year postoperatively using a 15-item SB survey, with the total number of symptoms reported as the SB score. Minimal clinically important difference (MCID-SB) and substantial clinical benefit (SCB-SB) thresholds according to the proportional pre- to postoperative resolution of SB were calculated, and 1- and 2-year postoperative patient-reported outcome measures (PROMs)-including the modified Harris Hip Score and 36-Item Short Form Survey-were compared relative to MCID-SB and SCB-SB achievement. Multivariable stepwise regression was used to evaluate the ability of individual symptom resolution for MCID and SCB achievements on PROMs. The SB score was 6 ± 2.9 preoperatively, improving to 2.8 ± 2.7 at 1 year postoperatively (P < .001). A proportional reduction in symptoms by 48.5% and 70.3% defined the MCID-SB and SCB-SB, respectively; this was achieved by 63.6% and 43.8% of the hips, respectively. Postoperatively, PROMs were superior where clinically meaningful SB resolution thresholds were achieved (P < .001). A significantly higher proportion of these cases returned to their main sport (79.4% vs 63.1% achieved MCID-SB; 83.8% vs 65.2% achieved SCB-SB) (P < .001). Odds ratios for symptoms associated with achieving the MCID on PROMs included resolution of groin pain (2.6-5.5), side hip pain (3.4), pain during (3.1) and after (2.6-3.5) activity, hamstring tightness (2.6), and limping after activity (2.6). Symptom resolution associated with achieving SCB included groin pain (3.0-3.1), pain during (3.3) and after (2.7-4.2) activity, and limping after activity (3-6.8). Achieving thresholds of clinically important SB resolution was associated with superior postoperative PROM scores and higher rates of return to sports for this athletic cohort. Resolution of groin pain, pain during/after activity, hamstring tightness, and limping after activity increased the odds of achieving clinically important improvement on PROMs.

Comparing Patient-Reported Outcomes in Patients Undergoing Lumbar Fusion for Degenerative Spondylolisthesis With Predominant Back Pain Versus Predominant Leg Pain Symptoms.

Retrospective review. This study aims to compare postoperative patient-reported outcome measures (PROMs) in predominant back pain (PBP) versus predominant leg pain (PLP) patients following lumbar fusion for degenerative spondylolisthesis (DS). Prior studies comparing PROMs in patients undergoing lumbar fusion with PBP versus PLP symptoms have included heterogeneous spinal pathology and restricted analysis to posterior fusion techniques. Demographics, perioperative characteristics, complications, and PROMs from a retrospective single-surgeon database were collected for primary, elective, and single-level lumbar fusion for DS. Preoperative/postoperative PROMs included visual analog scale (VAS)-back/leg pain (VAS-BP/VAS-LP), Oswestry disability index (ODI), 12-Item Short Form Physical and Mental Composite Score (SF-12 PCS/MCS), and Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF). Preoperative VAS-BP>VAS-LP established the PBP cohort and VAS-LP>VAS-BP established the PLP cohort. The average follow-up was 23.4±2.8 months. Improvement in PROMs (ΔPROM) at 6 weeks (ΔPROM-6W) and final follow-up (ΔPROM-FF) were calculated. χ2 and the Student t test analyzed categorical and continuous variables, respectively. Postoperative PROMs, ΔPROMs, and MCID achievement rates were compared between groups with multivariate linear or logistic regression. In total, 166 patients were selected with 108 in the PBP cohort. Both cohorts saw improvements in all PROM scores over time. The PBP cohort reported significantly greater ΔPROM-6W and ΔPROM-FF for VAS-BP (P<0.003). The PLP cohort reported greater ΔPROM-6W and ΔPROM-FF for VAS-LP and ΔPROM-FF for SF-12 PCS (P<0.014). MCID achievement rates for VAS-BP were higher in the PBP cohort, and VAS-LP MCID achievement rates were higher in the PLP cohort (P<0.015). Regardless of predominant pain location, patients-reported improvements in all PROs at the final follow-up. Patients with PLP-reported greater improvement in leg pain and physical function and patients with PBP-reported greater back pain improvement.

Lateral Extraarticular Tenodesis in Revision Anterior Cruciate Ligament Reconstruction: An Analysis of Clinical Outcomes and Failure Rates.

Background/Objectives: Lateral extraarticular tenodesis (LET) has been advocated in revision anterior cruciate ligament reconstruction (ACLR) to improve knee stability and furthermore, decrease failure rates. The aim of this study was to compare clinical outcomes, knee laxity, and failure rates after revision ACLR with LET (ACLR + LET) versus without LET. It was hypothesized that ACLR + LET improves clinical outcomes and reduces the failure rate. Methods: A retrospective analysis of prospectively collected data was conducted to examine patients who underwent revision ACLR with and without LET between 2017 and 2021 with a minimum follow-up of 24 months. Patients with coronal malalignment (>5°), posterior tibial slope >12°, and concomitant injuries to collateral ligaments were excluded. Patient reported outcome measures (PROMs) included the International Knee Documentation Committee (IKDC) subjective knee score, the Lysholm score, and the Tegner activity scale (TAS). Anterior knee laxity was measured with a Rolimeter and side-to-side difference (SSD) was determined. Revision ACLR failure was defined as ACL revision surgery and SSD > 5 mm. Group comparisons were performed using chi-square-, independent-samples students t-test or Mann-Whitney-U tests. Results: Of 56 eligible patients, 45 (80%, follow up, 23 isolated rACLR vs. 22 rACLR + LET) were included with a mean follow-up of 45.6 ± 15.8 months. Postoperative PROMs were not statistically different between rACLR and rACLR + LET groups (IKDC: 73.0 ± 18.9 vs. 68.7 ± 16.6, n.s.; Lysholm: 84.8 ± 12.3 vs. 77.7 ± 16.2, n.s.). Both groups showed similar TAS (rACLR vs. rACLR +LET (5; range 4-6 vs. 4; range 3-5; n.s.). Anterior knee laxity SSD was 2.4 ± 1.3 mm in the rACLR group and 1.8 ± 1.8 mm in the rACLR + LET group (n.s.). The failure rate was 13% in the rACLR group compared to 4.5% in the rACLR + LET group (n.s.). Conclusions: Isolated revision ACLR showed comparable postoperative patient-reported outcome measures and anterior knee laxity compared to ACLR + LET at mid-term follow up. The addition of a LET demonstrated a lower, though non-significant, failure rate after revision surgery. However, future studies with a prospective, randomized design and an increased number of patients are needed to clearly identify the exact indication for the use of additional LET.

Role of Preoperative Multiple-Drug-Resistant Bacteria Intestinal Colonization in Cardiac Surgery: A Retrospective Study.

Background/Objectives: Multiple-drug-resistant (MDR) bacteria are pathogens resistant to three or more antibiotic classes, and infection with these bacteria is associated with increased mortality, morbidity, and hospital management costs. Given the rise in antibiotic resistance, selecting appropriate antimicrobial drugs and avoiding the unnecessary use of new antibiotics are crucial. Due to their nosocomial nature, monitoring and preventing MDR infections are essential. Methods: This study enrolled patients who underwent cardiac surgery from January 2020 to May 2022. The patients included were those 18 years or older who tested positive for MDR intestinal colonization before surgery. Excluded were patients who tested positive after surgery, or were younger than 18, pregnant, or lactating. For each positive patient, the National Surgical Quality Improvement Program (NSQIP) score was calculated. The data collected included age, gender, body mass index (BMI), the type of surgery, the intensive care unit (ICU) length of stay, ICU readmission, mortality, and other infections (pneumonia, bacteremia, or surgical site infection) to establish a control group and postoperative outcome measures. Results: No statistically significant differences were found between the groups regarding the ICU length of stay, new ICU admissions, or mortality. Additionally, there were no differences in the infection rates, such as bacteremia, wound infections, and pneumonia. Conclusions: Preoperative rectal colonization by MDR bacteria does not appear to worsen postoperative outcomes for cardiac surgery patients. These findings suggest that patients with a preoperative MDR-positive rectal sample might undergo cardiac surgery without significantly increased risk. Besides the limitations of this study, pre-surgical antibiotic prophylaxis may not need to be adjusted for patients with preoperative MDR positivity.

Anterior cruciate ligament reconstruction with suture tape augmentation in the high-risk, young population.

This study evaluated patient-reported outcome measures and reinjury rates in higher-risk adolescents and young adults aged 14-25years old following Anterior Cruciate Ligament reconstruction using autograft with suture tape augmentation (SA ACLR). We performed a retrospective case series of patients aged 14-25 who underwent SA ACLR by a single surgeon between 2016 and 2020. After a minimum of 2years of follow-up, data was collected on reinjury and patient reported outcome measures, including Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale (MARS), Single Assessment Numeric Evaluation (SANE), and Visual Analog Pain Scale (VAPS). 27 patients were identified. 4 were lost to follow-up, and 23 met inclusion criteria (11 male, 12 female). Average age was 20, and average follow-up was 2.5years. Failure rate was 8.7%, with two patients requiring revision ACL reconstruction. One patient required two additional meniscal operations with intraoperative findings demonstrating maintenance of an intact ACL. Postoperative patient-reported outcomes measures (PROMs) were obtained for the patients who did not require additional surgery (n = 20), and preoperative PROMs were available for 16 of these patients. Postoperatively, patients reported a mean VAPS of 0.74 ± 1.27, MARS of 8.05 ± 5.58, and SANE of 83.05 ± 16.47. Mean KOOS was 86.92 ± 11.77 with subscores Pain of 86.94 ± 12.94, Symptoms of 82.16 ± 14.96, ADL of 95.81 ± 8.10, Sport of 75.61 ± 21.52, and QOL of 70.64 ± 22.04. Paired t-tests demonstrated significant improvements in VAPS, SANE, and KOOS outcomes following surgery. Patients were significantly less active postoperatively as reported by the MARS. A multivariable regression analysis showed that increased age predicted poorer postoperative KOOS Pain outcomes, and female sex predicted inferior KOOS Pain and Sport outcomes. SA ACLR is a safe and effective surgical technique in the high failure risk young adult demographic, with a low reinjury rate and acceptable KOOS scores. Patients were active with minimal pain at minimum two years of follow-up. Female sex was a risk factor for poorer outcomes in this population.

Transfibular Total Ankle Arthroplasty: Clinical, Functional, and Radiographic Outcomes and Complications at a Minimum of 5-Year Follow-up.

The Trabecular Metal Total Ankle Implant differs from other newer-generation implants in the transfibular approach, multiplanar external frame for alignment, tantalum trabecular metal interfaces, curved geometry, and shallow resection depths. The primary aim of this study was to report midterm clinical and radiographic results, as well as survivorship and adverse events at a minimum of 5-year follow-up. A total of 83 ankles (81 patients, average age 60.6 years old, 50.6% females) with average 6.3 years' (range, 5.0-10.1) follow-up were included. Postoperative patient-reported outcome measures (PROMs) included SF-12 physical (PCS) and mental component summary (MCS) scores, Ankle Osteoarthritis Scale (AOS), pain visual analog scale (VAS). Radiographic outcomes included postoperative range of motion (ROM) and coronal/sagittal alignment. Adverse events were reported using the Canadian Orthopaedic Foot and Ankle Society Reoperation Coding System (CROCS). Preoperative tibiotalar coronal deformity included 27 valgus (10 degrees, range 2-20 degrees) and 25 varus ankles (-9 degrees, range -2 to -25 degrees), corrected to neutral postoperatively. Postoperative tibiopedal ROM was 17.8 degrees dorsiflexion and 21.8 degrees plantarflexion. Adverse events occurred at average 28.7 months, most commonly gutter debridement (n = 17, 16.7%) and subsequent operative treatment unrelated to metal components (n = 10, 12.0%). There were 2 cases (2.4%) of acute deep infection treated with irrigation and debridement, polyethylene exchange, and retention of metal components without recurrence of infection. There were no cases of fibular nonunion, septic or aseptic loosening, or implant subsidence. Postoperative PROMS included SF-12 PCS: 40.4; SF-12 MCS: 56.0; VAS: 2.3; AOS Pain: 17.0; and AOS Disability: 24.9. Overall implant survival, defined by retention of the metal components, was 100% at final follow-up. At a minimum of 5 years, patients who underwent TM TAA reported minimal ankle pain and regained neutral ankle alignment and mobility, without septic or aseptic implant loosening. Although having certain limitations, this study suggests that TM TAA is a viable option for the treatment of end-stage ankle arthritis.

Five-item Modified Frailty Index in Elderly Patients Undergoing Laparoscopic Colorectal Surgery Predicts Postoperative Complications.

Owing to underlying diseases and decreased physiological functions, frailty in elderly patients may be associated with adverse postoperative complications and mortality. To date, there are various frailty assessment methods, with the five-item modified frailty index (mFI-5) being an objective and concise evaluation tool. This study aimed to clarify whether mFI-5 scoring, a measure of frailty, can predict postoperative outcomes in elderly patients undergoing laparoscopic colorectal surgery. A total of 107 patients aged over 80 years who underwent laparoscopic colorectal surgery at Nagasaki University Hospital between 2011 and 2018 were included in this study. The mFI-5 was used to assess the preoperative condition of each patient, with scores compared against various postoperative outcome measures. Univariate analysis was used to determine between-group differences for pre- and post-operative variables. Of the 107 patients [median age, 83 (80-99) years], 44.9% were male. The mFI-5 score was calculated and patients were divided into three groups: 0 (n=36, 33.6%); 1 (n=44, 41.1%); and 2+ (n=27, 25.3%). The groups were significantly associated with the American Society of Anesthesiology (ASA) classification (p<0.001). Postoperative complications occurred in 43 patients (40.2%), and a higher mFI-5 score was significantly associated with postoperative complications of Clavien-Dindo grade ≥III and duration of hospital stay. The mFI-5 is an objective and useful tool for predicting postoperative complications of laparoscopic surgery in elderly patients with colorectal cancer.

MCL pie crusting for concomitant medial meniscal surgery does not appear to adversely influence primary ACL reconstruction functional outcomes

ObjectivesMedial collateral ligament “pie-crusting” (MCLPC), selective release of the superficial MCL, has been shown to improve the arthroscopic access to the posterior horn of the medial meniscus without adversely affecting the outcomes of isolated meniscal surgery. However, whether MCL PC, to address concomitant meniscal lesions during anterior cruciate ligament reconstruction (ACLR) surgery, adversely affects ACLR outcomes is unknown. The aim of this study was to assess whether patients who had undergone MCLPC at the time of ACLR had similar post outcomes to patients undergoing isolated ACLR. Methods55 consecutive patients (33 male and 22 female), with minimum 2-year follow-up, who had undergone MCLPC with concomitant primary ACLR (PC group) were retrospectively matched on the basis of age, sex and follow-up with 55 patients who underwent isolated primary ACLR. Post-operative outcome measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee score, Tegner activity score, the EuroQol five-dimension health questionnaire and EuroQol visual analogue scale. ResultsThe two groups’ median postoperative EQ 5D-VAS, EQ 5D-index and Tegner scores were similar. The difference between pre-operative and post-operative KOOS scores was similar for the two group for all subscales except the ADL subscale which was higher in the MCLPC group (24, IQR ​= ​6–32) than in the isolated ACLR group (5, IQR ​= ​0–9.74). The median post op IKDC score was 84 in the MCLPC group and compared with 90 in the isolated ACLR group. However, the difference between pre-operative and post-operative IKDC scores was higher in patients in the MCLPC group (40, IQR ​= ​25–49) than in the isolated ACLR group (32, IQR ​= ​19.6–46.8). ConclusionsMCLPC, performed at the time of ACLR does not appear to adversely affect the functional post-operative outcomes. Level of evidenceIV.

Distal Mononeuropathy and Nerve Release After Open and Arthroscopic Shoulder Surgery: A Matched Cohort Analysis

The purpose of this study was to determine if patients who have undergone prior open or arthroscopic shoulder surgery and develop distal mononeuropathy (DMN) achieve the same clinical benefit after nerve release compared with those who did not have a prior shoulder procedure. Patients were identified by Current Procedural Terminology code for shoulder arthroplasty, shoulder stabilization, and rotator cuff repair and if they had an ensuing nerve release (cubital or carpal tunnel) within 2 years of shoulder surgery. Another cohort that underwent nerve release surgery for DMN with no prior history of shoulder surgery was identified and subsequently matched to the first cohort by a 3:1 (control:case) ratio. Patients were included if they were over the age of 18 years. Chart reviews and surveys stored using REDCap were used to collect demographics, surgical history, EMG/nerve conduction velocity results, postoperative symptoms, and patient-reported outcomes with a minimum 2-year follow-up. In total, 120 patients were included in this analysis (28 cases, 92 controls). The most common nerve release for DMN across both cohorts was open carpal tunnel release. Following nerve release, the case group had more postoperative persistent numbness/tingling than the control group. Both groups were similar with regard to postoperative pain, weakness, or patient-reported outcome measures. Residual postoperative numbness following nerve release was more likely to occur in the forearm for the case group than the control group. Patients with a history of arthroscopic rotator cuff repair and reverse total shoulder replacement shoulder surgery before the presentation of DMN are more likely to experience persistent numbness or tingling after nerve release surgery as well as experience symptoms in the forearm than those without prior shoulder surgery. Symptom prevalence retrospective study III.

Correlation between severity of preoperative low back pain and postoperative outcomes in lumbar disc herniation surgery: a retrospective cohort study

BACKGROUND CONTEXTLow back pain (LBP) frequently occurs in patients with lumbar disc herniation (LDH), however the extent to which discectomy ameliorates it and how preoperative LBP influences postoperative outcomes remains unclear. PURPOSETo evaluate the improvement in LBP and its impact on postoperative patient-reported outcome measures (PROMs). STUDY DESIGN/SETTINGMulticenter retrospective observational study. PATIENT SAMPLEPatients undergoing discectomy for LDH at 8 hospitals from April 2017 to March 2021. OUTCOME MEASURESData were collected on patients’ backgrounds, operative factors, and PROMs, including the Numeric Rating Scale (NRS) for pain in the low back, buttock, or leg, EuroQol 5 Dimension (EQ-5D), Oswestry Disability Index (ODI) scores, and postoperative satisfaction. METHODSPatients were categorized into mild (NRS 0–3), moderate (NRS 4–7), or severe (NRS 8–10) LBP groups. Inverse probability weighting with propensity scores was used to adjust for demographic and clinical differences between groups. Chi-square tests and one-way analysis of variance were conducted to compare background data and clinical characteristics. Additionally, multivariate logistic regression was performed to identify risk factors for less than 50% improvement in LBP. RESULTSThis study included 928 patients: 270 mild, 343 moderate, and 315 severe. After adjustment, preoperative NRS scores were significantly different across groups, with scores of 1.6 (SD 1.3), 5.6 (SD 1.0), and 8.8 (SD 0.9), respectively. Postoperative NRS scores also varied significantly, with worse outcomes observed in the severe group compared to the mild group, yet similar to the moderate group. A total of 46.8% of the mild group, 86.6% of the moderate group, and 72.9% of the severe group achieved a 50% decrease in NRS scores of LBP. Preoperative EQ-5D and ODI scores were significantly worse in the severe group compared to the mild or moderate groups, but postoperative scores were not significantly different between the severe and moderate groups. No significant differences in postoperative satisfaction were observed among the groups. Being female was a significant risk factor for less than 50% improvement in LBP (odds ratio = 1.56, p=.022). CONCLUSIONSDiscectomy significantly improved LBP in patients with LDH, including those with moderate or severe LBP. Patients with severe LBP showed similar improvements in PROMs as those with moderate LBP. Female gender emerged as a significant risk factor for less than optimal improvement in LBP.

Segmental Sagittal Alignment in Lumbar Spinal Fusion: A Review of Evidence-Based Evaluation of Preoperative Measurement, Surgical Planning, Intraoperative Execution, and Postoperative Evaluation.

Maintaining and restoring global and regional sagittal alignment is a well-established priority that improves patient outcomes in patients with adult spinal deformity. However, the benefit of restoring segmental (level-by-level) alignment in lumbar fusion for degenerative conditions is not widely agreed on. The purpose of this review was to summarize intraoperative techniques to achieve segmental fixation and the impact of segmental lordosis on patient-reported and surgical outcomes. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed, Embase, Cochrane, and Web of Science databases were queried for the literature reporting lumbar alignment for degenerative lumbar spinal pathology. Reports were assessed for data regarding the impact of intraoperative surgical factors on postoperative segmental sagittal alignment and patient-reported outcome measures. Included studies were further categorized into groups related to patient positioning, fusion and fixation, and interbody device (technique, material, angle, and augmentation). A total of 885 studies were screened, of which 43 met inclusion criteria examining segmental rather than regional or global alignment. Of these, 3 examined patient positioning, 8 examined fusion and fixation, 3 examined case parameters, 26 examined or compared different interbody fusion techniques, 5 examined postoperative patient-reported outcomes, and 3 examined the occurrence of adjacent segment disease. The data support a link between segmental alignment and patient positioning, surgical technique, and adjacent segment disease but have insufficient evidence to support a relationship with patient-reported outcomes, cage subsidence, or pseudoarthrosis. This review explores segmental correction's impact on short-segment lumbar fusion outcomes, finding the extent of correction to depend on patient positioning and choice of interbody cage. Notably, inadequate restoration of lumbar lordosis is associated with adjacent segment degeneration. Nevertheless, conclusive evidence linking segmental alignment to patient-reported outcomes, cage subsidence, or pseudoarthrosis remains limited, underscoring the need for future research.

Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury

PurposeTo investigate the influence of the timing of ACL reconstruction (ACLR) on patient-reported outcomes, comparing those with and without concomitant medial collateral ligament (MCL) injury. MethodsThis study included patients who underwent ACLR between September 2015 and October 2020. Inclusion criteria required patients to have preoperative and postoperative patient-reported outcome measures (PROMs) and a follow-up period of at least 2 years. Patients who sustained a grade 2 or 3 MCL injury with an ACL tear were compared to patients with no MCL injury as a control. All patients underwent ACL reconstruction using either bone-tendon-bone (BTB) autograft or BTB Allograft. Patient-reported outcomes (International Knee Documentation Committee (IKDC), Lysholm, and Knee Osteoarthritis and Score (KOOS)) were recorded, and outcomes were analyzed by sex and time from index injury. A stratified linear mixed-effects regression analysis was conducted. ResultsA total of 253 eligible patients with 2-year outcomes were enrolled. Combined ACL/MCL injury had lower IKDC (β=-6.1 vs β=-8.3, p=0.003), KOOS QOL (β=-9.3 vs β=-11, p=0.004), and KOOS Sport (β=-12 vs β=-13 , p=0.08) if performed after 6 weeks from index injury. Isolated ACL injuries showed lower KOOS ADL (β=-2.4, p=0.045) if surgery performed between 3-6 months. For combined ACL/MCL injury, autograft (compared to allograft) was found to have worse IKDC (β=-11 (-18, -4.2), p=0.002), Lysholm (β=-9.2 (-15, -3.1), p=0.004), KOOS QOL(β=-11 (-20, -1.6), p=0.023), KOOS Pain (β=-5.1 (-10, -0.03), p=0.049), KOOS Symptoms (β=-7.6 (-10, -0.03), p=0.02), and KOOS Sports (β=-21 (-32, -10), p=<0.001). ConclusionPatients undergoing ACL reconstruction with a grade 2 or 3 MCL injury have improved patient-reported outcomes if surgery is performed within 6 weeks from the time of injury. In this cohort, allografts resulted in better outcome scores compared with autografts. Level of EvidenceLevel III Retrospective Cohort Study

Utilizing T-Line Mesh for Periumbilical Hernia Repair: Evaluation of Short-term Outcomes.

Abdominal periumbilical hernias are prevalent within the adult population. When symptomatic, quality of life may be affected. This case series of 10 patients evaluates the short-term outcomes of using the T-Line mesh in periumbilical hernia repair. A retrospective review of adult patients with symptomatic periumbilical abdominal hernia treated with open repair with T-Line mesh was performed at a tertiary referral center. Ten patients with an average age of 51 years were offered surgical treatment. Measures of postoperative outcomes included readmission within the 30-day postoperative period; recurrence; surgical site infection; development of seroma and hematoma; and the presence of pain, numbness, or bloating. Descriptive statistics were computed in Microsoft Excel. All 10 patients reported improvement in symptoms. All repairs were elective and classified as clean (100%). Hernias included 40% primary umbilical, 50% ventral, and 10% incisional. The average defect size was 10 cm2, with a range from 1 to 25 cm2. The T-Line mesh was placed in a sublay manner, with an average mesh size of 36 cm2. No patients were readmitted in the 30-day postoperative period. There were no occurrences of surgical site infection or hernia recurrence. No hospital readmissions and no follow-up visits with hernia recurrence were noted at 3 months. We present a case series of 10 patients presenting with symptomatic periumbilical hernias who underwent repair with the T-Line hernia mesh without short-term surgical occurrences. Long-term studies are required to accurately reflect safety and efficacy.

Demographic Disparities and Outcomes Following Hip Arthroscopy: Exploring the Impact of Social Determinants of Health in Femoroacetabular Impingement Syndrome.

The purpose of this study was to explore the impact of social deprivation on preoperative characteristics and postoperative outcomes following hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS). Patients undergoing primary HA for FAIS were identified, and their social deprivation index (SDI) score was assigned on the basis of the provided ZIP code. Quartiles (Q1 to Q4) were established using national percentiles, with Q4 representing patients from the areas of greatest deprivation. Patient-reported outcomes (PROs) were collected preoperatively and at a minimum follow-up of 2 years. Achievement rates for clinically meaningful outcomes, including the minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB), were determined. The incidences of revision HA and conversion to total hip arthroplasty (THA) were recorded. SDI groups were compared with respect to preoperative characteristics and postoperative outcome measures. Predictors of MCID, PASS, and SCB achievement; revision HA; and conversion to THA were identified with use of multivariable logistic regression. In total, 2,060 hips were included, which had the following SDI distribution: Q1 = 955, Q2 = 580, Q3 = 281, and Q4 = 244. The composition of the included patients with respect to race and/or ethnicity was 85.3% Caucasian, 3.8% African American, 3.7% Hispanic, 1.7% Asian, and 5.4% "other." Patients with more social deprivation presented at a later age and with a higher body mass index (BMI), a longer duration of preoperative hip pain, and greater joint degeneration (p ≤ 0.035 for all). The most socially deprived groups had higher proportions of African American and Hispanic individuals, less participation in physical activity, and greater prevalences of smoking, lower back pain, and Workers' Compensation (p ≤ 0.018 for all). PRO scores and achievement of the PASS and SCB were worse among patients from areas of greater social deprivation (p ≤ 0.017 for all). Age, BMI, activity status, race and/or ethnicity classified as "other," SDI quartile, Workers' Compensation, preoperative back pain, duration of preoperative hip pain, and Tönnis grade were independent predictors of clinically meaningful outcome achievement, revision arthroscopy, and/or THA conversion (p ≤ 0.049 for all). Individuals with more social deprivation demonstrated inferior postoperative outcome measures. This was driven primarily by preoperative characteristics such as SDI, hip pain duration, joint degeneration, and overall health at presentation. Despite differential outcomes, patients still showed clinical improvement regardless of SDI quartile. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Outcomes reported in elective colorectal cancer surgery research for older patients: A scoping review.

Colorectal cancer rates are increasing in older populations, who often have comorbidities and face higher surgical risks and mortality rates. Therefore, surgical outcomes, such as 5-year mortality rates, may not be appropriate, necessitating a focus on postoperative quality of life. However, determining optimal postoperative outcome measures for older colorectal cancer patients poses a challenge. This scoping review aimed to explore currently available data describing postoperative outcomes used to assess older patients undergoing elective colorectal cancer surgery. We conducted a comprehensive literature search of major electronic databases from inception to March 2023. Studies exploring frail or older individuals with colorectal cancer undergoing elective surgical procedures, and which reported postoperative outcomes, were included. Outcomes were categorized as surgery-specific versus person-centred and summarized using narrative synthesis. The type and rate of surgery-specific outcomes were tabulated. Of 1366 identified citations, 16 studies focused on person-centred outcomes and 66 reported exclusively on surgery-specific outcomes. Nine 'person-centred outcome' studies reported discharge destination, primarily home discharge. Postoperative delirium ranged from 8.2% to 18.1% in six studies. Four studies explored geriatric syndromes, three analysed activities of daily living, and three studies reported significant quality of life improvement. The 66 'surgery-specific outcome' studies assessed mortality (N = 61); length of stay (N = 40); postoperative complications (N = 47); readmission (N = 18); reoperation (N = 16); and survival (N = 42). Person-centred outcomes are underreported, but crucial for guiding patient management. Older patients require adequate information about their postoperative recovery period to enhance wellbeing. Future research must address this gap to improve care for older people undergoing elective colorectal cancer surgery.

Prevalence and Clinical Impact of Coronal Malalignment Following Circumferential Minimally Invasive Surgery (CMIS) for Adult Spinal Deformity Correction.

Retrospective study. To determine prevalence and clinical importance of patients who had postoperative CM after CMIS for ASD correction. We reviewed patients who underwent CMIS technique. Inclusion criteria were patients who were diagnosed with ASD, which is defined as having at least one of the following: coronal Cobb angle >20, SVA >50mm, PI-LL >10, PT >20. They underwent >4 spinal levels fusion with CMIS technique and had at least 1-year follow-up. Preoperative and 1-year postoperative radiographs and clinical outcome measures (VAS, ODI, and SRS-22 scores) were used to make the comparisons. 120 patients were included. Radiographic outcomes, including CVA, coronal Cobb angle, LSF curve, SVA, LL, and PI-LL, and clinical outcomes, were significantly improved postoperatively in each of the 3 preoperative subgroups (Bao type A, B, and C). At 1-year post-operation, 10 patients (12.4 %) of type A turned out to be CM, 4 patients (21.1%) of type B, and 8 patients (40%) of type C remained CM. Comparing coronally aligned (CA) to coronally mal-aligned patients at 1-year follow-up in each coronal subtype revealed that clinical and radiographic outcomes were comparable. CMIS technique significantly improves radiographic and clinical outcomes for ASD patients. Incidence rates of postoperative CM were similar to open surgery. Type C patients were at risk of postoperative CM than types A and B. However, most 1-year outcomes were not significantly different between postoperative CA and CM patients regardless of the preoperative coronal alignment characteristics except ODI scores in type A.

No Association Between Patient Reported Outcomes and Ankle and Hindfoot Osteoarthritis Radiographic Severity

Category: Ankle Arthritis; Ankle Introduction/Purpose: The Kellgren-Lawrence scale has been used as a valid and reliable system to grade osteoarthritis. This study seeks to examine the association between preoperative Kellgren-Lawrence (KL) scale grade of ankle or hindfoot arthritis and postoperative outcome measures (PROMs) in patients undergoing total ankle arthroplasty (TAA), ankle arthrodesis (AA), or hindfoot arthrodesis. Methods: A retrospective review was conducted of 254 ankles (250 patients) with minimum 6-month follow-up, undergoing TAA, AA, or hindfoot arthrodesis from 2016-2022. Patients were identified by having undergone surgery via CPT codes (27702, 27870, 27815, or 27825). 131 patients (51.6%) underwent TAA. Of patients undergoing various ankle and hindfoot fusions, involved joints were tibio-talar (n=83; 32.7%), sub-talar (n=46; 18.1%), talo-navicular (n=15; 5.9%) and calcaneocuboid 1 (0.3%). Preoperative KL grade of the joint undergoing arthrodesis/arthroplasty was evaluated. Data collected included demographics, medical history, PROMs (FAOS, FAAM, VAS, SSS-8, PDI, and PCS), postoperative complications, readmission and reoperation rates. The final cohort mean age was 58.26 (range 18-85) years with mean BMI 31.97 (range 17.85-61.38) kg/m2 and mean follow-up of 1.69 (range 0.50-6.13) years. Results: The overall cohort was primarily KL grade 3 and 4 at each of the examined joints. There were no significant differences in demographics or procedure performed between groups, with the exception of age, which was statistically significantly associated with an increased KL grade for the TN joint (p=.006). Preoperatively, the tibiotalar joints with a KL grade of 3 were associated with significantly higher preoperative SSS-8 scores (p=.002). A preoperative KL grade of 2 at the subtalar joint was associated with significantly lower preoperative FAOS recreation scores (p=.030). Postoperatively, there was no statistically significant difference in patient reported outcomes with any of the examined joints KL grade. Lastly, there was no statistically significant association between KL score of any joint and postoperative complication, readmission, or reoperation. Conclusion: There was no association between preoperative Kellgren-Lawrence grade and post-operative PROMs or mean 1.69 year outcomes following TAA, AA, or hindfoot arthrodesis. Surgeons should be aware that, at least for patients indicated for TAA or ankle/hindfoot arthrodesis, preoperative KL grade does not seem to impact short term PROM scores.

Superior Capsular Reconstruction Versus Reversed Total Shoulder Arthroplasty in Management of Massive Irreparable Rotator Cuff Tear: A Systematic Review and Meta-analysis

Abstract Background rotator cuff pathology is one of the most common sources of shoulder disability and among the prevalent conditions treated by orthopaedic surgeons. Irreparable rotator cuff tear is generally large tear (in both anterior-posterior and medial-lateral dimensions) and retracted with poor attenuated tissue quality, muscular atrophy and fatty infiltiration. Aim of the Work to conduct a systematic review about superior capsular reconstruction Versus reversed total shoulder arthroplasty in treatment of massive irreparable rotator cuff tears aiming to reach a conclusion regarding superiority of one technique over the other. We may then present recommendations to orthopaedic surgeons to facilitate decision-making when approaching such cases. Patients and Methods this systematic review will be performed following the preferred reporting items for systematic reviews meta-analysis (Prisma). Six guided items and check list to answer the question of: comparison study between superior capsular reconstruction and reversed total shoulder arthroplasty in treatment of massive irreparable rotator cuff tears. Patients with irreparable rotator cuff tear of both gender and patients older than 18 years. Results all outcomes showed improvement in all studies either clinically and radiologically, also all studies had low complications rate as the following with variation of significance and heterogenicity between each group of studies. The mean age of patients underwent SCR was 64.7 ± 5.89 years, while for patients underwent RTSA; the mean age was 68.1 ± 22.18 years with metanalysis between the two groups; showing significant difference between them (p- value:0.0001) as the SCR operation was decided for age group younger than patients underwent RTSA with mean difference 5.24 (95% CI [ 2.57, 7.9]) years. Both SCR and RTSA showed significant improvement post operatively with functional scores and in active range of motion with no significant difference between the two operations except with JOA score and Constant score; both showed difference between the two groups favoring SCR over RTSA, (p-value:0.001) with JOA and (p-value:0.04) with constant score. Conclusion based on the evidence presented, both SCR and RTSA showed significant improvement in post-operative outcome measures in management of MIRCTs. All outcome measures showed comparable results with both SCR and RTSA except in JOA score and constant score, both showed significant improvement favoring RTSA. RTSA was the preferred choice for elderly patients with higher grade of glenohumeral arthritis and it was the most common revision surgery after failed SCR. It is preferred to mention SCR as the joint preserving surgical technique and that is why it would be the preferred technique in young age patients with relative lower grades of glenohumeral arthritis.

Comparative Study of Staples vs Plate and Screws for Arthrodesis of the First Metatarsophalangeal Joint

Category: Midfoot/Forefoot; Other Introduction/Purpose: Nitinol technology has revolutionized foot and ankle orthopaedic surgery, offering a quick and low-profile means of achieving bone healing. One application of this technology has been in the development of a first metatarsophalangeal (MTP) joint staple, utilized in place of crossing screws or a plate and interlocking screws constructs to achieve fusion at the first MTP joint. The objectives of this study were to compare radiographically and subjective outcomes for patients who had a first MTP joint fusion treated with an Enovis Dynaclip Delta staple vs those treated with a plate and interlocking screws. The hypothesis is the staple provides a quicker surgical time and equivalent rate of union compared to patients who were treated with standard plate and screws. Methods: A single-surgeon, consecutive case series of prospectively collected data was reviewed retrospectively for patients who underwent primary first MTP arthrodesis using a staple. Patients were age and gender matched to those who underwent primary first MTP arthrodesis with a plate and associated interlocking screws. Dates of surgery were November 2017 - December 2023. Exclusions included revision surgeries, prior forefoot/midfoot fusions, and ancillary fusions at the time of the index surgery. Preoperative and postoperative patient-reported outcome measures (PROMs) [Foot and Ankle Ability Measure (FAAM), Veterans-Rand 12 (VR-12) General Health Survey, visual analog pain scale (VAS), and radiographs (hallux valgus angle, dorsiflexion angle) were evaluated to compare the two groups. Comorbidities, operative time, fusion rates, and a patient satisfaction survey were also collected. Statistical analysis was performed using sutdent’s t-tests. Results: Twenty-two feet were included in both groups. Preoperative and postoperative PROMs between groups demonstrated no significant differences in all questionnaire categories assessed. The staple group demonstrated significant differences from preoperative to postoperative in FAAM ADL (p=0.004), FAAM sport (p=0.010), and VAS (p&lt; 0.001) while plate and screws demonstrated significant differences in FAAM ADL (p=0.032) and VAS (p=0.033). The radiographic measurements revealed a significant difference in the postoperative dorsiflexion angle for staple vs plate and screws 21.81±5.72 vs 26.47±6.99, respectively (p=0.012) and there were no other significant differences noted (table). Operative time revealed a significant difference between staple vs plate and screws (30.0 minutes vs 35.73 minutes, respectively) (p=0.006). The fusion rate was 95% in both groups. Conclusion: This study reports early results for a comparison of first MTP joint fusion treated with an Enovis Dynaclip Delta staple vs those treated with the standard plate and interlocking screws. While there were statistical differences within each group between most of the preoperative and postoperative PROMs, comparing the two groups, there was none. The fusion rate was the same in both groups. The staple group had an average of 5.7 minutes less operative time. Staple fixation achieves similar union rates to plate and screw constructs with a shorter operative time. Further patients are needed to expand this cohort.