Sports Scores Research Articles

Complications, Reoperations, and Patient-Reported Outcomes Following a 2-Stage Revision Total Ankle Arthroplasty for Chronic Periprosthetic Joint Infections.

As total ankle arthroplasty (TAA) becomes more common, chronic periprosthetic joint infections (PJIs) will be encountered more frequently. No studies have reported on patient-reported outcomes following a 2-stage revision procedure for a chronic PJI after a TAA. The primary purpose of this study was to investigate postoperative clinical outcomes at a minimum of 2 years following a 2-stage revision TAA for chronic PJI. Patients who underwent a 2-stage revision TAA for a chronic PJI (>4 weeks after a primary TAA) between January 2010 and December 2019 were eligible to be included in this study. Chronic PJI was defined as a sinus tract that directly communicated with the prosthesis or the same organism identified in ≥2 synovial fluid samples. Twelve patients were eligible to be included in this case series. One patient died prior to 2-year follow-up, which left 11 patients available for analysis. All 11 patients underwent reimplantation. The data were found not to be normally distributed; therefore, medians and interquartile ranges (IQRs) were reported. At a median of 3.0 years (IQR 2.0-4.0 years) following the second stage of their revision arthroplasty, the median Foot and Ankle Ability Measure (FAAM) Activities of Daily Living and Sports scores were 60.7 (IQR 52.4, 79.8) and 31.3 (IQR 9.4, 40.6), respectively. At final follow-up, 10 patients (90.9%) were ambulating with a TAA in place. Seven patients (63.6%) required a reoperation including 1 patient who underwent a below-knee amputation. Our study suggests that a 2-stage revision TAA may be an option for patients with a chronic PJI. However, patients who undergo a 2-stage revision TAA for a chronic PJI have lower than previously published 2-year FAAM scores and a high rate of reoperation. Level IV, case series.

Outcomes of Surgical Treatment for Sural Nerve Pain

Category: Ankle; Hindfoot Introduction/Purpose: Somatic neuropathy is a common complication following foot and ankle surgery, trauma, or compression due to entrapment. Symptoms can be intense and debilitating. The Sural nerve is commonly affected and is at risk due to the location and proximity to frequently used surgical approaches. The purpose of this study is to investigate the outcomes of sural nerve neurolysis and neurectomy with intramuscular burial for sural neuritis. Methods: IRB approval was obtained, and patients were identified who underwent operative treatment by two foot and ankle specialists for sural nerve related pain. Exclusion criteria included patients under the age of 18, prisoners, those who underwent concomitant osseous procedures, and less than 6-week follow-up. Demographics and preoperative outcomes including FFI, SF-36, FAAM, and VAS were recorded. Final follow-up questionnaires using PROMIS measures and FAAM were administered using REDCap. Results: The 25 patients meeting inclusion criteria for this study had a median age of 47 (interquartile range [IQR], 43 to 49) and had median follow-up of 33.7 months (IQR, 4.5 -73.2). Median FAAM ADL improved from 40.8 (IQR 38.1-51.3) preoperatively to 59.5 (IQR 47.6-76.2) postoperatively, p=0.032. FAAM Sports scores improved from 15.6 (IQR 9.4-21.9) to 31.3 (IQR 25.0-56.3) postoperatively, p=0.002. VAS scores improved from a median of 9.0 (IQR 7.0-9.0) to 4.5 (3.0-6.0), p<0.0001. At final follow-up patients reported PROMIS lower extremity function score median of 46.7 (IQR 36.7-51.2), PROMIS neuropathic pain quality score of 51.5 (IQR 45.5-60.2), and PROMIS pain interference of 55.7 (IQR 41.1-63.7). Patients with current or recent nicotine use, depression, anxiety, and complex regional pain syndrome (CRPS) prior to surgery reported poorer outcomes. Conclusion: Neurectomy with burial or neurolysis can significantly improve symptoms for sural neuritis secondary to neuroma or nerve entrapment. Tobacco use, depression and anxiety are associated with poorer outcomes following surgery. Further research is needed to More clearly identify patients at risk for worse outcomes and perioperative factors that could allow interventions to optimize patient outcomes.

Functional Outcomes of Primary Arthrodesis vs Open Reduction and Internal Fixation in the Treatment of Lisfranc Injuries

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: The lack of data regarding functional outcomes of midfoot primary arthrodesis (PA) and open reduction and internal fixation (ORIF) contributes to significant debate regarding the optimal method of treatment for Lisfranc injuries. Although PA is associated with lower rates of secondary procedure and posttraumatic arthritis, its impact on foot functionality has come into question due to sacrifice of tarsometatarsal (TMT) mobility. The authors hypothesize that there is no significant difference between patient recorded outcome measures (PROMs) among patients receiving PA and ORIF for the treatment of Lisfranc injuries. Methods: A retrospective cohort study of patients surgically treated for Lisfranc injuries between January 2010 and January 2019 at a Level I trauma center was undertaken. Retrospective chart review was utilized to obtain patient demographics, comorbidities, procedural information, complications, and additional treatments. Responding by survey, patients reported their functional competency in performing daily and sports-related activities via the validated Foot and Ankle Ability Measure (FAAM) instrument. For each patient, scores for the Activities of Daily Living (ADL) and Sports sections were calculated. Patients also reported their perceived current level of function on a percent scale with respect to functionality prior to TMT injury. Results: Twenty-four patients underwent PA, and 27 patients underwent ORIF. There were no significant differences between age (P=0.55), incidence of high energy injury mechanisms (P=0.14), comorbidities, or time to surgical intervention from injury (P=0.25) among PA and ORIF groups. There were no significant differences in FAAM scores among PA and ORIF groups. The average ADL scores for PA (72.42 +- 17.53) and ORIF (68.11 +- 28.24) were not significantly different (P=0.52), nor were the average Sports scores for PA (47.92 +- 25.48) and ORIF (48.56 +- 29.44) groups (P=0.94). However, patients in the PA group reported a significantly higher level of perceived ADL function (77.96% +- 17.97%) compared to patients in the ORIF group (60.04% +- 35.47%, P=0.03); this was not the case for perceived Sports functionality (P=0.67). Conclusion: This analysis of PROMs revealed no significant difference in the ability to participate in ADLs and sports between PA and ORIF groups. These results align with our hypothesis and suggest that despite sacrificing TMT joint mobility, functional outcomes of patients receiving PA were not significantly different from those receiving ORIF for Lisfranc injuries.

The acquisition of numerical compound attack and circular attack skills for fencing beginners using a foil weapon

The study aimed to find the differences between the results of the players in the performance of the numerical and circular complex attack skills for juniors fencing with a fencing weapon. Undoubtedly, sports results are constantly changing and continuously, this continuity implies to the use of the quantitative assessment system for the players’ specifications and skills, in order to form a model for a player who would be able to reach the higher levels, as the skills that players learn are determined by their sports scores. Accordingly, the researchers used the descriptive approach in the survey method for its relevance to the nature of the problem in order to achieve the objectives of the research. After they identified the research community with the junior players in Diyala province, which numbered (40) players, a sample of (24) players were selected in a systematic random manner. The results came with an important conclusion, which is that the research sample members performed the two skills at a high and close level, and there is no meaningful difference between these two performances.

Outcomes of Patellar Subchondroplasty Surgery: A Case Series.

A select subset of patients can present with anterior knee pain in the setting of normal patellar tracking, no significant cartilage damage, and the presence of a bone marrow lesion (BML) involving the patella on advanced imaging. One novel treatment option for this condition is patellar subchondroplasty, where calcium phosphate is injected into the subchondral bone under fluoroscopic guidance. The purpose of this study is to report preliminary outcomes of patients who have undergone subchondroplasty of the patella. The surgical log of the senior author was retrospectively reviewed to identify patients who had undergone patellar subchondroplasty from January 2014 to June 2019. Indications for surgery included the presence of retropatellar pain refractory to conservative management without significant arthritis with a related focal BML on magnetic resonance imaging. International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Veterans Rand 12-item Health Survey (VR-12) were obtained preoperatively, at 6 months and at final follow-up. Eight patients (nine knees) who underwent patellar subchondroplasty with minimum 1-year follow-up participated in the study. On preoperative magnetic resonance imaging, patients had a mean BML that was 2 cm in diameter. Patients had a median Kellgren-Lawrence grade of 2 both preoperatively and at final radiographic follow-up (15.50 ± 20.52 months). No patient underwent subsequent surgery or conversion to arthroplasty. Compared with baseline, VR-12 mental (p = 0.046) and physical (p = 0.003), KOOS joint replacement (p = 0.024), KOOS pain (p = 0.033), and KOOS sports (p = 0.034) scores were significantly increased at final follow-up (24.00 ± 13.55 months). In addition, on a scale of 0 to 100, patient-reported satisfaction was 73.88 ± 33.90. This study introduces patellar subchondroplasty as a surgical treatment for patients with symptomatic BMLs of the patella without significant arthritis after failure of conservative management. Our results demonstrated good outcomes and patient satisfaction. In addition, no patients converted to patellofemoral or total knee arthroplasty. This study suggests that patellar subchondroplasty may be a reasonable treatment option in the correct patient population.

Paper 49: Demographic and Clinical characteristics of patellar instability patients from prospective JUPITER (Justifying Patellar Instability Treatment by Early Results) cohort.

Objectives:The purpose of this study is to provide an objective analysis of patient demographics and clinical features for the young patients with patellar instability. JUPITER (Justifying Patellar Instability Treatment by Early Results) is a hypothesis-driven, multi-center, multi-armed, prospective cohort study developed to better describe demographic and clinical characteristics and predictors of clinical outcomes in the young patellar instability population.Methods:21 surgeons from 12 institutions enrolled patients between 10-30 years of age who presented with at least one documented patellar dislocation episode. Radiographs and MRI were evaluated for all patients at baseline to confirm patellar dislocation and skeletal maturity status. Patient demographics, dislocation history, physical exam characteristics and baseline validated patient reported outcome (PRO) scores were collected and analyzed. Conservative versus operative treatment was based on treating physician’s preference following standard of care guidelines. The cohort was divided between first-time vs recurrent dislocators and between conservative vs operative treatment.Results:At the end of enrollment in December 2020, a total of 1722 knees with patellar instability were enrolled. The mean age of the cohort was 17.7 years, 62.4% were female. 306 were skeletally immature. 59% of knees reported that they had more than 1 dislocation. ). 71% knees were enrolled in the operative group and 29% in the conservative group. For patients with recurrent dislocation, 89.7% were treated operatively and 10.2% were treated conservative (p<0.001). Operative treatment was indicated in 42.9% of first-time dislocators; 50% were due to presence of an osteochondral fracture. The recurrent and operative group patients were noted to have a higher percent of positive physical exam findings than first-time and conservative group patients on the affected knee (J-sign [p<0.001], apprehension [p<0.001], crepitus [p=0.041]) and the contralateral knee (except for the crepitus test [p=0.648]). The recurrent group was nearly twice as likely to be ligamentously lax (Beighton score of 5 or greater) compared to first-time dislocators (p<0.001). Baseline PROs varied with the recurrent group having lower Pedi-FABS (p=0.001) and KOOS-QoL (0.008) scores and higher Kujala (0.009), KOOS ADL (0.008), KOOS Sports (<0.001), and Pedi-IKDC (0.014) scores than the first-time dislocator group.Conclusions:Based on large prospective cohort of JUPITER group, operative management was indicated in 42.9% of first-time dislocators and 89.7% of recurrent dislocators. Besides osteochondral fracture, recognition of risk factors (young age, contralateral dislocation, anatomic risk factors) may account for higher rates of operative treatment after first-time dislocation. Recurrent dislocators were more likely to have positive physical exam findings on both knees and lower activity scores. However, the knee specific outcome scores were higher in patients with recurrent dislocations which may reflect adaptive mechanisms to improve function. This prospective study provides insights related to demographic information, clinical presentation and baselines PROs of patients with patellar instability. These baseline characteristics would help to identify the at-risk population and compare outcomes in a longitudinal fashion.

Research on Sustainable Development of Competitive Sports in China based on PSR and DEA Model

This paper evaluates the sustainable development of China's competitive sports by using PSG model, principal component analysis, entropy method, coupling coordination degree model and grey correlation model. Sports development in the area of the sample and take the PSG model, principal component analysis (PCA) and entropy method to evaluate various provinces and cities and regions in the development of competitive sports scores, the PSR model coupling coordination degree evaluation of parts of the development of the coordination degree between the three systems, and finally build obstacle factor analysis model of gray correlation analysis to find the obstructive factors for the development of competitive sports. Confirmatory analysis by quantitative research method shows that the eastern region has the highest score in sustainability evaluation and the highest coupling coordination degree. It is suggested that in order to promote the sustainable development of competitive sports, all regions should increase the expenditure of sports development and the number of sports talents reserve.

Long Term Outcome Measures Following Arthroscopically Assisted Particulated Juvenile Allograft Cartilage Implantation for Treatment of Difficult to Treat Osteochondral Lesions of the Talus

Category:Ankle; Arthroscopy; SportsIntroduction/Purpose:Conventional methods are not suitable for difficult to treat osteochondral lesions of the talus (OCLT) such as those defects that are large, shoulder lesions, failed previous surgery, or certain patient factors. Osteochondral autograft transfer system (OATS) has been accepted as the primary method of treatment for these more difficult defects, however, complications such as residual knee pain from the graft site, a multiday procedure, and the necessity for a malleolar osteotomy have made this technique not devoid of complications. Particulated juvenile articular cartilage transplantation for these lesions has theoretical advantage of performing the procedure arthroscopically, without need for an osteotomy or autograft. The purpose of this study is to determine long term patient reported outcomes for this procedure.Methods:Thirteen patients with difficult to treat OCLT underwent arthroscopic assisted implantation of DeNovo NT graft into defects from 2010-2012 by the same surgeon. 'Difficult to treat’ was defined as having at least three of the following features or two if both variables described lesion characteristics: 1) lesions size of 107mm2 or greater, 2) shoulder lesions, 3) patients who failed microfracture, 4) patient age over 40, or 5) patient BMI>25kg/m2. Patients were evaluated using physical examination, patient interviews, and pre and postoperative outcome score measures utilizing Visual Analogue Scale, Short Form 36 and Foot and Ankle Ability Measurement questionnaires, and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale. Patients had follow-up at 2 years, 4 years, and between 6-9 years at their most recent follow-up. Differences in functional outcome scores were compared before and after surgery.Results:Patients (Age: 46.5+-11.8years, Body Mass Index: 28.5 +-6.1kg/m2) had on average, most recent follow-up of 8.0 years (range 72-113 months). Average VAS pain score decreased for patients by 3.9 points, 95% CI [2.18, 5.60], when compared to preoperative assessment. FAAM ADL and Sports scores also showed improvement from 46.5 to 80.9, 95% CI [21.35, 47.43] and from 18.8 to 57.9, 95% CI [21.05, 57.10], respectively. SF-36 physical component scores showed significant improvement by an average of 45.5 points, 95% CI [32.42, 58.50]. AOFAS scores improved from 55.2 to 80.3, 95% CI [12.459, 37.741]. Patient demographics and results are seen in Tables 1 and 2 respectively.Conclusion:These results demonstrate clinically positive long-term outcomes for a cohort of patients with difficult OCLT, followed over the course of 6-8 years after treatment with arthroscopic assisted DeNovo NT implantation. Understanding the longevity of this intervention can better aid clinicians in deciding if this treatment option is appropriate for patients and should ultimately be included as part of the orthopedics’ armamentarium.

Arthroscopically Assisted Particulated Juvenile Allograft Cartilage Implantation and Bone Grafting for Treatment of Large Cystic Osteochondral Lesions of the Talus: A Case Series

Category:Ankle; Arthroscopy; Basic Sciences/Biologics; Sports; TraumaIntroduction/Purpose:Osteochondral lesions of the talus (OCLT) are common traumatic injuries and can be difficult to treat. Conventional methods consist of arthroscopic debridement and bone marrow stimulation techniques including microfracture, curettage, abrasion chondroplasty and antegrade/retrograde drilling predominantly leading to fibrocartilage formation. These methods have proved effective for small lesions; however, larger lesions with accompanying subchondral bone cysts require more invasive treatment with osteochondral allografts or autologous chondrocyte implantation. These procedures can require harvesting of osteochondral grafts from the knee or malleolar osteotomies, which have associated donor site morbidities and complications of osteotomy healing. We describe an alternative method, an all-arthroscopic technique to treat these large cystic OCLTs, and sought to determine long-term quality of life metrics for a cohort of patients.Methods:From 2010-2012, six patients with difficult to treat OCLTs underwent arthroscopic-assisted implantation of particulated juvenile allograft cartilage with viable chondrocytes (DeNovo NT) along with autogenous bone grafting from the calcaneus by a single surgeon. These lesions all had associated cystic changes requiring bone graft to fill the defect. Other inclusion criteria included at least two of the following: 1) shoulder lesions, 2) lesion size > 200 mm2, 3) failed previous microfracture treatment, or 4) age > 40 with a Body Mass Index (BMI) > 25 kg/m2. These six patients were fully evaluated using physical examination, patient interviews, and outcome score measures. Follow-up was completed at 2 years, 4 years, and between 6-9 years at their most recent visit. Pre-operative and post-operative functional outcome scores were compared with Wilcoxon Signed Ranked Test.Results:Six patients (age: 43.8 + 14.0 years, BMI: 28.4 + 6.7 kg/m2) had average lesion sizes of 188.5 + 50.9 mm2 (range: 125-260 mm2) and most recent follow-up of 8.4 + 1.2 years (range: 6.0-9.3 years). Post-operatively, average VAS pain scores decreased by 4.2 points, 95% CI [1.6-6.8]. FAAM ADL scores improved from 41.8 to 72.5, 95% CI [11.3-50.1]. SF-36 Physical Component Scores also showed significant improvement by 37.8 points, 95% CI [20.8-54.8]. FAAM Sports (p = 0.055) and AOFAS (p = 0.066) scores clinically improved from 13.3 to 39.2 and 57.7 to 86.3, respectively, and approached statistical significance. There were no intraoperative or perioperative complications with calcaneal bone grafting.Conclusion:A small cohort of patients followed over the course of ~8 years after implantation of particulated juvenile allograft cartilage (DeNovo NT) and autogenous calcaneal bone graft for cystic OCLTs had positive post-operative, self-reported functional outcomes. Patients significantly improved compared to pre-operative measures, with no complications observed. This may be an effective long-term treatment for patients with difficult to treat OCLTs.

The Adelaide Experience: Short Term Results with the Use of Cartiva Implant

Category:Midfoot/ForefootIntroduction/Purpose:Hallux rigidus is the most common arthritic condition of the foot. There are only few surgical options that does not require fusing the 1st MTPJ thus allowing motion in the joint. A new first metatarsophalangeal (MTP) joint hemiarthroplasty with a polyvinyl alcohol (PVA) hydrogel implant (Cartiva) has demonstrated pain relief and functional outcomes equivalent to first MTP arthrodesis at 2 and 5 years postoperation in few studies done in North America. We would like to present the Adelaide short term result with the use of this implant.Methods:40 Patients who underwent first PVA hydrogel MTP hemiarthroplasty in Adelaide by two senior foot and ankle surgeons (C.B and P.S) and by two international foot and ankle fellow (G.G and J.P) between 2017 and 2019 were included in this study. The follow up period was 24 months postoperation. Patients underwent physical examination and radiographic evaluation and completed a pain VAS, the Short-Form-36 (SF-36), and the Foot and Ankle Ability Measure (FAAM) sports subscale and activities of daily living (ADL) subscale. At the time of this study, 40 patients had reached 2 year follow-up.Results:There were no lost to follow up, leaving 40 patients with mean age 63.4 (range, 40.1-79.9) years. Mean follow-up was 24 months (range, 6-30 months). Postoperative active MTP natural joint dorsiflexion and peak MTP dorsiflexion were mean 18.2 (range, 10.0- 30.0) and 29.7 (range, 10.0-45.0) degrees, respectively. Pain VAS, SF-36, FAAM ADL, and FAAM Sports scores demonstrated clinically and statistically significant improvements. Radiographically, no patient demonstrated changes in implant position, implant loosening or subsidence, or implant wear. One implant was removed because of persistent pain 7 months post surgery and was converted to fusion 3 months after the removal of the Cartiva implant.Conclusion:Short term results for the use of Cartiva implant in Adelaide show that functional outcomes improved significantly, pain was reduced significantly, and the implant demonstrated excellent survivorship. Our results are similar for those described in the North American literature

Presence and predictors of pain after orthopedic surgery and associated orthopedic outcomes in children with cerebral palsy.

While children with cerebral palsy (CP) may undergo 8‐22 orthopedic surgeries in their lifetime, little is known about the associated pain. We aimed to assess the pain presence before and one year after lower extremity orthopedic surgery, predictors of pain presence at follow‐up, and the association between pain and orthopedic outcomes related to surgery. This retrospective study included 86 children with CP (M age = 10.0 years, SD = 3.2; range = 4.1‐17.3 years, Gross Motor Functional Classification System (GMFCS) level I‐III) who underwent orthopedic surgery and had completed questionnaires at gait analyses before (M = 2.7 months; range = 0.0‐5.7) and after surgery (M = 11.8 months; range = 9.0‐14.9). Pain presence, location, and Pediatric Outcomes Data Collection Instrument (PODCI) scores were documented before and after surgery at gait analyses. Pain prevalence was 60% at baseline and 56% at follow‐up. Significant predictors of pain presence at follow‐up included (1) pain presence at baseline (range of odds ratios [OR] across any/all locations = 3.22 to 15.54), (2) older age (range of OR for any pain, back, knee, and foot pain = 1.24‐1.26), (3) female sex (decreased OR for males for ankle pain = 0.12), (4) having hip surgery (decreased OR for foot pain = 0.20), and (5) lower GMFCS level (OR for foot pain = 0.41). Changes in PODCI Sports and Physical Function scores were associated with changes in hip and knee pain (P < .03); PODCI scores worsened for patients who had pain at both time points and improved for patients who had pain at baseline but not follow‐up. Pain was present for over half of the participants before and after orthopedic surgery. Pain presence at follow‐up was predicted by pain presence at baseline. Pain and functional outcomes were correlated at follow‐up. Prospective studies examining perioperative pain experience and factors predicting pain outcomes are warranted.

Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort Study.

BackgroundAnkle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, especially progressive exercise, has proven effective in improving function, while preventing recurrence.ObjectiveWe aim to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains.MethodsWe performed a prospective longitudinal cohort study of individuals eligible for workers’ compensation, who were referred for digital rehabilitation therapy for a sprained ankle. Therapeutic exercise sessions were to be performed independently by the patient at home using the biofeedback device provided by SWORD Health. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure–activities of daily living (FAAM–ADL) and FAAM–Sports scores. Participants were assessed at baseline, end of the program, and 6 months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction.ResultsIn total, 93 (89.4%) patients completed the program and 79 (76.0%) were available for follow-up. Changes in the primary outcomes between baseline and the 6-month follow-up were both significant (P<.001) and clinically meaningful: mean difference of –2.72 points (95% CI –3.31 to –2.13) on the NPRS (49.8% reduction), 21.7 points (95% CI 17.13-26.27) on the FAAM–ADL (41.1% increase), and 37.8 points (95% CI 30.45-45.15) on the FAAM-Sports (151.8% increase). Longer waiting periods between the accident date and treatment initiation were found to negatively impact functional status at baseline and at the end of the program, triggering an extension in the program duration. The total training volume (12.5 hours, SD 10.5 hours) was similar to that of other interventions for ankle sprains, but the dosage per week was much higher (2.4 hours per week, SD 0.87 hours per week). The mean patient satisfaction score was 8.8 (SD 1.57) out of 10. Among program completers, 83.9% attained full recovery and were discharged with no residual disability.ConclusionsBeing far less demanding in terms of human resources, the digital program presented constituted a viable, clinically effective, and convenient solution for ankle sprain rehabilitation, particularly during the pandemic. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results. This was a prospective cohort study and, as such, did not include a control group, but the results appear comparable to those published for face-to-face interventions.Trial RegistrationClinicalTrials.gov NCT04819022; https://clinicaltrials.gov/ct2/show/NCT04819022

Anterior cruciate ligament reconstruction in the over-50s. A prospective comparative study between surgical and functional treatment

IntroductionIn patients aged over-50 years, although data are sparse, results of anterior cruciate ligament (ACL) surgery are good if selection is correctly performed. However, non-operative treatment is usually proposed for this age group, as patients generally prefer just to scale down their sports activities. Non-operative results are acceptable, but with a high risk of residual instability, secondary lesions and lifestyle alteration. The main aim of the present study was to compare results between surgical versus non-surgical treatment of ACL tear in over-50 year-olds. Secondary objectives comprised assessing prognostic factors for poor functional outcome, and comparing the 2 groups epidemiologically to identify clinical decision-making factors. The study hypothesis was that results are comparable between operative and non-operative treatment of ACL tear. Material and methodThree hundred twenty patients were followed up prospectively: 92 non-surgical (NS group) and 288 surgical (S group). Classical epidemiological data were collected. Clinical laxity, differential laximetry, KOOS, IKDC, Tegner and ACL-RSI scores and radiologic assessment were collected pre- and postoperatively, as were intraoperative data. Early and late complications were collected. ResultsAll patients were followed up. Patients were principally female, and were older, less athletic, with more stable knee and less severe functional impact in the NS group. Functional scores improved in both groups, and especially in group S, where sports scores were also better. In the NS group, laximetry at follow-up correlated with preoperative marked pivot-shift (p=0.024). Severe differential laxity was predictive of poor IKDC score (p=0.06). In the S group, laximetry at follow-up correlated with preoperative explosive pivot-shift (p<0.001), lateral meniscal lesion (p=0.007), use of hamstring tendon (p=0.007), and non-operated early complications (p=0.004). Factors for poor global KOOS score in group S comprised female gender (p<0.001), high BMI (p<0.001) and skiing (p=0.038). Factors for poor Tegner scores comprised skiing or team sport (p<0.05), isolated moderate medial osteoarthritis (p=0.01), and non-operated early complications (p=0.022). Factors for poor IKDC score comprised female gender (p=0.064), and non-operated early complications (p=0.019). Complications did not differ between groups. Discussion/ConclusionResults were satisfactory in both groups, with significant improvement in functional scores, but were better in group S. For NS patients, pivot sport was barely feasible and sports activity scores decreased. In case of severe laxity at diagnosis, surgical treatment should be proposed. Level of evidenceIII; non-randomized prospective comparative series.

DESCRIPTIVE EPIDEMIOLOGY STUDY OF THE JUSTIFYING PATELLAR INSTABILITY TREATMENT BY EARLY RESULTS (JUPITER) COHORT

Background:Patellar instability is a common injury in young patients and can lead to significant morbidity and arthritis. Its management is controversial. JUPITER (Justifying Patellar Instability Treatment by Early Results) is a hypothesis-driven, multi-center, multi-armed, prospective cohort study developed to describe clinical characteristics and predictors of clinical outcomes in the young patellar instability population.Purpose:To describe the formation of JUPITER and provide a descriptive, epidemiologic analysis of patient demographics and clinical features of the patients in this prospective cohort.Methods:After training and institutional review board approval, surgeons began enrolling patients between 10-30 years of age who sustained a patellar dislocation. Patient demographics, dislocation history, physical exam characteristics, and PROMs were collected.Results:By January 1, 2019, 28 surgeons from 12 sites had prospectively enrolled 661 patients (677 knees) with patellar instability. 62% were female and mean age was 15.8 years. 447 knees (66%) were in the operative group and 230 (34%) in the non-operative group. 55% of knees reported that they had more than 1 dislocation (operative group 73%; non-operative group 27%, p<0.001). Operative treatment was indicated in 39% of first-time dislocators and 85% of recurrent dislocators (p<0.001).Recurrent and operative group patients had more positive physical exam findings than first-time and non-operative group patients on the affected knee (p<0.05 for J-sign, apprehension, crepitus) and the contralateral knee (p<0.05 J-sign, apprehension). The recurrent group was nearly twice as likely to be ligamentously lax (Beighton score 5 or greater) compared to first-time patients (p<0.001).Baseline PROMs varied with the recurrent group having lower Pedi-FABS (p=0.001) and KOOS-QoL (0.008) scores and higher Kujala (0.009), KOOS ADL (0.008), KOOS Sports (<0.001), and Pedi-IKDC (0.014) scores than the first-time dislocator group.Conclusions:The JUPITER Group has been able to accumulate the largest prospectively collected patellar instability database to date. Over half of patients in this group reported they sustained more than one dislocation. Operative management was indicated in 39% of first-time dislocators, 50% of which had sustained an osteochondral fracture, and 85% of recurrent dislocators. Recurrent dislocators were more likely to have positive physical exam findings on both the affected and contralateral knee.

Investigation of Teachers' Attitudes Towards Sports in Turkey

This research was conducted to examine the Attitudes of Teachers working in public schools towards Sports in terms of Different Variables. The data of the research were obtained from 403 teachers working in Aydın during the 2020-2021 academic year. As the data collection tool, "Attitude Scale towards Sports" made by Halil Evren Şentürk (2012) was used. Descriptive statistics and nonparametric tests were used to analyze the data. Mann Whitney U-test was used for comparisons of two groups, and Kruskal Wallis H was used for comparing more than two groups. The Cronbach's Alpha coefficient of the scale was found to be 0.97. As a result of the research, a statistically significant difference was found as a result of the analysis made between the sub-dimensions of the attitude towards sports in the variables of the teachers' Gender, Education and Branch (p &lt;0.05). In the gender variable, it was concluded that the Attitudes of Female Teachers towards Sports were higher than male teachers in all sub-dimensions of the scale. When the Educational Status Variable is examined, it is seen that in the dimension of Interest in Sports, Graduate Teachers' Attitudes towards Sports are higher than Undergraduate teachers. In the Active Sports dimension, it is concluded that the Graduate Teachers' Attitude towards Sports scores are higher than the Undergraduate Teachers. It was concluded that Physics, Biology and Science, Turkish and Literature, History, Geography and Social, Religious Culture and Moral Knowledge, PDR and Philosophy, Mathematics and Information Technologies, Vocational Courses and Technology Design teachers were higher than their attitude scores. Physical Education and Sports Teachers' attitude scores in the dimension of Life with Sports Foreign Language Teachers (German and English), Chemistry, Physics, Biology and Science, Turkish and Literature, Religion and Moral Knowledge, PDR and Philosophy, Mathematics and Information Technologies, Vocational Courses and It is higher than the attitude scores of Technology Design teachers. The attitude scores of Physical Education and Sports Teachers in the Active Sports dimension are Foreign Language Teachers (German and English), Chemistry, Physics, Biology and Science, Turkish and Literature, History, Geography and Social, Classroom and Preschool, Special Education, Religious Culture and It is higher than Teachers of Morality, PDR and Philosophy, Mathematics, Information Technology, Vocational Courses and Technology Design. It was concluded that there was no statistically significant difference between the sub-dimensions of age, marital status, education level and attitude towards sports (p&gt; 0.05).

Plate Versus Lag Screw Only Fixation of Unstable Ankle Fractures Involving the Fibula in Adolescent Patients.

Plate fixation has been the traditional technique for fracture repair of unstable ankle injuries with an associated lateral malleolus fracture. Recently, biomechanical and clinical data have demonstrated lag screw only fixation to be an effective alternative to plate fixation in the adult population. This comparison has yet to be studied in the adolescent or pediatric population. The objective of this study was to compare lag screw only fixation with traditional plating for lateral malleolus fractures in adolescents. A retrospective review was conducted of 83 adolescents with unstable oblique lateral malleolus fractures treated at a single pediatric level-1 trauma center between 2011 and 2019 with a minimum clinical follow-up until fracture union. Patients were divided into 2 surgical groups: (1) plate fixation (n=51) or (2) lag screw fixation (n=32). Radiographic and clinical outcomes and complications were measured in both groups. All patients in both groups achieved our primary outcome measure of fracture union without loss of reduction. The mean surgical time for subjects treated with a plate was 15 minutes longer (64 vs. 49 min) (P=0.001) and these patients were 3.8 times more likely to have symptomatic implants (P<0.044) than subjects treated with screws. Approximately 50% of the cohort was available by phone for patient-reported outcomes at a mean follow-up of 50 months. The mean Single Assessment Numerical Evaluation scores, Foot and Ankle Ability Measure Activities of Daily Living scores, Foot and Ankle Ability Measure sports scores, and return to sports rates were similar (92 vs. 93, 98.2 vs. 98.1, 93.2 vs. 94.0, 95% vs. 86%, respectively; P>0.05) between the 2 treatment methods. Lag screw only fixation is a safe and effective procedure for noncomminuted, oblique fibula fractures in the adolescent population as demonstrated by equivalent fracture healing rates without loss of reduction and similar outcome scores. Given these comparable results with the additional benefits of shorter surgical time and less symptomatic implants, lag screw only fixation should be considered as a viable treatment alternative to traditional lateral plating in the adolescent population. Level III.

Relationship Between Tibiotalar Joint Space and Ankle Function Following Ankle Surgery.

Joint-preserving procedures of the ankle may postpone the need for ankle arthrodesis (AA) or total ankle replacement (TAR). The challenge for the surgeon is to determine which patients may benefit from these joint-preserving procedures. We hypothesized that patents with less than 2 mm of ankle joint space on preoperative radiographs would report inferior outcomes following joint-preserving surgery compared with those with 2 mm or greater joint space. Patients 18 years of age or older treated with joint-preserving ankle surgery with a minimum of 2 years of follow-up were considered for study inclusion. The ankle joint space was measured on standardized weightbearing preoperative radiographs. At follow-up, patients completed questionnaires including the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales, the Short Form-12 (SF-12) Physical Component Summary and Mental Component Summary, the Tegner Activity Scale, and satisfaction with outcome. A total of 251 patients were included in the study. Forty-three patients had an ankle joint space of less than 2 mm. Compared with the 208 patients with an ankle joint space of 2 mm or greater, they had inferior FAAM ADL, FAAM Sports, and SF-12 Physical Component Summary scores (P = .001, P = .001, and P = .006, respectively). Additionally, a statistically significant positive correlation between joint space distance and the FAAM ADL (P = .012, r = 0.158), FAAM Sports (P < .001, r = 0.301), and SF-12 Physical Component Summary (P < .010, r = 0.163) scores was found. Patients with a preoperatively narrowed ankle joint space of less than 2 mm had significantly lower outcome scores following joint-preserving ankle surgery compared with patients with preserved ankle joint space. These results may assist clinicians in selecting patients who may benefit from ankle joint-preserving procedures, as well as counseling patients with a narrowed ankle joint space regarding expected outcome after joint-preserving ankle surgery. Level II, prognostic comparative study.

Postoperative Noncompliance following Repair of Acute Achilles Tendon Ruptures

Category:Trauma; Ankle; Hindfoot; SportsIntroduction/Purpose:Patient compliance with postoperative instructions is an important aspect of the orthopaedic surgery treatment regimen and can be a substantial deciding factor in achieving good outcomes. The postoperative period following acute Achilles tendon repairs requires diligent patient compliance in order to achieve optimal outcomes. The purpose of this study was to report the incidence of postoperative noncompliance and determine independent predictive factors of noncompliance following surgical management of acute Achilles tendon ruptures.Methods:A retrospective review of patients undergoing primary open repair of acute Achilles tendon ruptures with a single fellowship-trained orthopaedic foot & ankle surgeon at a single surgical location from 2010-2017 was performed. Patients <18 years of age, those who underwent surgical repair >21 days from the date of injury, those whose repair required a V-Y advancement, or those with bilateral tendon ruptures were excluded. Patient records were reviewed for collection of patient data and postoperative chart notes were reviewed to document instances of noncompliance. Instances were subcategorized into non- accidental or accidental. Multivariable regression analysis was performed to determine independent predictors of noncompliance. Regression coefficients with 95% confidence intervals [95% CI] and p-values were reported for significant findings. Mann-Whitney U tests were used to compare Foot and Ankle Ability Measure (FAAM)-Activities of Daily Living (ADL) and -Sports scores and Visual Analog Scale (VAS) pain scores between compliant and noncompliant groups.Results:Of 232 patients meeting the inclusion criteria, 19 (8.2%) patients had 21 documented instances of noncompliance during the first 12 postoperative weeks, with 7/21 (33.3%) occurring during the first 2 postoperative weeks, 8 (38.1%) between weeks 3- 6, and 6 (28.6%) between weeks 7 and 12. Sixteen of the 21 (76.2%) instances of noncompliance were determined to be non- accidental, while 5 (23.8%) were accidental. Multivariable analysis demonstrated male sex (0.10 [0.00, 0.19]; p=0.0498) to be an independent predictor of non-accidental noncompliance. Age, BMI, a history of depression or diabetes, mechanism of injury, and timing of surgery following injury were not predictive of postoperative compliance. At mean 4.7 (range, 2.0-8.3) years postoperatively, the groups did not differ in FAAM-ADL (p=0.4311), FAAM-Sports (p=0.4258), or VAS pain (p=0.5050) scores.Conclusion:Postoperative noncompliance following surgical Achilles tendon repair occurs in nearly 1 out of every 12 patients, based on our cohort. Males, who make up the majority of Achilles tendon ruptures, have increased rates of non-accidental noncompliance. Patient noncompliance is an issue for orthopaedic surgeons of all subspecialties, and further investigations of incidence and risk factors should take place across a variety of commonly performed surgeries.

Predictors of Spring Ligament Degeneration and Outcomes of Reconstruction during Correction of Adult Acquired Flatfoot Deformity

Category:Hindfoot; Midfoot/ForefootIntroduction/Purpose:It is currently unclear how injury to the spring ligament (SL) affects the preoperative presentation of adult acquired flatfoot deformity (AAFD). The purposes of this study were to retrospectively identify shared factors that could be used to preoperatively predict SL damage in patients undergoing AAFD correction as well as compare outcomes of patients undergoing SL reconstruction to those not undergoing reconstruction during AAFD correction.Methods:All patients undergoing operative correction of grade 2B AAFD secondary to tibialis posterior tendon dysfunction by a single fellowship-trained foot and ankle orthopaedic surgeon from 2011 to 2017 were reviewed. Operative reports were reviewed for the surgeon’s evaluation of the competency of the SL and to determine whether SL reconstruction was performed. Patient charts were reviewed for demographic information, preoperative Visual Analog Scale (VAS) pain level, and their Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and -Sports subscales. Preoperative radiographic parameters were assessed by a surgeon blinded to the intraoperative findings. Patient outcomes of VAS pain, FAAM-ADL, and FAAM-Sports were collected at a minimum of 24 months postoperatively. Multiple logistic regression analysis was performed to determine significant independent predictors of spring ligament tears.Results:The study included 115 feet undergoing corrective reconstruction, with 47 feet having a spring ligament tear (40.9%). Patients with tears were significantly older (p<0.001), with higher preoperative reported pain (p=0.01), and lower preoperative FAAM-ADL (p=0.04) and -Sports (p=0.006) scores than those without SL tears. Patients with a SLT demonstrated significant differences in AP talo-1st MT angle (p=.003), talonavicular uncoverage percentage (p<0.001), talonavicular angle (p=0.017), and Meary`s talo-1st MT angle (p=0.001). Based on multiple logistical regression analysis (odds ratio [95% confidence interval]), patient age (1.10 [1.03, 1.18]; p=0.003), talonavicular uncoverage percentage (1.35 [1.13, 1.60]; p<0.001), and talonavicular angle (0.82 [0.71, 0.96]; p=0.0133) were independently predictive of ligament degeneration. Patients undergoing SL reconstruction did not differ significantly in functional score improvements compared to those without reconstruction.Conclusion:Our findings suggest that a SLT is associated with more advanced flexible pes planovalgus, measured both by radiographic parameters as well as its impact on patient function. Increasing patient age, increasing talonavicular uncoverage percentage, and decreasing talonavicular angle are all independently associated with increased likelihood of patients with AAFD having a SLT. AAFD correction with concomitant SL reconstruction does not appear to influence absolute or changes in patient pain and function.

Results of an Accelerated Rehabilitation Program after Arthroscopic Broström Ankle Ligament Repair Augmented with an Arthroscopically Applied Suture Tape

Category:Arthroscopy; Ankle; SportsIntroduction/Purpose:The Broström-Gould is the gold standard in repair of the lateral ankle ligaments for chronic instability and arthroscopic Broström repairs have become increasingly popular with outcomes comparable to the open procedure. Despite demonstrated success, the arthroscopic Broström, like the open procedure, does not achieve the same mechanical strength as the intact native ankle ligaments and is therefore not appropriate for early aggressive rehabilitation. Suture tape augmentation of an open Broström procedure has been shown to further strengthen the repair and produce favorable outcomes in preventing recurrent instability. Studies reporting long-term clinical outcomes of patients who undergo this procedure are lacking. This study reports clinical and functional outcomes after an arthroscopic repair with arthroscopically applied suture tape augmentation and an accelerated post-operative rehabilitation protocol.Methods:Ninety-three patients with chronic recurrent ankle instability who had failed non-operative treatment (bracing, taping, physical therapy) underwent arthroscopic lateral ligament repair augmented by a suture tape applied in a novel all-arthroscopic fashion (double stranded polyethylene tape fixed to talus and fibula with interference screws). Postoperatively patients were placed in a CAM walker and allowed to bear weight immediately. On postoperative day 8 patients were placed in a functional brace and began physical therapy to include motion, strength, and proprioceptive activities. At week 4 patients began sports specific activities and were allowed to return to unrestricted activity at week 8. Foot and Ankle Ability Measure (FAAM), Visual Analog Score (VAS), Tegner Score, and range of motion measurements were performed. Statistical analysis was done to determine averages, ranges, and standard deviations of scores. Paired t-test was utilized to find statistically significant differences in scores.Results:Eighty-five patients (42 males, 43 females; average age 30.42 years) were available at a minimum of 24 months post- operatively (range 24-68). Postoperatively, average VAS scores fell to 0.85 from 4.67, (p<2.2e-16), average FAAM ADL scores rose from 69.44 to 93.09, (p<2.2e-16), average FAAM Sports scores rose from 49.76 to 89.61. (p<2.2e-16), average Ankle ROM scores decreased from 56.12o to 54.76o, (p=.001523) and average HF ROM decreased from 20.07o to 18.19o (p=1.225e-11). The average Tegner score postoperatively was 7.45 (4-10). Patients reported 75% excellent, 24% good, and 1% fair results. Average time to desired level of activity was 5.14 months. There were 5 complications: one wound dehiscence, 2 cases of anterolateral impingement, and two cases of superficial peroneal neuritis. There was no recurrent instability.Conclusion:The results indicate that acclerated rehabilitation after arthroscopic lateral ligament repair augmented with arthroscopically applied suture tape is a safe and effective procedure that produces favorable outcomes for patients with chronic recurrent ankle instability.