Preoperative Rehabilitation Program Research Articles

Preoperative rehabilitation optimization for spinal surgery: a narrative review of assessment, interventions, and feasibility.

Postoperative physical therapy (PT) is a cornerstone of orthopedic and musculoskeletal rehabilitation, proven to provide various positive clinical benefits. However, there is a paucity of literature evaluating the utility of preoperative rehabilitation specific to spine surgery. Thus, this review article aims to provide an overview of previously published studies discussing the efficacy of preoperative rehabilitation programs and its role in spinal surgery. Special emphasis was given to preoperative frailty assessments, physical performance tests, interventional strategies, feasibility, and future directions. We performed a literature review using PubMed, Google Scholar, EMBASE, and PubMed Central (PMC) using directed search terms. Articles that examined preoperative rehabilitation in adult spine surgery were compiled for this review. Prehabilitation programs focused on exercise, flexibility, and behavioral modifications have been shown to significantly improve pain levels and functional strength assessments in patients undergoing elective spine surgery. In addition, studies suggest that these programs may also decrease hospital stays, return to work time, and overall direct health care expenditure costs. Screening tools such as the FRAIL scale can be used to assess frailty while physical function tests like the timed-up-and go (TUGT), 5 repetition sit-to-stand test (5R-STST), and hand grip strength (HGS) can help identify patients who would most benefit from prehabilitation. This review illustrates that prehabilitation programs have the potential to increase quality of life, improve physical function and activity levels, and decrease pain, hospital stays, return to work time, and overall direct costs. However, there is a paucity of literature in this field that requires further study and investigation.

Current views on preoperative rehabilitation practice after anterior cruciate ligament injury among licensed physical therapists in Saudi Arabia: An online-based cross-sectional survey.

Preoperative rehabilitation is an important stage to both physically and mentally prepare patients for anterior cruciate ligament reconstruction (ACLR) and postoperative rehabilitation. This study aimed to investigate the current preoperative rehabilitation practice after anterior cruciate ligament injury among licensed physical therapists in Saudi Arabia. This was an online-based cross-sectional survey. A total of 114 physical therapists completed the survey. The survey consisted of 16 mandatory questions about management strategies, prescribed exercises, patients' physical and psychological concerns, and discussions about nonoperative management. The majority of the respondents used the following preoperative interventions: education (89.5%), closed kinetic chain exercises (66.7%), stretches (63.2%), open kinetic chain exercises (61.4%), proprioceptive exercises (59.6%), cold (56.1%), and activity modification advice (52.6%). More than half of the respondents would recommend patients awaiting ACLR to complete the exercises 2 to 4 times weekly (56.1%) for up to 8 weeks (80.7%) before ACLR. The respondents (73.7%) reported that patients awaiting ACLR did not receive preoperative rehabilitation due to 2 primary factors: the orthopedic team did not refer patients to rehabilitation specialists, and there was a lack of awareness about preoperative rehabilitation. Most therapists (86%) would discuss conservative management if a patient returned to their preinjury level of function before surgery. The surveyed physical therapists reported using various interventions and preoperative rehabilitation lengths with patients awaiting ACLR. The majority of the therapists indicated that patients awaiting ACLR did not receive preoperative rehabilitation. Future studies are needed to establish a consensus on the optimal preoperative rehabilitation program.

Your preoperative rehabilitation assistant: A study protocol for the impact of a telemedicine-supported preoperative home rehabilitation program on the prognosis of patients undergoing thoracoscopic surgery

Background Reduced cardiorespiratory fitness levels are associated with increased short-term complications after surgery, and potentially exert long-lasting effects on the postoperative lives, work and educational pursuits of patients. Currently, research suggests that lifestyle interventions, such as preoperative physical exercise undertaken by patients themselves, may improve patients’ cardiopulmonary fitness and reduce post-operative complications. This study aims to investigate the effectiveness and feasibility of a remote medical supervision model for prehabilitation exercise in patients undergoing thoracoscopic lung tumour resection surgery. Methods/Design All enrolled patients will participate in a 4-week pre-operative exercise intervention to improve their cardiorespiratory fitness. During this period, patients will wear wearable devices and exercise at home based on exercise prescriptions. The exercise prescription comprises aerobic exercise (three times a week or more), muscle strengthening exercise (twice a week or more), and respiratory muscle exercise (once a day). The primary aim is to investigate whether baseline VO2max could be improved following a 4-week preoperative exercise program. Secondary objectives include changes in forced expiratory volume in 1 s and forced vital capacity, degree of acceptance of the technology, quality of life, handgrip strength, postoperative complication rate and length of hospital stay. Discussion This study aims to evaluate the influence of preoperative prehabilitation exercises in a telemedicine active supervision mode in patients undergoing thoracoscopic lung tumour resection. As such, results of this trial might have some impact on future implementations of group- and home-based prehabilitation exercises in lung cancers. Trial registration This study was approved by the Medical Ethics Committee of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (approval number: TJ-IRB20220564) with registration at ClinicalTrials.gov (identifier: NCT05608759).

Feasibility of preoperative and postoperative physical rehabilitation for cardiac surgery patients – a longitudinal cohort study

BackgroundThis study aimed to determine the feasibility of a preoperative and postoperative (in- and outpatient) physical rehabilitation program, the Heart-ROCQ-pilot program.MethodsThis cohort study included patients undergoing cardiac surgery (including coronary artery bypass graft surgery, valve surgery, aortic surgery, or combinations of these surgeries) and participated in the Heart-ROCQ-pilot program. Feasibility involved compliance and characteristics of bicycle and strength training sessions in the three rehabilitation phases.ResultsOf the eligible patients, 56% (n = 74) participated in the program (41% of exclusions were due to various health reasons). On average across the rehabilitation phases, the compliance rates of bicycle and strength training were 88% and 83%, respectively. Workload to heart rate (W/HR) ratio and total absolute volume load for bicycle and strength training, respectively, improved in each rehabilitation phase (P < 0.05). The W/HR-ratio was higher during the last postoperative session compared to the first preoperative session (0.48 to 0.63 W/beat, P < 0.001) and similar to the last preoperative session (0.65 to 0.64 W/beat, P < 0.497). During less than 1% of the bicycle sessions, patients reported discomfort scores of 5 to 6 (scale 0–10, with higher scores indicating a higher level).ConclusionsThe Heart-ROCQ-pilot program was feasible for patients awaiting cardiac surgery. Patients were very compliant and were able to safely increase the training load before surgery and regained this improvement within eight weeks after surgery.

Effects of exercise prehabilitation before anterior cruciate ligament reconstruction on functional outcomes during pre- and postoperative rehabilitation — protocol for a single-blinded randomised controlled trial

BackgroundAlthough a benefit of preoperative training prior to anterior cruciate ligament (ACL) reconstruction is likely, there is no consensus on the optimal content (criteria-based programme), supervision (one-on-one guidance or self-administered training) and general setting of preoperative training after ACL injuries. The purpose of this trial is to investigate the efficacy of an individually adaptive, guided, structured and criteria-based preoperative rehabilitation programme in comparison to a non-guided and self-administered home training programme.MethodsThe planned single-blinded randomised controlled trial study was approved by the ethics committee of the German Sport University on June 14, 2022 (ethics application no. 093/2022) and prospectively registered (DRKS-ID: DRKS00030312; date of registration: 26.09.2022). N = 114 participants between 16 and 60 years of age with a unilateral ACL rupture and scheduled ACL reconstruction with a hamstring or quadriceps tendon autograft will be randomly (block-randomisation, 1:1 allocation) and blinded assigned to one of two groups: intervention group (structured, criteria-based, guided prehabilitation training) and comparator group (non-guided, self-administered home training). After surgical reconstruction, patients of both groups participate in the same standard, functional measurement-guided, postoperative rehabilitation programme. Stepwise increasing the functional requirements of the assessments, all participants participate in testing at the day of anamnesis (t1), 1–7 days before surgical reconstruction (t2), day of surgical reconstruction (t3) and 30 (t4), 60 (t5), 90 (t6) and 180 (t7) days post-reconstruction.The primary outcome is the overall self-reported knee condition, assessed by the sum score of all sub-scales of the Knee injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes include functional outcomes (range of motion, knee flexors and extensors and plantar flexors strength/torque, functional postural control, jumping ability), workability and return to sport (RTS) (psychological readiness, RTS success).DiscussionThe planned study targets to fill a gap in the evidence regarding effective designs of prehabilitation training before surgical ACL reconstruction. Potential difficulties that could affect the conduct of the study are lack of treatment adherence of the patients and high dropout.Trial registrationGerman Register of Clinical Trials DRKS-ID: DRKS00030312. Registered on 26 September 2022.

Preoperative pulmonary rehabilitation in medical inoperable patients with early stage non-small cell lung cancer and postoperative results

Aims: The impact of postoperative complications after surgery for lung cancer is substantial, with the increasing age of patients and the presence of comorbidities. Impairment in exercise capacity is a potential modifiable risk factor for postoperative complications. This study aimed to assess the contribution of preoperative pulmonary rehabilitation (PR) for increasing operability conditions in non-small cell lung cancer (NSCLC) for patients with limited pulmonary functions and postoperative results.&#x0D; Methods: The patients with NSCLC who had preoperative pulmonary rehabilitation and underwent surgical resection in our clinics between 2010-2019 were evaluated retrospectively. The patients enrolled in a comprehensive, multidisciplinary, supervised outpatient 10-day duration PR program preoperatively, consisting of bronchial hygiene, breathing control, energy conservation techniques, exercise training (endurance and strength), psychological support, and nutritional support. Exercise capacity and VO2 peak were evaluated by using an incremental shuttle walk test (ISWT).&#x0D; Results: Eighteen patients who underwent surgery due to NSCLC and had a pre-operative pulmonary rehabilitation program were evaluated. All the cases were male; the mean age was 66.2 (53-77) years. The squamous cell/adenocarcinoma ratio was 2.6 (13:5), and the mean tumor size was 4.6 (8-18) cm. The postoperative hospital stay was 12.7 (4-42) days, and they were followed up for an average of 30.2 (2-83) months. &#x0D; Conclusion: Complete surgical resection is the most effective curative treatment for lung cancer. However, many patients with lung cancer also have severe COPD, increasing their risk of postoperative complications and their likelihood of being considered "inoperable." Preoperative pulmonary rehabilitation (PR) has been proposed as an intervention for risk modification and to decrease surgical morbidity and mortality. The results of our study also revealed the importance of preoperative pulmonary rehabilitation in centers where lung cancer surgery was performed.

Effectiveness of a 3-Week Rehabilitation Program Combining Muscle Strengthening and Endurance Exercises Prior to Total Knee Arthroplasty: A Non-Randomized Controlled Trial

We evaluated the effectiveness of a high-intensity preoperative resistance and endurance training program in improving physical function among patients scheduled for total knee arthroplasty. This non-randomized controlled trial included 33 knee osteoarthritis patients scheduled to undergo total knee arthroplasty at a tertiary public medical university hospital. Fourteen and nineteen patients were non-randomly assigned to intervention and control groups, respectively. All patients underwent total knee arthroplasty and a postoperative rehabilitation program. The intervention group participated in a preoperative rehabilitation program comprising high-intensity resistance and endurance training exercises to increase lower limb muscle strength and endurance capacity. The control group received only exercise instruction. The primary outcome was the 6-min walking distance, which was significantly higher in the intervention group (399 ± 59.8 m) than in the control group (348 ± 75.1 m) 3 months post-surgery. There were no significant differences between the groups 3 months post-surgery in muscle strength, visual analog scale, WOMAC-Pain, range of motion of knee flexion, and extension. A 3-week preoperative rehabilitation program combining muscle strengthening and endurance training improved endurance 3 months after total knee arthroplasty. Thus, preoperative rehabilitation is important for improving postoperative activity.

Feasibility and Preliminary Outcomes of a Multimodal Preoperative Rehabilitation Program in a Veteran Population

Feasibility and Preliminary Outcomes of a Multimodal Preoperative Rehabilitation Program in a Veteran Population

112. The effect of preoperative rehabilitation on minimally invasive spine surgery patient outcomes

<h3>BACKGROUND CONTEXT</h3> Minimally invasive (MIS) spine surgery techniques were developed to mitigate complications associated with open procedures while achieving functional outcomes. More recently, preoperative rehabilitation programs have been implemented to prepare patients for surgery and to promote patient health. The purpose of this study was to identify the effect of preoperative rehabilitation on MIS spine surgery patient outcomes. <h3>PURPOSE</h3> Identify if preoperative rehabilitation influences patient outcomes following MIS spine surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> This study included 524 MIS patients. <h3>OUTCOME MEASURES</h3> Preoperative rehabilitation, perioperative complications, patient outcomes. <h3>METHODS</h3> MIS spine surgery patients with baseline (BL) and two-year (2Y) follow-up were included if they had preoperative rehabilitation data. Patients were divided into two groups: those who had preoperative rehabilitation [Prehab] and those who did not [no Prehab]. Prehab consisted of physical and mental components, ie, physical therapy for 3 months, 3 days a week for core, paraspinal and leg strengthening, with a review of postop protocols to do at home, including gait and balance training. Patients were also referred for cognitive behavioral therapy for 2 weeks to prepare for the stress of surgery. Patients were excluded if they presented with any of the following at baseline: severe neurological deficit (< 3/5), minimal ambulation, or current depression/anxiety. Means comparison tests and logistic regression analysis controlling for age, CCI, ASA grade, and invasiveness assessed differences between patient groups. Conditional inference tree (CIT) analysis determined thresholds for continuous variables. <h3>RESULTS</h3> A total of 216 patients met inclusion criteria (76 Prehab, 140 no Prehab). The majority were male (97, 44.9%), mean age of 55.17 years, and 2.3 levels fused and 28 (13.0%) undergoing 3-CO. There was a significant difference in LOS for patients who had (3.6 days) and didn't have (5.3 days) Prehab, p <.05. Multivariate regression showed that Prehab was an independent predictor of a shorter LOS (OR .686 [CI .484-.972], p=.034). CIT analysis determined Prehab patients were 85.0% less likely to have a LOS greater than 2.0 days (OR .015 [CI .001-.258], p=.004). By 2 years, Prehab patients had lower rates of readmissions (6.7% vs 20.0%) and reoperations (4.0% vs 15.3%) than no Prehab patients, both p <.05. <h3>CONCLUSIONS</h3> Preoperative rehabilitation appears to be independently associated with a shorter length of stay following minimally invasive spine surgery. Patients who had preoperative rehabilitation also had lower rates of readmissions and reoperations by two years postoperatively. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

P112. The effect of preoperative rehabilitation on adult spinal deformity patient outcomes

<h3>BACKGROUND CONTEXT</h3> Adult spinal deformity (ASD) is a debilitating disorder of the lumbar and thoracic spine that significantly impacts patient quality of life. Surgical correction is a proven treatment option that provides functional restoration and pain relief. Preoperative rehabilitation programs have recently been implemented to prepare patients for surgery and to promote patient health. The purpose of this study was to identify the effect of preoperative rehabilitation on surgical ASD patient outcomes. <h3>PURPOSE</h3> Identify if preoperative rehabilitation influences patient outcomes following ASD-corrective surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> A total of 689 ASD Patients. <h3>OUTCOME MEASURES</h3> Preoperative rehabilitation, cognitive behavioral therapy, length of stay, readmission, ODI. <h3>METHODS</h3> ASD patients with baseline (BL) and 2-year (2Y) followup were included if they had preoperative rehabilitation data. Patients were divided into 2 groups: those who had preoperative rehabilitation [prehab] and those who did not [no prehab]. Prehab consisted of physical and mental components. Physical therapy for 3 months, 3 days a week for core, paraspinal and leg strengthening, with a review of postop protocols to do at home, including gait and balance training. Patients were also referred for cognitive behavioral therapy for 2 weeks to prepare for the stress of surgery. Patients were excluded if they presented with any of the following at BL: severe neurological deficit (< 3/5), minimal ambulation or current depression/anxiety. Means comparison tests and multivariable logistic regression analysis controlling for age, CCI, ASA grade and invasiveness assessed differences between patient groups. <h3>RESULTS</h3> There were 183 patients that met inclusion criteria (52 prehab, 131 no prehab). The cohort was 50% female, mean age of 58.8 yrs and 6.9 levels fused and 159 (87.0%) undergoing an osteotomy. There was a significant difference in LOS for patients who had (3.9 days) and didn't have (6.2 days) prehab, p<.05. Multivariate regression showed that prehab was an independent predictor of a shorter LOS (OR .756 [CI .600-.954], p=.018). By 2Y, prehab patients had lower rates of readmissions (7.7% vs 16.0%) than no prehab patients, but not significantly different. Controlling for BL, prehab patients were more likely to report better ODI scores than no prehab patients at 2Y follow-up (OR .960 [CI .926-.996], p=.028). <h3>CONCLUSIONS</h3> Preoperative rehabilitation appears to be significantly associated with a shorter length of stay following adult spinal deformity-corrective surgery. Patients who had preoperative rehabilitation also had better reported clinical outcomes by 2 years postoperatively. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

The Effects of a Combined Pre- and Post-Operative Anterior Cruciate Ligament Reconstruction Rehabilitation Program on Lower Extremity Muscle Imbalance

This study examined whether the 5-week pre-operative progressive exercise rehabilitation program with weekly monitoring contributed to a significantly lower muscle activity imbalance in the treatment group, both before and immediately after anterior cruciate ligament reconstruction (ACLR), as well as during the next 5 weeks in comparison to the control group. Twelve professional soccer players took part in the study (from among the top three Polish levels of competition) (age: 26 ± 5 years, body mass: 73 ± 7 kg, stature: 180 ± 6 cm, training experience: 15 ± 4 years). The participants were randomly assigned to the treatment group (n = 6) or to the control group (n = 6). Both groups performed the same pre- and post-operative progressive exercise rehabilitation program, while the rehabilitation of the treatment group was extended by supplementary body-weight functional stabilization training. The three-way repeated-measures ANOVA revealed a statistically significant interaction for muscle × group × time (p &lt; 0.0001; F = 24.897; η2 = 0.806). The post-hoc analysis for the interaction effect of muscle × group × time indicated a significantly higher muscle activity imbalance for every measured muscle in the control group at any time point than in the treatment group (from p = 0.036 to p &lt; 0.0001). The muscle activity imbalance was significantly higher from the 1st to 4th weeks than in the last week before surgery for quadriceps (p &lt; 0.016 for all) and hamstrings (p &lt; 0.001). However, in the case of gluteal muscles’ activity imbalance, it was significantly higher at every time point of the post-operative phase than in the last week before surgery (p &lt; 0.001). The results of this study showed that the 5-week pre-operative rehabilitation program with weekly monitoring influenced outcomes of the post-operative phase. Nevertheless, performing both pre- and post-ACLR rehabilitation significantly reduced the muscle activity imbalance of lower limbs, but in the case of the quadriceps muscles, not to a sufficient level.

Comparative Effects of Pre-Operative Versus Post Operative Shoulder Rehabilitation Program Mastectomy Patients; A Cross Sectional Survey

Breast cancer is ranked the top in types of cancer that affects internationally. It affects up to 1 in 13 women during their lifetime. Physiotherapy is one of the major sources of recovery in patients of Mastectomy in terms of pain, ranges, and function. OBJECTIVE: To compare the effects of pre-operative shoulder rehabilitation program versus post-operative mastectomy patients. METHODS: This was a randomized clinical trial. The study setting was Oncology Department, Mayo Hospital Lahore, Shokat Khanum and Gulab Devi Hospital Lahore. The study was completed in 6 months. Total 50 subjects were allocated in two groups using lottery method of randomization. Patient with age less than 40 years, diagnosed with breast cancer were included, while those with associated signs of musculoskeletal problems, autoimmune systemic disease and advanced medical problem was excluded. Group A received set of exercises comprised of range of motion exercises and lymph edema education pre and post operatively. Group B received post rehabilitation exercises only. Data was analyzed by SPSS 16.0. Independent t test was applied to analyze between group differences and paired sample t test to see within group improvement. Descriptive statistics was in form of mean, variance and appropriate graphs. RESULTS: Independent sample test results regarding post interventional disability of arm, shoulder, and hand (DASH) score showed significant p value 0.000 with a mean difference of 23.28000 while assuming equal variances. The mean and standard deviation of pain score was 3.76 (SD+0.778) pre/post combination group and post-operative rehabilitation program alone 4.1200 (SD+0.78102) with a statistically equal improvement in both groups (0.109). CONCLUSION: The study concluded that there was significant difference with better outcomes in terms of improvement in function, pain and range in patients having combination protocol i.e. pre-operative and post-operative rehab protocol in patient of mastectomy as compared to post-operative rehabilitation protocol alone.

Preoperative rehabilitation in patients undergoing pulmonary resections

Introduction: Pulmonary resections result in permanent impairment of the respiratory function due to reduction of the gas-exchange surface. Most of these procedures are elective, which makes it possible to implement a preoperative rehabilitation programme, aimed at increasing general fitness, improving chest and diaphragm mobility, muscle strength and lung ventilation, and also at training the proper breathing pattern, effective coughing and pain-relief techniques. Improvement of patients' respiratory function and general fitness may contribute to the limitation of postoperative functional impairment, and therefore morbidity. Objectives: The aim of this systematic review was analysis of the effect of the preoperative rehabilitation on the postoperative course following pulmonary resections in lung cancer patients. Method: Systematic review of the literature published within the last 15 years was performed using PubMed and Worldcat databases. Methodological quality of selected papers was assessed using the PEDro scale. Results: Eight out of the 236 initially retrieved papers met the pre-set criteria, and search of the attached references found an additional 2 papers. In 9 of the papers included in the final analysis positive impact of the preoperative rehabilitation was shown, and no effect was found in one of them. There were no studies showing any negative effect of the preoperative rehabilitation. Conclusions: Preoperative rehabilitation may be beneficial, and its effects may last for several months after surgery. Rehabilitation programmes longer than 2 weeks were associated with functional improvement.

PREOPERATIVE CARDIAC REHABILITATION IN A 28 YEARS-OLD WOMAN WITH VALVULAR HEART DISEASE

Background: Valvular heart disease (VHD) is one third of all heart disease. In industrialized countries, the prevalence is estimated at 2,5% and in developing countries is between twenty to thirty cases per-1000 people. VHD presents a huge health burden worldwide. If heart failure has occured, surgery is the treatment of choice. Cardiorespiratory fitness declined in post-surgical patients. Preoperative cardiac rehabilitation is considered to be able to increase the cardiorespiratory fitness baseline so that postoperative outcomes are better.Case Presentation: We reported 28 years-old female with severe MS and MR as well as mild TR with symptoms dyspnea on effort which improves with rest. She was the candidate for mitral valve replacement. She was given a 14-days preoperative cardiac rehabilitation program including breathing exercise by pursed lips breathing, effective cough exercise, range of motion exercise, ankle pumping exercise, endurance exercise based on the result of the 6 minutes walking test (6MWT) and inspiratory muscle training (IMT) using threshold IMT. Conclusion: Preoperative cardiac rehabilitation program improved pulmonary functional capacity, cardiorespiratory fitness and functional activity.Keyword: valvular heart disease, cardiac rehabilitation, pulmonary functional capacity, cardiorespiratory fitness.

Clinical, Functional, and Physical Activity Outcomes 5 Years Following the Treatment Algorithm of the Delaware-Oslo ACL Cohort Study.

Anterior cruciate ligament (ACL) injuries can be treated with or without ACL reconstruction (ACLR), and more high-quality studies evaluating outcomes after the different treatment courses are needed. The purpose of the present study was to describe and compare 5-year clinical, functional, and physical activity outcomes for patients who followed our decision-making and treatment algorithm and chose (1) early ACLR with preoperative and postoperative rehabilitation, (2) delayed ACLR with preoperative and postoperative rehabilitation, or (3) progressive rehabilitation alone. Early ACLR was defined as that performed ≤6 months after the preoperative rehabilitation program, and late ACLR was defined as that performed >6 months after the preoperative rehabilitation program. We included 276 patients from a prospective cohort study. The patients had been active in jumping, pivoting, and cutting sports before the injury and sustained a unilateral ACL injury without substantial concomitant knee injuries. The patients chose their treatment through a shared decision-making process. At 5 years, we assessed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale, sports participation, quadriceps muscle strength, single-legged hop performance, and new ipsilateral and contralateral knee injuries. The 5-year follow-up rate was 80%. At 5 years, 64% of the patients had undergone early ACLR, 11% had undergone delayed ACLR, and 25% had had progressive rehabilitation alone. Understandably, the choices that participants made differed by age, concomitant injuries, symptoms, and predominantly level-I versus level-II preinjury activity level. There were no significant differences in any clinical, functional, or physical activity outcomes among the treatment groups. Across treatment groups, 95% to 100% of patients were still active in some kind of sports and 65% to 88% had IKDC-SKF and KOOS scores above the threshold for a patient acceptable symptom state. Patients with ACL injury who were active in jumping, pivoting, and cutting sports prior to injury; who had no substantial concomitant knee injuries; and who followed our decision-making and treatment algorithm had good 5-year knee function and high sport participation rates. Three of 4 patients had undergone ACLR within 5 years. There were no significant differences in any outcomes among patients treated with early ACLR, delayed ACLR, or progressive rehabilitation alone. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Modular prosthesis fracture in a patient with developmental dysplasia of the hip: a case report and literature review

BackgroundModular prosthesis fracture, especially distal femoral fracture, is a rare complication of total hip arthroplasty (THA). However, it is catastrophic, and may have a serious impact on the patients. A distal femoral prosthesis fracture in a patient with developmental dysplasia of the hip (DDH) with nonunion at the subtrochanteric osteotomy site has not yet been reported in any literature. This report presents the first such case, with a purpose of analyzing the causes of modular prosthesis fractures and nonunion of the osteotomy area, so as to provide orthopedic surgeons with experience and lessons.Case presentationWe report the case of a 52-year-old woman with the distal femoral prosthesis fracture after THA and subtrochanteric osteotomy for Crowe type IV DDH. The patient had severe pain in the left thigh and her activities were limited. Plain radiographs revealed fracture of the left distal femoral prosthesis and nonunion in the subtrochanteric osteotomy region of the left femur. After a revision of the THA, the patient’s symptoms were resolved.ConclusionsA prosthesis fracture combined with nonunion at the subtrochanteric osteotomy site is a rare complication. Modular THA combined with a subtrochanteric osteotomy in the treatment of Crowe type IV DDH should reduce the damage to blood supply and avoid further nonunion of the osteotomy area, which may otherwise lead to modular prosthesis fractures. A detailed preoperative plan and suitable rehabilitation program may help minimize the occurrence of subtrochanteric osteotomy nonunion and reduce complications, including femoral prosthesis fractures, in patients with DDH.

Does preoperative pulmonary rehabilitation/physiotherapy improve patient outcomes following lung resection?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether preoperative physiotherapy (pulmonary prehabilitation) is beneficial for patients undergoing lung resection. Altogether 177 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A meta-analysis by Li et al. showed that patients who received a preoperative rehabilitation programme (PRP) had reduced incidence of postoperative pulmonary complications (PPCs) (odds ratio 0.44, 95% CI 0.27-0.71), reduced length of stay (LOS) (-4.23 days, 95% CI -6.14 to -2.32 days) and improved 6-min walking distance (71.25 m, 95% CI 39.68-102.82) and peak oxygen uptake consumption (VO2 peak) (3.26, 95% CI 2.17-4.35). A meta-analysis by Steffens et al. showed that PPCs were reduced in patients with PRP (relative risk 0.49, 95% CI 0.33-0.73) and reduced LOS (-2.86 days, 95% CI -5.40 to -0.33). The results of 3 additional meta-analyses, 4 randomized controlled trials and 1 observational study all provide further support to PRP in enhanced recovery after surgery and the improvement in exercise capacity. We conclude that PRP improves exercise capacity in patients undergoing surgical resection for lung cancer. Moderate quality evidence supports preoperative exercise providing significant reduction in PPCs and hospital LOS. Referral to exercise programmes should be considered in patients awaiting lung resection, particularly those deemed borderline for suitability for surgical resection.

Spanish Survey on Liver Surgery Units

Purpose: The technical, human, scientific and medical assistance characteristics of the Units that attend a complex pathology are little studied and known. Material and Methods: Multi-institutional descriptive study (survey) on the characteristics of the Units where liver surgery (LS) is performed in Spain. Results: 88 surveys were sent. 60 centres answered (68.2%) belonging to all spanish autonomous communities (17). The sum of inhabitants attended was near 35 millions inhabitants (75% of spanish population). Mean number of beds per hospital was 740. 21 Units (35%) also perform liver transplantation. The mean number of surgeons per Unit is 5. Only 3 Units had a HPB fellowship program. 100% of the Units have intraoperative ultrasound for open approach and 50 (83.3%) have intraoperative ultrasound for laparoscopic approach. In 61.7% of the Units (37/60) the ultrasound was performed by the surgeon, radiologist 15% (9/60) and both 23.3% (14/60). 65% (39/60) of the Units have a 3D laparoscopic tower. 65% (39/60) have an ICG module. 95% (57/60) have the equipment to perform radiofrequency ablation of lesions. 40% has Portal flow measurement device (24/60). 100% can perform intraoperative cholangiography. The mean of liver resections per Unit during 2019 was: 20 major hepatectomies, 29 minor hepatectomies and 3 liver hydatidosis cases. Mean percentage of laparoscopic liver surgery was 20%. Preoperative nutritional assessment is carried out systematically by 43.3% Units (26/60), selectively 50% (30/60) and never 6.7% (4/60). Operative fragility is assessed in 45% of the Units (27/60), selectively in 50% and never in 6.7% (4/60). 86.7% Units (52/60) have a preoperative rehabilitation program, and it is systematically applied by 42.3% (22/52) and selectively by 57.7% (30/52). Answers about real-life practice in liver resections are in Table 1. Laparoscopic approach is more frequent in minor hepatectomies. Abdominal drain and hemostatics are more employed in major resections. In 2015-2018, 39 Units published 226 manuscripts. Mean impact factor/paper was 1,3. Conclusions: This survey provides updated information about the majority of the Units where liver surgery is performed in Spain, and could also serve as a starting point for prospective multicenter studies..EP011_Table IReal life approach comparing minor/major hepatectomiesMINORMAJORpApproach<0.001Laparoscopic50 (83.3%)16 (26.7%)Open10 (16.7%)44 (73.3%)Pringle Manouver0.060Never2 (3.33%)1 (1.67%)Selective41 (68.3%)30 (50.0%)Systematic17 (28.3%)29 (48.3%)Parenchyma Dissection1.000Ultrasonic bisturi55 (91.7%)54 (90.0%)Others5 (8.33%)6 (10.0%)Haemostasia0.798Aquamantis ®7 (11.7%)5 (8.33%)Energy (Caiman ®, Ligasure ®, etc…)4 (6.67%)2 (3.33%)Clips/sutures3 (5.00%)3 (5.00%)Mix of previous methods46 (76.7%)50 (83.3%)Abdominal Drain<0.001031 (51.7%)10 (16.7%)129 (48.3%)48 (80.0%)202 (3.33%)Hemostatics0.001Always15 (25.0%)35 (58.3%)Never3 (5.00%)2 (3.33%)Selective42 (70.0%)23 (38.3%)Eras Protocol0.713No25 (41.7%)28 (46.7%)Yes35 (58.3%)32 (53.3%) Open table in a new tab

Are there Sex differences in Return to Play Rates in High Level Athletes Following Hip Arthroscopy?

Objectives:Return to sport is a common co ncern in those undergoing arthroscopic surgery for the treatment of femoroacetabular impingement. These are commonly young active individuals with high-level athletic aspirations. Setting expectations in terms of appropriate time frame and success rates are an integral piece of pre-operative education and planning. The goals of this study were to examine return to play (RTP) rates and time frames in professional and collegiate athletes following hip arthroscopy, evaluate sex differences in return to play (morphology and rates), and evaluate differences in return to play for the most common sports.Methods:A retrospective review of a continuous cohort of patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement and labral injury was conducted between January 2014 and December 2018. Athletes whom were participating in collegiate or professional sports prior to surgery were included. Chart review was conducted to gather sport specific information, morphologic data, clearance dates, successful return, and subsequent surgery. Successful return to sport was determined by being able to return to participation following clearance in at least one season. Descriptive statistics were utilized to summarize the data set and chi-square and t-tests were utilized to examine differences between groups.Results:265 patients undergoing 332 hip arthroscopies participating in collegiate or professional sports prior to surgery were identified (75.4% male and 24.6% female), with 237 collegiate athletes and 95 professional athletes. There was a significant difference in mean alpha angles between males and females, 70.2 ± 10.5 males and 60.7± 10.0 in females, (p<0.001), but no significant differences in coronal center edge angles or femoral version. 87% of the athletes participated in hockey, football, lacrosse, soccer, baseball, soccer, or basketball. Given that a significant portion of the athletes were in college, there was a portion that graduated and thus no longer participated in collegiate athletics (27 hips), and 3 athletes (all with bilateral hip arthroscopies) were unable to return to sport due to other conditions. 91.9% of athletes were able to return to sport. 19 athletes (22 hips) were unable to return to sport. The group that was unable to return was predominantly female (73%), and this difference was significant (p<0.001). There was a significant difference between the returning group and the group that failed to return to sport in alpha angle (RTP 68.6 ± 10.8 vs No RTP 60.7± 10.6), but there were no differences in coronal center edge angle or femoral version. The difference in alpha angle is due to the predominance of females (whom had significantly lower alphas) in the unable to return group. 10 athletes (11 hips, 3.3%) required subsequent surgery (revision arthroscopy, conversion to periacetabular osteotomy, or hip resurfacing). Times for return to play were available to 205 of the athletes, averaging 6.8 months± 2.8. There was no significant difference between the males and females for return to play. There was trend towards shorter length of return for hockey athletes. There was a significant difference in the return to sport rates between the sport groups, but there were some groups with smaller sample sizes that should be taken into account. The groups with more athletes unable to return were soccer and lacrosse; these sports also had a high number of female athletes. There were no hockey athletes that were unable to return, and only 1 football athlete was unable to return.Conclusions:Hip arthroscopy for the treatment of femoroacetabular impingement and labral injury allows patients to return to sport at a high level within an average of 6.8 months. However, female athletes are less likely to have a successful return and should potentially be counseled as such. This may also inform pre-operative rehabilitation programs and intra-operative planning for female athletes. Further research should examine causes for decreased rate of return for females, and potential ways to maximize recovery and return to sport following hip arthroscopy.Athletes’ Ability to Return to Play by Sport Able Unable % RTP Football52198.20%Hockey710100.00%Soccer21580.80%Basketball24292.30%Baseball32294.10%Lacrosse43589.60%

Effects of a preoperative neuromobilization program offered to individuals with carpal tunnel syndrome awaiting carpal tunnel decompression surgery: A pilot randomized controlled study

Study DesignPilot randomized controlled trial with parallel groups. IntroductionEngaging individuals with carpal tunnel syndrome (CTS) awaiting carpal tunnel decompression surgery in a preoperative rehabilitation program may mitigate pain and sensorimotor impairments, enhance functional abilities before surgery, and improve postoperative outcomes. Purpose of the StudyTo assess the feasibility and the efficacy of a novel preoperative neuromobilization exercise program (NEP). MethodsThirty individuals with CTS were randomly allocated into a four-week home-based neuromobilization exercise group or a standard care group while awaiting surgery. Outcome measures included feasibility (ie, recruitment, attrition, adherence, satisfaction, and safety) and efficacy metrics (ie, median nerve integrity and neurodynamics, tip pinch grip, pain, and upper limb functional abilities) collected before (ie, at the baseline and about four weeks later) and four weeks after surgery. ResultsThirty individuals with CTS were recruited (recruitment rate = 11.8%) and 25 completed the study (attrition rate = 16.7%). Adherence (94%) and satisfaction with the program (eg, enjoy the exercises and likeliness to repeat the NEP (≥4.2/5) were high and no serious adverse event was reported. NEP-related immediate pre- and post-surgery beneficial effects on pain interference were documented (P = .05, η2 = .10), whereas an overall increased neurodynamics (P = .04, η2 = .11) and decreased pain severity (P = .01, η2 = .21) were observed. DiscussionEngaging in the proposed NEP has limited beneficial effect as a stand-alone intervention on pre- and post-surgery outcomes for individuals with CTS. Expanding the program’s content and attribute by adding other components including desensitization maneuvers and novel therapies promoting corticospinal plasticity is recommended. ConclusionA preoperative NEP completed by individuals with CTS awaiting surgery is feasible, acceptable, and safe. However, given the limited beneficial effectsof the program, revision of its content and attributes is recommended before proceeding to large-scale trials.