PROMIS Physical Function Scores Research Articles

Preoperative Degenerative Changes at the Medial Sesamoid-Metatarsal Joint Is Associated with Postoperative Patient-Reported Outcomes in Hallux Valgus

Introduction/Purpose: While hallux valgus (HV) is understood to be a triplanar deformity of the first metatarsal, less is known about the contribution of the sesamoid-metatarsal joint (SMJ) to pain and function. Osteoarthritis of the SMJ is frequently present in HV feet, with an incidence rate ranging from 32% to 81%. Following surgical correction, approximately 10% of HV patients remain dissatisfied, but factors affecting postoperative outcomes are poorly understood. The primary aim of our study was to describe the relationship between degenerative changes at the SMJ as measured on weightbearing CT (WBCT) scans and 1-year patient-reported outcome scores following a modified Lapidus procedure for correction of HV. We hypothesized that decreased joint space at the SMJ would affect postoperative patient-reported outcomes. Methods: This study included 48 consecutive patients who underwent a modified Lapidus procedure for HV, had preoperative and at least 5-month postoperative WBCT scans, and had preoperative PROMIS scores and at least 1-year postoperative PROMIS Physical Function (PF), Pain Interference, and Pain Intensity scores. For each patient, the first metatarsal and sesamoids on pre- and postoperative WBCT scans were segmented using Disior Bonelogic software and uploaded to Geomagic Design X to perform distancing mapping. The minimum and average distances between the first metatarsal head and medial sesamoid (medial-SMJ) for each patient pre- and postoperatively were calculated. Sesamoid subluxation was measured on WBCT scans using the grading system from 0 to 3 (Yildirim et al.). A simple linear regression model was used to investigate the correlations between minimum preoperative and postoperative medial-SMJ distances and 1-year postoperative PROMIS scores in patients with postoperative reduction of the sesamoids (grade 0). Results: Preoperatively, the mean minimum and average medial-SMJ distances were 0.76 ± 0.37 mm and 1.54 ± 0.33 mm, respectively. Postoperatively, the mean minimum and average medial-SMJ distances were 1.08 ± 0.25 mm and 1.73 ± 0.24 mm, respectively. Thirty-five of 48 patients had a complete reduction of the sesamoids. Lower preoperative minimum distances at the medial-SMJ were significantly correlated with worse 1-year PROMIS PF scores (r=0.405, P=0.016) (Figure 1). Similarly, lower preoperative minimum distances at the medial-SMJ were significantly correlated with worse 1-year PROMIS Pain Intensity scores (r=-0.350, P=0.039) but did not reach significance for 1-year PROMIS Pain Interference scores (r=-0.286, P=0.095). The postoperative minimum medial-SMJ distance was not correlated with 1-year PROMIS PF, Pain Interference, and Pain Intensity scores. Conclusion: In HV patients undergoing a modified Lapidus procedure with postoperatively reduced sesamoids, decreased joint space at the medial sesamoid-metatarsal head articulation was associated with worse 1-year postoperative function as measured by PROMIS PF scores and worse 1-year postoperative pain as measured by PROMIS Pain Intensity scores. In contrast, postoperative degenerative changes at the SMJ were not found to be associated with patient-reported outcomes. Our results suggest that pre-existing SMJ arthritic changes may affect postoperative outcomes and may be a source of dissatisfaction following HV surgery despite appropriate correction of the deformity. Figure 1. Preoperative medial sesamoid to the first metatarsal head minimum distance relative to 1-year PROMIS Physical Function, Pain Intensity, and Pain Interference scores. A simple linear regression demonstrates a significant association between preoperative medial sesamoid –metatarsal head minimum joint distance and 1-year PROMIS Physical Function (r=0.405, P=0.016) and Pain Intensity (r=‒0.305, P=0.039) scores.

A Comparative Analysis of Outcomes using PROMIS after Operative vs Non-operative Treatment of Achilles Rupture

Introduction/Purpose: Achilles tendon rupture is a common injury in the adult population. The role of operative and non- operative management remains controversial with the development of functional rehabilitation programs. The purpose of this study is to evaluate and compare the patient-reported outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS) after operative and non-operative treatment of acute Achilles rupture. PROMIS is a valid, reliable, and effective tool to evaluate patient outcomes after treatment for Achilles ruptures. Our hypothesis is that there is no significant difference in PROMIS scores between patients undergoing operative compared to non-operative treatment of Achilles rupture. Methods: Under an IRB-approved protocol, Achilles rupture was identified using ICD 9 and ICD10 codes of 727.67 and S86.0. Patients who underwent Achilles tendon primary repair were identified using CPT code 27650 (Repair, primary open or percutaneous, ruptured Achilles tendon). Revision Achilles repair and chronic Achilles ruptures were excluded. All patients treated non-operative underwent a strict functional rehabilitation protocol. We included patients treated between 1/1/2015 and 11/30/2022. PROMIS physical function (PF), pain interference (PI), and depression scores were routinely collected prospectively during the initial office visit and follow-up appointments. A distribution-based method used to determine the minimal clinically important difference (MCID), which was 1/2 standard deviation of each PROMIS domain. A medical records review was performed to collect patient demographic data. Statistical analysis was used to compare preoperative and postoperative scores and significance was indicated when P< 0.05. Results: 216 patients with Achilles tendon ruptured were included (115 Nonoperative versus 101 Operative). Patients treated non-operatively were older than those treated surgically (mean age: 45.1 vs 35.6; p< 0.001). The operative group had a lower BMI compared to non-operative group (27.8 vs. 29.5; p=0.004). There is no statistical difference in the Achilles tendon re-rupture rate between both groups (operative: 2% vs. 4.3%; p=0.344). Both groups are effective in improving PROMIS PF, PI, and depression scores (p < 0.001). The mean PROMIS PF change (pre- to post-treatment) is significantly greater in the operative, compared to the non-operative group (13.2 vs. 9.5; p=0.042). Both treatments had similar mean PROMIS PI change, mean PROMIS depression change, and rates of meeting MCID for all 3 PROMIS domains at 6 months. Conclusion: In patients with Achilles tendon rupture, operative management may lead to statistically significant higher improvements in physical function compared to non-operative management. However, non-operative management was associated with similar overall rates of re-rupture, PROMIS PI and depression outcomes, and chances of meeting MCID as those who underwent operative intervention. Nonoperative management of Achilles tendon rupture, similar to operative treatment, is a successful treatment option and leads to significant improvement in physical function, pain interference, and depression PROMIS scores.

Defining the patient acceptable symptom state using PROMIS following reconstruction of the progressive collapsing foot deformity

BackgroundThe patient acceptable symptom state (PASS) represents the threshold beyond which patients are satisfied with their outcome. This study aimed to define PASS thresholds for progressive collapsing foot deformity (PCFD) reconstruction using Patient-Reported Outcomes Measurement Information System (PROMIS) scores and anchor question responses. MethodsThis retrospective study consisted of 109 patients who underwent flexible PCFD reconstruction, had preoperative and 2-year postoperative PROMIS scores, and 2-year postoperative anchor question responses. ROC curve analyses were performed to quantify PASS thresholds. ResultsPASS thresholds for the PROMIS Physical Function (PF) and Pain Interference (PI) domains were found to be lower and higher, respectively, than population norms. Furthermore, patients with higher preoperative PROMIS PF scores or lower preoperative PROMIS PI scores had a significantly higher likelihood of achieving the PASS thresholds. ConclusionIn addition to guiding future outcomes research, these results may help surgeons optimize treatment for PCFD and better manage patient expectations. Level of evidenceIII, retrospective cohort study

Worse Quality of Life Associated With Hyperextension Varus Tibial Plateau Fracture Pattern.

Compare patient-reported outcome measures between hyperextension varus tibial plateau (HEVTP) fracture patterns to non-HEVTP fracture patterns. Retrospective study. Single academic Level 1 Trauma Center. All patients who underwent fixation of a tibial plateau fracture from 2016 to 2021 were collected. Exclusion criteria included inaccurate Current Procedural Terminology code, ipsilateral compartment syndrome, bilateral fractures, incomplete medical records, or follow-up <10 months. In patients who underwent fixation of a tibial plateau fracture, compare Patient-Reported Outcomes Measurement Information System-Physical Function, PROMIS Preference, and Knee Injury and Osteoarthritis Outcome Score (KOOS) between patients with a HEVTP pattern with those without. Two-hundred and seven patients were included, of which 17 (8%) had HEVTP fractures. Compared with non-HEVTP fracture patterns, patients with HEVTP injuries were younger (42.6 vs. 51.0, P = 0.025), more commonly male (71% vs. 44%, P = 0.033), and had higher body mass index (32.8 vs. 28.0, P = 0.05). HEVTP fractures had significantly more ligamentous knee (29% vs. 6%, P = 0.007) and vascular (12% vs. 1%, P = 0.035) injuries. Patient-Reported Outcomes Measurement Information System-Physical Function scores were similar between groups; however, PROMIS-Preference (0.37 vs. 0.51, P = 0.017) was significantly lower in HEVTP fractures. KOOS pain, activities of daily living, and quality-of-life scores were statistically lower in HEVTP fractures, but only KOOS quality-of-life was clinically relevant (41.7 vs. 59.3, P = 0.004). The HEVTP fracture pattern, whether unicondylar or bicondylar, was associated with a higher rate of ligamentous and vascular injuries compared with non-HEVTP fracture patterns. They were also associated with worse health-related quality of life at midterm follow-up. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Recovery Curves for Lisfranc ORIF Using PROMIS Physical Function and Pain Interference.

To determine the postoperative trajectory and recovery of patients who undergo Lisfranc open reduction and internal fixation using Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI). Retrospective cohort study. Level 1 trauma center. Patients who underwent Lisfranc open reduction and internal fixation between January 2002 and December 2022 with documented PROMIS PF and/or PI scores after surgery. PROMIS PF and PI were mapped over time up to 1 year after surgery. A subanalysis was performed to compare recovery trajectories between high-energy and low-energy injuries. A total of 182 patients were included with average age of 38.7 (SD 15.9) years (59 high-energy and 122 low-energy injuries). PROMIS PF scores at 0, 6, 12, 24, and 48 weeks were 30.2, 31.4, 39.2, 43.9, and 46.7, respectively. There was significant improvement in PROMIS PF between 6 and 12 weeks ( P < 0.001), 12-24 weeks ( P < 0.001), and 24-48 weeks ( P = 0.022). A significant difference in PROMIS PF between high and low-energy injuries was seen at 0 week (28.4 vs. 31.4, P = 0.010). PROMIS PI scores at 0, 6, 12, 24, and 48 weeks were 62.2, 58.5, 56.6, 55.7, and 55.6, respectively. There was significant improvement in PROMIS PI 0-6 weeks ( P = 0.016). A significant difference in PROMIS PI between high-energy and low-energy injuries was seen at 48 weeks with scores of (58.6 vs. 54.2, P = 0.044). After Lisfranc open reduction and internal fixation, patients can expect improvement in PF up to 1 year after surgery, with the biggest improvement in PROMIS PF scores between 6 and 12 weeks and PROMIS PI scores between 0 and 6 weeks after surgery. Regardless the energy type, Lisfranc injuries seem to regain comparable PF by 6-12 months after surgery. However, patients with higher energy Lisfranc injuries should be counseled that these injuries may lead to worse PI at 1 year after surgery as compared with lower energy injuries. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The MCID of the PROMIS physical function instrument for operatively treated tibial plateau fractures

IntroductionUnderstanding minimal clinically important differences (MCID) in patient reported outcome measurement are important in improving patient care. The purpose of this study was to determine the MCID of Patient-Reported Outcome Measurement System (PROMIS) Physical Function (PF) domain for patients who underwent operative fixation of a tibial plateau fracture. MethodsAll patients with tibial plateau fractures that underwent operative fixation at a single level 1 trauma center were identified by Current Procedural Terminology codes. Patients without PROMIS PF scores or an anchor question at two-time points postoperatively were excluded. Anchor-based and distribution-based MCIDs were calculated. ResultsThe MCID for PROMIS PF scores was 4.85 in the distribution-based method and 3.93 (SD 14.01) in the anchor-based method. There was significantly more improvement in the score from the first postoperative score (<7 weeks) to the second postoperative time (<78 weeks) in the improvement group 10.95 (SD 9.95) compared to the no improvement group 7.02 (SD 9.87) in the anchor-based method (P < 0.001). The percentage of patients achieving MCID at 7 weeks, 3 months, 6 months, and 1 year were 37–42 %, 57–62 %, 80–84 %, and 95–87 %, respectively. DiscussionThis study identified MCID values for PROMIS PF scores in the tibial plateau fracture population. Both MCID scores were similar, resulting in a reliable value for future studies and clinical decision-making. An MCID of 3.93 to 4.85 can be used as a clinical and investigative standard for patients with operative tibial plateau fractures.

Safety of a Novel Capsular Closure Device in Hip Arthroscopy for Femoroacetabular Impingement

Abstract Introduction: The utilization of hip arthroscopy for the management of femoroacetabular impingement has increased. Capsular closure has been shown to maintain biomechanical stability postoperatively compared to unrepaired capsules. The novel Cap-Fix device (Smith and Nephew, Watford, UK) was developed to aid in capsular closure both by improving the placement of suture and decreasing the number of steps required for capsulotomy. This study aimed to evaluate the safety of the Cap-Fix device for use in capsulotomy and capsular repair following hip arthroscopy. Materials and Methods: A retrospective review of 30 patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement (FAI) with capsular repair using the Cap-Fix 45° or 70° Suture Passer was performed. The Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) measures were used to evaluate patient-reported outcomes at the baseline and the follow-up intervals. Outcomes of interest included complications and patient-reported outcomes at 2-week, 6-week, and 3-month follow-up. Results: All patients completed 2- and 6-week follow-up, and 28 (93.3%) completed 3-month follow-up. Two patients experienced complications; one with pain requiring glucocorticoid injection at 6 weeks postoperatively, and another with a 12-mm capsular defect found on 3-month postoperative magnetic resonance imaging requiring repeat arthroscopic debridement, revision labral repair, and capsular plication. By 3 months postoperatively, statistically significant improvement in HOOS JR but not PROMIS-PF scores was seen. Conclusion: The Cap-Fix device appears to be safe for use in capsulotomy and subsequent capsular repair during hip arthroscopy for FAI.

Arthroscopic subacromial decompression improved outcomes in situationally depressed patients compared to clinically depressed or nondepressed patients

The purpose of this study is to evaluate patient reported outcomes after arthroscopic extensive débridement of the shoulder with subacromial decompression (SAD) for subacromial impingement using the Patient-Reported Outcomes Measurement Information System (PROMIS) system and evaluate if depression (Dep) (clinical or situational) impacts patients achieving a Minimal Clinically Important Difference (MCID). Preoperative PROMIS Physical function (PF), Mood, and Dep scores were obtained at the closest date prior to arthroscopic rotator cuff repair and postoperative scores were collected at every clinical visit thereafter. Final PROMIS score used for data analysis was determined by the patients final PROMIS value between 90 to 180 days. Clinical Dep was determined by patients having a formal diagnosis of "Depression or Major Depressive Disorder" at the time of their surgery. Situationally depressed patients, those without a formal diagnosis yet exhibited symptomatic depressive symptoms, were classified by having a PROMIS-Dep cutoff scores larger than 52.5. A total of 136 patients were included for final statistical analysis. 13 patients had a clinical but not situational diagnosis of Dep, 86 patients were identified who had no instance of clinical or situational Dep (nondepressed). 35 patients were situationally depressed. All three cohorts demonstrated a significant improvement in postoperative PROMIS Dep, PI, and PF score relative to their preoperative value (P=.001). Situationally depressed patients achieved greater delta PROMIS-Dep compared to patients with major depressive disorder. Depressed patients had a higher chance of achieving MCID for PROMIS-Dep compared to nondepressed patients (P=.01). Logistic regression analysis demonstrated that underlying Dep did not alter the odds of obtaining MCID compared to nondepressed patients. Nonsmoking patients had significantly greater odds of achieving MCID for PF (P=.02). Patients improved after undergoing SAD regardless of underlying Dep or depressive symptoms. Depressed patients exhibited greater change in PROMIS scores compared to nondepressed patients. Smoking remains a risk factor for postoperative outcomes in patients undergoing SAD for subacromial impingement. Identifying and counseling patients with underlying depressive symptoms without a formal major depressive disorder diagnosis may lead to improved outcomes. These findings may help guide clinicians in deciding who would benefit the most from this procedure.

Patient-Reported Outcome Measurement Information System Depression and Anxiety in Elective Knee Surgery Patients.

Mental health has been shown to play an important role in patient-reported outcomes (PRO); however, there is a general lack of literature describing patient-reported outcome measurement information system (PROMIS) depression and anxiety computer adaptive tests in elective knee surgery patients. The purpose of our study was to assess the prevalence of depression and anxiety symptoms before and after elective knee surgery and to determine whether these symptoms influence postoperative functional outcomes. An institutional review board-approved prospective orthopaedic registry was retrospectively queried for patients undergoing elective knee surgery from June 2015 to November 2018. Electronic surveys collecting patient demographic information and PROs were administered pre- and postoperatively. Of the 663 patients that completed baseline questionnaires, 466 completed 2-year follow-up (70.3%). PROs included PROMIS depression, PROMIS anxiety, International Knee Documentation Committee Subjective Knee Form (IKDC), and PROMIS physical function (PF). Wilcoxon rank sum and Spearman's rank order correlation were utilized to determine associations between variables. Multivariable analysis was used to control for confounding variables. Average PROMIS depression and anxiety scores significantly improved 2 years after surgery. PROMIS depression and anxiety scores significantly correlated with each other. PROMIS depression and anxiety scores significantly correlated with PROMIS PF and IKDC scores. After controlling for confounders on multivariable analysis, worse 2-year PROMIS anxiety was predictive of less functional improvement and worse 2-year PF and IKDC, while worse 2-year PROMIS depression was predictive of less improvement in IKDC. This study confirms the important relationship between mental health and functional outcomes. Given that psychiatric comorbidities are potentially modifiable with treatment, proper recognition could potentially lead to better orthopaedic outcomes. In addition, the prevalence of depression and anxiety symptoms postoperatively, as documented by PROMIS computer adaptive tests, may act as a barrier to achieving optimal functional outcomes after elective knee surgery. LEVEL OF EVIDENCE: Level III.

Non-White Race and Concomitant Orthopedic Conditions Are Risk Factors for Failure to Achieve Clinically Relevant Improvement After Total Knee Arthroplasty

BackgroundData from the American Joint Replacement Registry demonstrate that 1-year minimal clinically important difference (MCID) achievement rates after total knee arthroplasty (TKA) are substantially lower when using general patient reported outcome measures, such as Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), than joint specific measures. The purpose of this study was to evaluate patient characteristics and outcomes associated with MCID achievement after TKA using the PROMIS-PF measure. MethodsA retrospective review of 263 patients undergoing TKA with preoperative and 1-year postoperative PROMIS-PF scores from March 12, 2020 to February 8, 2022 was performed. Three multivariate models were built to evaluate predictors of MCID achievement. Preoperative predictors evaluated included demographics, comorbidities, history of spine and knee surgery, and baseline PROMIS-PF. Postoperative clinical outcomes evaluated included lengths of stay, discharge statuses, complications, and utilizations of other orthopaedic services. ResultsThere were 109 patients (41%) who achieved an MCID at 1-year postoperatively. Non-white patients had 2.17 times lower odds of achieving MCID. No clinical outcomes assessed were independently predictive of MCID achievement. During the 1-year postoperative period, 63% of patients sought care for another orthopaedic condition. Patients requiring postoperative injections on another joint had a 2.27 times lower odds of achieving MCID. Those seen for spine conditions postoperatively had a 2.44 lower odds of achieving MCID. ConclusionsRace, postoperative injections, and treatment for spine conditions after TKA were independent predictors of failure to achieve MCID. These results may guide preoperative patient consultation and risk-adjustment in future studies using PROMIS-PF as an endpoint for evaluation of TKA outcomes.

PROMIS physical function and pain perform poorly psychometrically in patients undergoing medial patellofemoral ligament reconstruction.

The purpose of this study was to assess the validity, floor and ceiling effects, and dimensionality of PROMIS Physical Function (PF) and Pain compared to legacy patient reported outcome (PRO) measures in patients undergoing medial patellofemoral ligament (MPFL) reconstruction. Patients who underwent MPFL reconstruction between 2018 to 2020 were retrospectively reviewed. Preoperatively, patients completed the IKDC, VR-12, Kujala, SF-12, KOOS JR, PROMIS PF and Pain surveys. Inter-survey convergence was assessed with Spearman correlations. Psychometric analysis included investigations of inter-survey convergent validity, intra-survey floor and ceiling effects, and Rasch analyses with person-item fit and iterative question elimination model fit testing. A total of 76 patients (mean age: 22.6 ± 8.4years) who completed preoperative surveys were included (compliance: 91.7-96.2%). Preoperatively, age was significantly associated with both PROMIS PF (coefficient: - 0.291, P = 0.005) and Pain scores (coefficient: 0.294, P = 0.002). PROMIS PF had a Very Good correlation with IKDC and PROMIS Pain had a Very Good correlation with KOOS JR. Other correlations ranged from Poor to Good. No significant floor or ceiling effects were observed for any PRO. On iterative question elimination Rasch modelling, only two questions from PROMIS PF remained after 6 rounds of elimination while PROMIS Pain had no questions remaining after 3 rounds of elimination. Preoperative PROMIS PF and Pain provided only Fair to Good correlations with most legacy PROs. Although no significant floor and ceiling effects were observed, PROMIS PF and Pain did not perform well psychometrically in this population of patients undergoing MPFL reconstruction. These results suggest PROMIS questionnaires should be used with caution in this population, especially if used in isolation, when discussing clinical expectations with patients. The authors recommend continued use of legacy PROs specific to assessment of patellar instability and function that have established validity in patellar instability populations. Level IV.

Early Outcomes after Minimally Invasive Percutaneous Calcaneal Osteotomy in the Treatment of Cavovarus and Planovalgus Foot Deformities

Category: Hindfoot; Other Introduction/Purpose: A calcaneal osteotomy is often included as part of the treatment in planovalgus and cavovarus foot deformities. Often this is done through an open approach where complications of wound infection and sural nerve injury are common. More recently, this strategy has been modified using minimally invasive techniques. A percutaneous approach, in comparison to the standard open calcaneal osteotomy, allows for reduced postoperative complication and decreased pain compared to an open procedure. This retrospective chart review aims to evaluate the postoperative outcomes of patients undergoing calcaneal osteotomy via a minimally invasive percutaneous approach in foot reconstructive surgery to assess early functional outcomes, complication rate and revision rates. Methods: One fellowship-trained foot and ankle orthopaedic surgeon at one academic institution performed minimally invasive calcaneal osteotomy on 20 patients. All cases were completed between March 2021 and March 2023. Patient charts were reviewed for outcome data including complication rate, union rate, revision rate, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Results: Participants included 15 females and 5 males, 4 of whom were smokers. Average age was 42.2 years. Average BMI was 32.3, and average follow up was 130.4 days. Complications included 1/20 patients had a postoperative wound breakdown of the screw site requiring incision and debridement with closure and 2/20 cases of sural neuritis. One resolved 6 months after treatment and the other was present but became less symptomatic. All participants achieved union, and there were no revisions. All shifts corrected hindfoot deformity either via medializing or lateralizing osteotomy. Average preoperative PROMIS scores in the domains of physical function, pain interference, and mobility were 36.8 (28.6-46), 67.1 (54.3-78), and 34.6 (25-40), respectively. Average postoperative PROMIS scores were 35.7 (21-76), 62.3 (39-76), and 33.4 (16-75), respectively. Conclusion: Minimally invasive calcaneal osteotomy appears to be an efficacious and safe treatment option for the correction of cavovarus and planovalgus hindfoot deformities with the ability to obtain appropriate hindfoot correction with low complication rates and high union rates. Early outcome measures show a favorable pain interference PROMIS score as well as a trend in improvements in PROMIS physical function scores. Longer term data will need to be done to assess long term functional outcome and revision rates.

Outcomes after Bipolar Osteochondral Allograft Transplantation in the Ankle

Category: Ankle Arthritis; Ankle Introduction/Purpose: Surgical treatment options for symptomatic, full-thickness articular cartilage loss in the ankle are not consistently effective in restoring ankle function. Osteochondral allograft transplantation provides a standard-of-care alternative for patients, however, outcomes reported to date have been only fair, with a high incidence of reoperation and revision. However, recent cartilage storage and preservation techniques have significantly improved the percent viable chondrocytes at the time of implantation in OCAs. These high-chondrocyte-viability allografts should lead to improved survivability of OCAs and improved outcome measures. This study aimed to document the initial outcomes for patients undergoing bipolar OCA transplantation in the ankle after advances in tissue preservation, transplantation techniques, and patient management strategies. Methods: Patients with symptomatic tibiotalar arthritis were prospectively enrolled into a registry designed to follow outcomes after OCA surgeries in the ankle. All patients underwent complete OCA replacement of their tibial plafond and talar dome, with most undergoing fibular articular resurfacing. All OCA were size and side matched and preserved in Missouri Osteochondral Allograft Preservation System (MOPS). Patients followed a standardized, procedure-specific rehabilitation protocol after surgery, including remaining non-weight bearing for 8 weeks, weekly therapy visits, limited step count during recovery, and avoidance of high impact activities until 1 year after surgery. Patients followed-up with their physician at regular post-operative timepoints. Radiographs and patient reported outcome measures (VAS, AAOS Foot and Ankle, PROMIS PF, PROMIS Mobility) were obtained at each follow-up visit. Demographic and operative data were collected from the electronic medical record. All reported complications, reoperations, revisions, and failures were recorded in the EMR. Results: 14 patients were included for analyses with 12 undergoing primary OCA transplantation, and 2 undergoing revision OCA transplantation. Mean age and follow up was 36 and 44.1 months, respectively. All patients underwent tibia and talus OCA transplantation, with 10/14 including a fibula OCA transplantation. Initial success was 92.9% with one documented failure (tibial OCA collapse). Radiographic assessments indicated OCA integration and maintenance of joint space in 12 patients (85.7%). AAOS and VAS pain scores improved significantly from preoperative measures at each timepoint (p=.002, p=.03), while postoperative improvements in PROMIS Mobility and PROMIS Physical Function scores did not reach significance (p&gt;0.15) (Table 1). Patients that were non-adherent to postoperative restriction and rehabilitation protocols, all 1-year postoperative PROs were significantly lower than for patients who were adherent. Conclusion: Ankle osteoarthritis in young patients continues to present a challenging dilemma. Previous attempts at large bipolar OCAs in the ankle have yielded fair, to poor, results. However, recent advances in bulk osteochondral allograft preservation has improved chondrocyte viability. Based on the results of our study, the use of high-chondrocyte-viability allografts for OCA transplantation is a viable option for the treatment of symptomatic bipolar osteochondral defects in the ankle joint. However, post operative rehab protocols are equally important in determining outcomes, and patient selection and education is key to ensuring successful outcomes. Longer term follow up is ongoing.

PROMIS Scores for Chronic Plantar Fasciitis Before and After Gastrocnemius Recession

Category: Ankle; Hindfoot Introduction/Purpose: There has been an established relationship between increased loading on the Achilles tendon and tension on the plantar fascia. This supports the idea that either tight gastrocnemius and soleus muscles or contractures of the Achilles tendon are risk factors for plantar fasciitis. Gastrocnemius recession has gained popularity as a viable surgical intervention for cases of chronic plantar fasciitis due to isolated gastrocnemius contracture. To our knowledge, this is the first study to investigate PROMIS scores in patients with plantar fasciitis before and after gastrocnemius recession. Methods: The Electronic Medical Record was queried for medical record numbers associated with Current Procedural Terminology code 27687 (gastrocnemius recession). Our study included all patients with a preoperative diagnosis of chronic plantar fasciitis with treatment via isolated gastrocnemius recession with one-year minimum follow-up. 40 patients were included in our study. Patient variables were collected via chart review. Preoperative and postoperative PROMIS scores were collected in the clinic. Results: Preoperative and postoperative PROMIS scores improved for physical function and pain interference from 39.27 and 62.78 to 44.54 and 56.5 (p=0.0005, p=0.0001) respectively, PROIMS Depression scores were not significantly different (p=0.6727). VAS scores significantly decreased from 7.05 to 1.71 (p &lt; 0.0001). Patients with preoperative peripheral neuropathy had significantly lower improvement in PROMIS physical function scores (p=0.0029). Tobacco use led to significantly lower improvement in in PROMIS depression (p=0.0202). Conclusion: Gastrocnemius recession is an effective option for patients with refractory pain in plantar fasciitis. Our PROMIS and VAS data confirm this procedure's utility and highlight its ability to significantly decrease pain and improve physical function in patients with chronic plantar fasciitis. We believe we have added to the literature by incorporating the, inherently superior, PROMIS scores. Based on the results of this study, the authors recommend gastrocnemius recession for patients who fail conservative management for plantar fasciitis.

The Impact of Total Hip Arthroplasty Surgical Approach on Short-Term Postoperative and Patient-Reported Outcomes.

Background While multiple studies have compared outcomes between the direct anterior approach (DAA) and posterolateral (PL) total hip arthroplasty (THA), the debate over the optimal approach remains. Proponents of the DAA suggest that its muscle-sparing properties and unrestricted rehabilitation facilitate a more rapid return to function. The majority of studies demonstrate that patient-reported outcomes (PROs) are similar between approaches beyond the one-year timeframe, but results are mixed when evaluating earlier time points. The purpose of this study was to compare clinical outcomes and PROs between DAA and PL THAs at six weeks postoperatively. Methods A retrospective review of 749 primary THAs (151 PL, 598 DAA) from March 2020 to November 2022 was performed. All surgeries were performed by one of the five board-certified and fellowship-trained orthopedic surgeons. All patients completed Patient Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) questionnaires preoperatively and at six weeks postoperatively. A univariate comparison of clinical outcomes (length of stay (LOS), home discharge rate, 90-day ED returns, and readmissions) and six-week PROMIS-PF scores between approaches was performed. Multivariate analysis was performed to evaluate the effect of the approach on outcomes after adjusting for baseline differences between groups. Results Patients undergoing DAA THA experienced significantly shorter average LOS (0.71 vs. 1.36 days, p<0.001), higher rates of home discharge (99.0 vs. 92.1%, p<0.001), and lower rates of 90-day readmissions (0.7 vs. 6.0%, p<0.001) than those undergoing the PL approach. At six weeks postoperatively, DAA patients achieved higher average PROMIS-PF scores (42.2 vs. 39.9, p=0.001). After adjusting for the Charlson Comorbidity Index and baseline physical function, the DAA was significantly associated with shorter LOS (β=-0.52, p<0.001), increased odds of home discharge (OR=5.70, p=0.001), reduced risk of 90-day readmission (OR=0.14, p=0.001), and higher PROMIS-PF scores at six weeks postoperatively (β=1.37, p=0.045). Conclusion In comparison to patients undergoing PL THA, those treated using the DAA experienced improved clinical and PROs over the six-week postoperative period. While both approaches resulted in satisfactory outcomes, these results support the assertion that DAA THA may result in more rapid recovery and return to function.

Patient-Reported Outcomes After Ferric Carboxymaltose Treatment for Iron Deficiency Anemia: A Prospective Observational Study.

Iron deficiency anemia (IDA) is a common cause of fatigue and impaired quality of life. The present study aimed to evaluate the impact of intravenous iron supplementation with ferric carboxymaltose (FCM) on fatigue, physical function, and general health among patients with IDA attending routine clinical care. This was a prospective, single arm, observational study of adult patients prescribed with intravenous FCM for the treatment of IDA during routine clinical care. We used Patient-Reported Outcomes Measurement Information System (PROMIS) instruments to evaluate fatigue (PROMIS Short Form v1.0 13a [FACIT-Fatigue]), general health status (PROMIS Scale v1.2), and physical function (PROMIS Short Form v2.0 4a) before and at 3 and 6 months after FCM treatment. A total of 152 patients were enrolled. Mean age was 47.4 ± 16.0 years and 82.2% were female. Mean serum hemoglobin was 10.2 ± 1.4 g/dL at baseline. All patients were treated with at least one FCM dose at baseline, with 77.6% receiving a two-dose treatment course. The mean baseline FACIT-Fatigue score was 61.0 ± 9.0, improving significantly to 50.2 ± 9.5 at 3 months after FCM treatment. A minimum 5-point improvement, pre-defined as clinically meaningful, was seen in the FACIT-Fatigue, PROMIS Global Physical Health, Global Mental Health and PROMIS Physical Function scores for 72.7%, 52.8%, 41.7% and 39.8% of patients at 3 months (p < 0.0001 for each change from baseline), with statistically significant improvement continuing at 6 months. Mean serum hemoglobin was significantly increased at both 3 and 6 months (12.8 g/dL [N = 44] and 12.4 g/dL [N = 54], respectively). IDA patients attending routine clinical practice reported substantial levels of fatigue and impairments in physical function and global health prior to intravenous iron treatment. Patients experienced significant improvements in fatigue symptoms, physical function, and global health at 3 months after treatment with FCM, which were sustained at 6 months.

The trajectory of patient-reported outcomes and minimal clinically important differences in isolated and polytraumatic pelvis and acetabular fractures.

Patient-reported minimal clinically important differences (MCID) provide a standard to compare clinical outcomes. The purpose of this study was to calculate the MCID of PROMIS Physical Function (PF), Pain Interference (PI), Anxiety (AX), and Depression (DEP) scores in patients with pelvis and/or acetabular fractures. All patients with operatively treated pelvic and/or acetabular fractures were identified. Patients were categorized as either only pelvis and/or acetabular fractures (PA) or polytrauma (PT). PROMIS PF, PI, AX, and DEP scores were evaluated at 3-month, 6-month, and 12-month intervals. Distribution-based MCID and anchor-based MCID were calculated for the overall cohort, PA, and PT groups. The overall distribution-based MCIDs were PF (5.19), PI (3.97), AX (4.33), and DEP (4.41). The overall anchor-based MCIDs were PF (7.18), PI (8.03), AX (5.85), DEP (5.00). The percentage of patients achieving MCID for AX was 39.8-54% at 3months and 32.7-56% at 12months. The percentage of patients achieving MCID for DEP was 35.7-39.3% at 3months and 32.1-35.7% at 12months. The PT group had worse PROMIS PF scores than the PA group at all time points [post-operative, 3-month, 6-month, and 12-month scores, (28.3 (6.3) vs. 26.8 (6.8) P = 0.016), (38.1 (9.2) vs. 35.0 (8.7) P = 0.037), (42.8 (8.2) vs. 39 (9.6) P = 0.015), (46.2 (9.7) vs. 41.2 (9.7) P = 0.011)]. An overall MCID for PROMIS PF was 5.19-7.18, PROMIS PI 3.97-8.03, PROMIS AX of 4.33-5.85, and PROMIS DEP of 4.41-5.00. The PT group had worse PROMIS PF at all time points. The percentage of patients achieving MCID for AX and DEP plateaued at 3months post-operatively. Level IV.

Paper 48: Association of 3D MRI Volumetric Assessment of Rotator Cuff Pathology with Preoperative Patient Reported Outcomes

Paper 48: Association of 3D MRI Volumetric Assessment of Rotator Cuff Pathology with Preoperative Patient Reported Outcomes

Poster 223: Patient Reported Outcomes Following Treatment with Leukocyte Rich Platelet Rich Plasma Injections for Proximal Hamstring Tendinopathy

Poster 223: Patient Reported Outcomes Following Treatment with Leukocyte Rich Platelet Rich Plasma Injections for Proximal Hamstring Tendinopathy

Superior Outcomes with Reverse Shoulder Arthroplasty Versus Nonoperative Management for Proximal Humerus Fractures: A Matched Cohort Analysis.

To evaluate early outcomes (within 1 year) for geriatric proximal humerus fractures managed nonoperatively or with reverse shoulder arthroplasty (RSA). Retrospective cohort Setting: Academic level 1 trauma center, level 2 trauma/geriatric fracture centerPatients/Intervention: 71 patients with proximal humerus fractures that underwent nonoperative management or RSA, matched by age, comorbidity burden, and fracture morphology. Patient reported outcomes, range of motion, and complications rates within 1 year of treatment. RSA patients demonstrated greater active forward flexion (aFF) and external rotation compared to nonoperative patients throughout the first 6 months after treatment (p<0.05 for all). RSA patients achieved satisfactory ROM (>90° aFF) at higher rates than nonoperative patients (96.2% vs 62.2%, p<0.01). RSA led to significantly lower shoulder pain and PROMIS pain interference scores throughout the first year post-treatment (p<0.05). PROMIS physical function scores were also higher in the RSA group at 3 months, 6 months, and 1 year compared to the nonoperative group (p<0.05 for all). Similar complication rates were experienced in both groups (nonoperative=8.9%, RSA=7.7%; p=0.36). In an age, comorbidity and fracture morphology matched analysis, treatment of proximal humerus fractures with RSA is associated with greater shoulder ROM throughout the first 6 months of treatment, decreased pain, and improved physical function compared to nonoperative management, without significant differences in short term complications. These results suggest that RSA may be superior to nonoperative management during the early recovery period for proximal humerus fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.