Subjective Patient Outcomes Research Articles

Subjective and Objective Outcomes in Patients With COPD After Pulmonary Rehabilitation - The Impact of Comorbidities.

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with multiple systemic manifestations and comorbidities, which contribute independently to its total morbidity and mortality. Pulmonary rehabilitation is an evidence-based intervention that is indicated for COPD patients who remain symptomatic, despite optimal pharmacological therapy. Although it is well documented in pure COPD, the role of pulmonary rehabilitation is uncertain in coexisting comorbidities. The aim of the present study was to clarify the effect of a pulmonary rehabilitation program in COPD patients with concomitant comorbidities.Methods: Thirty two patients with COPD were evaluated before and after a comprehensive pulmonary rehabilitation program, in terms of dyspnea, quality of life (QOL), pulmonary function tests and exercise capacity. The patients were also divided into two groups, according to the presence or the absence of comorbidities. Patients with none or only one comorbidity (Group 1, n = 11) were compared to those who had two or more comorbidities (Group 2, n = 21).Results: All patients significantly improved in dyspnea, as expressed by modified Medical Research Council scale and the COPD assessment Test (p < 0.001), QOL as assessed by the St. George respiratory questionnaire (p < 0.001) and exercise tolerance in six minute walking test (p < 0.001). Peak oxygen uptake relatively increased and body mass decreased in Group 1 compared to Group 2 (p < 0.05).Conclusion: Pulmonary rehabilitation in COPD seems to be beneficial for all patients, independently of the presence, the number or the nature of their comorbidities. Thus, the presence of comorbidities must not represent an exclusion criterion for patients that are referred to pulmonary rehabilitation programs.Trial Registration: Current controlled trials ISRCTN14648515 Retrospectively registered 15 February 2018.

Transobturator Tape: Over 10 Years Follow-up

ObjectivesTo assess subjective and objective outcomes in incontinent patients following “out-in” TOT, at >10-year follow-up; to evaluate effect on quality of life and other urinary symptoms, late adverse events and predictive factors for failure. MethodsThis single-centre prospective study evaluated women with “complicated” or “uncomplicated” stress urinary incontinence (SUI) following “out-i”’ TOT between 2003 and 2007.The pre-op work-up comprised: history; pelvic examination; cough stress test; urodynamic study; UDI-6; and King's Health questionnaires.Work-up was the same as pre-op plus the Patient Global Impression of Improvement scale with final follow-up in 2017. ResultsOne hundred thirty six consecutive patients underwent TOT; at final follow-up (mean 145 months) we evaluated 123. Cure rates: objective: 78.9%; subjective: 62.6%; no significant deterioration in SUI cure rates over time.Urgency and urgency urinary incontinence (UUI) significantly reduced. Voiding dysfunction increased without urodynamic obstruction. De novo urgency appeared in 7.3% and de novo UUI in 4.1%.In the 31 uncomplicated SUI patients, the objective cure rate was 87.1% and the subjective cure rate was 72.2%. De novo urgency appeared in 9.7% and de novo UUI in 3.2%.Nine King's Health questionnaires domains saw statistically significant improvements.In univariate analysis, pre-op wet OAB was associated with subjective recurrent SUI (P < .038) and parity >2 was associated with objective recurrent SUI (P = .023).We had 5 cases of partial mesh exposure. ConclusionCure rates are satisfactory, 10 years after TOT surgery, with good quality of life and few major complications. However, some postoperative symptoms may be caused by long-term treatment failure or by advancing age or another pathology.

Indications and outcomes of simultaneous high tibial osteotomy and ACL reconstruction.

The purpose of this study was to systematically review the existing literature reporting surgical outcomes of simultaneous high tibial osteotomy (HTO) and anterior cruciate ligament reconstruction (ACLR) in anterior cruciate ligament deficient (ACLD) knees. This study was conducted per the methods of the Cochrane Handbook for Systematic Reviews of Intervention, with findings reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies and pertinent data was extracted. Studies reporting post-operative outcomes following simultaneous HTO and ACLR in ACLD knees were included. The search identified 515 studies, of which 18 (n = 516) were included. The mean MINORS scores for non-comparative and comparative studies were 11.6 ± 1.34 and 17.3 ± 1.9, respectively. Simultaneous HTO and ACLR resulted in improved functional subjective patient outcomes across a variety of scales. Simultaneous HTO and ACLR was effective in correcting varus angulation, with the post-operative mechanical angle ranging from 0.3° valgus to 7.7° valgus. The reported complication rate ranged from 0 to 23.5%. Across six studies, a total of 13 (6.5%) patients required revision HTO; while across four studies, 20 (17.5%) patients had failure of the ACL graft, with one receiving revision ACLR. Combined HTO and ACLR may be indicated in patients with ACLD knees with varus angulation. This systematic review found that the combined surgery resulted in significant improvement in post-operative functional subjective outcomes. However, it remains unclear if HTO with ACLR is superior to ALCR or HTO alone due to the lack of comparative studies. Overall, HTO with ACLR was found to have low rates of complications, re-ruptures, and need for revision surgery. This review found that patients continued to have progression of OA despite combined HTO with ACLR. Future research is required to better understand the effects of combined HTO and ACLR compared to ACLR or HTO alone and to evaluate the long-term post-operative progression of medial compartment OA following combined HTO and ACLR. IV.

Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials.

The efficacy of low intensity extracorporeal shock wave therapy (LI-ESWT) for erectile dysfunction (ED) has received hard criticism and recently published meta-analyses were not able to provide further insights, nor specific recommendations. The aim of this systematic review and meta-analysis is to evaluate the efficacy of LI-ESWT for ED, identify the ideal treatment population and treatment protocol, and provide recommendations for future research in the field. A systematic research for relevant clinical studies published from January 2010 to September 2018 was performed, using the following databases: Medline, Embase, The Cochrane Library, Scopus, and Web of Science. Only clinical studies that investigated the efficacy of LI-ESWT for ED only, and reported primary outcomes using IIEF-EF scores/questionnaires were included. Both, randomised controlled trials (RCTs) and cohort studies were included, but the meta-analysis was performed only for sham-controlled RCTs. Ten RCTs including 873 patients were selected for the meta-analysis. Pooling data of these studies showed that LI-ESWT could significantly improve erectile function in men with ED regarding both patient-subjective outcomes (IIEF-EF: +3.97; 95% CI [2.09-5.84]; p < 0.0001, EHS ≥ 3: OR: 4.35; 95% CI [1.82-10.37]; p = 0.0009) and patient-objective outcomes (peak systolic velocity: +4.12; 95% CI [2.30-5.94]; p < 0.00001). In conclusion, the present meta-analysis provided results showing that LI-ESWT significantly improves erectile function in patients with vasculogenic ED.

The relationship between gait and functional outcomes in patients treated with circular external fixation for malunited tibial fractures

BackgroundLower extremity fractures have a profound negative effect on a patient’s gait and outcomes. Correction of deformity, and with it normalization of objective gait parameters, may result in better subjective and objective functional outcomes in patients treated with circular external fixation for malunited tibial fractures. AimThe purpose of this study was to investigate the relationships between gait parameters, patient reported outcome measures (PROMs), and health related quality of life measures in patients treated with circular external fixation for the correction of deformity related to tibial malunions. MethodsThis retrospective study included patients with posttraumatic tibial deformities, aged 14–65, with a minimum follow-up of 24 months following deformity correction. Patients with congenital deformities, head injuries, spinal cord injury, neurological disorders, or contralateral lower limb amputation were excluded. Functional outcomes were assessed by the Foot Function Index (FFI); Short Form 12 (SF-12); the EQ 5D; and the ASAMI score. Gait analysis was performed using Dartfish® and the Edinburgh Visual Gait Score (EVGS). The relationships between the EVGS and functional outcome scores were analyzed using Pearsons’ moment correlations with Bonferroni corrections. ResultsEleven patients with a mean age of 42 (range 23–57) were analyzed. The mean EVGS was 2.6 ± 2.1, the mean FFI 29.6 ± 33.4, the mean EQ5 Index Value 0.7 ± 0.2, the mean EQ5 VAS 85.4 ± 19.5, the SF12 mean Physical Component Score (PCS) 46.7 ± 11.1, and the mean Mental Component Score (MCS) 55.2 ± 7.5. The following relationships were strong and significant: EVGS and FFI (r = 0.7; P = 0.02), EVGS and PCS (r = −0.82; P = 0.02), and FFI and EQ5 (r = −0.79, P = 0.05). SignificanceThe results of this study suggest that correction of deformity with realignment and restoration of normal anatomy was associated with improved functional outcomes and physical well-being. Patient reported quality of life is strongly associated with patient perceived functional outcome, but not with objective gait parameters.

Outcomes and factors of elbow arthroscopy upon returning to sports for throwing athletes with osteoarthritis

BackgroundElbow arthroscopy had good functional outcome for throwing athletes. Returning to sports is a major concern for all athletes, but only a few reports have investigated the clinical factors related to the duration of returning to sports. The present study evaluates the efficacy of elbow arthroscopic surgery on throwing elbows with osteoarthritis and defines the clinical factors related to the duration of the returning to sports.MethodsThis was a retrospective study with fifteen active baseball throwing athletes with elbow osteoarthritis who were treated with elbow arthroscopy. Perioperative clinical factors were analyzed for functional outcomes. A multiple linear regression analysis was used to analyze the clinical factors associated with the duration of returning to training and sports.ResultsThe 15 patients’ mean age was 27 years. The mean follow-up time was 2.6 years. The mean procedural complexity was 3.1 ± 1.6 (range 1–6). The elbow total range of motion (ROM) improved significantly from 100.7 ± 28.7° to 125.7 ± 18.5° (p = 0.001). The terminal flexion range of the elbow increased significantly from 116.0 ± 22.6° to 130.0 ± 13.2° (p = 0.001), and the terminal extension range improved from 15.3 ± 11.1° to 4.3 ± 5.9° (p = 0.001). Before the operation, the average subjective patient outcome for return to sports (SPORTS) score was 3.4 ± 1.5, which increased significantly to 9.67 ± 0.45 (p = 0.003) at the last follow-up. The multiple linear regression analysis revealed that higher procedural complexity hinders the athletes from returning to competition.ConclusionsElbow arthroscopy offered highly satisfactory results in the throwing elbows of elite athletes and significantly improved the range of motion and SPORTS score. The procedural complexity was significantly related to the duration of returning to competition. Early and aggressive arthroscopic intervention is recommended for elite throwing athletes with elbow osteoarthritis who fail to respond to conservative treatment.

A Critical Radiographic Analysis of Coronal Plane Deformity Correction Using a 3-Piece Mobile Bearing Ankle Joint Replacement: A Retrospective Study of 25 Patients

Total ankle replacement can be a viable option for patients with end-stage ankle arthritis associated with coronal plane deformity. With proper ankle balancing, a well-aligned ankle implant can be maintained over time and provide successful patient outcomes. The purpose of this study was to evaluate radiographic and subjective outcomes in patients with ankle arthritis along with coronal plane deformity who underwent total ankle arthroplasty with a 3-piece mobile-bearing implant. Our primary inclusion criterion was patients who demonstrated more than 5° of tibiotalar coronal deformity in either varus or valgus direction. Sixty-three consecutive patients who underwent total ankle replacement were reviewed. Of these, 25 (39.7%) met the inclusion criteria. Sixteen (64%) patients had a varus deformity (Group 1) and 9 (36%) had valgus deformity (Group 2) preoperatively. Alignment was evaluated radiographically at 5 different intervals: preoperative, immediate postoperative, and 6, 12, and 36 months postoperative. In patients with varus deformity, the mean tibiotalar angle was 12.6°, 0.8°, 1.0°,1.0°, and 0.8° for preoperative, immediate postoperative, and 6, 12, and 36 months, respectively. The same measurements and intervals for patients with valgus deformity were found to be 10.3°, 1.4°, 1.6°, 1.4°, and 1.4°. A statistically significant difference was observed in preoperative and postoperative coronal plane deformity. This correction was maintained at final follow-up visit. American Orthopaedic Foot and Ankle Society scores and visual analogue scale scores were recorded as well, and statistically significant improvements in preoperative and postoperative scores were found (p < .001). In conclusion, coronal plane deformity correction of the ankle can be accomplished and maintained in total ankle replacement procedures with proper soft tissue balancing and osseous procedures as indicated.

Interprofessional collaboration and patient-reported outcomes in inpatient care: protocol for a systematic review

BackgroundInterprofessional collaboration (IPC) is a core demand of policymakers, funding parties, and health care professionals in practice. Although the causal mechanism from increased IPC to improved patient outcomes seems to be intuitive, there is a lack of credible causal evidence concerning the effects not only on the objective but also on the subjective patient outcomes. The aim of the planned systematic review is to focus on the effect of IPC on patient-reported outcomes and experiences in inpatient care.MethodsA systematic literature review will be undertaken by searching the following electronic databases: PubMed, Web of Science/Social Science Citation Index, Cochrane Library (CENTRAL), Current Contents (LIVIVO), CINAHL, and EMBASE. Additional studies will be identified through forward and backward citation tracking, manually searching the Internet and Google Scholar, and consultation of experts. Data will be synthesized through narrative description, grouping, and thematic analysis of the extracted data. If heterogeneity for some studies and outcomes is sufficiently low, a quantitative meta-analysis of effect sizes and standard errors will be applied.DiscussionThe systematic review will synthesize the evidence regarding the effectiveness of IPC and how it is perceived by patients in inpatient care. As the patients’ perspective becomes increasingly relevant in the context of quality improvement, the results can help decision-makers in policy- and health care institutions to understand and develop strategies to ensure a high quality of care.Systematic review registrationPROSPERO registration number: CRD42017073900; date of registration in PROSPERO 07 August 2017.

Septic Arthritis After Anterior Cruciate Ligament Reconstruction: How Important Is Graft Salvage?

Background: Septic arthritis (SA) of the knee after anterior cruciate ligament reconstruction (ACLR) is a rare but potentially devastating condition. In certain cases, graft removal becomes necessary. Purpose: To evaluate clinical, subjective, and radiologic outcomes of patients with SA after ACLR and assess whether graft retention has superior clinical results as compared with graft removal. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who were at least 12 months out from arthroscopic treatment of SA after isolated ACLR at our institution were eligible for inclusion. Patients were categorized into 2 groups: group 1, patients with initial graft retention; group 2, patients with initial graft removal. Group 2 was subdivided into 2 groups: group 2a, patients with graft reimplantation; group 2b, patients without graft reimplantation. Objective and subjective assessments were obtained at follow-up, including the International Knee Documentation Committee (IKDC) knee examination form, KT-1000 arthrometer measurements, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score, Lysholm score, and IKDC subjective evaluation. Radiologic assessment was performed with pre- and postoperative magnetic resonance imaging. Results: Of the 41 patients included, 33 (81%) were available for follow-up at a mean ± SD 54.7 ± 24.4 months at an age of 28.4 ± 9.3 years. When compared with patients from group 2 (n = 12), patients from group 1 (n = 21) obtained significantly better results on the objective IKDC score (normal or nearly normal: group 1, 66.6%; group 2, 36.4%; P = .047) and KT-1000 measurements (group 1, 1.3 ± 1.0 mm; group 2, 2.9 ± 1.5 mm; P = .005). Group 1 also scored better than group 2 on the Lysholm (P = .007), IKDC subjective (P = .011), and WOMAC (P = .069) measures. Between groups 2a (n = 4) and 2b (n = 8), no significant differences in outcomes could be detected (P values, .307-.705), although patients with anterior cruciate ligament graft reimplantation showed a clear tendency toward better results in objective and not subjective parameters. Magnetic resonance imaging evaluation showed higher rates of cartilage damage and meniscal tears among patients with graft resection versus graft retention. Conclusion: Patients with graft retention showed superior postoperative results when compared with patients who underwent initial graft resection, although subanalysis showed comparable outcomes between graft retention and reimplantation. Thus, while graft-retaining protocols should have the highest priority in the treatment of SA after ACLR, graft reimplantation should be performed in cases where graft resection becomes necessary, to avoid future cartilage and meniscal lesions. Finally, further studies with larger numbers of patients are needed to gain a better understanding of the outcomes of patients with SA after ACLR.

State of the art of quality-of-life measurement in patients with chronic otitis media and conductive hearing loss

The evaluation of results after middle ear reconstruction has been mainly based on functional parameters. In clinical practice as well as in otological research, the pure tone audiogram represents the gold standard in the assessment of the postoperative outcome. In order to assess the patient's subjective outcome, outcome analyzes focus increasingly on the health-related quality of life (HRQOL). However, the evaluation of HRQOL requires reliable and validated measuring instruments. A modest number of validated questionnaires for determination of the disease-specific HRQOL in patients with chronic otitis media and/or conductive hearing loss are currently available. Three of seven available questionnaires were developed and validated in the German-speaking countries, the Zurich Chronic Middle Ear Inventory21 (ZCMEI-21), the Chronic Otitis Media Outcome Test15 (COMOT-15) and the Stapesplasty Outcome Test25 (SPOT-25). In this review, all seven available disease-specific measuring instruments as well as the generic questionnaires, which were used in previous clinical trials, are explained and current findings of quality-of-life research in patients with chronic otitis media and/or conductive hearing loss are presented.

Hypercholesterolemia Is Associated with the Subjective Evaluation of Postoperative Outcomes in Patients with Idiopathic Carpal Tunnel Syndrome Who Undergo Surgery: A Multivariate Analysis.

Carpal tunnel syndrome is a compression neuropathy of the median nerve at the wrist; its symptoms include neuropathic pain and sensory and motor disturbance distributed by the median nerve. Carpal tunnel syndrome and hypercholesterolemia have similar backgrounds, but the effect of these similarities on postoperative outcomes has not been reported. Using multivariate analysis, the authors analyzed the relationship between prognostic factors, including the presence of hypercholesterolemia, and subjective postoperative outcomes of patients with idiopathic carpal tunnel syndrome. Of 168 hands with carpal tunnel syndrome that were treated surgically, 141 that were followed up and assessed 1 year postoperatively or thereafter were included. The mean postoperative follow-up period was 40.8 months. Surgery was performed through a small palmar skin incision under local anesthesia. The outcomes were postoperative symptoms, including pain and numbness, and overall Kelly assessment. Preoperative numbness and pain resolved and alleviated in 94 of 141 hands and was diminished in 59 of 64 hands. Univariate analysis showed that postoperative numbness and Kelly assessment were significantly associated with hypercholesterolemia. Multivariate analysis showed that postoperative numbness was significantly associated with smoking and hypercholesterolemia, and Kelly assessment was significantly associated with smoking (adjusted OR, 3.3; 95 percent CI, 1.1 to 10; p = 0.04) and hypercholesterolemia (adjusted OR, 2.9; 95 percent CI, 1.4 to 6.3; p = 0.01). Hypercholesterolemia, usually a systemic condition in sites other than the hand, is associated with the subjective evaluation of postoperative symptoms in patients with idiopathic carpal tunnel syndrome. Risk, III.

Comparison of Endoscopic Turbinoplasty Versus Conventional Partial Inferior Turbinectomy in Chronic Hypertrophic Rhinitis.

To compare the benefits of endoscopic turbinoplasty and conventional partial inferior turbinectomyin terms of symptomatic relief of the post operative subjective and objective outcomes in patients with chronic hypertrophic rhinitis. A comparative longitudinal study was carried out over a period of 18months. 60 cases were assigned randomly into two groups-group A (endoscopic turbinoplasty) and group B (conventional partial inferior turbinectomy) and post-operatively were followed up to 6months to look for postoperative subjective and objective outcomes. Symptomatic improvement in nasal obstruction was found to be consistently better in group A patients at postoperative days 7 and 15, but both groups achieved comparable symptom relief at the third month. A statistically significant difference in SNOT 22 scores were observed between the two groups at all follow-ups. Relatively higher rates of post-operative morbidities were observed in group B at the 7th and 15th postoperative days. Endoscopic turbinoplasty may be better than conventional partial inferior turbinectomy in terms of improvement in nasal obstruction and decreased postoperative morbidity in the immediate postoperative period.

Factors Affecting Subjective and Objective Outcomes and Return to Play in Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study.

Purpose To analyze the prognostic factors influencing subjective and objective outcomes and return to play (RTP) after anterior cruciate ligament reconstruction (ACL-R). Methods Primary ACL-Rs using a transtibial technique performed between 2008 and 2012 were included. Data regarding patients, surgery, sports, and rehabilitation, including an on-field rehabilitation (OFR) and duration of the rehabilitation program, were collected. The International Knee Documentation Committee (IKDC) subjective and objective evaluation forms, and the Knee Injury and Osteoarthritis Outcome Score and Lysholm questionnaires were used for the assessment of subjective and objective outcomes. The Subjective Patient Outcome for Return to Sports and ACL–return to sport after injury (RSI) scores were used for RTP evaluation. Several potential predictors of outcome were tested with a univariate analysis. All the variables with p < 0.1 were retested in a logistic regression model to evaluate their association with the outcomes. Results In total, 176 cases were included with an average follow-up of 44.1 months. Of the patients, 92.2% were rated as normal or nearly normal at the IKDC evaluation. In addition, 90.1% of the patients returned to sport, with 57.6% returning to the same preinjury level. Objective outcomes were negatively influenced by late rehabilitation (odds ratio [OR] = 2.75). Performing an OFR phase during the rehabilitation was associated with better subjective outcomes (OR = 2.71). Length of rehabilitation strongly influenced the RTP rate (OR = 13.16). Conversely, higher ACL-RSI score was inversely related to RTP. Objective IKDC score was inversely related to the ACL-RSI (OR = 0.31), whereas subjective score was correlated with both the total ACL-RSI score (OR = 0.15) and the level of activity (OR = 0.20). Conclusion This study confirmed the role of rehabilitation on subjective and objective outcomes and on RTP. Particularly, the complete adherence to a rehabilitation program, including an OFR phase, resulted in better subjective outcomes and higher RTP rate. The relationship between psychological factors, measured through the ACL-RSI score, and RTP was confirmed. Level of Evidence Level III, observational study without a control group.

Patellofemoral Cartilage Lesions Treated With Particulated Juvenile Allograft Cartilage: A Prospective Study With Minimum 2-Year Clinical and Magnetic Resonance Imaging Outcomes

To analyze the functional outcomes of patients treated with particulated juvenile articular cartilage (PJAC) for symptomatic articular cartilage lesions in the patellofemoral joint, correlates clinical outcomes with magnetic resonance imaging (MRI) appearance of the repair tissue using cartilage-sensitive quantitative T2-mapping. All patients treated with PJAC for patellofemoral lesions were identified and prospectively followed with clinical outcome scores (International Knee Documentation Committee [IKDC], Knee Outcome Survey-Activities of Daily Living [KOS-ADL], and Marx Activity Scale [MAS]). Postoperative MRI scans using quantitative T2 mapping were obtained and interpreted by an independent musculoskeletal radiologist. Twenty-seven patients treated with PJAC for 30 full-thickness patellofemoral cartilage lesions were identified; mean postoperative follow-up was 3.84years. Improvements from pre- to postoperative mean IKDC (45.9 vs 71.2, P < .001) and KOS-ADL (60.7 vs 78.8, P < .001) scores were observed; no significant change in MAS was seen (7.04 vs 7.17, P= .97). Advanced age, history of previous surgery, lesion location (patella vs trochlea), or concomitant tibial tubercle osteotomy did not affect outcome scores. Greater body mass index was associated with less improvement in KOS-ADL score. No patients required reoperation for graft-related issues. Lesion fill exceeding 67% by MRI assessment was noted in 69.2% of lesions; depth of lesion fill did not correlate with clinical outcomes. Quantitative T2-mapping revealed prolonged relaxation time at the graft site compared with adjacent normal cartilage at both deep and superficial zones. This study found significantly improved pain and function in patients treated with PJAC for symptomatic patellofemoral articular cartilage defects. No patients required reoperation for graft-related issues. Postoperative MRI revealed majority lesion fill in more than 69% of patients, but persistent morphologic differences between graft site and normal adjacent cartilage remain. Though we support PJAC use in this setting to improve patient subjective outcomes, improved appearance on postoperative imaging was not found to provide additional clinical benefit. Level IV, case series.

Back to Sports After Arthroscopic Revision Bankart Repair.

Background:Recurrent instability following primary arthroscopic stabilization of the shoulder is a common complication. Young, athletic patients are at the greatest risk of recurring instability. To date, the literature contains insufficient description regarding whether return to sports is possible after revision arthroscopic Bankart repair.Hypothesis:Patients presenting with recurrent instability after primary arthroscopic stabilization should expect limitations in terms of their ability to partake in sporting activities after revision surgery.Study Design:Case series; Level of evidence, 4.Methods:Twenty athletes who underwent arthroscopic revision stabilization of the shoulder after failed primary arthroscopic Bankart repair were included in the study after completing inclusion and exclusion criteria surveys. Athletic Shoulder Outcome Scoring System (ASOSS), Shoulder Sport Activity Score (SSAS), and the Subjective Patient Outcome for Return to Sports (SPORTS) scores were determined to assess the participants’ ability to partake in sporting activities. Furthermore, sport type and sport level were classified and recorded. To assess function and stability, Rowe, American Shoulder and Elbow Surgeons, Constant-Murley, and Walch-Duplay scores were measured and recorded.Results:Follow-up consultations were carried out after a mean of 28.7 months. The mean age at follow-up examination was 27.75 years. At the time of follow-up, 70% of the patients were able to return to their original sporting activities at the same level. However, 90% of patients described a limitation in their shoulder when participating in their sports. At 28.7 months after surgery, the mean ASOSS score was 76.8; the SSAS score decreased from 7.85 before first-time dislocation to 5.35 at follow-up (P < .005). The SPORTS score was 5.2 out of 10 at the follow-up consultation. Function- and instability-specific scores showed good to excellent results. The mean external rotational deficit for high external rotation was 9.25°, and for low external rotation it was 12°.Conclusion:Patients can return to their original type and level of sport after arthroscopic revision Bankart repair, but they must expect persistent deficits and limitations to the shoulder when put under the strains of sporting activity. Patients with shoulder injuries who partake in sports that put greater demand on the shoulder show the smallest probabilities of returning to sporting activity.

Lesion Size Does Not Predict Outcomes in Fresh Osteochondral Allograft Transplantation

Background: Cartilage repair algorithms use lesion size to choose surgical techniques when selecting a cartilage repair procedure. The association of fresh osteochondral allograft (OCA) size with graft survivorship and subjective patient outcomes is still unknown. Purpose: To determine if lesion size (absolute or relative) affects outcomes after OCA transplantation. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 156 knees in 143 patients who underwent OCA transplantation from 1998 to 2014 for isolated femoral condyle lesions. The mean age was 29.6 ± 11.4 years, and 62.9% were male. The majority of patients (62.2%) presented for cartilage repair because of osteochondritis dissecans. The mean graft area, used as a surrogate for absolute size of the lesion, was 6.4 cm2 (range, 2.3-11.5 cm2). The relative size of the lesion was calculated as the tibial width ratio (TWR; ratio of graft area to tibial width) and affected femoral condyle ratio (AFCR; ratio of graft area to affected femoral condyle width) using preoperative radiographs. All patients had a minimum follow-up of 2 years. Further surgical procedures were documented, and graft failure was defined as revision OCA transplantation or conversion to arthroplasty. International Knee Documentation Committee (IKDC) pain, function, and total scores were obtained. Satisfaction with OCA transplantation was assessed. Results: The mean follow-up among patients with grafts remaining in situ was 6.0 years (range, 1.9-16.5 years). The OCA failure rate was 5.8%. Overall survivorship of the graft was 97.2% at 5 years and 93.5% at 10 years. No difference in postoperative outcomes between groups was found in absolute or relative size. Change in IKDC scores (from preoperative to latest follow-up) was greater for knees with large lesions compared to knees with small lesions, among all measurement methods. Overall satisfaction with the results of OCA transplantation was 89.8%. Conclusion: The size of the lesion, either absolute or relative, does not influence outcomes after OCA transplantation for isolated femoral condyle lesions of the knee.

Visual outcomes of patients bilaterally implanted with the extended range of vision intraocular lens: A prospective study.

Purpose:The aim of this study was to analyze the objective and subjective visual outcomes of patients bilaterally implanted with the extended range of vision intraocular lens (EROV IOL), the Tecnis Symfony.Methods:This was a prospective interventional case series conducted at a tertiary eye care hospital in South India. The study included patients with bilateral implantation of EROV IOLs. The uncorrected and corrected visual acuity for distance, intermediate, and near vision was recorded at 6 weeks and 6 months’ postoperative visit. A subjective questionnaire was administered to assess spectacle independence, photic phenomenon, and overall satisfaction. All data were recorded using Microsoft Excel worksheet. The analyses were performed using SPSS for windows software.Results:Our study included fifty patients with bilateral implantation of EROV IOLs. The mean age was 59.84 ± 11.68 years. The mean uncorrected binocular distance, intermediate, and near visual acuity (in standard decimal equivalent) was 0.89,0.99 and 0.99 respectively, at 6 months’ postoperative visit. Ninety-six percent of the patients did not require spectacles for distance and 98% of the patients were free from spectacles for intermediate and near vision. 94% of our patients perceived no or minimal photic phenomena such as glare and halos. The mean subjective patient satisfaction score (out of 10) for distance, intermediate, and near was 9, 10, and 9, respectively.Conclusion:The EROV IOLs demonstrated high levels of spectacle independence for distance, intermediate, and near vision. The incidence of photic phenomena observed was minimal with a high level of patient satisfaction.

A Comprehensive Evaluation of Factors Affecting Healing, Range of Motion, Strength, and Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair.

Background:Rotator cuff repair (RCR) leads to improved patient outcomes, which may or may not coincide with biological healing of the tendon. Many patient factors may play a role in subjective and objective patient outcomes of surgery.Purpose:To evaluate the effect of various patient factors and tendon healing on range of motion, strength, and functional outcomes after arthroscopic RCR.Study Design:Case-control study; Level of evidence, 3.Methods:We reviewed patients who underwent arthroscopic RCR. Postoperative endpoints included physical examination, repeat magnetic resonance imaging (MRI), and patient-reported outcome measures. The Short Form–36 (SF-36) was also completed at enrollment. Physical examination included range of motion and strength testing. Preoperative tear characteristics and postoperative healing on MRI were recorded. Associations between these characteristics and rotator cuff healing were determined. Multivariate models investigated factors affecting healing and final outcomes.Results:A total of 81 patients had MRI before and a minimum of 1 year after RCR. Patient-reported outcomes were available for all patients at mean 2.7 years (range, 1-7.7 years) after RCR. Seventy-five patients had physical examination data. Patients were less likely to heal if they had tears involving multiple tendons (P = .037), tears >2.2 cm (P = .037), tears retracted >2.0 cm (P = .006), and tears with cumulative Goutallier grade ≥3 (P = .003). Patients who healed were stronger on manual muscle testing in forward elevation (P < .001) and external rotation (P = .005) and on forward elevation isometric testing (P = .033), and they reported better patient-reported outcomes (P ≤ .01) at final follow-up. In multivariate models, tendon healing was associated with less pain (P = .019) and better patient-reported outcomes (all P ≤ .006). Lower SF-36 mental component summary (MCS) score was associated with increased pain (P = .025) and lower final American Shoulder and Elbow Surgeons score (P = .035), independent of healing status.Conclusion:Larger, more retracted tears with greater fatty infiltration are less likely to heal per MRI. Patients who do not heal are weaker and have worse patient-reported outcome measures. Lower SF-36 MCS score was associated with poorer patient-reported outcomes independent of tendon healing.

Defibrillator shocks and their effect on objective and subjective patient outcomes: Results of the PainFree SST clinical trial

The effect of implantable cardioverter-defibrillator (ICD) shock on device-measured activity and patient-reported outcomes is unknown. The purpose of this study was to analyze the acute and long-term effects of ICD shock on objective behavioral data (ie, device-based physical activity) and subjective patient-reported outcomes (eg, quality of life and shock anxiety). The PainFree Smart Shock Technology (SST) clinical trial included 2770 patients with a single- or dual-chamber ICD or cardiac resynchronization therapy - defibrillator device who were followed for 22 ± 9 months. Participants completed measures of quality of life (EuroQol-5D [EQ-5D] questionnaire) and shock anxiety (Florida Shock Anxiety Scale) at baseline, biannual visits, and monthly for 6 months after an ICD shock. Daily physical activity data were obtained from a built-in device accelerometer. The average daily activity was 185.3 ± 119.4 min/d. Activity was significantly reduced after an ICD shock (P < .0001) and recovered to a normal level after ∼90 days. An ICD shock was also associated with decreased quality of life (EQ5-D health score) and increased EQ-5D anxiety scores, but it did not affect mobility, self-care, activity, or pain. Similarly, shock anxiety (Florida Shock Anxiety Scale) increased in shocked patients and remained significantly elevated at 24 months, regardless of appropriate or inappropriate shock delivery. ICD shocks have a long-lasting adverse effect on both objective, device-measured physical activity and subjective patient-reported outcomes of quality of life and shock anxiety. Successful management of patients with an ICD requires attention to clinically relevant behavioral and psychological outcomes to expedite recovery and return to activities of daily living.

Assessment of postsurgical outcomes between different implants in patients with empty nose syndrome: A meta-analysis.

ObjectivesThe aim of this study was to evaluate the impact of surgery and different implant materials on subjective outcomes in patients with empty nose syndrome (ENS).MethodsPostsurgical outcomes were assessed in a meta-analysis of patients with ENS who underwent treatment with different implants.ResultsWe identified 122 relevant studies, and 6 were included in the meta-analysis (4 prospective trials and 2 randomized controlled trials). A significant difference was found between the preoperative and postoperative Sino-Nasal Outcome Test (SNOT) scores for different implants. With respect to implant materials, significant differences were observed between autografts/allografts (AG) and foreign material grafts (FGs). A subgroup analysis of different countries showed that more patients from China underwent surgical implant therapy than patients from other countries.ConclusionsThis meta-analysis suggests that surgery can improve the symptoms and SNOT scores of patients with ENS, AGs are more effective than FGs in patients with ENS, and that more patients from China undergo surgical implant therapy than patients from other countries.