Publications by authors named "David P Trofa"

104 Publications

Return to Play Criteria Following Surgical Management of Osteochondral Defects of the Knee: A Systematic Review.

Cartilage 2022 Jul-Sep;13(3):19476035221098164

Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.

Objective: The objective of this study was to identify and describe the existing literature on criteria used for return to play (RTP) following surgical management of osteochondral defects of the knee.

Design: A systematic review was performed to evaluate the surgical management of osteochondral defects of the knee in skeletally mature patients with a minimum of 2-year follow-up using Level I to IV studies in PubMed EMBASE from January 1998 to January 2016.

Results: Twelve studies with at least one explicitly stated criterion for RTP were identified from a review of 253 published articles. The majority of included studies were Levels II and IV (33%, respectively). Autologous chondrocyte implantation (ACI) was exclusively evaluated in 33.3% of papers and 16.7% evaluated osteochondral allograft transplantation (OCA). Eight different RTP criteria were used alone or in combination across the reviewed studies and time was the most often utilized criterion (83.3%). Minimum time to RTP ranged from 3 to 18 months.

Conclusions: This systematic review identifies current criteria used in the available literature to dictate RTP. Time from surgery was the most commonly employed criterion across the reviewed studies. Given the complex biological processes inherent to the healing of cartilaginous defects, further research is needed to design more comprehensive guidelines for RTP that are patient-centered and utilize multiple functional and psychological domains relevant to the process of returning to sport.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/19476035221098164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9280827PMC
July 2022

Rehabilitation Variability Following Osteochondral Autograft and Allograft Transplantation of the Knee.

Cartilage 2022 Apr-Jun;13(2):19476035221093071

Center for Shoulder, Elbow and Sports Medicine, Columbia University, New York, NY, USA.

Objective: The aim of this study is to assess the variability of postoperative rehabilitation protocols used by orthopedic surgery residency programs for osteochondral autograft transplantation (OAT) and osteochondral allograft transplantation (OCA) of the knee.

Design: Online postoperative OAT and OCA rehabilitation protocols from US orthopedic programs and the scientific literature were reviewed. A custom scoring rubric was developed to analyze each protocol for the presence of discrete rehabilitation modalities and the timing of each intervention.

Results: A total of 16 programs (10.3%) from 155 US academic orthopedic programs published online protocols and a total of 35 protocols were analyzed. Twenty-one protocols (88%) recommended immediate postoperative bracing following OAT and 17 protocols (100%) recommended immediate postoperative bracing following OCA. The average time protocols permitted weight-bearing as tolerated (WBAT) was 5.2 weeks (range = 0-8 weeks) following OAT and 6.2 weeks (range = 0-8 weeks) following OCA. There was considerable variation in the inclusion and timing of strength, proprioception, agility, and pivoting exercises. Following OAT, 2 protocols (8%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks). Following OCA, 1 protocol (6%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks).

Conclusion: A minority of US academic orthopedic programs publish OAT and OCA rehabilitation protocols online. Among the protocols currently available, there is significant variability in the inclusion of specific rehabilitation components and timing of many modalities. Evidence-based standardization of elements of postoperative rehabilitation may help improve patient care and subsequent outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/19476035221093071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9247380PMC
June 2022

Clinical Outcomes of Arthroscopic Bony Bankart Repair for Anterior Instability of the Shoulder: A Systematic Review.

Am J Sports Med 2022 Jun 24:3635465221094832. Epub 2022 Jun 24.

Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA.

Background: Individual studies reporting the clinical outcomes of arthroscopic bony Bankart repair for anterior shoulder instability have reported excellent results but have been limited by their small sample sizes. No systematic review of the literature has been performed examining the clinical outcomes of arthroscopic bony Bankart repair.

Purpose: To provide a systematic review of the literature to examine the functional outcomes, recurrence rate, and return to sports rate after arthroscopic bony Bankart repair for anterior instability of the shoulder.

Study Design: Systematic review; Level of evidence, 4.

Methods: A systematic review of the literature based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted using the Cochrane Database of Systematic Reviews, Ovid/Embase, PubMed, and Web of Science. Studies that examined clinical outcomes after arthroscopic bony Bankart repair for anterior shoulder instability were included. Data pertaining to study characteristics and design, patient demographic characteristics, and clinical results, including functional outcomes, recurrence rate, and return to sports, were collected. The results from the studies were pooled, and weighted means and overall rates were calculated.

Results: In total, 21 studies with 769 patients were included for analysis. Most patients were male (91.7%), the mean age was 26.7 years (range, 12-71 years), and the mean follow-up was 42.7 months (range, 6-120 months). The most commonly reported functional outcome score was the Rowe score (12 studies), which improved on average from 41.9 preoperatively to 90.8 postoperatively. The rate of recurrent instability was reported by all 21 studies, and the overall recurrence rate was 11.9% (88/738). Return to sports after arthroscopic bony Bankart repair was reported by 11 studies, with a pooled return to sports rate of 91.0% (264/290).

Conclusion: Arthroscopic bony Bankart repair for anterior shoulder instability resulted in improvements in functional outcomes, a low rate of recurrent instability, and a high rate of return to sports. Although these findings are extremely promising, future prospective studies with larger sample sizes are needed to further evaluate the clinical outcomes of arthroscopic bony Bankart repair.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/03635465221094832DOI Listing
June 2022

Comorbidity scores reported in anatomic and reverse total shoulder arthroplasty: a systematic review.

Int Orthop 2022 Jun 6. Epub 2022 Jun 6.

OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA.

Background: Due to the aging population, the number of reverse shoulder arthroplasty (RSA) and anatomic shoulder arthroplasty (TSA) continue to increase annually. Although outcome measures are frequently reported in literature for patients who undergo shoulder arthroplasty, no studies have analyzed reporting of patient comorbidities in this population. The purpose of this study was to evaluate reporting of comorbidity indices in shoulder arthroplasty literature and assess how this reporting may inform management and outcomes.

Methods: A database was compiled systematically using PubMed to identify articles pertaining to shoulder arthroplasty published between 2019 and 2021. The search terms, "reverse shoulder arthroplasty" and "anatomic shoulder arthroplasty," were used to identify clinical studies. Non-clinical (e.g., translational and basic science) and review articles were excluded. Included studies were then analyzed for reporting of comorbidity indices.

Results: A total of 199 articles were included in this review and reported comorbidities. Of these, 15.6% (31 of 199) pertained to TSA, while 84.4% (168 of 199) pertained to RSA. Within this review, 57.8% (115 of 199) articles utilized comorbidity scores, while 42.2% (84 of 199) reported only comorbid diagnoses. Among the scores utilized, the American Society of Anesthesiologists (ASA) physical status classification system was the most widely used among both the TSA (52.9%, 9 of 17) and the RSA studies (58.2%, 57 of 98). Additional scores within the RSA literature included the Charlson Comorbidity Index (CCI) (35.3%, 6 of 17), the Charlson Comorbidity Index by Deyo et al. (J Clin Epidemiol. 45(6):613-9, 1992) (CCI-Deyo; 5.9%, 1 of 17), the Modified Charlson Comorbidity Index (modified-CCI) (5.9%, 1 of 17), the Elixhauser et al. (Med Care. 36(1):8-27, 1998) Comorbidity Measure (ECM) (11.8%, 2 of 17), and the Modified Frailty Index (mFI) (5.9%, 1 of 17). With the TSA literature, the additional comorbidity scores included the CCI (30.6%, 30 of 98), the CCI-Deyo (6.1%, 6 of 98), the modified-CCI (1.0%, 1 of 98), the ECM (8.2%, 8 of 98), the Factor-5 modified Frailty Index (mFI-5) (1.0%, 1 of 98), and the mFI (1.0%, 1 of 98).

Conclusion: The reporting of comorbidity indices is an important factor when considering patient outcomes and complications reported in shoulder arthroplasty literature. Although the reporting of these scores appears to be more prevalent in current literature, there is no standard or consistency in terms of which scores are reported. Given this diversity in comorbidity scores, further research is necessary to develop a single standardized score to properly analyze the effect of comorbidities on shoulder arthroplasty patient outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-022-05462-6DOI Listing
June 2022

The Current Utilization of Patient-reported Outcome Measurement Information System in Shoulder, Elbow, and Sports Medicine.

J Am Acad Orthop Surg 2022 Jun;30(12):554-562

From the Department of Orthopaedic Surgery, Columbia University Medical Center, NY, NY (Trofa and Desai), the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Li), and the Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI (Makhni).

Clinical research using patient-reported outcome measures has been critical within the field of shoulder, elbow, and sports medicine in helping clinicians deliver evidence-based and value-based medicine. Recently, however, clinicians have advocated for improving the process of obtaining clinically meaningful information from patients while decreasing survey fatigue and increasing compliance. To that end, the National Institutes of Health created the Patient-Reported Outcome Measures Information System (PROMIS) in which a number of institutions and research investigations have adopted for reporting outcomes. A special focus has also been placed on PROMIS Computer Adaptive Testing forms, which tailor questioning through item response theory. The purpose of this study was to provide insight into the utilization, advantages, and disadvantages of PROMIS within the field of shoulder, elbow, and sports medicine and provide a comparison with legacy patient-reported outcome measure measurements.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5435/JAAOS-D-22-00030DOI Listing
June 2022

The 'Bauer bump:' ice hockey skates as a common cause of Haglund syndrome.

Phys Sportsmed 2022 May 27:1-6. Epub 2022 May 27.

Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, NY, NY, USA.

Ice hockey is a fast-paced contact sport with a high rate of injury. While many of the injuries are acute and related to high skating speeds, frequent collisions, and sharp skates, the clinician must also be aware of the chronic injuries that commonly arise from playing this sport. The "Bauer bump" is one such chronic injury, which is the onset of Haglund syndrome in ice hockey players occurring in the context of wearing ice hockey skates. With this condition, players notice a bony enlargement of their posterosuperior calcaneus with or without the accompanying symptoms of retrocalcaneal bursitis and insertional Achilles tendinopathy. It is important for clinicians to understand the nature of Haglund syndrome in hockey players so that it can be appropriately diagnosed, managed, and ultimately, prevented.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00913847.2022.2079962DOI Listing
May 2022

Outcomes and failure rates after revision meniscal repair: a systematic review and meta-analysis.

Int Orthop 2022 07 27;46(7):1557-1562. Epub 2022 Apr 27.

Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.

Purpose: The purpose of this meta-analysis is to determine the outcomes and failure rates for revision meniscus repairs in patients with re-tears after primary repair failure.

Methods: A literature search was conducted using PubMed and Embase with the terms "Meniscus," "Meniscal," "Revised," and "Revision." The search strategy was based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol and included four articles (79 patients). The search criteria were limited to studies reporting outcomes and failure rates. The exclusion criteria included languages other than English, biomechanical studies, letters to editors, non-full text, review articles, meta-analysis, and case reports.

Results: Four comparative studies with 79 patients (53 males, 26 females) with a mean age of 23.9 ± 6.4 years treated with a revision meniscus repair were included in the final analysis. Within this analysis, we found a failure rate of 25.3% (20 of 79 patients). Of these failed repairs, 30.95% (13 of 42) were of the medial meniscus, and 18.9% (7 of 37) were of the lateral meniscus. In the four articles, the postoperative Tegner sports activity score was found to be 6.1 ± 1.6 (range, 2 to 10). The post-operative Lysholm score was reported in three articles (45 patients). At a mean follow-up of 58.3 ± 23.9 months, the mean post-operative Lysholm score was 89.1 ± 7.6 (range, 38 to 100). The Coleman score for the included articles ranged between 52 and 59.

Conclusion: This analysis found that revision meniscus repairs in patients with re-tears after primary repair failure result in clinical outcomes similar to that of primary repairs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-022-05413-1DOI Listing
July 2022

Fractures of the posterior malleolus: a systematic review and analysis of patient-reported outcome scale selection.

Eur J Orthop Surg Traumatol 2022 Apr 16. Epub 2022 Apr 16.

Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY, USA.

Purpose: Despite the extensive use of PROs in ankle fracture research, no study has quantified which PROs are most commonly used for assessing outcomes of patients who sustain fractures of the posterior malleolus. The purpose of this study was therefore to quantify which PROs are most commonly used for outcome research after posterior malleolus fractures.

Methods: A systematic search was performed using the preferred reporting items for systematic reviews and meta-analyses guidelines. Articles were identified through Pubmed, EMBASE, Web of Science, and cochrane central register of controlled trials through May of 2021. Included articles were analyzed for the primary outcome of the most commonly reported PRO.

Results: The American orthopedic foot and ankle ankle-hindfoot score (AOFAS) was the most commonly used PRO for assessment of posterior malleolus fracture outcomes, used in 37 of 72 studies (51.4%). The second and third most common were the olerud-molander ankle score (OMAS) (22 studies, 30.6%) and the visual analogue score (VAS) (21 studies, 29.2%). Eleven different PROs were used only once. Quality of evidence was graded as low given the percentage of studies that were observational or case series (68 of 72 studies, 94.4%).

Conclusion: Investigators have used many different PROs to assess outcomes for posterior malleolus fractures, the most common of which are the AOFAS, OMAS, and VAS. Future investigators should attempt to unify outcome reporting for these injuries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00590-022-03261-8DOI Listing
April 2022

Outcomes After Arthroscopic Revision Bankart Repair: An Updated Systematic Review of Recent Literature.

Arthroscopy 2022 Apr 7. Epub 2022 Apr 7.

OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.; Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, U.S.A.. Electronic address:

Purpose: To provide an update of recent literature with a specialized focus on clinical outcomes following arthroscopic revision Bankart repair (ARBR) by performing a systematic review of all available literature published between 2013 and 2020.

Methods: A literature search reporting clinical outcomes after ARBR was performed. Criteria for inclusion consisted of original studies; Level of Evidence of I-IV; studies focusing on clinical outcomes after ARBR published between January 1, 2013, and January 4, 2021; studies reporting recurrent dislocation or instability rate after ARBR; reoperation/revision following ARBR, return to sport rates following ARBR; and patient-reported outcomes. The primary outcomes of interest were failure defined as recurrent instability or dislocation, return to sport rates, and patient-reported outcomes at follow-up.

Results: A large proportion of patients undergoing arthroscopic revision Bankart repair were male, ranging between 67.7% and 93.8%. Failure rate and return to sports rate ranged between 6.1% and 46.8% and 25.9% and 88.3%, respectively, when patients with significant or greater than 20% glenoid bone loss was excluded. Patient-reported outcome scores, which included American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale, saw significant improvement over mean follow-up of ranging 21.64 to 60 months.

Conclusions: Both the failure rate and RTS rates after ARBR had a wide range, given the heterogeneity of the studies included, which varied in patient selection criteria pertaining to patients with greater than 20% glenoid bone. Although there have been advancements in arthroscopic techniques and a trend favoring arthroscopic stabilization procedures, there is a lack of consensus in recent literature for careful patient selection criteria that would minimize failure rates and maximize RTS rates after ARBR.

Level Of Evidence: Level IV, a systematic review of Level III-IV studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2022.03.030DOI Listing
April 2022

Distal Clavicle Excision: An Epidemiologic Study Using the National Ambulatory Surgery Sample Database.

Cureus 2022 Feb 10;14(2):e22092. Epub 2022 Feb 10.

Sports Medicine Center, OrthoCarolina, Charlotte, USA.

Background: This study aimed to examine national trends pertaining to patient demographics and hospital characteristics among distal clavicle excision (DCE) procedures performed in the United States.

Methods: The National Ambulatory Surgery Sample (NASS) database was queried for data. Encounters with Current Procedural Terminology (CPT) code 29824 were selected. Metrics derived from these encounters included patient demographic information such as age, geographic location, median household income per zip code, and primary expected insurance payer. Hospital characteristics derived included total charges for DCE procedures, location of the hospital, disposition of the patient, hospital census region, control/ownership of the hospital, and location/teaching status of the hospital. The proportion of DCE performed concomitantly with rotator cuff repair (RCR) was also analyzed. P-values were obtained from continuous variables using a t-test with a linear regression model. P-values were obtained from event variables using chi-square analysis.

Results: The incidence of arthroscopic DCE in the US decreased from 99,070 in 2016 to 93,678 (5.5%) in 2018. Of note, the proportion of DCE performed concomitantly with RCR significantly increased from 50.4% in 2016 to 52.8% in 2018 (P < 0.0001). Median patient age increased from 2016 to 2018 (56.4 to 57.2; P< 0.0001). The income quartile that saw the highest number of encounters was between $43,000 and $53,999 (P< 0.0001). Hospital trends display an increasing cost from $16,944 to $18,855 over the study period (P= 0.0016). Private insurance, including health maintenance organizations (HMOs), were the largest payers for this procedure; however, a decreasing trend in DCE covered by private insurance was noticed (50.2% to 47.3%; P < 0.0001). Medicare was the second-largest payer ranging from 27.9% in 2016 to 29.9% in 2018. The urban teaching model of hospitals continues to see the highest number of encounters for this procedure.

Conclusions: In both 2016 and 2018, private insurance was the most common payer, most DCEs were performed in urban teaching hospitals, and most patients undergoing the procedure had a median household income between $43,000 and $59,000. Between 2016 and 2018, there was a significant increase in costs associated with DCE, as well as an increase in the median age of patients undergoing the procedure. The proportion of DCE performed concurrently with RCR also significantly increased during the study period.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.22092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8920810PMC
February 2022

Adjustable-loop cortical suspension device for posterolateral corner reconstruction in the setting of fibular avulsion fracture: a case series and novel technique description.

Arch Orthop Trauma Surg 2022 Mar 19. Epub 2022 Mar 19.

OrthoCarolina Sports Medicine Center, 1915 Randolph Rd, Charlotte, NC, 282077, USA.

Introduction: A novel technique using an adjustable-loop cortical suspension toggle device for reduction of a fibular head avulsion fracture (arcuate fracture) in posterolateral corner (PLC) reconstruction is described. Results of clinical follow-up are presented.

Materials And Methods: 9 patients were retrospectively identified who underwent posterolateral corner reconstruction using an adjustable-loop cortical suspension toggle device. Radiographic examination was used to evaluate the successful healing of the avulsed fibular head fragments post-operatively.

Results: 7 patients reported satisfactory results with their clinical outcome with no feelings of knee instability or objective instability on exam at final follow-up. Post-operative radiographs obtained > 6 months following reconstruction demonstrated well reduced and healed fracture in 5 of 6 patients, with 1 patient demonstrating maintained reduction but incomplete fracture union at 6 months.

Conclusion: This novel surgical technique for PLC reconstruction with an avulsed fibular head fracture is a viable alternative to previously described methods. The majority of patients report subjective satisfaction with a stable knee post-operatively.

Level Of Evidence: IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00402-022-04412-6DOI Listing
March 2022

The Role of Advanced Academic Degrees in Orthopaedic Sports Medicine Faculty.

Orthop J Sports Med 2022 Feb 7;10(2):23259671211073713. Epub 2022 Feb 7.

Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA.

Background: Limited knowledge exists on the role of advanced academic degrees within faculty positions in orthopaedic sports medicine.

Purpose: To 1) provide an assessment of the baseline demographics of advanced degrees among orthopaedic sports medicine faculty and 2) examine the impact of advanced degrees on research productivity and career attainment of orthopaedic sports medicine faculty.

Study Design: Cross-sectional study; Level of evidence, 4.

Methods: Orthopaedic sports medicine academics were identified using faculty listings on websites of the 200 orthopaedic surgery residency programs during the 2020-2021 academic year. Advanced degrees were defined as those additional to the primary medical degree (Doctor of Medicine [MD] or Doctor of Osteopathic Medicine [DO]). Outcome measures included timing of advanced degree obtainment, residency program rankings, research productivity, and current academic rank and leadership roles. Statistical analysis was performed using chi-square and Mann-Whitney tests to determine the association of advanced degrees on outcome measures.

Results: In total, 911 orthopaedic sports medicine faculty members were identified, of whom 100 had an advanced degree. The most common advanced degrees were Master of Science (MS/MSc; 38%), Doctor of Philosophy (PhD; 23%), and Master of Business Administration (MBA; 13%). The presence of an advanced degree was associated with greater research productivity, including higher h-index and number of publications, as well as more editorial board positions on orthopaedics journals ( < .001). Advanced degrees were not significantly associated with attending a higher ranked orthopaedic surgery residency program, current academic rank, or leadership roles. At the institutional level, orthopaedic sports medicine programs that employed faculty with an advanced degree had a higher residency program ranking and the presence of a sports medicine fellowship was more likely ( < .05).

Conclusion: Advanced degrees in orthopaedic sports medicine were associated with greater faculty research engagement and employment at a higher ranked institution; they were not associated with matching to a highly ranked orthopaedic surgery residency program, higher faculty rank, or academic leadership roles.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/23259671211073713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8832599PMC
February 2022

Isolated Osteochondral Autograft Versus Allograft Transplantation for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Systematic Review and Meta-analysis.

Am J Sports Med 2022 Feb 9:3635465211053594. Epub 2022 Feb 9.

OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA.

Background: Focal cartilage lesions of the knee remain a difficult entity to treat. Current treatment options include arthroscopic debridement, microfracture, autograft or allograft osteochondral transplantation, and cell-based therapies such as autologous chondrocyte transplantation. Osteochondral transplantation techniques restore the normal topography of the condyles and provide mature hyaline cartilage in a single-stage procedure. However, clinical outcomes comparing autograft versus allograft techniques are scarce.

Purpose: To perform a comprehensive systematic review and meta-analysis of high-quality studies to evaluate the results of osteochondral autograft and allograft transplantation for the treatment of symptomatic cartilage defects of the knee.

Study Design: Systematic review and meta-analysis; Level of evidence, 2.

Methods: A comprehensive search of the literature was conducted using various databases. Inclusion criteria were level 1 or 2 original studies, studies with patients reporting knee cartilage injuries and chondral defects, mean follow-up ≥2 years, and studies focusing on osteochondral transplant techniques. Exclusion criteria were studies with nonknee chondral defects, studies reporting clinical outcomes of osteochondral autograft or allograft combined with other procedures, animal studies, cadaveric studies, non-English language studies, case reports, and reviews or editorials. Primary outcomes included patient-reported outcomes and failure rates associated with both techniques, and factors such as lesion size, age, sex, and the number of plugs transplanted were assessed. Metaregression using a mixed-effects model was utilized for meta-analyses.

Results: The search resulted in 20 included studies with 364 cases of osteochondral autograft and 272 cases of osteochondral allograft. Mean postoperative survival was 88.2% in the osteochondral autograft cohort as compared with 87.2% in the osteochondral allograft cohort at 5.4 and 5.2 years, respectively ( = .6605). Patient-reported outcomes improved by an average of 65.1% and 81.1% after osteochondral autograft and allograft, respectively ( = .0001). However, meta-analysis revealed no significant difference in patient-reported outcome percentage change between osteochondral autograft and allograft ( = .97) and a coefficient of 0.033 (95% CI, -1.91 to 1.98). Meta-analysis of the relative risk of graft failure after osteochondral autograft versus allograft showed no significant differences ( = .66) and a coefficient of 0.114 (95% CI, -0.46 to 0.69). Furthermore, the regression did not find other predictors (mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location) that may have significantly affected patient-reported outcome percentage change or postoperative failure between osteochondral autograft versus allograft.

Conclusion: Osteochondral autograft and allograft result in favorable patient-reported outcomes and graft survival rates at medium-term follow-up. While predictors for outcomes such as mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location did not affect the comparison of the 2 cohorts, proper patient selection for either procedure remains paramount to the success and potentially long-term viability of the graft.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/03635465211053594DOI Listing
February 2022

The risk of COVID-19 transmission upon return to sport: a systematic review.

Phys Sportsmed 2022 Feb 11:1-7. Epub 2022 Feb 11.

Department of Orthopaedic Surgery and Sports Medicine, Mount Sinai, New York, NY, USA.

Objectives: To evaluate COVID-19 transmission rates in athletes upon return to sport (RTS), as well as the effectiveness of preventive and surveillance measures associated with RTS.

Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Cochrane Library databases were searched to identify all articles reporting on RTS during COVID-19. Articles were excluded on the basis of the following criteria: (1) non-English text, (2) only abstract available, (3) population not athlete-specific, (4) outcome not RTS-specific, (5) COVID-19 transmission data not quantified, (6) editorial, or (7) review article or meta-analysis. Study characteristics; athlete demographics; COVID-19 preventive, surveillance, and diagnostic measures; COVID-19 transmission outcomes; and RTS recommendations were collected from each included article and analyzed.

Results: 10 studies were included in the final analysis, comprising over 97,000 athletes across a wide variety of sports, levels of play, and RTS settings. Of the 10 studies, eight identified low transmission rates and considered RTS to be safe/low risk. Overall, COVID-19 transmission rates were higher in athletes than in contacts, and more prevalent in the greater community than in athletes specifically. The risk of COVID-19 did not appear to be necessarily higher for athletes who played high-contact team sports, shared common facilities, or lived in communities impacted by high transmission rates, provided that rigorous COVID-19 safety and testing protocols were implemented and followed. Mask wearing and physical distancing during active play presented the greatest challenge to athletes.

Conclusion: Rigorous preventive and surveillance measures can mitigate the risk of COVID-19 transmission in athletes upon RTS. However, the heterogeneity of RTS playing conditions, availability of COVID-19 resources, rise of unforeseen novel variants, and undetermined long-term impact of vaccination on athletes remain a challenge to safe and effective RTS in the era of COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00913847.2022.2035197DOI Listing
February 2022

Comparative Studies in the Shoulder Literature Lack Statistical Robustness: A Fragility Analysis.

Arthrosc Sports Med Rehabil 2021 Dec 12;3(6):e1899-e1904. Epub 2021 Oct 12.

Boston University Medical Center, Boston, Massachusetts.

Purpose: Evidenced-based decision-making is rooted in comparative clinical studies; however, a small number of outcome event reversals have the potential to change study significance. The purpose of this study was to determine the utility of applying fragility analysis to comparative studies in the published orthopaedic shoulder literature.

Methods: Comparative clinical shoulder research studies reporting 1:1 dichotomous categorical data were analyzed in 6 leading orthopaedic journals between 2006 and 2016. Statistical significance was defined as a value of less than .05. The fragility index (FI) for each study outcome was determined by the number of event reversals required to change the value to either greater or less than 0.05, thus changing the study conclusions. The associated fragility quotient (FQ) was determined by dividing the FI by the total population comprising a particular outcome.

Results: Of the 23,897 studies screened, 3,591 met search criteria, with 198 comparative studies ultimately included for analysis, 67 of which were randomized controlled trials. There were 357 total outcome events with 74 reported as significant and 283 as not significant. The FI was 4 (IQR 2-6) with an associated FQ of 0.066 (interquartile range [IQR] 0.038-0.102). There was no difference in statistical fragility between randomized and nonrandomized trials with both revealing a FI of 4 and FQ of 0.068 (IQR 0.044-0.107) and 0.065 (IQR 0.031-0.101), respectively.

Conclusions: This current analysis reveals that comparative shoulder studies published in six leading orthopaedic journals are at risk of statistical fragility. As such, contemporary clinical shoulder literature may not be as robust as traditionally perceived with the reversal of only a few outcome events required to change study significance. Therefore, we advocate the reporting of both FI and FQ in addition to the value as statistical complements to all comparative investigations to provide a more comprehensive understanding of trial stability and significance in the published shoulder literature.

Clinical Relevance: Comparative study designs are commonly employed in shoulder research. Several studies in both the general medical and orthopaedic literature have identified a lack of statistical robustness through comprehensive fragility analysis. Our findings demonstrate the value may be an inadequate independent statistical metric requiring the complement of a FI and FQ to aid in the interpretation and understanding of study significance for clinical decision-making.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.asmr.2021.08.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689245PMC
December 2021

Machine Learning Model Developed to Aid in Patient Selection for Outpatient Total Joint Arthroplasty.

Arthroplast Today 2022 Feb 8;13:13-23. Epub 2021 Dec 8.

New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.

Background: Patient selection for outpatient total joint arthroplasty (TJA) is important for optimizing patient outcomes. This study develops machine learning models that may aid in patient selection for outpatient TJA based on medical comorbidities and demographic factors.

Methods: This study queried elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) cases during 2010-2018 in the American College of Surgeons National Surgical Quality Improvement Program. Artificial neural network models predicted same-day discharge and length of stay (LOS) fewer than 2 days (short LOS). Multiple linear and logistic regression analyses were used to identify variables significantly associated with predicted outcomes.

Results: A total of 284,731 TKA cases and 153,053 THA cases met inclusion criteria. For TKA, prediction of short LOS had an area under the receiver operating characteristic curve (AUC) of 0.767 and accuracy of 84.1%; prediction of same-day discharge had an AUC of 0.802 and accuracy of 89.2%. For THA, prediction of short LOS had an AUC of 0.757 and accuracy of 70.6%; prediction of same-day discharge had an AUC of 0.814 and accuracy of 78.8%.

Conclusion: This study developed machine learning models for aiding patient selection for outpatient TJA, through accurately predicting short LOS or outpatient vs inpatient cases. As outpatient TJA expands, it will be important to optimize preoperative patient selection and effectively screen surgical candidates from a broader patient population. Incorporating models such as these into electronic medical records could aid in decision-making and resource planning in real time.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.artd.2021.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8666332PMC
February 2022

Return-to-Sport Outcomes After Primary Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Tendon Grafts: A Systematic Review.

Orthop J Sports Med 2021 Dec 2;9(12):23259671211055726. Epub 2021 Dec 2.

Department of Orthopedics, Columbia University Irving Medical Center, New York, New York, USA.

Background: Ulnar collateral ligament (UCL) reconstruction is the current gold standard of treatment for overhead athletes with a symptomatic, deficient UCL of the elbow who have failed nonoperative treatment and wish to return to sport (RTS) at a high level. The palmaris longus and hamstring tendons are common graft choices, but no study has analyzed the existing literature to assess whether one graft is superior to the other.

Purpose: To systematically report on the outcomes of UCL reconstruction using palmaris and hamstring autografts.

Study Design: Systematic review; Level of evidence, 4.

Methods: A combination of the terms "ulnar collateral ligament," "valgus instability," "Tommy John surgery," "hamstring," and "palmaris longus" were searched in PubMed, Embase, and the Cochrane Library. RTS and return-to-same-level (RSL) rates, patient-reported outcomes, and complications were included for analysis. We used the modified Coleman Methodology Score and risk-of-bias tool for nonrandomized studies to assess the quality of the included studies.

Results: This review included 6 studies (combined total of 2154 elbows) that directly compared palmaris and hamstring graft use in UCL reconstruction. Follow-up ranged from 24 to 80.4 months, and the mean patient age across all studies was 21.8 years. The mean RSL across all studies and grafts was 79.0%, and the mean RTS was 84.1%, consistent with results previously reported in the literature. The mean RTS and RSL rates for the palmaris graft group were 84.6% and 82%, respectively; the hamstring graft group showed mean RTS and RSL rates of 80.8% and 80.8%. Meta-analysis revealed no significant difference in RSL between the 2 graft groups (odds ratio, 1.06; 95% CI, 0.77-1.46). The combined complication rate of the included studies was 18.2%, with failure rates ranging from 0% to 7.1%.

Conclusion: Results of this review indicated that both palmaris and hamstring tendon grafts are viable options for primary UCL reconstruction. Graft choice should be determined by a combination of patient and surgeon preference.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/23259671211055726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8646802PMC
December 2021

Comparable Subjective and Objective Clinical Outcomes After Fibular or Combined Tibial-Fibular-based Reconstruction of the Posterolateral Corner of the Knee: A Systematic Review and Meta-analysis.

J Am Acad Orthop Surg Glob Res Rev 2021 12 2;5(12). Epub 2021 Dec 2.

From the OrthoCarolina-Sports Medicine Center (Dr. Yeatts, Dr. Rao, Mr. Hong, Dr. Moorman, Dr. Piasecki, Dr. Fleischli and Dr. Saltzman), Atrium Health-Musculoskeletal Institute, Charlotte, NC (Dr. Yeatts, Hong, Dr. Moorman, Dr. Piasecki, Dr. Fleischli, and Dr. Saltzman), and the Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY (Dr. Trofa).

Introduction: To compare subjective and objective outcomes of fibular and combined tibial-fibular (TF)-based posterolateral corner (PLC) reconstruction.

Methods: A systematic review of literature reporting outcomes of posterolateral corner reconstruction was conducted including outcome studies of surgically treated PLC injuries with a minimum 1-year follow-up, postoperative subjective and objective outcomes including the patient-reported outcome scorings of Lysholm score, International Knee Documentation Committee evaluation (subjective and objective), dial test, and varus stress radiographs.

Results: The 32 studies included comprised 40 cohorts: 12 cohorts (n = 350 knees) used a fibular-based technique, and 28 cohorts (n = 593 knees) used a combined TF-based technique. No statistically significant differences were found in patient-reported outcomes or objective clinical measurements comparing the two techniques using the Lysholm score (P = 0.204, τ2 = 3.46), International Knee Documentation Committee evaluation (subjective P = 0.21 τ2 = 15.57; objective P = 0.398), dial test (P = 0.69), or varus stress radiographs (P = 0.98, τ2 = 0.08).

Conclusions: This study found no statistically significant differences in subjective or objective clinical outcome measurements after fibular-based versus combined TF-based PLC reconstruction. Further prospective evaluation comparing long-term clinical outcomes, complications, and surgical time may help to elucidate a preferred reconstructive technique.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00181DOI Listing
December 2021

Outcomes and reoperation rates after tibial tubercle transfer and medial patellofemoral ligament reconstruction: higher revision stabilization in patients with trochlear dysplasia and patella alta.

Knee Surg Sports Traumatol Arthrosc 2022 Jul 7;30(7):2227-2234. Epub 2021 Nov 7.

OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA.

Purpose: To determine the reoperation rate, risk factors for reoperation, and patient-reported outcomes after isolated or combined tibial tubercle transfer and medial patellofemoral ligament reconstruction, for patellofemoral instability surgery.

Methods: Patient's records who underwent medial patellofemoral ligament reconstruction and/or tibial tubercle transfer for patellar instability by 35 surgeons from 2002 to 2018 at a single academic institution were retrospectively reviewed using CPT codes. Four-hundred-and-eighty-six patients were identified. Radiographic measurements, demographic parameters, and subsequent revision procedures and their indications were identified. A modified anterior knee pain survey was conducted by mail and with follow-up phone survey.

Results: The overall rate of reoperation was 120/486 (24.7%). The most common cause for reoperation was removal of hardware 42/486 (8.6%). The rate of reoperation for isolated medial patellofemoral ligament reconstruction 43/226 (19%) was lower than that of isolated tibial tubercle transfer 45/133 (33.8%) or a combined procedure 32/127 (25.2%) (P = 0.007). Woman had a higher rate of reoperation (29.4%) compared to men (15.9%) (P = 0.002). Patients at risk for a revision stabilization procedure included those with severe trochlear morphology (C or D) (6.1%) and those with Caton-Deschamps index > 1.3 (7.3%). Patients who underwent reoperation of any kind had poorer patient-reported outcomes.

Conclusion: The overall reoperation rate after patellofemoral instability surgery remains high, and any reoperation portends worse patient-reported outcomes. Re-operations for instability are more likely in patients with trochlear dysplasia and patella alta and may benefit from more aggressive initial treatment, such as medial patellofemoral ligament reconstruction and tibial tubercle transfer in combination. Using the results of this study, surgeons will be able to engage in meaningful discussion with patients to counsel patients on expectations postoperatively.

Level Of Evidence: IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-021-06784-5DOI Listing
July 2022

Academic Influence as Reflected by h Index Is Not Associated With Total Industry Payments but Rather With National Institutes of Health Funding Among Academic Orthopaedic Sports Medicine Surgeons.

Arthroscopy 2022 05 29;38(5):1618-1626. Epub 2021 Oct 29.

Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A.. Electronic address:

Purpose: (1) To compare the total number and dollar amount of industry funding and National Institutes of Health (NIH) funding to academic orthopaedic sports medicine surgeons and (2) to examine the impact of academic influence on industry funding and NIH funding to academic orthopaedic sports medicine surgeons.

Methods: Academic orthopaedic sports medicine surgeons were identified using faculty web pages. Academic influence was approximated by a physician's Hirsch index (h index) and number of publications and obtained from the Scopus database. Total industry payments were acquired through the Open Payments Database, and NIH funding was determined from the NIH website. Statistical analysis was performed using Mann-Whitney U test and Spearman correlations with significance set at P < .05.

Results: Physicians who received industry research payments and NIH funding had a significantly higher mean h index and more mean total publications than physicians who did not receive industry research payments and NIH funding. There were no significant differences in h index (P = .374) or number of publications (P = .126) between surgeons receiving industry nonresearch funding and those who did not. h Index and number of publications were both weakly correlated with the amount of industry research and nonresearch funding.

Conclusion: Although academic influence is associated with industry research funding and NIH funding, there is no association between measures of academic influence and total industry and industry nonresearch payments. Combined with the weak associations between academic influence and the amount of industry payments, academic influence does not appear to be a major determinant of industry funding to academic orthopaedic sports medicine surgeons.

Clinical Relevance: Surgeons should be cognizant of potential conflicts with industry, but the relationship between academic sports medicine surgeons and industry may be less subject to bias than previously believed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2021.10.017DOI Listing
May 2022

Resident Involvement in Hip Arthroscopy Procedures Does Not Affect Short-Term Surgical Outcomes.

Arthrosc Sports Med Rehabil 2021 Oct 19;3(5):e1367-e1376. Epub 2021 Aug 19.

Columbia University Irving Medical Center, New York, New York, U.S.A.

Purpose: To evaluate whether the presence of residents in hip arthroscopy (HA) procedures affects short-term surgical outcomes.

Methods: The American College of Surgeons National Surgical Quality Improvement Program Database was used to identify patients who underwent HA from 2006 to 2012. Demographic and 30-day outcome variables were compared between cohorts of patients with and without residents. Multivariate logistic regression was used to identify whether resident involvement was an independent risk factor for adverse outcomes. Propensity score matching was performed to control for all demographic and intraoperative variables.

Results: A total of 869 patients (59.7% female) were included in this study, 626 of which reported data on resident involvement. Patients were mostly White (73.4% of cases without a resident, 51.8% with a resident, < .05). Those with residents were younger ( = .016), had lower modified 5-item frailty index (mFI-5) scores ( = .028), and had fewer cardiac comorbidities ( = .008). There was no difference in diabetic status, dyspnea symptoms, history of chronic obstructive pulmonary disease, renal comorbidity, neurologic comorbidity, cumulative comorbidities, history of bleeding disorders, inpatient vs. outpatient treatment, preoperative functional status, smoking history, and steroid use for chronic conditions. There was no difference in all complications, operative time, length of stay, reoperation, readmission, wound complication, venous thromboembolism, blood transfusions, or sepsis. Propensity score match for demographic and intraoperative differences found no association between resident involvement and increased complications. Resident involvement was not an independent risk factor for all complications studied.

Conclusion: Resident involvement in HA procedures was not a risk factor for 30-day complications between 2006 and 2012. Resident involvement did not increase the risk of adverse outcomes, readmission, reoperation, or length of stay, nor did it significantly increase operative times.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.asmr.2021.06.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527250PMC
October 2021

The Fragility of Significance in the Hip Arthroscopy Literature: A Systematic Review.

JB JS Open Access 2021 Oct-Dec;6(4). Epub 2021 Oct 21.

Boston University School of Medicine, Boston, Massachusetts.

The purpose of the present study was to perform the first examination of the utility of p values and the degree of statistical fragility in the hip arthroscopy literature by applying both the Fragility Index (FI) and the Fragility Quotient (FQ) to dichotomous comparative trials. We hypothesized that dichotomous comparative trials evaluating categorical outcomes in the hip arthroscopy literature are statistically fragile.

Methods: The PubMed and MEDLINE databases were queried from 2008-2018 for comparative studies evaluating dichotomous data in the hip arthroscopy literature. The present analysis included both randomized controlled trials (RCTs) and non-RCTs in which dichotomous data and associated p values were reported. Fragility analysis was performed with use of the Fisher exact test until an alteration of significance was determined.

Results: Of the 5,836 studies screened, 4,156 met the search criteria, with 52 comparative studies included for analysis. One hundred and fifty total outcome events with 33 significant (p < 0.05) outcomes and 117 nonsignificant (p ≥ 0.05) outcomes were identified. The final FI incorporating all 150 outcome events from 52 comparative studies was only 3.5 (interquartile range, 2 to 6), with an associated FQ of 0.032 (interquartile range, 0.017 to 0.063). Twenty-two studies (42.3%) either failed to report loss to follow-up (LTF) data or reported LTF greater than the overall FI of 3.5.

Conclusions: The peer-reviewed hip arthroscopy literature may not be as stable as previously thought, as the sole reliance on a threshold p value has proven misleading. We therefore recommend reporting of the FI and FQ, in conjunction with p values, to aid in the evaluation and interpretation of statistical robustness and quantitative significance in future comparative hip arthroscopy studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.OA.21.00035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542173PMC
October 2021

Targeting Rule Implementation Decreases Concussions in High School Football: A National Concussion Surveillance Study.

Orthop J Sports Med 2021 Oct 15;9(10):23259671211031191. Epub 2021 Oct 15.

Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA.

Background: Concussions occur at higher rates in high school football as compared with all other high school sports. In 2014, the National Federation of State High School Associations implemented rules defining illegal contact against a defenseless player above the shoulders to reduce concussions in football players in the United States. To the best of our knowledge, rates of emergency department (ED)-diagnosed concussions of high school football players before and after the 2014 rule implementation have not been compared.

Hypothesis: It was hypothesized that (1) there would be lower rates of helmet-to-helmet and helmet-to-body-part concussions after rule implementation and (2) alternative mechanisms of concussion would not differ, as these would be less influenced by rule implementation.

Study Design: Cohort study; Level of evidence, 3.

Methods: Data from the National Electronic Injury Surveillance System (NEISS) were analyzed for high school football players 14 to 18 years old sustaining a concussion from January 1, 2009, to December 31, 2019. Data were collected on mechanism of injury, setting, and loss of consciousness. Raw data were used to calculate national estimates based on the assigned statistical sample weight of each hospital by the NEISS.

Results: A total of 4983 (national estimate = 154,221) high school football concussions were diagnosed in US EDs; 58.8% of concussions occurred during competition and 41.2% during practice. Between 2009 and 2013 the rate of concussions diagnosed in EDs rose 10.7% as compared with a 6.2% decrease between 2015 and 2019 ( = .04). Between 2009 and 2013, the rate of helmet-to-helmet concussions rose 17.6% as compared with a 5.6% decrease between 2015 and 2019 ( = .03). There were no significant changes between other mechanisms of concussion before and after the 2014 rule implementation.

Conclusion: We identified a decreased trend in overall and helmet-to-helmet high school football concussions diagnosed in the ED after implementation of the targeting rule. This study adds to the growing literature regarding the importance and efficacy of rule implementation in reducing sports-related concussions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/23259671211031191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8521430PMC
October 2021

The Fragility of Statistical Significance in Patellofemoral Instability Research: A Systematic Review.

Am J Sports Med 2021 Oct 11:3635465211039202. Epub 2021 Oct 11.

Department of Orthopaedic Surgery & Sports Medicine, Mount Sinai, New York, New York, USA.

Background: Fragility analysis is increasingly utilized to evaluate the robustness of results within the orthopaedic literature and has frequently revealed instability of reported outcomes.

Purpose/hypothesis: The purpose of this investigation was to utilize a fragility analysis to evaluate the stability of reported results in the patellofemoral instability (PFI) literature. We hypothesized the demonstration of significant fragility in patellofemoral research to be similar to that identified throughout other areas of the orthopaedic literature.

Study Design: Systematic review; Level of evidence, 4.

Methods: The PubMed database was queried from January 1, 2000, to October 10, 2020 for comparative trials in 10 prominent orthopaedic journals that reported dichotomous outcomes related to the management of PFI. The fragility index (FI) and the fragility quotient (FQ) were calculated for each individual outcome event, and the overall FI and FQ were determined for all included studies.

Results: A total of 22 comparative studies comprising 11 randomized controlled trials and 11 nonrandomized trials were included for the analysis. A total of 75 outcome events underwent a fragility analysis and revealed a median FI and FQ of 3 (interquartile range [IQR], 1-5) and 0.043 (IQR, 0.018-0.081), respectively. Also 27% of included studies reported loss to follow-up greater than the overall FI, therefore suggesting the maintenance of the follow-up may have resulted in the reversal of significance.

Conclusion: The result of the comprehensive fragility analysis demonstrated a lack of robustness in PFI research with the alteration of only a few outcome events required to reverse statistical significance. We therefore recommend the triple reporting of the value, the FI, and the FQ to aid in the interpretation of the statistical integrity of future comparative trials in the PFI literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/03635465211039202DOI Listing
October 2021

Implementation of an Injury Prevention Program in NCAA Division I Athletics Reduces Injury-Related Health Care Costs.

Orthop J Sports Med 2021 Sep 16;9(9):23259671211029898. Epub 2021 Sep 16.

Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Background: The estimated cost per year of injuries in collegiate athletics has been reported to be billions of dollars in the United States. Injury prevention programs are often assessed only by their ability to reduce injuries, and there is little evidence of any potential reduction in associated health care costs.

Purpose: To investigate changes in injury-related health care costs at a National Collegiate Athletic Association (NCAA) Division I university after the implementation of an injury prevention program.

Study Design: Cohort study; Level of evidence, 3.

Methods: Included were 12 sports teams that used the injury prevention program (user group) and 16 teams that did not implement the program (nonuser group). The injury surveillance and prevention system (Sparta Science) utilized a commercially available force-plate system to assess kinematic variables, flag high-risk athletes, and guide individual conditioning programs. Data were obtained from 3 academic years before (2012-2014) and 2 academic years after (2015-2016) implementation of the Sparta Science system. The number of injuries and associated health care costs (surgery, clinic visits, imaging, and physical therapy) were compared between users and nonusers.

Results: Total average annual injuries did not change significantly between users and nonusers after implementation of the program; however, users demonstrated a 23% reduction in clinic visits as compared with a 14% increase for nonusers ( = .049). Users demonstrated a 13% reduction in associated health care encounters, compared with a 13% increase for nonusers ( = .032). Overall health care costs changed significantly for both groups, with an observed 19% decrease ($2,456,154 to $1,978,799) for users and an 8% increase ($1,177,542 to $1,270,846) for nonusers ( < .01 for both). Costs related to associated health care encounters also decreased by 20% for users as compared with a 39% increase for nonusers ( = .027).

Conclusion: This study demonstrated the ability to significantly reduce injury-related health care costs in NCAA Division I athletes via a comprehensive injury surveillance and prevention program utilizing force-plate technology. Given the substantial and appropriate focus on value of care delivery across the US health care system, we recommend the continued study of sports injury surveillance and prevention programs for reducing injury-related health care costs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/23259671211029898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450687PMC
September 2021

All-Suture Anchors in Orthopaedic Surgery: Design, Rationale, Biomechanical Data, and Clinical Outcomes.

J Am Acad Orthop Surg 2021 Oct;29(19):e950-e960

From the Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY (Trofa and Bixby), OrthoCarolina Sports Medicine Center, Charlotte, NC (Fleischli and Saltzman), and the Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC (Fleischli and Saltzman).

All-suture anchors (ASAs) are a relatively new alternative to traditional suture anchors, comprised of sutures, suture tapes, or ribbons woven through a soft sleeve. These novel anchors are typically smaller than traditional anchors, allowing for more anchors to be used in the same amount of space or for use when bone stock is limited, for example, in revision settings. They can be inserted through curved guides to reach more challenging locations, and they have thus far had similar loads to failure during biomechanical testing as traditional anchors. However, these benefits must be weighed against new challenges. When using ASAs, care must be taken to fully deploy and seat the anchor against cortical bone for optimal fixation and to prevent gap formation. Furthermore, decortication, often performed to enhance the biologic environment for soft-tissue healing, may weaken the cortical bone on which ASA fixation depends on. The purpose of this article is to provide insight on the designs, advantages, and potential disadvantages associated with ASAs, as well as review the available biomechanical and clinical data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5435/JAAOS-D-20-01224DOI Listing
October 2021

Current Trends in Orthobiologics: An 11-Year Review of the Orthopaedic Literature.

Am J Sports Med 2021 Sep 16:3635465211037343. Epub 2021 Sep 16.

OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA.

Background: The use of "orthobiologics" or regenerative therapies in orthopaedic surgery has grown in recent years. Particular interest has been raised with regard to platelet-rich plasma, bone marrow aspirate, adipose-derived cells, and amniotic cells. Although studies have analyzed outcomes after orthobiologic treatment, no study has analyzed how the literature as a whole has evolved.

Purpose: To evaluate trends in platelet-rich plasma, bone marrow aspirate, adipose-derived cells, and amniotic cell publications and to assess how these might inform efforts to establish minimum reporting standards and forecast future use.

Study Design: Systematic review; Level of evidence, 4.

Methods: A database was compiled systematically using PubMed to identify articles published between 2009 and 2019 within 9 prominent orthopaedic journals and pertaining to the use of platelet-rich plasma, bone marrow aspirate, adipose-derived cells, and amniotic cells in the treatment of musculoskeletal conditions. Included articles were classified as clinical, nonclinical (translational or basic science), or review, and a variety of study parameters were recorded for each. Additional queries were performed to identify articles that utilized minimum reporting standards.

Results: A total of 474 articles (132 clinical, 271 nonclinical, 71 review) were included, consisting of 244 (51.5%) platelet-rich plasma, 146 (30.8%) bone marrow aspirate, 72 (15.2%) adipose-derived cells, and 12 (2.5%) amniotic cells. The greatest annual increase in publications for each orthobiologic topic was from 2018 to 2019. The demonstrated the highest number of overall (34.2%) and clinical (50.0%) publications, and accounted for 44.3% of all platelet-rich plasma publications. The accounted for the second highest overall number of publications (24.9%) and highest nonclinical publications (41.0%). Platelet-rich plasma accounted for 91.5% of all level 1 clinical studies, while much greater than half of bone marrow aspirate, adipose-derived cells, and amniotic cell publications were level 3 or lower. Out of the 207 articles that used some form of reporting protocol, 59 (28.5%) used an established algorithm and 125 (60.4%) used their own.

Conclusion: Interest in orthobiologics continues to grow, as evidenced by an increasing trend in publications over an 11-year period. However, current reporting on orthobiologic formulations is largely heterogeneous, emphasizing the need for minimum reporting standards and higher-quality studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/03635465211037343DOI Listing
September 2021

The Fragility of Statistical Findings in Achilles Tendon Injury Research: A Systematic Review.

J Am Acad Orthop Surg Glob Res Rev 2021 09 2;5(9). Epub 2021 Sep 2.

From the Harvard Medical School, Boston, MA (Dr. Parisien); the Columbia University Medical Center, New York, NY (Dr. Danford, Dr. Trofa); the Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (Jarin); the Boston University Medical Center, Boston, MA (Dr. Li); and the Jacksonville Orthopaedic Institute, Jacksonville, FL (Dr. Vosseller).

Introduction: Probability analysis with the reporting of P values is often used to determine the statistical significance of study findings in the Achilles literature. The purpose of this study was to determine the utility of applying a fragility analysis to comparative trials evaluating Achilles tendon injuries.

Methods: We identified all dichotomous outcome data for comparative studies of Achilles tendon injuries published in 11 orthopaedic journals from 2000 to 2020. The fragility index (FI) was determined by the number of event reversals required to change a P value from less than 0.05 to greater than 0.05, or vice-versa. The associated fragility quotient was determined by dividing the FI by the sample size.

Results: Of the 51,357 studies screened, 1,487 met the search criteria, with 51 comparative studies and 177 total outcome events included for analysis. The overall FI was only 4 with an associated fragility quotient of 0.048. One-half of the studies failed to report lost to follow-up data, with an additional 21.6% reporting loss to follow-up of greater than or equal to 4.

Conclusion: Our fragility analysis suggests that Achilles tendon injury outcomes are not as statistically stable as previously thought and should be interpreted with caution.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415978PMC
September 2021

A Systematic Review of the Orthopaedic Literature on Truncal and Lower Extremity Injuries in Major League Baseball Players.

J Am Acad Orthop Surg Glob Res Rev 2021 08 3;5(8). Epub 2021 Aug 3.

From the Department of Orthopedics, Columbia University Medical Center, New York, NY (Dr. Swindell, Dr. Coury, Dr. Dantzker, Lopez, Dr. Trofa, Dr. Ahmad), and the Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC (Dr. Saltzman).

Background: Orthopaedic injuries in Major League Baseball (MLB) players can have a tremendous impact on player health, longevity, salaries, and time lost from play.

Purpose: To summarize all data published between January 1980 and August 2019 on truncal and lower extremity orthopaedic injuries sustained by MLB players.

Methods: A literature review of studies examining injuries in MLB was performed using the PubMed and Embase databases. Included studies focused on truncal and lower extremity injuries in professional baseball players. Studies pertaining to nonorthopaedic injuries, and case reports, were excluded.

Results: A total of 41 articles met the inclusion criteria and were selected for the final analysis. Articles were divided based on anatomic region of injury: hip and pelvis (16%), thigh (15%), truncal (14%), knee (13%), and ankle (11%). Most studies (83.7%) were level 3 evidence. Most studies obtained data using publicly available internet resources (29.8%) compared with the MLB Health and Injury Tracking System (22.1%).

Conclusion: This review provides physicians with a single source of the most current literature regarding truncal and lower extremity orthopaedic injuries in MLB players. Most research was published on hip and pelvic, truncal, and thigh injuries and consisted of level III evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8337061PMC
August 2021

Patient-Reported Outcome Measurement Information System (PROMIS) in Orthopaedic Trauma Research.

SICOT J 2021 16;7:39. Epub 2021 Jul 16.

Department of Orthopaedic Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital, 622 West 168th Street, PH 11-1130, New York, 10032 NY, USA.

This review describes the development, advantages and disadvantages, and applications of the Patient-Reported Outcome Measurement Information System (PROMIS) in orthopaedic trauma. PROMIS is a useful tool for quantifying outcomes in orthopedic trauma. It allows measurement of outcomes across multiple domains while minimizing administration time. PROMIS also reliably identifies clinical, social, and psychological risk factors for poor outcomes across a variety of orthopaedic injuries and disease states. However, PROMIS lacks specificity for certain anatomic regions and validation for mental health outcomes. It also is limited by ceiling effects in certain active patient populations. Orthopaedic traumatologists should be familiar with PROMIS, as its use is increasing and it is a valuable tool that can aid in clinical decision making.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1051/sicotj/2021035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284342PMC
July 2021
-->