scholarly journals Predictors of Clinical Outcomes After Proximal Hamstring Repair

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711882371 ◽  
Author(s):  
Eric N. Bowman ◽  
Nathan E. Marshall ◽  
Michael B. Gerhardt ◽  
Michael B. Banffy
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Activity Level ◽  
Medical Comorbidities ◽  
Outcome Scores ◽  
The Mean ◽  
Tegner Score ◽  
Proximal Hamstring

Background: Proximal hamstring avulsions cause considerable morbidity. Operative repair results in improved pain, function, and patient satisfaction; however, outcomes remain variable. Purpose: To evaluate the predictors of clinical outcomes after proximal hamstring repair. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed proximal hamstring avulsions repaired between January 2014 and June 2017 with at least 1-year follow-up. Independent variables included patient demographics, medical comorbidities, tear characteristics, and repair technique. Primary outcome measures were the Single Assessment Numerical Evaluation (SANE), International Hip Outcome Tool–12 (iHOT-12), and Kerlan-Jobe Orthopaedic Clinic (KJOC) Athletic Hip score. Secondary outcome measures included satisfaction, visual analog scale for pain, Tegner score, and timing of return to sports. Results: Of 102 proximal hamstring repairs, 86 were eligible, 58 were enrolled and analyzed (67%), and patient-reported outcomes were available for 45 (52%), with a mean 29-month follow-up. The mean patient age was 51 years, and 57% were female. Acute tears accounted for 66%; 78% were complete avulsions. Open repair was performed on 90%. Overall satisfaction was 94%, although runners were less satisfied compared with other athletes ( P = .029). A majority of patients (88%) returned to sports by 7.6 months, on average, with 72% returning at the same level. Runners returned at 6.3 months, on average, but to the same level 50% of the time and at a decreased number of miles per week compared to nonrunners (15.7 vs 7.8, respectively; P < .001). Postoperatively, 78% had good/excellent SANE Activity scores, but the mean Tegner score decreased (from 5.5 to 5.1). Acute tears had higher SANE Activity scores. The mean iHOT-12 and KJOC scores were 99 and 77, respectively. Endoscopic repairs had equivalent outcome scores to open repairs, although conclusions were limited given the small number of patients in the endoscopic group. Greater satisfaction was noted in patients older than 50 years ( P = .024), although they were less likely to return to running ( P = .010). Conclusion: Overall, patient satisfaction and functionality were high. With the numbers available, we were unable to detect any significant differences in functional outcome scores based on patient age, sex, body mass index, smoking status, medical comorbidities, tear grade, activity level, or open versus endoscopic technique. Acute tears had better SANE Activity scores. Runners should be cautioned that they may be unable to return to the same preinjury activity level after proximal hamstring repair. Clinical Relevance: When counseling patients with proximal hamstring tears, runners and those with chronic tears should set appropriate expectations.

scholarly journals Predictors of Clinical Outcomes after Proximal Hamstring Repairs

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0026
Author(s):  
Eric N. Bowman ◽  
Nathan E. Marshall ◽  
Gerhardt Brenton Michael ◽  
Michael B. Banffy
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Smoking Status ◽  
Activity Level ◽  
Secondary Outcome ◽  
Functional Difference ◽  
Medical Comorbidities ◽  
Open Versus ◽  
Proximal Hamstring

Objectives: Proximal hamstring avulsions cause considerable morbidity. Operative repair results in improved pain, function, and patient satisfaction; however, outcomes remain variable. The purpose of this study was to evaluate the predictors of clinical outcomes after proximal hamstring repairs. Methods: A retrospective review of proximal hamstring avulsions undergoing repair between January 2014 and June 2017 was performed. Patients were excluded for skeletal immaturity, previous tear, revision surgery, allograft reconstruction, fracture, subsequent extremity injury or surgery. Independent variables included: patient demographics, medical comorbidities, tear characteristics, and repair technique. Primary outcome measures were the Single Assessment Numerical Evaluation (SANE), International Hip Outcome Tool (iHOT-12), and the Kerlan-Jobe Orthopaedic Clinic (KJOC) Athletic Hip Score. Secondary outcome measures included satisfaction, visual analog scale (VAS), and level and timing of return to running or sports. Results: Of 86 eligible patients, 58 were analyzed (67%), with 29-month mean follow-up. Average age was 51; 57% were female. Acute tears accounted for 66%; 78% were complete avulsions. Open repair was performed on 90%. Overall satisfaction was 94%, though runners were less satisfied (p=0.029). At 7.6 months on average, 88% returned to sports, 72% at the same level. Runners less often returned to the same level, and at a decreased number of miles (15.7 vs. 7.8, p<0.001). Post-operatively, SANE scores improved, but average Tegner decreased (5.5 to 5.1). Acute repairs had higher SANE Activity scores. Higher satisfaction without functional difference for those over 50 years (p=0.024). Conclusion: Overall, patient satisfaction and functionality were high. There were no significant differences in functional outcome scores based on age, sex, body-mass index, smoking status, medical comorbidities, tear grade, activity level, or open versus endoscopic technique. Acute repairs had better SANE Activity scores. Runners should be cautioned that they may be unable to return to the same pre-injury activity level following proximal hamstring repair. [Table: see text]

Graft-Recipient Anteroposterior Mismatch Does Not Affect the Midterm Clinical Outcomes of Osteochondral Allograft Transplantation of the Femoral Condyle

2018 ◽  
Vol 46 (10) ◽  
pp. 2441-2448 ◽  
Author(s):  
Dean Wang ◽  
Francesca R. Coxe ◽  
George C. Balazs ◽  
Brenda Chang ◽  
Kristofer J. Jones ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Outcomes ◽  
Femoral Condyle ◽  
Osteochondral Allograft ◽  
Radius Of Curvature ◽  
Allograft Transplantation ◽  
Outcome Scores ◽  
The Mean ◽  
Graft Recipient

Background: For the treatment of femoral condyle cartilage defects with osteochondral allograft transplantation (OCA), many surgeons have relaxed their graft-recipient size-matching criteria given the limited allograft supply. However, since the anteroposterior (AP) length is typically correlated with the radius of curvature for a given condyle, a large mismatch in graft-recipient AP length can indicate a corresponding mismatch in the radius of curvature, leading to articular incongruity after implantation. Purpose: To evaluate the association between femoral condyle graft–recipient AP mismatch and clinical outcomes of OCA. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review was conducted of patients treated with OCA for femoral condyle chondral defects from 2000 to 2015. Graft characteristics, including AP and mediolateral dimensions, were gathered from vendor-specific allograft offering documents. Patient condyle dimensions were measured on preoperative magnetic resonance imaging. Reoperations and patient responses to validated outcome measures were reviewed. Failure was defined by any partial removal/revision of the allograft or conversion to knee arthroplasty. A multivariable logistic regression model was fitted to examine the association of AP mismatch with OCA failure while adjusting for patient age and number of previous ipsilateral knee surgical procedures. Results: A total of 69 knees from 69 patients (mean age, 35.7 years; 71% male) met the inclusion criteria. Mean duration of follow-up was 4 years (range, 2-16 years). The mean absolute graft-recipient AP mismatch was 6.7 mm (range, 0-20 mm; P < .01). At final follow-up, 19 knees had failed. There was no significant difference in the mean absolute AP mismatch between failures (8.1 mm) and nonfailures (6.2 mm; P = .17). Multivariate logistic regression revealed that AP mismatch was not associated with graft failure ( P = .14). At final follow-up, significant improvements were noted in the 36-Item Short Form Health Survey, International Knee Documentation Committee subjective form, and Knee Outcome Survey–Activities of Daily Living ( P < .01 for all). Magnitude of AP mismatch was not associated with postoperative outcome scores or achievement of minimal clinically significant differences in outcome scores. Conclusion: Magnitude of graft-recipient AP mismatch was not associated with midterm OCA failure rates or patient-reported outcome scores, suggesting that AP length mismatch within the limits measured here is not a contraindication for graft acceptance.

scholarly journals Arthroscopic-assisted Treatment of Popliteus Tendinitis

2020 ◽  
Author(s):  
Biao Chen ◽  
Hankun Liu ◽  
Haitao Chen ◽  
Liaobin Chen ◽  
Hua Wang
Keyword(s):  
Clinical Outcomes ◽  
International Knee Documentation Committee ◽  
Lateral Approach ◽  
Popliteus Tendon ◽  
Ikdc Score ◽  
The Mean ◽  
Improved Function ◽  
Tegner Score ◽  
Lost To Follow Up

Abstract Background: Popliteus tendinitis is an unusual factor to cause pain of the knee joint in its posterolateral compartment. There are few reports that the arthroscopy used for the treatment of refractory and symptomatic popliteus tendinitis. This study aimed to evaluate the effect of arthroscopic treatment of popliteus tendinitis via an auxiliary extreme lateral approach and to investigate the pathogenesis and treatment of popliteus tendinitis.Methods: From 2014 to 2018, arthroscopic popliteus tendon ablation was performed in 15 patients (15 knees) with popliteus tendinitis via an auxiliary extreme lateral approach. Clinical outcomes were assessed using the Lysholm knee scoring scale, the Tegner score, the International Knee Documentation Committee (IKDC) score and the visual analogue scale (VAS) pain score at the 24-month follow-up after surgery.Results: A total of 15 patients (mean age, 51.1 ± 7.1 years) were included; they had a mean body mass index of 23.8 ± 2.1. The minimum follow-up period was 24 months. Comparing the postoperative state to the preoperative state, the mean postoperative Lysholm score, Tegner score, and IKDC score improved significantly from 70.0 ± 5.0, 3.0 ± 0.9, and 62.3 ± 5.5 to 89.3 ± 4.2, 4.6 ± 0.61, and 80.5 ± 4.4, respectively (p < 0.01). The preoperative VAS score for pain improved from 4.3 ± 0.7 to 0.9 ± 0.6 (p < 0.01). No patients were lost to follow-up.Conclusion: Following arthroscopic-assisted treatment, all the patients with popliteus tendinitis achieved satisfactory clinical outcomes in terms of pain relief and improved function.

scholarly journals Combined endoscopic and mini-open repair of chronic complete proximal hamstring tendon avulsion: a novel approach and short-term outcomes

2021 ◽  
Author(s):  
Shai Factor ◽  
Amal Khoury ◽  
Ran Atzmon ◽  
Matias Vidra ◽  
Eyal Amar ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Open Repair ◽  
Hamstring Tendon ◽  
Activity Level ◽  
Short Term ◽  
The Mean ◽  
Proximal Hamstring ◽  
Tendon Avulsion ◽  
Mini Open

  To evaluate the outcome of a novel, combined endoscopic and mini-open repair (CEMR) of a chronic complete retracted proximal hamstring tendon avulsion (PHA). A retrospective case series of a single-surgeon database for all patients, with a minimum of 1-year follow-up, who underwent CEMR between July 2015 and September 2019 was performed. Patients were evaluated for their functional outcome using the Perth Hamstring Assessment Tool (PHAT). At the latest follow-up, patients were evaluated for their muscle strength, subjective satisfaction and post-operative complications. Twelve patients who underwent endoscopic surgery for chronic PHA were identified, of which seven patients underwent CEMR. After exclusion of one patient from the study due to an open claim for health insurance, six patients (five males) with a mean age of 48 years (range 20–61 years) were evaluated. The mean time from injury to surgery was 12 months (range 2–43 months). At a mean follow-up of 28 months (range 12–55 months), the average PHAT score was 73 (range 70–80). The mean subjective activity level percentage improved from 34 (range 20–50) pre-surgery to 81 (range 75–90) post-surgery. The mean strength of the quadriceps, hamstring at 30°, and hamstring at 90° of the operated leg compared to the uninjured leg did not differ significantly. One patient underwent adhesiolysis 1 year after the index procedure for treatment of subcutaneous adhesions. CEMR is a viable and safe option for the treatment of chronic complete proximal hamstring tears, with good to excellent short-term functional outcome. Level of evidence: IV.

Surgical Management of Chronic Incomplete Proximal Hamstring Avulsion Injuries

2020 ◽  
Vol 48 (5) ◽  
pp. 1160-1167
Author(s):  
Babar Kayani ◽  
Atif Ayuob ◽  
Fahima Begum ◽  
Natalia Khan ◽  
Fares S. Haddad
Keyword(s):  
Patient Satisfaction ◽  
Muscle Strength ◽  
Surgical Intervention ◽  
High Patient Satisfaction ◽  
Clinical Recurrence ◽  
Sporting Activity ◽  
Outcome Scores ◽  
Proximal Hamstring Avulsion ◽  
Proximal Hamstring

Background: Chronic incomplete proximal hamstring avulsion injuries are debilitating injuries associated with prolonged periods of convalescence and poor return to preinjury level of function. This study explores the efficacy of operative intervention for these injuries on patient satisfaction, muscle strength, range of motion, functional performance, return to preinjury level of sporting activity, and injury recurrence. Hypothesis: Surgical intervention of chronic incomplete proximal hamstring avulsion injuries enables return to preinjury level of sporting function with low risk of clinical recurrence. Study Design: Case series: Level of evidence, 4. Methods: This prospective single-surgeon study included 41 patients with incomplete proximal hamstring avulsion injuries refractory to 6 months of nonoperative treatment. All study patients underwent primary operative repair of the avulsed proximal hamstring tendon and received standardized postoperative rehabilitation. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 28.2 months (range, 25.0-35.0 months) from date of surgery. Results: All patients returned to their preinjury level of sporting activity. Mean ± SD time from surgery to return to full sporting activity was 22.2 ± 6.7 weeks. There were no episodes of clinical recurrence. At 3 months after surgery, 39 patients (95.1%) were satisfied/very satisfied with the outcomes of their surgery, and as compared with preoperative values, improvements were recorded in isometric hamstring muscle strength at 0° (84.9% ± 10.9% vs 40.4% ± 8.8%; P < .001), 15° (89.6% ± 7.6% vs 44.2% ± 11.1%; P < .001), and 45° (94.1% ± 5.1% vs 66.4% ± 9.0%; P < .001); mean passive straight leg raise angle (71.2°± 13.5° vs 45.4°± 11.9°; P < .001); mean lower extremity functional score (70.9 ± 5.1 vs 48.4 ± 5.2; P < .001); and mean Marx activity rating score (5.6 ± 2.8 vs 2.7 ± 1.0; P < .001). High patient satisfaction and functional outcome scores were maintained at 1- and 2-year follow-up. Conclusion: Operative repair of chronic incomplete proximal hamstring avulsion injuries enabled return to preoperative level of sporting function with no episodes of clinical recurrence at short-term follow-up. Surgical intervention was associated with high patient satisfaction and improved isometric hamstring muscle strength, range of motion, and functional outcome scores as compared with preoperative values. High patient satisfaction and improved functional outcomes were sustained at 2-year follow-up.

scholarly journals Outcomes and Return to Sport After Revision Anterior Cruciate Ligament Reconstruction in Adolescent Athletes

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876488 ◽  
Author(s):  
Michael Saper ◽  
Stephanie Pearce ◽  
Joseph Shung ◽  
Robert Zondervan ◽  
Roger Ostrander ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patient Satisfaction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Activity Level ◽  
Common Mechanism ◽  
Adolescent Athletes ◽  
The Mean ◽  
Anterior Cruciate

Background: The number of adolescent anterior cruciate ligament (ACL) injuries is rising with increased participation in higher level athletics at earlier ages. With an increasing number of primary ACL reconstructions (ACLRs) comes a rise in the incidence of revision ACLRs. Purpose: To evaluate the clinical results of revision ACLR across a group of high-level adolescent athletes with at least 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of 21 adolescent athletes (age range, 10-19 years) who underwent revision ACLR with at least 2-year follow-up was conducted. Patient-reported outcome measures (PROMs) included the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm knee scoring scale, Tegner activity level scale, and modified Cincinnati Knee Rating System. Return to sport (RTS) and overall patient satisfaction were also assessed. Results: The mean age at the time of surgery was 16.5 years (range, 14-19 years), and the mean follow-up was 46.4 months (range, 24-97 months); 42.9% of patients were female, and 52.4% of patients participated in collision sports. The mean time to failure after primary ACLR was 13.1 ± 8.0 months, and the most common mechanism of failure was noncontact in at least 66.7% of cases. The revision graft type included bone–patellar tendon–bone (BPTB) in 71.4% of cases; 26.7% of BPTB grafts were from the contralateral extremity. Concomitant procedures were performed for intra-articular lesions in 71.4% of patients. The mean patient satisfaction rate was 95.3%. There were 3 cases of a graft reinjury at a mean of 25 months postoperatively. The mean PROM scores were as follows: IKDC, 87.5 ± 12.7; Tegner, 7.2 ± 2.0; Lysholm, 93.7 ± 9.8; and Cincinnati, 93.4 ± 10.0. Of those attempting to RTS, 68.4% of patients successfully returned at the same level of competition. Patients with a lateral compartment chondral injury were less likely to RTS ( P < .05). Independent variables shown to have no significant relationship to PROMs or RTS included age, follow-up, sport classification, associated meniscal tears, revision graft size/type, and concomitant procedures. Conclusion: Revision ACLR can be an effective surgical option in adolescents participating in collision and contact sports, with good to excellent subjective outcome scores. At a minimum 2-year follow-up, a graft rupture after revision ACLR occurred in 14% of cases. Of the athletes attempting to RTS, 68.4% returned to their preinjury level of competition.

scholarly journals Is Patient Satisfaction Associated With Clinical Outcomes After Osteochondral Allograft Transplantation in the Knee?

2018 ◽  
Vol 47 (1) ◽  
pp. 82-87 ◽  
Author(s):  
Luís E.P. Tírico ◽  
Julie C. McCauley ◽  
Pamela A. Pulido ◽  
Marco K. Demange ◽  
William D. Bugbee
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Knee Injury ◽  
International Knee Documentation Committee ◽  
Activity Level ◽  
Osteochondral Allograft ◽  
The Mean ◽  
Function Activity

Background: The association between patient satisfaction and patient-reported outcomes after cartilage repair is not well understood. Purpose: To investigate the association of patient satisfaction with pain, function, activity level, and quality of life after fresh osteochondral allograft (OCA) transplantation in the knee. Study Design: Case-control study; Level of evidence, 3. Methods: This study comprised 371 patients (396 knees) who underwent primary OCA transplantation for osteochondral lesions in the knee between 1997 and 2015. Mean ± SD patient age was 31.8 ± 11.6 years, and 62% were male. The majority of grafts (62%) were located on the femoral condyle; the mean number of grafts per knee was 1.5 ± 0.8; and the median graft area was 6.9 cm2 (range, 1.8-50 cm2). Pain, function, activity level, and quality of life were evaluated pre- and postoperatively via International Knee Documentation Committee scores and Knee injury and Osteoarthritis Outcome Scores. Patient satisfaction with the results of the OCA transplantation was assessed postoperatively. All follow-up evaluations occurring at postoperative 1 year or later were included in the analysis. Results: The mean follow-up time was 5.5 years. Overall, the satisfaction rate was 88.1%, and this rate was constant over time. Satisfaction rates varied by diagnosis, age, sex, and anatomic location of the allograft. Postoperative International Knee Documentation Committee pain, function, and total scores differed between patients who were satisfied and not satisfied (all P < .001). All Knee injury and Osteoarthritis Outcome Score subscale results differed between those who were satisfied and not satisfied (all P < .001). Having a diagnosis of osteochondritis dissecans was the only variable that predicted which patients would be satisfied with the results of the allograft, after controlling for age, sex, anatomic location of the graft, and number of grafts. Conclusion: A consistently high and durable patient satisfaction rate after OCA transplantation was found. Satisfied patients reported lower pain and higher function, activity levels, and quality of life as compared with patients who were not satisfied. Patients with osteochondritis dissecans had a particularly high level of satisfaction with the OCA procedure.

Arthroscopic Labral Base Repair in the Hip: 5-Year Minimum Clinical Outcomes

2017 ◽  
Vol 45 (12) ◽  
pp. 2882-2890 ◽  
Author(s):  
Benjamin G. Domb ◽  
Leslie C. Yuen ◽  
Victor Ortiz-Declet ◽  
Jody Litrenta ◽  
Itay Perets ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Arthroscopic Surgery ◽  
Slipped Capital Femoral Epiphysis ◽  
Harris Hip Score ◽  
Severe Dysplasia ◽  
Patient Satisfaction Score ◽  
Patient Reported ◽  
The Mean

Background: Arthroscopic labral base repair (LBR) in the hip is a previously described technique designed to restore the native functional anatomy of the labrum by reproducing its seal against the femoral head. LBR has been shown to have good short-term outcomes. Hypothesis/Purpose: The purpose was to evaluate clinical outcomes of an LBR cohort with a minimum 5-year follow-up. It was hypothesized that patients who underwent LBR would continue to have significant improvement from their preoperative scores and maintain scores similar to their 2-year outcomes. Study Design: Case series; Level of evidence, 4. Methods: Data for patients undergoing primary hip arthroscopic surgery with LBR from February 2008 to May 2011 with a minimum 5-year follow-up were prospectively collected and retrospectively reviewed. Patients with preoperative Tonnis osteoarthritis grade ≥2, previous hip conditions (slipped capital femoral epiphysis, avascular necrosis, Legg-Calv-Perthes disease), severe dysplasia (lateral center-edge angle <18°), or previous ipsilateral hip surgery were excluded. Statistical equivalence tests evaluated patient-reported outcomes (PROs) including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and patient satisfaction (0-10 scale; 10 = very satisfied). Results: Of the 70 patients (74 hips) who met inclusion and exclusion criteria, 60 (85.7%) patients (64 hips) were available at a minimum 5-year follow-up. All PRO scores significantly improved from preoperative values with a mean follow-up of 67.8 ± 7.4 months (range, 60.0-89.7 months). The mean mHHS increased from 64.4 ±13.8 to 85.3 ± 17.7 ( P < .001), the mean NAHS from 63.7 ± 17.0 to 87.0 ± 14.7 ( P < .001), and the mean HOS-SSS from 47.1 ± 23.2 to 76.5 ± 25.9 ( P < .001). The mean VAS score decreased from 5.9 ± 2.4 to 2.0 ± 2.1 ( P < .001). The mean patient satisfaction score was 8.1 ± 2.0. The improvement in PRO scores was sustained from 2- to 5-year follow-up. At 2 and 5 years, survivorship rates were 96.9% and 90.6%, respectively, and the respective secondary arthroscopic surgery rates were 10.9% (7/64) and 17.2% (11/64). Conclusion: At a minimum 5-year follow-up, arthroscopic LBR continued to be a successful procedure and valid technique based on 3 PROs, the VAS, patient satisfaction, and survivorship. Significantly improved outcome scores were maintained compared with preoperative values and showed no signs of deterioration from the 2-year scores. The long-term survivorship of hip arthroscopic surgery has yet to be determined; however, these midterm results demonstrate the rates of additional procedures (both secondary arthroscopic surgery and conversion to total hip arthroplasty), that may be necessary after 2 years.

scholarly journals Comparative Study of Open Reduction and Internal Fixation and Primary Subtalar Arthrodesis for Sanders Type IV Intra-articular Calcaneal Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Seunghun Woo ◽  
Hyung Jin Chung ◽  
Su-Young Bae ◽  
Tae Sik Goh
Keyword(s):  
Patient Satisfaction ◽  
Internal Fixation ◽  
Clinical Outcomes ◽  
Open Reduction ◽  
Calcaneal Fractures ◽  
Subtalar Arthrodesis ◽  
Type Iv ◽  
Significant Difference ◽  
The Mean

Category: Trauma Introduction/Purpose: To compare clinical outcome of Sanders type IV intra-articular calcaneal fracture treated with open reduction and internal fixation (ORIF) versus ORIF and primary subtalar arthrodesis (PSTA). Methods: Between March 2003 and November 2013, 22 patients with 22 Sanders type IV intra-articular calcaneal fractures were included in this study. Of these, 11 feet were treated with ORIF (ORIF group), 11 feet were treated with ORIF and PSTA (PSTA group). The mean follow-up periods was 34.6 months (range, 18-72 months). Clinical outcomes were assessed along with the American Orthopaedic Foot and Ankle Society’s Ankle-Hindfoot Scale (AOFAS score), the Visual Analog Scale Pain score (VAS score) at 6-, 12 month, and last follow-up. The patient satisfaction, returning to previous occupation and postoperative complications were also investigated. Results: Complete bone union were achieved in all patients. No statistical difference was found between the results for ORIF compared with PSTA: the mean preoperative Bohler angle were, respectively, -3.2±9.2 and -6.6±12.7 degrees (p=0.475); the mean last follow-up AOFAS scores were 73.8±14.9 and 80.5±4.6 (p=0.795); the mean VAS last follow-up VAS scores were 29.7±20.6 and 23.4±10.0 (p=0.986). Secondary subtalar arthrodesis were conducted in 5 patients (45.5%) of ORIF group due to subtalar osteoarthritis symptom within 2 years, postoperatively. Conclusion: We were unable to demonstrate a significant difference of clinical outcomes between ORIF and PSTA however, the patient satisfaction was higher in the PSTA group. PSTA may be considerable choice for patients who need fast recovery to daily activity and to prevent the need for secondary subtalar arthrodesis.

scholarly journals Treatment of osteochondral lesions in the ankle with a particulated juvenile cartilage allograft

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0016
Author(s):  
Karim Boukhemis ◽  
Christopher Kreulen ◽  
J. Chris Coetzee ◽  
Steven Neufeld ◽  
Gregory Berlet ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Outcome Measures ◽  
Activity Level ◽  
Clinical Population ◽  
Treatment Modalities ◽  
Outcome Analysis ◽  
Osteochondral Lesions ◽  
Data Set

Category: Ankle Introduction/Purpose: Numerous treatment modalities are in use today to treat symptomatic osteochondral lesions in the ankle; however, there are ongoing challenges with the treatment of certain types of lesions and concern regarding the long-term effectiveness of current common techniques. Methods: The purpose of this study was to collect mid and long-term clinical outcomes of pain, function, and activity level (VAS, SF-12, FAAM ADL, FAAM sports) Single-arm, multi-center study collected outcomes prospectively in standard clinic patients who would be undergoing or who had previously undergone treatment with DeNovo NT. The main exclusion criteria were high surgical risk, clinically diagnosed autoimmune diseases, or an active joint infection; all other patients receiving DeNovo NT could be approached for the study. The outcome analysis for this abstract focused on enrolled subjects’ final follow-up to date. Results: Clinical outcomes have been prospectively collected for 24 subjects with a total of 48 months follow-up. Twenty four of the treated lesions were located on the talus, none on the tibia. Out of the 24 patients, 23 had a single lesion and 1 had more than one. The average lesion size was 108.1 mm +/- 60.0 [23]. The Hepple classification was used to categorize each lesion. Interestingly, 19/24 were classified as 3 or higher. Cartilage ICRS was also used for classification. Out of the subjects, 23/24 were ICRS grade 3 or 4. There was also a concomitant procedure for 22/24 patients. Pre and post op VAS scores of 47.5 (+/- 23.1) and 12.2 +/- 17.8. SF-12 scores pre and post of 38.0 +/- 8.5 and 50.1 +/- 8.2. FAAM ADL’s pre and post 60.4 +/- 16.3 and 90.4 +/-11.8. FAAM sport scale scores pre and post 28.8 +/- 16.7 and 74.5 +/- 22.4. all outcome measures were statistically significant. Conclusion: Four year complete data is a challenge in this particular clinical population. This data set encompasses symptomatic osteochondral lesions of the talus treated with particulated juvenile cartilage allograft. The outcomes reflect an improvement in symptoms and patient satisfaction when treated with this technique. Based on these final outcome measures (V AS, SF-12, FAAM ADL’s, FAAM sport scale score) and satisfaction, it can be concluded that this is a viable option to get patients back to their pre-injury state.

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