Knee injury outcomes measures Wright, Rick W
Journal of the American Academy of Orthopaedic Surgeons
17, Številka:
1
Journal Article
Recenzirano
Outcomes measures have long been used in the assessment of knee injuries and management protocols. In the past decade, there has been a shift from clinician-based outcomes tools to the development ...and validation of patient-reported outcomes measures. General health as well as disease- and medical condition-specific outcomes measures have been so modified. The Medical Outcomes Study 36-Item Short Form is the most commonly used general health measure in orthopaedics. Joint-specific measures include the Western Ontario and McMaster Universities Osteoarthritis Index, the Knee Injury and Osteoarthritis Outcome Score, and the International Knee Documentation Committee Subjective Form. The Lysholm Knee Scale and the Cincinnati Knee Rating Scale continue to be popular, especially for the assessment of ligamentous injuries. The ACL Quality of Life score is a disease-specific, patient-reported outcomes measure of anterior cruciate ligament deficiency. The historically used Tegner activity level scale and the recently developed Marx activity level scale are used in conjunction with these outcomes measures to make possible a global assessment of recovery from knee injuries and clinician interventions.
Meniscal repair offers the potential to avoid the long-term articular cartilage deterioration that has been shown to result after meniscectomy. Failure of the meniscal repair can occur several years ...postoperatively. Limited evidence on the long-term outcomes of meniscal repair exists.
We performed a systematic review of studies reporting the outcomes of meniscal repair at a minimum of five years postoperatively. Pooling of data and meta-analysis with a random-effects model were performed to evaluate the results.
Thirteen studies met the inclusion criteria. The pooled rate of meniscal repair failure (reoperation or clinical failure) was 23.1% (131 of 566). The pooled rate of failure varied from 20.2% to 24.3% depending on the status of the anterior cruciate ligament (ACL), the meniscus repaired, and the technique utilized. The rate of failure was similar for the medial and the lateral meniscus as well as for patients with an intact and a reconstructed ACL.
A systematic review of the outcomes of meniscal repair at greater than five years postoperatively demonstrated very similar rates of meniscal failure (22.3% to 24.3%) for all techniques investigated. The outcomes of meniscal repair at greater than five years postoperatively have not yet been reported for modern all-inside repair devices.
Knee meniscal repair has a success rate of approximately 80% in both men and women, and meniscal repair is a critical procedure for maintaining long-term knee health.
In many cases, athletes return to play after anterior cruciate ligament (ACL) reconstruction. In such cases, after a second ACL tear, these athletes may again expert full return to play after ACL ...revision. Unfortunately, results after revision ACL reconstruction are inferior to results after primary surgery. Sport specific data is difficult to determine, as are predictors of positive outcomes which include concomitant pathology or psychological factors. Chances of return to the same level may be 60% or less.
Background:
The long-term prognosis and risk factors for quality of life and disability after anterior cruciate ligament (ACL) reconstruction remain unknown.
Hypothesis/Purpose:
Our objective was to ...identify patient-reported outcomes and patient-specific risk factors from a large prospective cohort at a minimum 10-year follow-up after ACL reconstruction. We hypothesized that meniscus and articular cartilage injuries, revision ACL reconstruction, subsequent knee surgery, and certain demographic characteristics would be significant risk factors for inferior outcomes at 10 years.
Study Design:
Therapeutic study; Level of evidence, 2.
Methods:
Unilateral ACL reconstruction procedures were identified and prospectively enrolled between 2002 and 2004 from 7 sites in the Multicenter Orthopaedic Outcomes Network (MOON). Patients preoperatively completed a series of validated outcome instruments, including the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity rating scale. At the time of surgery, physicians documented all intra-articular abnormalities, treatment, and surgical techniques utilized. Patients were followed at 2, 6, and 10 years postoperatively and asked to complete the same outcome instruments that they completed at baseline. The incidence and details of any subsequent knee surgeries were also obtained. Multivariable regression analysis was used to identify significant predictors of the outcome.
Results:
A total of 1592 patients were enrolled (57% male; median age, 24 years). Ten-year follow-up was obtained on 83% (n = 1320) of the cohort. Both IKDC and KOOS scores significantly improved at 2 years and were maintained at 6 and 10 years. Conversely, Marx scores dropped markedly over time, from a median score of 12 points at baseline to 9 points at 2 years, 7 points at 6 years, and 6 points at 10 years. The patient-specific risk factors for inferior 10-year outcomes were lower baseline scores; higher body mass index; being a smoker at baseline; having a medial or lateral meniscus procedure performed before index ACL reconstruction; undergoing revision ACL reconstruction; undergoing lateral meniscectomy; grade 3 to 4 articular cartilage lesions in the medial, lateral, or patellofemoral compartments; and undergoing any subsequent ipsilateral knee surgery after index ACL reconstruction.
Conclusion:
Patients were able to perform sports-related functions and maintain a relatively high knee-related quality of life 10 years after ACL reconstruction, although activity levels significantly declined over time. Multivariable analysis identified several key modifiable risk factors that significantly influence the outcome.
Shoulder outcomes measures Wright, Rick W; Baumgarten, Keith M
Journal of the American Academy of Orthopaedic Surgeons,
07/2010, Letnik:
18, Številka:
7
Journal Article
Recenzirano
General health as well as disease- or condition-specific outcome measures have long been used to assess patients with shoulder conditions. Currently, a variety of validated measures is available. ...Shoulder outcomes measures may be general (eg, American Shoulder and Elbow Surgeons; Constant; Disabilities of the Arm, Shoulder, and Hand), disease-specific (eg, Rotator Cuff Quality of Life, Western Ontario Rotator Cuff Index), or condition-specific (eg, Oxford Shoulder Instability Questionnaire). The results of shoulder arthroplasty and arthritis treatment can be assessed with the Hospital for Special Surgery score and the validated Western Ontario Osteoarthritis of the Shoulder Index. Combining a general health outcome measure, a general shoulder measure, a disease- or condition-specific shoulder measure, and an activity measure allows for broad patient assessment.
Revision anterior cruciate ligament (ACL) reconstruction is believed to have an inferior outcome compared with primary ACL reconstruction. The available literature on the outcome of revision ACL ...reconstruction is sparse compared with that for primary reconstruction. The purpose of this systematic review was to test the hypothesis that the outcome of revision ACL reconstruction compares unfavorably with the historical outcome of primary ACL reconstruction.
A systematic review of studies evaluating the outcome of revision ACL reconstructions with a minimum of two years of follow-up was performed. Pooled data were collected when appropriate and a mixed-effect-model meta-analysis was performed for important outcome measures that were reported in several studies (objective graft failure, Lysholm score, International Knee Documentation Committee IKDC subjective score, and IKDC objective score). Objective failure was defined as repeat revision, a side-to-side difference of >5 mm measured with use of a KT1000 arthrometer, or a pivot-shift grade of 2+ or 3+.
Twenty-one studies were included, and 863 of the 1004 patients in these studies had a minimum of two years of follow-up and were analyzed. The pooled mean age of the patients at the time of the revision procedure was 30.6 years, and 66% were male. Objective failure occurred in 13.7% ± 2.7% of the patients (95% confidence interval, 8.0% to 19.4%). The mean Lysholm score in 491 patients was 82.1 ± 3.3 (95% confidence interval, 74.6 to 89.5) according to a mixed-model meta-analysis. The mean IKDC subjective score in 202 patients was 74.8 ± 4.4 (95% confidence interval, 62.5 to 87.0).
Revision ACL reconstruction resulted in a worse outcome compared with primary ACL reconstruction. Patient-reported outcome scores were inferior to previously published results of primary ACL reconstruction, but these differences may not be clinically important. A dramatically elevated failure rate was noted after revision ACL reconstruction; this rate was nearly three to four times the failure rate in prospective series of primary ACL reconstructions.
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