| 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. |
- Svantesson, Eleonor, et al.
(författare)
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Clinical Outcomes After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group.
- 2020
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Ingår i: Orthopaedic journal of sports medicine. - 2325-9671. ; 8:7
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Tidskriftsartikel (refereegranskat)abstract
- A stringent outcome assessment is a key aspect of establishing evidence-based clinical guidelines for anterior cruciate ligament (ACL) injury treatment. To establish a standardized assessment of clinical outcome after ACL treatment, a consensus meeting including a multidisciplinary group of ACL experts was held at the ACL Consensus Meeting Panther Symposium, Pittsburgh, Pennsylvania, USA, in June 2019. The aim was to establish a consensus on what data should be reported when conducting an ACL outcome study, what specific outcome measurements should be used, and at what follow-up time those outcomes should be assessed. The group reached consensus on 9 statements by using a modified Delphi method. In general, outcomes after ACL treatment can be divided into 4 robust categories: early adverse events, patient-reported outcomes (PROs), ACL graft failure/recurrent ligament disruption, and clinical measures of knee function and structure. A comprehensive assessment after ACL treatment should aim to provide a complete overview of the treatment result, optimally including the various aspects of outcome categories. For most research questions, a minimum follow-up of 2 years with an optimal follow-up rate of 80% is necessary to achieve a comprehensive assessment. This should include clinical examination, any sustained reinjuries, validated knee-specific PROs, and health-related quality of life questionnaires. In the midterm to long-term follow-up, the presence of osteoarthritis should be evaluated. This consensus paper provides practical guidelines for how the aforementioned entities of outcomes should be reported and suggests the preferred tools for a reliable and valid assessment of outcome after ACL treatment.
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| 3. |
- 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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| 4. |
- 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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| 5. |
- 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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| 6. |
- 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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| 7. |
- Diermeier, Theresa, et al.
(författare)
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Treatment After Anterior Cruciate Ligament Injury: Panther Symposium ACL Treatment Consensus Group
- 2020
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Ingår i: Orthopaedic Journal of Sports Medicine. - 2325-9671. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best-practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance toward consensus opinions regarding the best available evidence on operative versus nonoperative treatment for ACL injury. The purpose of this study was to report the consensus statements on operative versus nonoperative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. There were 66 international experts on the management of ACL injuries, representing 18 countries, who were convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the scientific organizing committee and session chairs for the 3 working groups. Panel participants reviewed preliminary statements before the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Ultimately, 80% agreement was defined a priori as consensus. A total of 11 of 13 statements on operative versus nonoperative treatment of ACL injury reached consensus during the symposium. Overall, 9 statements achieved unanimous support, 2 reached strong consensus, 1 did not achieve consensus, and 1 was removed because of redundancy in the information provided. In highly active patients engaged in jumping, cutting, and pivoting sports, early anatomic ACL reconstruction is recommended because of the high risk of secondary meniscal and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight-plane activities, nonoperative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomic ACL reconstruction is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and nonoperative treatment with patients after an ACL injury.
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| 8. |
- Franceschetti, Edoardo, et al.
(författare)
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No difference between cemented and cementless total knee arthroplasty in young patients: a review of the evidence
- 2017
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 25:6, s. 1749-1756
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The present piece of work provides improved knowledge about the evidence related to TKA in patients 60 years of age or younger, with special focus on fixation methods. Main concern of the review is to analyse the difference of survival rate and complications of cemented and cementless implants. Methods: An electronic search was carried out between October and December 2015, through CINAHL, PubMed and the Cochrane Central Registry of Controlled Trials web databases. Articles in English, Italian, French and Spanish were considered for inclusion. Only peer-reviewed studies with adult patients aged 60 years or less, with diagnosis of osteoarthritis in more than 90% of the subjects, were considered for inclusion. All studies had to report outcomes after TKA with either cemented or cementless fixation technique. Results: No significant differences in terms of clinical, functional and radiological outcomes were found between cemented and cementless implants. Good clinical and functional results were obtained in terms of the Knee Society score and Western Ontario and McMaster Universities Osteoarthritis Index for both techniques. Radiographic results showed that radiolucent lines of <2 mm in width were detected at radiographs, without difference between cemented or cementless implants. Well-conducted trials on cemented versus cementless TKA were carried out in few papers. A survival rate of over 90% was reported in the majority of the studies at a mean follow-up of 8.6 years (range 5–18 years). Conclusion: Similar results were observed in terms of functional outcome and survival rates for both cemented and cementless TKAs. High survival rates were reported for both operative techniques and cemented TKA did not offer additional benefit. Assuming that cementless prosthesis allows a stable fixation and reduces the time of operation, the authors recommend the cementless fixation as a primary choice in the investigated patient population. However, evidence is low, and further research is needed. Level of evidence: IV.
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| 9. |
- 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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| 10. |
- Hamrin Senorski, Eric, 1989, et al.
(författare)
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Factors that affect patient reported outcome after anterior cruciate ligament reconstruction-a systematic review of the Scandinavian knee ligament registers.
- 2019
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Ingår i: British journal of sports medicine. - : BMJ. - 1473-0480 .- 0306-3674. ; 53:7
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Tidskriftsartikel (refereegranskat)abstract
- To perform a systematic review of findings from the Scandinavian knee ligament registers with regard to factors that affect patient reported outcome after anterior cruciate ligament (ACL) reconstruction.Systematic review.Four electronic databases: PubMed, EMBASE, the Cochrane Library and AMED were searched, and 157 studies were identified. Two reviewers independently screened the titles, abstracts and full text articles for eligibility. A modified version of the Downs and Black checklist was applied for quality appraisal.Studies published from the Scandinavian registers from their establishment in 2004 and onwards that documented patient reported outcome and provided information on concomitant injuries were eligible.A total of 35 studies were included. Younger age at ACL reconstruction, male sex, not smoking and receiving a hamstring tendon autograft positively influenced patient reported outcome. Patients with concomitant cartilage and meniscal injuries reported inferior subjective knee function compared with patients with an isolated ACL tear. One study reported that patients treated non-reconstructively reported inferior knee function compared with patients who had ACL reconstruction.Younger age, male sex, not smoking, receiving a hamstring tendon autograft and the absence of concomitant injuries were associated with superior patient reported outcomes after ACL reconstruction.
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