Publications by authors named "Nienke W Willigenburg"

35 Publications

Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomized Clinical Trial.

JAMA Netw Open 2022 07 1;5(7):e2220394. Epub 2022 Jul 1.

Department of Orthopaedic Surgery, Joint Research, OLVG Amsterdam, Amsterdam, the Netherlands.

Importance: There is a paucity of high-quality evidence about the long-term effects (ie, 3-5 years and beyond) of arthroscopic partial meniscectomy vs exercise-based physical therapy for patients with degenerative meniscal tears.

Objectives: To compare the 5-year effectiveness of arthroscopic partial meniscectomy and exercise-based physical therapy on patient-reported knee function and progression of knee osteoarthritis in patients with a degenerative meniscal tear.

Design, Setting, And Participants: A noninferiority, multicenter randomized clinical trial was conducted in the orthopedic departments of 9 hospitals in the Netherlands. A total of 321 patients aged 45 to 70 years with a degenerative meniscal tear participated. Data collection took place between July 12, 2013, and December 4, 2020.

Interventions: Patients were randomly allocated to arthroscopic partial meniscectomy or 16 sessions of exercise-based physical therapy.

Main Outcomes And Measures: The primary outcome was patient-reported knee function (International Knee Documentation Committee Subjective Knee Form (range, 0 [worst] to 100 [best]) during 5 years of follow-up based on the intention-to-treat principle, with a noninferiority threshold of 11 points. The secondary outcome was progression in knee osteoarthritis shown on radiographic images in both treatment groups.

Results: Of 321 patients (mean [SD] age, 58 [6.6] years; 161 women [50.2%]), 278 patients (87.1%) completed the 5-year follow-up with a mean follow-up time of 61.8 months (range, 58.8-69.5 months). From baseline to 5-year follow-up, the mean (SD) improvement was 29.6 (18.7) points in the surgery group and 25.1 (17.8) points in the physical therapy group. The crude between-group difference was 3.5 points (95% CI, 0.7-6.3 points; P < .001 for noninferiority). The 95% CI did not exceed the noninferiority threshold of 11 points. Comparable rates of progression of radiographic-demonstrated knee osteoarthritis were noted between both treatments.

Conclusions And Relevance: In this noninferiority randomized clinical trial after 5 years, exercise-based physical therapy remained noninferior to arthroscopic partial meniscectomy for patient-reported knee function. Physical therapy should therefore be the preferred treatment over surgery for degenerative meniscal tears. These results can assist in the development and updating of current guideline recommendations about treatment for patients with a degenerative meniscal tear.

Trial Registration: ClinicalTrials.gov Identifier: NCT01850719.
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http://dx.doi.org/10.1001/jamanetworkopen.2022.20394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9270699PMC
July 2022

Greater tuberosity fractures are not a continuation of Hill-Sachs lesions, but do they have a similar etiology?

JSES Int 2022 May 12;6(3):396-400. Epub 2022 Jan 12.

Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, the Netherlands.

Background: It is unclear whether greater tuberosity fractures (GTF) in the setting of a shoulder dislocation are due to an avulsion of the rotator cuff or a result of an extensive Hill-Sachs lesion (HSL). To explore whether these lesions have similar etiology, the primary aim of this study is to compare the postinjury morphology of the proximal humerus after GTF and HSL.

Methods: Computed tomography scans of 19 patients with HSL and 18 patients with GTF after first-time shoulder dislocations were analyzed. We assessed the location by measuring height in relation to the highest point of the humerus and angles for the origin (most medial point of lesion), center, and endpoint (most lateral point of lesion) between GTF and HSL and the bicipital groove. For both GTF and HSL, we assessed whether infraspinatus and supraspinatus insertions were involved and whether they were off-track or on-track.

Results: Measured from the bicipital groove, HSLs and GTFs have different origins (153˚ vs. 110˚;  < .0001, respectively), centers (125˚ vs. 60˚;  < .0001, respectively), and endpoints (92˚ vs. 37˚;  < .0001, respectively). HSLs had a higher position (0.76 cm vs. 1.71 cm;  < .0001), involved the supraspinatus footprint less often (16% vs. 72%;  = .0008), and were less likely to be off-track (31% vs. 94%;  = .0002). Half of the GTF were on the lateral side of the glenoid track and thus extra-capsular, versus 0% of HSL.

Conclusion: HSLs and GTFs have different anatomical characteristics and thus GTFs are likely to be distinct from extensive HSLs.
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http://dx.doi.org/10.1016/j.jseint.2021.11.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9091784PMC
May 2022

Comparison of early migration patterns between a ceramic and polyethylene liner in uncemented Trabecular Titanium cups: a 2-year randomized controlled trial of 52 hips using radiostereometric analysis.

Acta Orthop 2022 04 28;93:451-458. Epub 2022 Apr 28.

Department of Orthopedic Surgery, OLVG, Amsterdam; Department of Orthopedic Surgery, LUMC, Leiden, The Netherlands.

Background And Purpose: Ceramic liners may reduce early stability of uncemented acetabular components due to higher stiffness. However, the bone ingrowth capacities of porous trabecular titanium might compensate for this effect. This prospective randomized trial quantifies migration patterns of the Delta-TT cup, and compares polyethylene and ceramic liners.

Patients And Methods: Patients undergoing primary uncemented total hip arthroplasty with the Delta-TT cup and femoral stem with ceramic head were randomized to a polyethylene (n = 25) or ceramic (n = 28) liner. Radiostereometric analysis (RSA) radiographs, patient-reported hip function (HOOS-PS, OHS), and quality of life (EQ5D) were collected at baseline and 1.5, 3, 6, 12, and 24 months postoperatively. Model-based RSA was used to calculate 3D cup translation and rotation, and mixed models were used to compare effects over time between groups.

Results: At 2 years follow-up, Delta-TT cups showed similar mean proximal translation of 0.56 mm (95% CI 0.38-0.75) in the ceramic (CE) group and 0.54 mm (0.30-0.77) in the polyethylene (PE) group, with a between group effect of 0.02 mm (-0.20-0.23). Most cup migration occurred in the first 1.5 to 3 months, stabilizing within 6 months. Any between-group effects were ≤ 0.30 mm for translation and ≤ 0.45° for rotation. Improvements in patient-reported hip function and quality of life were similar in both groups.

Interpretation: Regardless of liner type, Delta-TT cups showed some initial migration and stabilized within 6 months, which seems promising for long-term fixation in both cup-liner constructs.
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http://dx.doi.org/10.2340/17453674.2022.2267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9052219PMC
April 2022

Educating Parents Improves Their Ability to Recognize Adolescent Idiopathic Scoliosis: A Diagnostic Accuracy Study.

Children (Basel) 2022 Apr 15;9(4). Epub 2022 Apr 15.

Department of Orthopedic and Trauma Surgery, OLVG, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands.

(1) In countries where scoliosis screening programs ended, the responsibility for detection shifted from healthcare professionals to parents. Since recognizing scoliosis is difficult for parents, more patients are presenting late. Increased awareness of scoliosis may favor earlier detection. This study examines the effect of educating parents to recognize scoliosis. (2) In this cross-sectional study a consecutive group of parents completed a digital assessment. They had to complete two identical series of fourteen cases (eight with scoliosis and six without). Each case displayed two photographs of the child's back; one in standing position and one during forward-bending. Based on visual inspection, parents had to indicate if the child had to be referred to a physician. After assessing the first series, information was given on how to detect scoliosis. Subsequently, parents assessed the second series of cases. Sensitivity and specificity were calculated before and after education. (3) A total of 100 parents completed the assessment. The sensitivity to detect scoliosis was slightly but significantly higher after education (68.8% versus 74.0%; = 0.002), while specificity was not (74.0% versus 74.8%; = 0.457). (4) This study showed that educating parents improved their ability to recognize scoliosis without increasing the false positive referral rate. Although written instructions can bridge the gap with professional screening programs, the overall sensitivity in this study remained low. Therefore, education can improve the awareness and ability to detect scoliosis, but will not replace screening by professionals.
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http://dx.doi.org/10.3390/children9040563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9025014PMC
April 2022

An individualized decision between physical therapy or surgery for patients with degenerative meniscal tears cannot be based on continuous treatment selection markers: a marker-by-treatment analysis of the ESCAPE study.

Knee Surg Sports Traumatol Arthrosc 2022 Jun 5;30(6):1937-1948. Epub 2022 Feb 5.

Department of Orthopedic Surgery, Joint Research, OLVG Amsterdam, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.

Purpose: Marker-by-treatment analyses are promising new methods in internal medicine, but have not yet been implemented in orthopaedics. With this analysis, specific cut-off points may be obtained, that can potentially identify whether meniscal surgery or physical therapy is the superior intervention for an individual patient. This study aimed to introduce a novel approach in orthopaedic research to identify relevant treatment selection markers that affect treatment outcome following meniscal surgery or physical therapy in patients with degenerative meniscal tears.

Methods: Data were analysed from the ESCAPE trial, which assessed the treatment of patients over 45 years old with a degenerative meniscal tear. The treatment outcome of interest was a clinically relevant improvement on the International Knee Documentation Committee Subjective Knee Form at 3, 12, and 24 months follow-up. Logistic regression models were developed to predict the outcome using baseline characteristics (markers), the treatment (meniscal surgery or physical therapy), and a marker-by-treatment interaction term. Interactions with p < 0.10 were considered as potential treatment selection markers and used these to develop predictiveness curves which provide thresholds to identify marker-based differences in clinical outcomes between the two treatments.

Results: Potential treatment selection markers included general physical health, pain during activities, knee function, BMI, and age. While some marker-based thresholds could be identified at 3, 12, and 24 months follow-up, none of the baseline characteristics were consistent markers at all three follow-up times.

Conclusion: This novel in-depth analysis did not result in clear clinical subgroups of patients who are substantially more likely to benefit from either surgery or physical therapy. However, this study may serve as an exemplar for other orthopaedic trials to investigate the heterogeneity in treatment effect. It will help clinicians to quantify the additional benefit of one treatment over another at an individual level, based on the patient's baseline characteristics.

Level Of Evidence: II.
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http://dx.doi.org/10.1007/s00167-021-06851-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9165275PMC
June 2022

Pulmonary function in children and adolescents with untreated idiopathic scoliosis: a systematic review with meta-regression analysis.

Spine J 2022 07 25;22(7):1178-1190. Epub 2021 Dec 25.

Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.

Background Context: One of the controversies in untreated idiopathic scoliosis is the influence of curve size on respiratory function. Whereas scoliosis patients with curves over 90 to 100 degrees are agreed to be at risk for cardiorespiratory failure in later life, the impairment of curves below 90 degrees is generally considered mild. Although various studies showed that pulmonary function is affected in patients with scoliosis, quantification of the relation between curve size and pulmonary function is lacking.

Purpose: This systematic review with meta-regression analysis aims to characterize the relation between pulmonary function tests and scoliosis severity in children and adolescents with idiopathic scoliosis.

Study Design: Systematic review with meta-regression analysis.

Methods: Pubmed, Embase, Cochrane, and CINAHL were systematically searched until November 3, 2020, for original articles that reported (1) severity of scoliosis quantified in Cobb angle, and (2) pulmonary function tests in children and adolescents with untreated idiopathic scoliosis. Exclusion criteria were other types of scoliosis, non-original data, post-treatment data, and case reports. All study designs were included, and relevant study details and patient characteristics were extracted. The primary outcome was the effect of Cobb angle on pulmonary function as expressed by the slope coefficient of a linear meta-regression analysis.

Results: A total of 126 studies, including 8,723 patients, were retrieved. Meta-regression analysis revealed a statistically significant inverse relation between thoracic Cobb angle and absolute and predicted forced vital capacity in 1 second, forced vital capacity, vital capacity, and total lung capacity. For these outcomes, the slope coefficients showed a decrease of 1% of the predicted pulmonary function per 2.6 to 4.5 degrees of scoliosis. A multivariable meta-regression analysis of potential confounders (age, year of publication, and kyphosis) hardly affected the majority of the outcomes.

Conclusion: This meta-regression analysis of summary data (means) from 126 studies showed an inverse relationship between the thoracic Cobb angle and pulmonary function. In contrast to previous conclusions, the decline in pulmonary function appears to be gradual over the full range of Cobb angles between <20 and >120 degrees. These findings strengthen the relevance of minimizing curve progression in children with idiopathic scoliosis.
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http://dx.doi.org/10.1016/j.spinee.2021.12.011DOI Listing
July 2022

Interobserver agreement for detecting Hill-Sachs lesions on magnetic resonance imaging.

Clin Shoulder Elb 2021 06 27;24(2):98-105. Epub 2021 May 27.

Shoulder and Elbow Unit, Joint Research, OLVG Hospital, Amsterdam, Netherlands.

Background: Our aim is to determine the interobserver reliability for surgeons to detect Hill-Sachs lesions on magnetic resonance imaging (MRI), the certainty of judgement, and the effects of surgeon characteristics on agreement.

Methods: Twenty-nine patients with Hill-Sachs lesions or other lesions with a similar appearance on MRIs were presented to 20 surgeons without any patient characteristics. The surgeons answered questions on the presence of Hill-Sachs lesions and the certainty of diagnosis. Interobserver agreement was assessed using the Fleiss' kappa (κ) and percentage of agreement. Agreement between surgeons was compared using a technique similar to the pairwise t-test for means, based on large-sample linear approximation of Fleiss' kappa, with Bonferroni correction.

Results: The agreement between surgeons in detecting Hill-Sachs lesions on MRI was fair (69% agreement; κ, 0.304; p<0.001). In 84% of the cases, surgeons were certain or highly certain about the presence of a Hill-Sachs lesion.

Conclusions: Although surgeons reported high levels of certainty for their ability to detect Hill-Sachs lesions, there was only a fair amount of agreement between surgeons in detecting Hill-Sachs lesions on MRI. This indicates that clear criteria for defining Hill-Sachs lesions are lacking, which hampers accurate diagnosis and can compromise treatment.
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http://dx.doi.org/10.5397/cise.2021.00115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8181846PMC
June 2021

Long Head of Biceps Tenotomy Is Not Inferior to Suprapectoral Tenodesis in Arthroscopic Repair of Nontraumatic Rotator Cuff Tears: A Multicenter, Non-inferiority, Randomized, Controlled Clinical Trial.

Arthroscopy 2021 06 6;37(6):1767-1776.e1. Epub 2021 Feb 6.

Department of Orthopedic Surgery, Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, The Netherlands.

Purpose: To determine if long head of the biceps (LHB) tenotomy is not inferior to suprapectoral LHB tenodesis when performed in conjunction with arthroscopic repair of small- to medium-sized nontraumatic rotator cuff tears.

Methods: This multicenter, randomized, non-inferiority trial recruited 100 participants older than 50 years who had a supraspinatus and/or infraspinatus tear sagittally smaller than 3 cm and arthroscopically confirmed LHB pathology. During arthroscopic rotator cuff repair, we randomized 48 patients to undergo suprapectoral LHB tenodesis and 52 patients to undergo LHB tenotomy. Data were collected preoperatively and at 6 weeks, 3 months, and 1 year postoperatively. The primary outcome was non-inferiority of the Constant-Murley score (CMS) at 1-year follow-up. Secondary outcomes included the Dutch Oxford Shoulder Score; Disabilities of the Arm, Shoulder and Hand questionnaire; Popeye deformity; elbow flexion strength index; arm cramping pain; and quality of life (EQ-5D score). The integrity of the rotator cuff repair was assessed with magnetic resonance imaging. Differences between intervention groups were analyzed by mixed modeling.

Results: The mean CMS in the LHB tenotomy group improved from 44 (95% confidence interval [CI], 39-48) to 73 (95% CI, 68-79). In patients with LHB tenodesis, the mean CMS improved from 42 (95% CI, 37-48) to 78 (95% CI, 74-82). The difference between groups at 1-year follow-up was 4.8 (97.5% CI, -∞ to 11.4), with a P value for non-inferiority of .06. The secondary outcomes also improved over time, with no remarkable differences between groups. A Popeye deformity occurred in 33% of tenodesis patients and 47% of tenotomy patients (P = .17). Tenotomy was performed with a shorter operative time (73 minutes vs 82 minutes, P = .03). Magnetic resonance imaging showed a recurrent rotator cuff tear in 20% of all cases.

Conclusions: Although statistically "inconclusive" regarding non-inferiority of the CMS at 1-year follow-up, any observed differences between patients with LHB tenotomy and those with LHB tenodesis in all outcome scores were small.

Level Of Evidence: Level I, randomized controlled trial and treatment study.
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http://dx.doi.org/10.1016/j.arthro.2021.01.036DOI Listing
June 2021

How are you doing in the eyes of your spouse? Level of agreement between the self-completed EQ-5D-5L and two proxy perspectives in an orthopaedic population: a randomized agreement study.

Health Qual Life Outcomes 2021 Jan 27;19(1):35. Epub 2021 Jan 27.

Department of Orthopaedic Surgery, LUMC, Leiden, The Netherlands.

Objectives: To determine the level of agreement between both proxy versions and the self-completed EQ-5D-5L.

Design: A randomized agreement study.

Setting And Participants: We recruited 120 patients (compos mentis) and their proxies at the orthopaedic outpatient clinic. Patients completed the regular EQ-5D-5L and their proxy completed the proxy version of the EQ-5D-5L and rated the patients' health from their own (proxy-proxy) perspective (i.e. how do you rate the health of the patient), and from the patient's (proxy-patient) perspective (i.e. how do you think the patient would rate their own health if they were able to).

Measures: The primary outcome was the agreement between patients and their proxy, quantified as the intra class correlation coefficient for the EQ-5D-5L Utility score.

Results: Average Utility scores were 0.65 with the self completed EQ-5D-5L, versus 0.60 with the proxy-patient version and 0.58 with the proxy-proxy version. The ICC was 0.66 (95% CI 0.523, 0.753) for the proxy-patient perspective and 0.58 (95% CI 0.411, 0.697) for the proxy-proxy perspective. The mean gold standard score of the VAS-Health was 69.7 whereas the proxy-proxy perspective was 66.5 and the proxy-patient perspective was 66.3.

Conclusion And Implications: The proxy-patient perspective yielded substantial agreement with the self completed EQ-5D-5L, while the agreement with the proxy-proxy perspective was moderate. In this study population of patients without cognitive impairment, proxies tended to underestimate the quality of life of their relative.
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http://dx.doi.org/10.1186/s12955-021-01679-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839187PMC
January 2021

Functional Outcomes of Arthroscopic Partial Meniscectomy Versus Physical Therapy for Degenerative Meniscal Tears Using a Patient-Specific Score: A Randomized Controlled Trial.

Orthop J Sports Med 2020 Oct 29;8(10):2325967120954392. Epub 2020 Oct 29.

Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.

Background: It is unknown whether the treatment effects of partial meniscectomy and physical therapy differ when focusing on activities most valued by patients with degenerative meniscal tears.

Purpose: To compare partial meniscectomy with physical therapy in patients with a degenerative meniscal tear, focusing on patients' most important functional limitations as the outcome.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: This study is part of the Cost-effectiveness of Early Surgery versus Conservative Treatment with Optional Delayed Meniscectomy for Patients over 45 years with non-obstructive meniscal tears (ESCAPE) trial, a multicenter noninferiority randomized controlled trial conducted in 9 orthopaedic hospital departments in the Netherlands. The ESCAPE trial included 321 patients aged between 45 and 70 years with a symptomatic, magnetic resonance imaging-confirmed meniscal tear. Exclusion criteria were severe osteoarthritis, body mass index >35 kg/m, locking of the knee, and prior knee surgery or knee instability due to an anterior or posterior cruciate ligament rupture. This study compared partial meniscectomy with physical therapy consisting of a supervised incremental exercise protocol of 16 sessions over 8 weeks. The main outcome measure was the Dutch-language equivalent of the Patient-Specific Functional Scale (PSFS), a secondary outcome measure of the ESCAPE trial. We used crude and adjusted linear mixed-model analyses to reveal the between-group differences over 24 months. We calculated the minimal important change for the PSFS using an anchor-based method.

Results: After 24 months, 286 patients completed the follow-up. The partial meniscectomy group (n = 139) improved on the PSFS by a mean of 4.8 ± 2.6 points (from 6.8 ± 1.9 to 2.0 ± 2.2), and the physical therapy group (n = 147) improved by a mean of 4.0 ± 3.1 points (from 6.7 ± 2.0 to 2.7 ± 2.5). The crude overall between-group difference showed a -0.6-point difference (95% CI, -1.0 to -0.2; = .004) in favor of the partial meniscectomy group. This improvement was statistically significant but not clinically meaningful, as the calculated minimal important change was 2.5 points on an 11-point scale.

Conclusion: Both interventions were associated with a clinically meaningful improvement regarding patients' most important functional limitations. Although partial meniscectomy was associated with a statistically larger improvement at some follow-up time points, the difference compared with physical therapy was small and clinically not meaningful at any follow-up time point.

Registration: NCT01850719 (ClinicalTrials.gov identifier) and NTR3908 (the Netherlands Trial Register).
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http://dx.doi.org/10.1177/2325967120954392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607803PMC
October 2020

Study protocol: Effectiveness of dual-mobility cups compared with uni-polar cups for preventing dislocation after primary total hip arthroplasty in elderly patients - design of a randomized controlled trial nested in the Dutch Arthroplasty Registry.

Acta Orthop 2020 10 4;91(5):514-519. Epub 2020 Aug 4.

OLVG, Amsterdam.

Background and purpose - Dislocation is the leading reason for early revision surgery after total hip arthroplasty (THA). The dual-mobility (DM) cup was developed to provide more stability and mechanically reduce the risk of dislocation. Despite the increased use of DM cups, high-quality evidence of their (cost-)effectiveness is lacking. The primary objective of this randomized controlled trial (RCT) is to investigate whether there is a difference in the number of hip dislocations following primary THA, using the posterolateral approach, with a DM cup compared with a unipolar (UP) cup in elderly patients 1 year after surgery. Secondary outcomes include the number of revision surgeries, patient-reported outcome measures (PROMs), and cost-effectiveness.Methods and analysis - This is a prospective multicenter nationwide, single-blinded RCT nested in the Dutch Arthroplasty Registry. Patients ≥ 70 years old, undergoing elective primary THA using the posterolateral approach, will be eligible. After written informed consent, 1,100 participants will be randomly allocated to the intervention or control group. The intervention group receives a THA with a DM cup and the control group a THA with a UP cup. PROMs are collected preoperatively, and 3 months, 1 and 2 years postoperatively. Primary outcome is the difference in number of dislocations between the UP and DM cup within 1 year, reported in the registry (revisions), or by the patients (closed or open reduction). Data will be analyzed using multilevel models as appropriate for each outcome (linear/logistic/survival). An economic evaluation will be performed from the healthcare and societal perspective, for dislocation and quality adjusted life years (QALYs).Trial registration - This RCT is registered at www.clinicaltrials.gov with identification number NCT04031820.
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http://dx.doi.org/10.1080/17453674.2020.1798658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023924PMC
October 2020

Posterolateral or direct lateral approach for hemiarthroplasty after femoral neck fractures: a systematic review.

Hip Int 2021 Mar 17;31(2):154-165. Epub 2020 Jun 17.

Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.

Background: The posterolateral approach (PLA) and direct lateral approach (DLA) are the most commonly used approaches for inserting a hemiarthroplasty in the treatment of femoral neck fractures. A recent review concluded that the routine use of PLA should be questioned, but this conclusion itself can be questioned. The aim of this study is to provide an updated overview and critical appraisal of the available evidence, focussing on outcomes most relevant for patients.

Methods: We conducted a comprehensive search of literature in the MEDLINE and EMBASE databases and Cochrane Library. Studies (till June 2018) to identify hip fracture clinical trials/comparative studies comparing alternative surgical approaches (PLA and DLA). We explored sources of heterogeneity and conducted pooled analyses when appropriate.

Results: 264 potentially eligible studies were identified of which 1 RCT, 3 prospective, 3 registry data and 5 retrospective studies were included. The RCT consisted performance and attrition bias. The mean MINORS score of the prospective/register studies was 17.3 (SD 3.5) and 13.8 (SD 1.9) of the 5 retrospective studies. The GRADE score for all the outcomes was very low. Due to the high and various types of biases across the included studies, we did not pool the data. None of studies assessed the activities of daily living functionality. 6 studies reported significantly more dislocations or reoperations due to dislocation in the PLA group, 6 other studies found no differences. DLA patients were more likely to develop abductor insufficiency leading to limping and more need for walking aids. The PLA patients tended to have better quality of life, less pain and more satisfaction compared to the DLA patients.

Conclusion: Based on low-quality studies, PLA may be associated with more dislocations, but patients had less walking problems and a lower tendency to abductor insufficiency compared with DLA. Further clinical trials with methodology rigor are needed to determine which approach is more effective in terms of outcomes relevant to patients.
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http://dx.doi.org/10.1177/1120700020931766DOI Listing
March 2021

Translation, cross-cultural and construct validity of the Dutch-Flemish PROMIS® upper extremity item bank v2.0.

Qual Life Res 2020 Apr 1;29(4):1123-1135. Epub 2020 Jan 1.

Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands.

Purpose: To develop a Dutch-Flemish translation of the PROMIS® upper extremity (PROMIS-UE) item bank v2.0, and to investigate its cross-cultural and construct validity as well as its floor and ceiling effects in patients with musculoskeletal UE disorders.

Methods: State of the art translation methodology was used to develop the Dutch-Flemish PROMIS-UE item bank v2.0. The item bank and four legacy instruments were administered to 205 Dutch patients with musculoskeletal UE disorders visiting an orthopedic outpatient clinic. The validity of cross-cultural comparisons between English and Dutch patients was evaluated by studying differential item functioning (DIF) for language (Dutch vs. English) with ordinal logistic regression models and McFadden's pseudo R-change of ≥ 2% as critical value. Construct validity was assessed by formulating a priori hypotheses and calculating correlations with legacy instruments. Floor/ceiling effects were evaluated by determining the proportion of patients who achieved the lowest/highest possible raw score.

Results: Eight items showed DIF for language, but their impact on the test score was negligible. The item bank correlated, as hypothesized, moderately with the Dutch-Flemish PROMIS pain intensity item (Pearson's r = - 0.43) and strongly with the Disabilities of the Arm, Shoulder and Hand questionnaire, Subscale Disability/Symptoms (Spearman's ρ = - 0.87), the Functional Index for Hand Osteoarthritis (ρ = - 0.86), and the Michigan Hand Outcomes Questionnaire, Subscale Activities of Daily Living (ρ = 0.87). No patients achieved the lowest or highest possible raw score.

Conclusions: A Dutch-Flemish PROMIS-UE item bank v2.0 has been developed that showed sufficient cross-cultural and construct validity as well as absence of floor and ceiling effects.
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http://dx.doi.org/10.1007/s11136-019-02388-2DOI Listing
April 2020

Can even experienced orthopaedic surgeons predict who will benefit from surgery when patients present with degenerative meniscal tears? A survey of 194 orthopaedic surgeons who made 3880 predictions.

Br J Sports Med 2020 Mar 1;54(6):354-359. Epub 2019 Aug 1.

Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands.

Objectives: To examine the ability of surgeons to predict the outcome of treatment for meniscal tears by arthroscopic partial meniscectomy (APM) and exercise therapy in middle-aged patients.

Design And Setting: Electronic survey. Orthopaedic surgeon survey participants were presented 20 patient profiles. These profiles were derived from a randomised clinical trial comparing APM with exercise therapy in middle-aged patients with symptomatic non-obstructive meniscal tears. From each treatment group (APM and exercise therapy), we selected five patients with the best (responders) and five patients with the worst (non-responders) knee function after treatment. 1111 orthopaedic surgeons and residents in the Netherlands and Australia were invited to participate in the survey.

Interventions: For each of the 20 patient profiles, surgeons (unaware of treatment allocation) had to choose between APM and exercise therapy as preferred treatment and subsequently had to estimate the expected change in knee function for both treatments on a 5-point Likert Scale. Finally, surgeons were asked which patient characteristics affected their treatment choice.

Main Outcomes: The primary outcome was the surgeons' percentage correct predictions. We also compared this percentage between experienced knee surgeons and other orthopaedic surgeons, and between treatment responders and non-responders.

Results: We received 194 (17%) complete responses for all 20 patient profiles, resulting in 3880 predictions. Overall, 50.0% (95% CI 39.6% to 60.4%) of the predictions were correct, which equals the proportion expected by chance. Experienced knee surgeons were not better in predicting outcome than other orthopaedic surgeons (50.4% vs 49.5%, respectively; p=0.29). The percentage correct predictions was lower for patient profiles of non-responders (34%; 95% CI 21.3% to 46.6%) compared with responders (66.0%; 95% CI 57.0% to 75.0%; p=0.01).In general, bucket handle tears, knee locking and failed non-operative treatment directed the surgeons' choice towards APM, while higher level of osteoarthritis, degenerative aetiology and the absence of locking complaints directed the surgeons' choice towards exercise therapy.

Conclusions: Surgeons' criteria for deciding that surgery was indicated did not pass statistical examination. This was true regardless of a surgeon's experience. These results suggest that non-surgical management is appropriate as first-line therapy in middle-aged patients with symptomatic non-obstructive meniscal tears.

Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03462134.
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http://dx.doi.org/10.1136/bjsports-2019-100567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057800PMC
March 2020

How do the costs of physical therapy and arthroscopic partial meniscectomy compare? A trial-based economic evaluation of two treatments in patients with meniscal tears alongside the ESCAPE study.

Br J Sports Med 2020 May 21;54(9):538-545. Epub 2019 Jun 21.

Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands.

Objectives: To examine whether physical therapy (PT) is cost-effective compared with arthroscopic partial meniscectomy (APM) in patients with a non-obstructive meniscal tear, we performed a full trial-based economic evaluation from a societal perspective. In a secondary analysis-this paper-we examined whether PT is non-inferior to APM.

Methods: We recruited patients aged 45-70 years with a non-obstructive meniscal tear in nine Dutch hospitals. Resource use was measured using web-based questionnaires. Measures of effectiveness included knee function using the International Knee Documentation Committee (IKDC) and quality-adjusted life-years (QALYs). Follow-up was 24 months. Uncertainty was assessed using bootstrapping techniques. The non-inferiority margins for societal costs, the IKDC and QALYs, were €670, 8 points and 0.057 points, respectively.

Results: We randomly assigned 321 patients to PT (n=162) or APM (n=159). PT was associated with significantly lower costs after 24 months compared with APM (-€1803; 95% CI -€3008 to -€838). The probability of PT being cost-effective compared with APM was 1.00 at a willingness to pay of €0/unit of effect for the IKDC (knee function) and QALYs (quality of life) and decreased with increasing values of willingness to pay. The probability that PT is non-inferior to APM was 0.97 for all non-inferiority margins for the IKDC and 0.89 for QALYs.

Conclusions: The probability of PT being cost-effective compared with APM was relatively high at reasonable values of willingness to pay for the IKDC and QALYs. Also, PT had a relatively high probability of being non-inferior to APM for both outcomes. This warrants further deimplementation of APM in patients with non-obstructive meniscal tears.

Trial Registration Numbers: NCT01850719 and NTR3908.
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http://dx.doi.org/10.1136/bjsports-2018-100065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212930PMC
May 2020

Normative values and affecting factors for the elbow range of motion.

Shoulder Elbow 2019 Jun 11;11(3):215-224. Epub 2017 Sep 11.

Shoulder and Elbow Unit, Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

Introduction: Abnormalities in the elbow range of motion (ROM) can be subtle; therefore, it is important that the examiner can compare findings with reliable reference values, matching the patients' characteristics. Primarily, we aimed to provide normative values for the elbow ROM in subpopulations based on age, sex, dominance and body mass index (BMI). The secondary objective was to determine intra- and inter-rater reliability.

Methods: aROM (active range of motion) and pROM (passive range of motion) were measured bilaterally in healthy adults using a universal goniometer. The influence of factors affecting the ROM was calculated using Pearson's correlation coefficient. In two samples of subjects, intra-rater and inter-rater reliability were determined.

Results: The study population ( = 352) consisted of 47.2% male and 52.8% female subjects. For aROM (dominant hand), mean flexion was 146°, extension -2°, pronation 80° and supination 87°. Male subjects had smaller ROM compared to females ( < 0.001). Differences between dominant and nondominant hand were less than one degree. pROMs were 3° to 5° larger than aROMs ( < 0.001). Intra- and inter-rater reliability was good.

Conclusions: Elbow ROM is influenced by age, sex and BMI. In the general population, the ROM of the uninjured side can serve as a reference in case of an injured elbow.
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http://dx.doi.org/10.1177/1758573217728711DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555111PMC
June 2019

Ten percent re-dislocation rate 13 years after the arthroscopic Bankart procedure.

Knee Surg Sports Traumatol Arthrosc 2019 Dec 23;27(12):3929-3936. Epub 2019 May 23.

Department of Orthopedics, OLVG, Amsterdam, The Netherlands.

Purpose: The aim of the present study was to determine the long-term outcome after the arthroscopic Bankart procedure, in terms of recurrent instability, shoulder function, glenohumeral arthropathy and patient satisfaction.

Methods: Patients who underwent the arthroscopic Bankart procedure between January 1999 and the end of December 2005 were invited to complete a set of Patient Reported Outcome Measures (PROMs) and visit the hospital for clinical and radiological assessment. PROMs included the Western Ontario Shoulder Instability Index (WOSI), the Oxford Shoulder Instability Score (OSIS) and additional questions on shoulder instability and patient satisfaction. Clinical assessment included the apprehension test and the Constant-Murley score. The Samilson-Prieto classification was used to assess arthropathy on standard radiographs. The primary outcome was a re-dislocation that needed reduction. Secondary outcomes in terms of recurrent instability included patient-reported subluxation and a positive apprehension test.

Results: Of 104 consecutive patients, 71 patients with a mean follow-up of 13.1 years completed the PROMs, of which 53 patients (55 shoulders) were also available for clinical and radiological assessment. Re-dislocations had occurred in 7 shoulders (9.6%). Subluxations occurred in 23 patients (31.5%) and the apprehension test was positive in 30 (54.5%) of the 55 shoulders examined. Median functional outcomes were 236 for WOSI, 45 for OSIS, and 103 for the normalized Constant-Murley score. Of all 71 patients (73 shoulders), 29 (39.7%) reported being completely satisfied, 33 (45.2%) reported being mostly satisfied and 8 (11%) reported being somewhat satisfied. Glenohumeral arthropathy was observed in 33 (60%) of the shoulders.

Conclusion: Despite 10% re-dislocations and frequent other signs of recurrent instability, shoulder function and patient satisfaction at 13 years after arthroscopic Bankart repair were good.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1007/s00167-019-05534-yDOI Listing
December 2019

Remplissage With Bankart Repair in Anterior Shoulder Instability: A Systematic Review of the Clinical and Cadaveric Literature.

Arthroscopy 2019 04;35(4):1257-1266

Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, The Netherlands.

Purpose: To compare the clinical and biomechanical results of an arthroscopic Bankart repair alone with an arthroscopic Bankart repair combined with remplissage.

Methods: A literature search was performed on May 1, 2018, in PubMed and Embase for studies comparing an isolated arthroscopic Bankart repair and an arthroscopic Bankart repair with remplissage. The quality of the studies was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Cochrane Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) checklist. Results regarding failures, biomechanical properties, and shoulder function were extracted.

Results: We included 13 studies (6 clinical and 7 biomechanical studies), and their overall quality was very low to low. In the biomechanical studies, adding a remplissage to the Bankart repair prevented engagement in all cadavers, resulted in more stiffness, and impaired the range of motion. Among clinical studies, all reported lower recurrence rates and most showed better shoulder function after a Bankart repair with remplissage compared with an isolated Bankart repair. The return-to-sport rates were mostly similar, whereas the loss of range of motion was often higher after a Bankart repair with remplissage.

Conclusions: The addition of a remplissage procedure to a Bankart repair for managing small to medium Hill-Sachs lesions might be beneficial in reducing the risk of recurrent instability and improving shoulder function, without increasing the risk of complications.

Level Of Evidence: Level III, systematic review of Level II and III studies.
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http://dx.doi.org/10.1016/j.arthro.2018.10.117DOI Listing
April 2019

Arthroscopic Partial Meniscectomy vs Physical Therapy for Nonobstructive Meniscal Tears-Reply.

JAMA 2019 02;321(8):806

Department of Orthopedic Surgery, OLVG Amsterdam, Amsterdam, the Netherlands.

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http://dx.doi.org/10.1001/jama.2018.20265DOI Listing
February 2019

Responsiveness and Minimal Important Change of the IKDC of Middle-Aged and Older Patients With a Meniscal Tear.

Am J Sports Med 2019 02 4;47(2):364-371. Epub 2019 Jan 4.

Investigation performed at Department of Orthopaedic Surgery, OLVG Amsterdam, Amsterdam, the Netherlands.

Background: Responsiveness and the minimal important change (MIC) are important measurement properties to evaluate treatment effects and to interpret clinical trial results. The International Knee Documentation Committee (IKDC) Subjective Knee Form is a reliable and valid instrument for measuring patient-reported knee-specific symptoms, functioning, and sports activities in a population with meniscal tears. However, evidence on responsiveness is of limited methodological quality, and the MIC has not yet been established for patients with symptomatic meniscal tears.

Purpose: To evaluate the responsiveness and determine the MIC of the IKDC for patients with meniscal tears.

Study Design: Cohort study (design); Level of evidence 2.

Methods: This study was part of the ESCAPE trial: a noninferiority multicenter randomized controlled trial comparing arthroscopic partial meniscectomy with physical therapy. Patients aged 45 to 70 years who were treated for a meniscal tear by arthroscopic partial meniscectomy or physical therapy completed the IKDC and 3 other questionnaires (RAND 36-Item Health Survey, EuroQol-5D-5L, and visual analog scales for pain) at baseline and 6-month follow-up. Responsiveness was evaluated by testing predefined hypotheses about the relation of the change in IKDC with regard to the change in the other self-reported outcomes. An external anchor question was used to distinguish patients reporting improvement versus no change in daily functioning. The MIC was determined by the optimal cutoff point in the receiver operating characteristic curve, which quantifies the IKDC score that best discriminated between patients with and without improvement in daily function.

Results: Data from all 298 patients who completed baseline and 6-month follow-up questionnaires were analyzed. Responsiveness of the IKDC was confirmed in 7 of 10 predefined hypotheses about the change in IKDC score with regard to other patient-reported outcome measures. One hypothesis differed in the expected direction, while 2 hypotheses failed to meet the expected magnitude by 0.02 and 0.01 points. An MIC of 10.9 points was calculated for the IKDC of middle-aged and older patients with meniscal tears.

Conclusion: This study showed that the IKDC is responsive to change among patients aged 45 to 70 years with meniscal tears, with an MIC of 10.9 points. This strengthens the value of the IKDC in quantifying treatment effects in this population.
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http://dx.doi.org/10.1177/0363546518812880DOI Listing
February 2019

Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears: The ESCAPE Randomized Clinical Trial.

JAMA 2018 10;320(13):1328-1337

Department of Orthopedic Surgery, Joint Research, OLVG, Amsterdam, the Netherlands.

Importance: Despite recent studies suggesting arthroscopic partial meniscectomy (APM) is not more effective than physical therapy (PT), the procedure is still frequently performed in patients with meniscal tears.

Objective: To assess whether PT is noninferior to APM for improving patient-reported knee function in patients with meniscal tears.

Design, Setting, And Participants: Noninferiority, multicenter, randomized clinical trial conducted in 9 hospitals in the Netherlands. Participants were aged 45 to 70 years with nonobstructive meniscal tears (ie, no locking of the knee joint). Patients with knee instability, severe osteoarthritis, and body mass index greater than 35 were excluded. Recruitment took place between July 17, 2013, and November 4, 2015. Participants were followed up for 24 months (final participant follow-up, October 11, 2017).

Interventions: Three hundred twenty-one participants were randomly assigned to APM (n = 159) or a predefined PT protocol (n = 162). The PT protocol consisted of 16 sessions of exercise therapy over 8 weeks focused on coordination and closed kinetic chain strength exercises.

Main Outcomes And Measures: The primary outcome was change in patient-reported knee function on the International Knee Documentation Committee Subjective Knee Form (range, 0 to 100; from worse to best) from baseline over a 24-month follow-up period. The noninferiority margin was defined as a difference between treatment groups of 8 points and was assessed with a 1-sided α of .025. The primary analysis followed the intention-to-treat principle.

Results: Among 321 patients who were randomized (mean [SD] age, 58 [6.6] years; 161 women [50%]), 289 (90%) completed the trial (161 women and 158 men). In the PT group, 47 participants (29%) had APM during the 24-month follow-up period, and 8 participants randomized to APM (5%) did not have APM. Over a 24-month follow-up period, knee function improved in the APM group by 26.2 points (from 44.8 to 71.5) and in the PT group by 20.4 points (from 46.5 to 67.7). The overall between-group difference was 3.6 points (97.5% CI, -∞ to 6.5; P value for noninferiority = .001). Adverse events occurred in 18 participants in the APM group and 12 in the PT group. Repeat surgery (3 in the APM group and 1 in the PT group) and additional outpatient visits for knee pain (6 in the APM group and 2 in the PT group) were the most frequent adverse events.

Conclusions And Relevance: Among patients with nonobstructive meniscal tears, PT was noninferior to APM for improving patient-reported knee function over a 24-month follow-up period. Based on these results, PT may be considered an alternative to surgery for patients with nonobstructive meniscal tears.

Trial Registration: ClinicalTrials.gov Identifier: NCT01850719.
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http://dx.doi.org/10.1001/jama.2018.13308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583004PMC
October 2018

An assessment of quality of randomized controlled trials in shoulder instability surgery using a modification of the clear CLEAR-NPT score.

Shoulder Elbow 2018 Oct 31;10(4):238-249. Epub 2018 Jan 31.

Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, The Netherlands.

Background: The present study aimed to evaluate the methodological quality and determine the quality of reporting of randomized controlled trials (RCTs) that assess surgical treatment for shoulder instability.

Methods: A Cochrane, Pubmed, EMBASE and Trip database search was performed, including the relevant literature, regarding RCTs that report on shoulder instability published between January 1994 and January 2017. Methodological quality was assessed with a modification of the Checklist to Evaluate A Report of a Nonpharmacologic Trial (CLEAR-NPT). Points were assigned based on 18 items regarding patient characteristics, randomization, care provider characteristics, surgical details and blinding, with a total score ranging from 0 points to 18 points. Missing items were verified with the corresponding authors of the studies. Quality of reporting corresponds to the total scores including the items that were additionally provided by the authors.

Results: We included 22 studies. Of these, nine corresponding authors provided additional information. The average methodological quality was 16.9 points (11 studies) and the average quality of reporting was 9.5 points (22 studies). Items scoring worst included information regarding the surgeon's experience, the patients' level of activity, comorbidities, analyzing according to 'intention-to-treat' principles, and blinding of care providers, participants and assessors.

Conclusions: RCTs reporting on shoulder instability surgery are well performed but poorly reported.
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http://dx.doi.org/10.1177/1758573218754370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134533PMC
October 2018

Eyes-Closed Single-Limb Balance is Not Related to Hypermobility Status in Dancers.

J Dance Med Sci 2017 Jun;21(2):70-75

Mayo Clinic, Biomechanics Laboratories and Mayo Clinic Sports Medicine Center, Rochester, Minnesota.

Hypermobility may be associated with decreased lower extremity proprioception, which in turn may increase injury risk. The prevalence of hypermobility in dancers varies across studies, but joint hypermobility appears to be more common in dancers than in the general population. The purpose of this study was to determine how hypermobility affects eyes-closed single-limb balance as an indirect measure of proprioception in dancers. The secondary aim was to compare hypermobility and balance across dancer affiliation groups. Data were collected from 45 professional dancers, 11 collegiate modern dancers, 227 student dancers, and 15 pre-professional dancers during routine dance screens. Dancer hypermobility status was assessed via an eight-point Beighton-Horan Laxity test. Single-limb balance time, in seconds, was assessed in parallel position with the eyes closed. Hypermobile (HM) and non-hypermobile (NHM) dancers showed very similar balance times (HM median: 36.5 seconds; NHM median: 33.0 seconds; p = 0.982). Hypermobility was not significantly different between dancer affiliation groups (p = 0.154): 47% in ballet academy students, 27% in collegiate modern dancers, 62% in pre-professional dancers, and 36% in professional dancers. The student, pre-professional, and professional ballet dancers all demonstrated longer balance times than the collegiate modern dancers; however, this difference was only significant between the professional ballet dancers and collegiate modern dancers (p = 0.026). Dancers demonstrated a higher prevalence of hypermobility than what has been reported for the general population. Joint hypermobility did not affect eyes-closed single-limb balance time. Future studies are needed to determine if joint hypermobility affects more sensitive measures of proprioception and risk of injury.
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http://dx.doi.org/10.12678/1089-313X.21.2.70DOI Listing
June 2017

Portable Myoelectric Brace Use Increases Upper Extremity Recovery and Participation But Does Not Impact Kinematics in Chronic, Poststroke Hemiparesis.

J Mot Behav 2017 Jan-Feb;49(1):46-54. Epub 2016 Oct 17.

f Better Rehabilitation and Assessment for Improved Neurorecovery Laboratory , Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University Medical Center , Columbus , Ohio , USA.

The authors examined the efficacy of an 8-week regimen combining repetitive task-specific practice (RTP) with a myoelectric brace (RTP+Myomo) on paretic upper extremity (UE; use in valued activities, perceived recovery, and reaching kinematics) in 12 subjects (4 men; M age = 53.5 years; mean time poststroke = 61.7 months). Seven subjects were administered RTP+Myomo therapy, and 5 were administered RTP only. Both groups participated in individualized, 45-min therapy sessions occurring 3 days/week over an 8-week period. The arm, hand ability, activities of daily living, and perceptions of recovery subscales of the Stroke Impact Scale (SIS), as well as UE reaching kinematics, assessed before and after the intervention. Subjects in the RTP+Myomo group showed greater improvements on all SIS subscales, with the recovery scale reaching statistical significance (p = .03). Subjects in the RTP-only group showed a greater increase in hand velocity in the reach up task (p = .02), but no changes were observed in the range of shoulder flexion or elbow extension during reaching. None of the changes in kinematic outcome measures significantly correlated with any of the changes in SIS subscales. RTP integrating myoelectric bracing may be more beneficial than RTP only in improving self-reported function and perceptions of overall recovery. The authors observed no changes in the range of elbow extension, and no relationship between self-reported improvements and changes in reaching kinematics.
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http://dx.doi.org/10.1080/00222895.2016.1152220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470353PMC
August 2017

Examining Standing Turnout with Two Measurement Methods During Dance Wellness Screening.

J Dance Med Sci 2016 ;20(3):109-14

Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, USA.

This study describes trends in mean standing functional turnout angles measured on a floor protractor (FP) and the Functional Footprint(®) rotational instrument (RI) during routine clinical screens. Twenty-three professional ballet dancers, 26 collegiate modern students, and 46 ballet academy dancers participated in the study. All dancers demonstrated greater total turnout on the FP compared to the RI (p < 0.001), and the collegiate dancers had significantly smaller total turnout angles compared to both of the other groups (p < 0.001). A significant interaction between measurement method and training group (p = 0.047) on lower extremity asymmetry indicated that only in professionals left turnout angle was greater than right turnout angle on the RI (4.30° ± 6.64°) but not on the FP (0.17° ± 4.57°). It is concluded that turnout can be measured using either the FP or the RI measurement method, with recognition that FP measurements will be an average of 10° greater than those on the RI. Lower extremity asymmetries in turnout angles may be better detected on the RI than the FP.
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http://dx.doi.org/10.12678/1089-313X.20.3.109DOI Listing
May 2017

Redislocation risk after an arthroscopic Bankart procedure in collision athletes: a systematic review.

J Shoulder Elbow Surg 2016 Sep;25(9):1549-58

Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery OLVG, Amsterdam, The Netherlands.

Background: The purpose of this review was to determine the redislocation risk for collision athletes after an arthroscopic Bankart repair and to compare the redislocation rate between collision athletes and noncollision athletes after an arthroscopic Bankart repair.

Methods: A PubMed and Embase query was performed, screening all relevant literature of arthroscopic Bankart procedures mentioning redislocation rates in collision athletes. Studies with a follow-up <2 years or lacking information on redislocation rates in collision athletes were excluded. We used the modified Coleman Methodology Score to assess the quality of included studies. Finally, the data in all the studies were combined and analyzed.

Results: There were 1012 studies screened on title and abstract, of which 111 studies were full-text screened, and finally 20 studies were included. Four studies reported on collision athletes only, whereas 16 compared collision with noncollision athletes. Fourteen studies reported increased redislocation rates for collision athletes in comparison to noncollision athletes (absolute risk difference varying from 0.4% to 28.6%), whereas 2 studies reported decreased rates (absolute risk differences of -6% and -2.4%). A combined analysis revealed that collision athletes have an increased absolute risk of 8.09 with 95% CI from 3.61 to 12.57% for development of postoperative instability in comparison to noncollision athletes (P = .001).

Conclusion: Collision athletes have an increased risk for redislocation in comparison to noncollision athletes after an arthroscopic Bankart repair, although there were no differences in return to sport.
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http://dx.doi.org/10.1016/j.jse.2016.05.002DOI Listing
September 2016

Comparison of Injuries in American Collegiate Football and Club Rugby: A Prospective Cohort Study.

Am J Sports Med 2016 Mar 19;44(3):753-60. Epub 2016 Jan 19.

Sports Health & Performance Institute, The Ohio State University, Columbus, Ohio, USA Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, USA

Background: American football and rugby players are at substantial risk of injury because of the full-contact nature of these sports. Methodological differences between previous epidemiological studies hamper an accurate comparison of injury rates between American football and rugby.

Purpose: To directly compare injury rates in American collegiate football and rugby, specified by location, type, mechanism, and severity of injury, as reported by licensed medical professionals.

Study Design: Cohort study; Level of evidence, 2.

Methods: Licensed medical professionals (athletic trainer or physician) associated with the football and rugby teams of a National Collegiate Athletic Association Division I university reported attendance and injury details over 3 autumn seasons. Injuries were categorized by the location, type, mechanism, and severity of injury, and the injury rate was calculated per 1000 athlete-exposures (AEs). Injury rate ratios (IRRs) were calculated to compare overall, game, and practice injury rates within and between sports.

Results: The overall injury rate was 4.9/1000 AEs in football versus 15.2/1000 AEs in rugby: IRR = 3.1 (95% CI, 2.3-4.2). Game injury rates were higher than practice injury rates: IRR = 6.5 (95% CI, 4.5-9.3) in football and IRR = 5.1 (95% CI, 3.0-8.6) in rugby. Injury rates for the shoulder, wrist/hand, and lower leg and for sprains, fractures, and contusions in rugby were >4 times as high as those in football (all P ≤ 0.006). Concussion rates were 1.0/1000 AEs in football versus 2.5/1000 AEs in rugby. Most injuries occurred via direct player contact, especially during games. The rate of season-ending injuries (>3 months of time loss) was 0.8/1000 AEs in football versus 1.0/1000 AEs in rugby: IRR = 1.3 (95% CI, 0.4-3.4).

Conclusion: Overall injury rates were substantially higher in collegiate rugby compared with football. Similarities between sports were observed in the most common injury types (sprains and concussions), locations (lower extremity and head), and mechanisms (direct player contact). Upper extremity injuries were more common in rugby, and the rate of season-ending injuries was similar between sports.
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http://dx.doi.org/10.1177/0363546515622389DOI Listing
March 2016
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