| 1. |
- Ayeni, Olufemi R, 1976, et al.
(författare)
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Diagnosing femoroacetabular impingement from plain radiographs: Do radiologists and orthopaedic surgeons differ?
- 2014
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Ingår i: Orthopaedic Journal of Sports Medicine. - : SAGE Publications. - 2325-9671. ; 2:7
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Tidskriftsartikel (refereegranskat)abstract
- Background: A diagnosis of femoroacetabular impingement (FAI) requires careful history and physical examination, as well as an accurate and reliable radiologic evaluation using plain radiographs as a screening modality. Radiographic markers in the diagnosis of FAI are numerous and not fully validated. In particular, reliability in their assessment across health care providers is unclear. Purpose: To determine inter- and intraobserver reliability between orthopaedic surgeons and musculoskeletal radiologists. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Six physicians (3 orthopaedic surgeons, 3 musculoskeletal radiologists) independently evaluated a broad spectrum of FAI pathologies across 51 hip radiographs on 2 occasions separated by at least 4 weeks. Reviewers used 8 common criteria to diagnose FAI, including (1) pistol-grip deformity, (2) size of alpha angle, (3) femoral head-neck offset, (4) posterior wall sign abnormality, (5) ischial spine sign abnormality, (6) coxa profunda abnormality, (7) crossover sign abnormality, and (8) acetabular protrusion. Agreement was calculated using the intraclass correlation coefficient (ICC). Results: When establishing an FAI diagnosis, there was poor interobserver reliability between the surgeons and radiologists (ICC batch 1 = 0.33; ICC batch 2 = 0.15). In contrast, there was higher interobserver reliability within each specialty, ranging from fair to good (surgeons: ICC batch 1 = 0.72; ICC batch 2 = 0.70 vs radiologists: ICC batch 1 = 0.59; ICC batch 2 = 0.74). Orthopaedic surgeons had the highest interobserver reliability when identifying pistol-grip deformities (ICC = 0.81) or abnormal alpha angles (ICC = 0.81). Similarly, radiologists had the highest agreement for detecting pistol-grip deformities (ICC = 0.75). Conclusion: These results suggest that surgeons and radiologists agree among themselves, but there is a need to improve the reliability of radiographic interpretations for FAI between the 2 specialties. The observed degree of low reliability may ultimately lead to missed, delayed, or inappropriate treatments for patients with symptomatic FAI. © The Author(s) 2014.
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| 2. |
- Ayeni, Olufemi R, 1976, et al.
(författare)
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Femoro-acetabular impingement clinical research: is a composite outcome the answer?
- 2016
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Ingår i: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 24:1, s. 295-301
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Tidskriftsartikel (refereegranskat)abstract
- Femoro-acetabular impingement (FAI) is increasingly recognized as an important cause of hip pain in the young adult. However, the methods of evaluating the efficacy of surgical intervention are often not validated and/or inconsistently reported. Important clinical, gait, radiographic and biomarker outcomes are discussed. This article (1) presents the rationale for considering a composite outcome for FAI patients; (2) examines a variety of important end points currently used to evaluate FAI surgery; (3) discusses a strategy to generate a composite outcome by combining these end points; and (4) highlights the challenges and current areas of controversy that such an approach to evaluating symptomatic FAI patients may present.
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| 3. |
- Ayeni, Olufemi R, 1976
(författare)
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Femoroacetabular Impingement: The Pursuit of Evidence
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Femoroacetabular Impingement (FAI) is an important cause of hip pain in the young adult. It is the result of abnormal contact between the femoral head and neck junction and the acetabular rim. Although FAI has only recently been recognized as a medical and surgical condition, there has been a dramatic rise in diagnosis, treatment and scientific publications addressing this entity. Despite initial promising reports of outcomes following surgical management of this condition, there remains controversy about the best approach to diagnosing and managing this condition. This thesis aims to evaluate the current state of the evidence, the global perceptions of the condition from clinicians and world experts, as well as provide a study design that can definitively evaluate the efficacy of surgical intervention. Study 1 is a survey of 202 surgeon members of the Canadian Orthopaedic Association, evaluating their perceptions of the evidence for the management of FAI. The majority of surgeons were unsure of the existence of evidence supporting the best clinical test for FAI, the use of a diagnostic intra-articular injection for diagnosis of FAI, and for non-operative management of FAI. Study 2 is a survey of international surgeons from global organizations evaluating the state of opinions in terms of the diagnosis and treatment of FA,I as well as exploring the current demographic characteristics of surgeons performing FAI surgery. The survey was completed by 900 respondents. Surgeons performing a higher volume of FAI surgery (> 100 cases per year) were significantly more likely to have practiced for more than 20 years, to be practicing at an academic hospital, and to have formal arthroscopy training. High-volume surgeons were over two-fold more likely to practice in North America and Europe than the rest of the world. . Study 3 is a systematic review of the literature that assesses the quality of the literature addressing FAI over the 5-year span of 2011-2015. The review demonstrated that in comparison with previous work, there has been 3.5-fold increase in the number of publications over the past 5 years with a shift towards improving the level of evidence available guiding the arthroscopic management of FAI. Study 4 is a systematic review of the world’s English literature to assess the current strategies used to diagnose and treat FAI. We identified 105 studies reporting surgical interventions for FAI. Most studies were completed in North America and in Europe. Asia and Oceania had smaller contributions with no studies from South America or Africa. Most research performed in North America, Europe, and Oceania investigated arthroscopic FAI surgery followed by surgical dislocation, and mini-open and combined approaches. Methods of diagnosis were consistent worldwide, with radiography being the mainstay of diagnostic evaluation. Study 5 is a systematic review of the literature that evaluated the reporting of non-hip score related outcomes following FAI surgery. The most common non-hip score outcomes reported included; patient satisfaction, symptom improvement, pain improvement, hip range of motion. The most frequently reported standardized hip outcome scores used were the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Study 6 is a systematic review of the literature evaluating the consistency of reporting clinical and radiographic outcomes follow FAI surgery. There was a lack of consensus and consistency with regard to reported outcomes (clinical and radiographic) after arthroscopic treatment of FAI Study 7 is a narrative review with global content and research experts evaluating the current state of the evidence pertaining to FAI as well as proposing critical questions needing addressing with rigorous scientific investigation. Study 8 is a study protocol for investigating the surgical efficacy of FAI surgery with a randomized controlled trial. This study has received ethics approval at the primary site as well as other international sites. This study demonstrates the feasibility of a prospective randomized controlled trial addressing FAI.
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| 4. |
- de Sa, D., et al.
(författare)
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A Comparison of Supine and Lateral Decubitus Positions for Hip Arthroscopy: A Systematic Review of Outcomes and Complications
- 2016
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Ingår i: Arthroscopy-the Journal of Arthroscopic and Related Surgery. - : Elsevier BV. - 0749-8063. ; 32:4
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This systematic review examines outcomes and risk profiles of the hip arthroscopy in the supine versus lateral decubitus positions to elucidate any superiority of one approach over the other. Methods: Three databases (Embase, PubMed, and Medline) were searched for studies that addressed hip arthroscopy performed in either position, and were subsequently screened by two reviewers with data abstracted in duplicate. Results: Similar outcomes were observed. Supine studies showed a greater mean postoperative improvement for modified Harris hip score (33.74), visual analog scale (-3.99), nonarthritic hip score (29.61), Harris hip score (35.73), and hip outcome score (31.4). Lateral decubitus studies showed greater improvement using the Western Ontario and McMaster University Osteoarthritis (14.76) score. Supine studies reported more neuropraxic injuries (2.06% v 0.47%), labral penetration (0.65% v 0%), and heterotopic ossification (0.21% v 0%). Lateral decubitus studies reported more fluid extravasation (0.21% v 0.05%) and missed loose bodies (0.08% v 0.01%). Similar rates of revision (1.8% lateral, 1.4% supine) and conversion to open procedures (2.6% in lateral, 2.0% in supine) were also identified. Conclusions: Because of quality of evidence, direct comparisons are currently limited; however, the supine position is associated with more neuropraxic injuries, labral penetration, and heterotopic ossification, whereas lateral decubitus has increased risk of fluid extravasation and missed loose bodies. At this time, no evidence exists to establish superiority of one position.
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| 5. |
- de Sa, Darren, et al.
(författare)
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Evaluating healthcare resource utilization and outcomes for surgical hip dislocation and hip arthroscopy for femoroacetabular impingement.
- 2016
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Ingår i: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 24:12, s. 3943-3954
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Tidskriftsartikel (refereegranskat)abstract
- Surgical hip dislocation (SHD) and hip arthroscopy are surgical methods used to correct deformity associated with femoroacetabular impingement (FAI). Though both of these approaches appear to benefit patients, no studies exist comparing healthcare resource utilization of the two surgical approaches. This systematic review examines the literature and the records of two surgeons to evaluate the resource utilization associated with treating symptomatic FAI via these two methods.
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| 6. |
- Grassi, A., et al.
(författare)
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Postural stability deficit could predict ankle sprains: a systematic review
- 2018
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 26:10, s. 3140-3155
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To perform a systematic review aimed to determine (1) if the postural stability deficit represents a risk factor for ankle sprains; (2) the most effective postural stability evaluation to predict ankle sprains and (3) eventual confounding factors that could influence postural stability and ankle sprain risk. Methods A systematic electronic search was performed in MEDLINE, EMBASE and CINAHL using the search terms (balance) OR (postural stability) matched with (lower limb) OR (ankle) OR (foot) and (sprain) OR (injury) on October 2 2017. All prospective studies that evaluated postural stability as risk factor for ankle sprains were included. The PRISMA Checklist guided the reporting and data abstraction. Methodological quality of all included papers was carefully assessed. Results Fifteen studies were included, evaluating 2860 individuals. Various assessment tools or instruments were used to assess postural stability. The injury incidence ranged from 10 to 34%. Postural stability deficit was recognized as risk factor for ankle sprain (OR = 1.22-10.2) in 9 cases [3 out of 3 with Star Excursion Balance Test (SEBT)]. Among the six studies that measured the center-of-gravity sway, five were able to detect worse postural stability in athletes that sustained an ankle sprain. In nine cases, the measurement of postural stability did not show any statistical relationship with ankle sprains (four out of five with examiner evaluation). In the studies that excluded patients with history of ankle sprain, postural stability was reported to be a significant risk factor in five out of six studies. Conclusions The ultimate role of postural stability as risk factor for ankle sprains was not defined, due to the high heterogeneity of results, patient's populations, sports and methods of postural stability evaluation. Regarding assessment instruments, measurement of center-of-gravity sway could detect athletes at risk, however, standardized tools and protocols are needed to confirm this finding. The SEBT could be considered a promising tool that needs further investigation in wider samples. History of ankle sprains is an important confounding factor, since it was itself a source of postural stability impairment and a risk factor for ankle sprains. These information could guide clinicians in developing screening programs and design further prospective cohort studies comparing different evaluation tools.
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| 7. |
- Kay, J., et al.
(författare)
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A Historical Analysis of Randomized Controlled Trials in Anterior Cruciate Ligament Surgery
- 2017
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Ingår i: Journal of Bone and Joint Surgery - American Volume. - : Ovid Technologies (Wolters Kluwer Health). - 0021-9355 .- 1535-1386. ; 99:24, s. 2062-2068
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Tidskriftsartikel (refereegranskat)abstract
- Background: The purpose of this systematic review was to comprehensively assess the quality of reporting of randomized controlled trials (RCTs) relating to anterior cruciate ligament (ACL) reconstruction. Specifically, this review explored factors related to the quality of the RCTs and trends in the quality of reporting over time. Methods: The online databases PubMed, Ovid (MEDLINE), and Embase were used to search for all RCTs on the topic of ACL reconstruction from database inception until April 14, 2016. The quality of reporting was evaluated using the Detsky quality index and the Consolidated Standards of Reporting Trials (CONSORT) checklist for reporting trials of non-pharmacologic treatments. A multivariate regression analysis was used to assess predictors of quality reporting. Results: The online search yielded 2,933 articles, 412 of which met the inclusion criteria and were assessed for quality of reporting. There was a significant (p < 0.0001) increase in the number of RCTs published over time. The mean Detsky score (and standard deviation) across all included RCTs was 68.9% +/- 13.2%. The strongest predictors of quality reporting were the inclusion of a CONSORT flow diagram (b-coefficient, 10.0; 95% confidence interval [CI]: 8.45 to 11.61; p < 0.0001) and being published in the year 2009 or later (b-coefficient, 5.2; 95% CI: 3.87 to 6.45; p < 0.0001). The factors demonstrating the greatest improvement over time were the inclusion of a full description of the randomization procedure (p = 0.001) and prospective calculation of the sample size (p = 0.002). Conclusions: There has been a significant increase in both the quantity and quality of RCTs relating to ACL reconstruction over time. Specifically, the reporting of a methodologically sound randomization process and prospective calculation of sample size have significantly improved in recent years. However, since the year 2009, the number of trials and reporting in these trials has remained relatively consistent. The use of a CONSORT flow diagram is a strong predictor of high-quality reporting.
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| 8. |
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| 9. |
- Khan, M., et al.
(författare)
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New perspectives on femoroacetabular impingement syndrome
- 2016
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Ingår i: Nature Reviews Rheumatology. - : Springer Science and Business Media LLC. - 1759-4790 .- 1759-4804. ; 12:5, s. 303-310
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Tidskriftsartikel (refereegranskat)abstract
- Femoroacetabular impingement (FAI) is characterized by an abnormality in the shape of the femoral head-neck or acetabulum that results in impingement between these two structures. Arthroscopic treatment has become the preferred method of management of FAI owing to its minimally invasive approach. Surgical correction involves resection of impinging osseous structures as well as concurrent management of the associated chondral and labral pathology. Research from the past 5 years has shown that repair of the labrum results in a better anatomic correction and improved outcomes compared with labral debridement. Research is underway to improve cartilage assessment by using innovative imaging techniques and biochemical tests to inform predictions of prognosis. Several ongoing randomized controlled trials, including the Femoroacetabular Impingement Trial (FAIT) and the Femoroacetabular Impingement Randomized Controlled Trial (FIRST), will provide critical information regarding the diagnosis, management and prognosis of patients undergoing arthroscopic management of FAI.
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| 10. |
- Khan, Moin, et al.
(författare)
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Sources and quality of literature addressing femoroacetabular impingement: a scoping review 2011-2015.
- 2016
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Ingår i: Current reviews in musculoskeletal medicine. - : Springer Science and Business Media LLC. - 1935-973X .- 1935-9748. ; 9:4, s. 396-401
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Tidskriftsartikel (refereegranskat)abstract
- A systematic review was performed to explore the current trends over the last 5years in femoroacetabular impingement (FAI) literature and compare the quality and sources of publications in the literature to that published previously. We identified 1066 relevant studies including 186,572 patients. The number of publications increased during the reviewed time period with the most dramatic increase from 2011 to 2013. Seventy-three percent (N=786) of all studies were of levels 4 and 5 quality evidence. The percent of publications which were levels 1, 2 and 3 increased by almost twofold from 16.1% (N=26) to 28.7% (N=51) between 2011 and 2015. In comparison to previous work, there has been 3.5-fold increase in the number of publications over the past 5years with a shift towards improving the level of evidence available guiding the arthroscopic management of FAI.IV-Systematic Review.
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