Journal of Bone and Joint Surgery, American Volume最新文献

{"title":"Association Between Tourniquet Use and Patient-Reported Outcomes Following Total Knee Arthroplasty: A Multicenter Comparison.","authors":"Brian Gibbs, Jhase Sniderman, Shariq Mohammed, Michael Kain, David Freccero, Ayesha Abdeen","doi":"10.2106/JBJS.24.00266","DOIUrl":"10.2106/JBJS.24.00266","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is one of the most commonly performed elective procedures in North America. While advancements have been made in patient optimization, surgical technique, and implant design, tourniquet use remains a contentious issue as it relates to patient outcomes and postoperative experience.</p><p><strong>Methods: </strong>As part of the PEPPER trial, we identified 5,684 patients who underwent primary TKA, of whom 4,866 (85.6%) underwent surgery with a tourniquet (the YT group) and 818 (14.4%) underwent surgery without a tourniquet (the NT group). The cohort was predominantly female (60.8%), White (77%), and of an ethnicity other than Hispanic or Latino (96.8%). The mean age of the patients was 64.6 ± 9.2 years. The primary outcomes were the Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR); Patient-Reported Outcomes Measurement Information System Physical Health Summary (PROMIS-PH10); and numeric pain rating scale (NPRS), which were captured preoperatively and at 1, 3, and 6 months postoperatively. The secondary outcomes were length of stay, discharge disposition, analgesic consumption, and postoperative complications. Multivariable analysis was performed to assess the associations between tourniquet use and patient-reported outcome measures (PROMs) following TKA.</p><p><strong>Results: </strong>The percentages of patients achieving the minimal clinically important difference (MCID) for the KOOS JR were significantly different at 1 month only (YT, 55.4%; NT, 47.9%). This difference disappeared at 3 and 6 months. There was no difference between the YT and NT groups in terms of the percentage of patients achieving the MCID for the PROMIS-PH10 or NPRS at any time point. There were no differences between the YT and NT groups at any time point with respect to the KOOS JR, PROMIS-PH10, and NPRS. There were no differences in opioid consumption, operative time, length of stay, wound-related complications, or readmissions postoperatively.</p><p><strong>Conclusions: </strong>Tourniquet use was associated with more patients achieving the MCID for the KOOS JR at 1 month compared with no tourniquet use. This difference disappeared at 3 and 6 months. At 1, 3, and 6 months, there were no differences in opioid consumption, health-care utilization, or complications between patients undergoing TKA with a tourniquet versus without a tourniquet. Tourniquet use did not have a clinically meaningful impact on PROMs in the multivariable analysis. Arthroplasty surgeons may use these data during preoperative discussions with patients regarding tourniquet use as it relates to the surgeon's preference and how it could influence postoperative function.</p><p><strong>Level of evidence: </strong>Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"976-984"},"PeriodicalIF":4.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral Neck System Compared with 3 Cannulated Screws in the Treatment of Femoral Neck Fracture in Patients Aged 60 and Older: A Multicenter Registry-Based Study.","authors":"Zachary O Mallon, Heather A Prentice, Adam M Schlauch, Brian H Fasig, Elizabeth W Paxton, Cameron Sadeghi, Kanu Okike","doi":"10.2106/JBJS.24.00781","DOIUrl":"10.2106/JBJS.24.00781","url":null,"abstract":"<p><strong>Background: </strong>While the Femoral Neck System (FNS) is increasingly utilized for the fixation of femoral neck fractures in elderly patients, studies comparing the device to the historical standard (that is, multiple cannulated screws) are lacking. The purpose of this study was to determine the risk of all-cause revision following fixation with the FNS device compared with multiple cannulated screws in patients ≥60 years of age with a femoral neck fracture.</p><p><strong>Methods: </strong>Patients ≥60 years of age who underwent fixation of a femoral neck fracture with the FNS or 3 cannulated screws (2017 to 2022) were identified using the Kaiser Permanente Hip Fracture Registry. Exclusion criteria were polytrauma, pathologic fracture, open fracture, additional surgeries at other sites during the same hospital stay, and prior procedures on the affected hip. The primary outcome measure was all-cause revision surgery, and the secondary outcome measures were mortality, emergency department visits, and readmissions. Multivariable Cox proportional hazards or logistic regression was performed, controlling for a wide range of potential confounders.</p><p><strong>Results: </strong>A total of 352 FNS and 1,686 cannulated-screw repairs were included. The overall incidence of revision at 2 years was 4.0% and 4.8% for the FNS and cannulated-screw constructs, respectively. Mortality at 2 years was 23.6% and 25.2%, respectively. In the adjusted analysis, no difference in all-cause revision risk was observed when comparing the FNS to cannulated screws (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.50 to 1.71; p = 0.79). A subgroup analysis of procedures performed by surgeons who used both devices also did not demonstrate a difference in revision rates (HR = 0.91; 95% CI = 0.39 to 2.17; p = 0.84).</p><p><strong>Conclusions: </strong>In this study of patients ≥60 years of age with a femoral neck fracture, the rates of all-cause revision and mortality were found to be similar between the FNS and multiple cannulated screws.</p><p><strong>Level of evidence: </strong>Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"958-967"},"PeriodicalIF":4.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors That Influence Returning to Driving Following Primary Total Knee Arthroplasty: A Prospective Investigation.","authors":"Devon R Pekas, Miguel Perez, Andrea A Yu-Shan, Cody Bailey, Nicholas Peterman, Mehmet E Kilinc, W Garret Burks, Joseph T Moskal, Benjamin R Coobs, Peter J Apel","doi":"10.2106/JBJS.24.01177","DOIUrl":"10.2106/JBJS.24.01177","url":null,"abstract":"<p><strong>Background: </strong>It is unclear when a patient can return to driving after total knee arthroplasty (TKA). Currently, most surgeons simply restrict all patients from driving for 4 to 6 weeks after TKA despite variability in patient age, general health, and physical capabilities. The primary objective of this study was to create novel clinical prediction calculators to estimate the return-to-driving time following primary TKA.</p><p><strong>Methods: </strong>In this study, 167 patients who were undergoing a primary TKA were prospectively enrolled. Subjects received text message surveys every third day postoperatively to determine when they returned to driving. Subjects completed 8 physical performance maneuvers at their 2, 6, and 12-week postoperative clinical appointments. Additionally, subjects completed return-to-driving surveys and a structured interview. Data on demographic characteristics, operative factors, patient-reported outcomes, and patient factors were collected. Cox proportional hazard and parametric survival models were utilized to create 2 novel calculators for predicting return-to-driving time.</p><p><strong>Results: </strong>There were 156 patients (mean age, 67.7 years [range, 39 to 83 years]) who completed the study. The median return-to-driving time was 18 days (interquartile range [IQR], 12 to 27 days). Univariate analysis demonstrated that male patients returned to driving sooner (18 days) than female patients (25.3 days) (p < 0.001) and that patients who underwent left-sided surgery returned to driving sooner (20.1 days) than patients who underwent right-sided surgery (24.4 days) (p = 0.021). For preoperative factors, age, sex, laterality, and preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) had an effect on return-to-driving time and therefore were included in the novel preoperative clinical prediction calculator. For postoperative factors, age, sex, laterality, preoperative KOOS, and 6 metrics from the physical performance maneuvers had an effect on return-to-driving time and therefore were included in the novel postoperative physical performance-based instrument.</p><p><strong>Conclusions: </strong>Overall, patients undergoing primary TKA returned to driving considerably earlier than previously reported. Patient-related factors and postoperative physical performance significantly affect return-to-driving time. Using the novel preoperative clinical prediction tool, individual patients can be advised when to expect to return to driving. After surgery, the novel postoperative physical performance-based instrument can inform patients when they may be ready to return to driving.</p><p><strong>Level of evidence: </strong>Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"968-975"},"PeriodicalIF":4.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rise of Medicare Advantage is Impacting the Fidelity of Traditional Medicare Claims Data: Implications for Reporting of Long-Term Total Knee Arthroplasty Survivorship.","authors":"Xiao T Chen, Amy E Glasgow, Elizabeth B Habermann, Nathanael D Heckmann, John J Callaghan, David G Lewallen, Daniel J Berry, Nicholas A Bedard","doi":"10.2106/JBJS.24.00993","DOIUrl":"10.2106/JBJS.24.00993","url":null,"abstract":"<p><strong>Background: </strong>Traditional Medicare (TM) claims data are widely used by researchers and registries to report survivorship following total knee arthroplasty (TKA). The purpose of the present study was to investigate whether the mass exodus of patients from TM to Medicare Advantage (MA) has compromised the fidelity of TM data.</p><p><strong>Methods: </strong>We identified 11,717 Medicare-eligible patients (15,282 knees) who had undergone primary TKA from 2000 to 2020 at a single institution. Insurance type was analyzed, and 84% of TKAs were covered by TM. The rates of survivorship free from revision or reoperation were calculated for patients with TM coverage. The same survivorship end points were recalculated after censoring of patients who transitioned to MA after primary TKA, thereby modeling the impact of losing patients from the TM dataset. Differences in survivorship were compared. The mean duration of follow-up was 10 years.</p><p><strong>Results: </strong>From 2000 to 2020, there was a decrease in TM insurance (from 94% to 68%) and a corresponding increase in MA insurance (from 0% to 19%) among patients undergoing TKA. Following TKA, 25% of patients with TM coverage switched to MA. For patients with TM at the time of surgery, the 15-year rates of survivorship free from any reoperation or revision were 90% and 96%, respectively. When patients were censored upon transition from TM to MA, the 15-year rates of survivorship free from any reoperation (92% versus 90%; hazard ratio [HR] = 1.2; p = 0.001) or any revision (97% versus 96%; HR = 1.3; p = 0.002) were significantly higher.</p><p><strong>Conclusions: </strong>One in 4 patients left TM for MA after primary TKA, effectively making them lost to follow-up within TM datasets. The mass exodus of patients out of TM resulted in falsely elevated estimates of survivorship free from reoperation and from revision, with increasing divergence in survivorship over time, when MA data were excluded. As MA continues to grow, efforts to incorporate these data will become increasingly important.</p><p><strong>Level of evidence: </strong>Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1371-1376"},"PeriodicalIF":4.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complication Rates and Functional Outcomes After Total Ankle Arthroplasty in Patients with Rheumatoid Arthritis.","authors":"Colleen M Wixted, Albert T Anastasio, Billy I Kim, James K DeOrio, James A Nunley, Mark E Easley, Samuel B Adams","doi":"10.2106/JBJS.24.00048","DOIUrl":"10.2106/JBJS.24.00048","url":null,"abstract":"<p><strong>Background: </strong>For patients with rheumatoid arthritis (RA) undergoing total ankle arthroplasty (TAA), conflicting data have been reported regarding complications and patient-reported outcome (PRO) improvement when compared with patients with osteoarthritis (OA). The purpose of this study was to compare complication rates and PROs among patients with RA, primary OA, or posttraumatic arthritis.</p><p><strong>Methods: </strong>This was a retrospective study of 1,071 primary TAAs performed at a single institution between March 2000 and October 2020. Minimum follow-up was 2 years. Patients were stratified by indication for TAA (OA, n = 372; posttraumatic arthritis, n = 642; RA, n = 57). Patient demographics, intraoperative variables, postoperative complications, and PRO measures were compared among the groups using univariable statistics. Cox regression was performed to assess the risk of implant failure. The overall cohort had a mean age of 63.4 years, 51.3% were male, and 94.8% were White. The mean duration of follow-up (and standard deviation) was 5.7 ± 3.1 years.</p><p><strong>Results: </strong>Compared with the OA and posttraumatic arthritis groups, the RA cohort had the lowest mean age (p < 0.001), lowest percentage of males (p < 0.001), and highest American Society of Anesthesiologists (ASA) score (p < 0.001). Univariable analysis showed no significant difference in the infection rate among the groups (p = 1.0). The RA cohort had the highest rate of heterotopic ossification postoperatively (2 of 57, 3.5%; p < 0.040). Cox regression analysis showed no increased risk of implant failure for the RA cohort (p = 0.08 versus the OA cohort, 0.14 versus the posttraumatic arthritis cohort). For the Short Musculoskeletal Function Assessment (SMFA), Short Form (SF)-36, Foot and Ankle Outcome Score (FAOS)-symptoms subscale, and FAOS-activities of daily living subscale, the RA group reported significantly worse scores in the postoperative period (p < 0.001). However, the RA cohort demonstrated improvements in all PROs.</p><p><strong>Conclusions: </strong>In the largest single-institution study to date, patients with RA reported poorer PRO scores compared with the OA and posttraumatic arthritis groups but experienced functional outcome improvement from the preoperative baseline.</p><p><strong>Level of evidence: </strong>Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1480-1488"},"PeriodicalIF":4.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's New in Spine Surgery.","authors":"Jason Pui Yin Cheung, Søren Ohrt-Nissen","doi":"10.2106/JBJS.25.00101","DOIUrl":"10.2106/JBJS.25.00101","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1292-1297"},"PeriodicalIF":4.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's Important (Arts & Humanities): The Bone Question.","authors":"Alexandra Sheldon","doi":"10.2106/JBJS.24.001193","DOIUrl":"10.2106/JBJS.24.001193","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"897-898"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight Loss Before Total Hip Arthroplasty Was Not Associated with Decreased Postoperative Risks.","authors":"Michael W Seward, Jessica A Grimm, Charles P Hannon, Nicholas A Bedard, Daniel J Berry, Matthew P Abdel","doi":"10.2106/JBJS.24.01110","DOIUrl":"10.2106/JBJS.24.01110","url":null,"abstract":"<p><strong>Background: </strong>Many surgeons use body mass index (BMI) cutoffs when offering total hip arthroplasty (THA). However, little is known about who loses weight before THA, and if weight loss improves outcomes. This study determined how many patients lost weight before primary THA, identified predictors of preoperative weight loss, and evaluated whether preoperative weight loss was associated with improved outcomes.</p><p><strong>Methods: </strong>Among 53,038 primary THAs that were performed between 2002 and 2019, we identified 2,463 patients who had a BMI of ≥30 kg/m 2 (measured 1 to 24 months before surgery) and had their weight measured at the time of surgery. The mean age was 66 years; 47% were women. The mean BMI was 35 kg/m 2 . Nonparametric models evaluated potential associations with weight loss. Univariable and multivariable logistic regression and Cox proportional hazards models evaluated the impact of preoperative weight change on hospital length of stay, discharge disposition, operative time, periprosthetic joint infection (PJI), complications, revision, and reoperation. The mean follow-up was 5 years.</p><p><strong>Results: </strong>Overall, 17% of the patients gained >5 pounds (2.27 kg), 38% maintained their weight, 16% lost 5 to <10 pounds (4.54 kg), 17% lost 10 to <20 pounds (9.07 kg), and 12% lost ≥20 pounds before THA. Only 28% of patients with a preoperative BMI of ≥40 kg/m 2 achieved a BMI of <40 kg/m 2 by the time of surgery; those who did required a mean of 1.3 years to lose the weight. In multivariable analyses, there were no significant improvements in operative time, length of stay, and discharge disposition, or survivorship free of PJI, complication, revision, or reoperation for any weight-loss category when compared with those who maintained their weight.</p><p><strong>Conclusions: </strong>Only 12% of patients lost ≥20 pounds, and only 28% of patients with a BMI of ≥40 kg/m 2 achieved a BMI of <40 kg/m 2 before primary THA. There was no decrease in complications, revisions, or reoperations for any preoperative weight-loss category when compared with those who maintained their weight. While weight loss benefits overall health, the results of this study call into question whether preoperative weight loss alone is enough to reduce postoperative complications for most patients.</p><p><strong>Level of evidence: </strong>Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"849-857"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Computer Navigation and Patient-Specific Instrumentation on Risk of Revision, PROMs, and Mortality Following Primary TKR: An Analysis of National Joint Registry Data.","authors":"M M Farhan-Alanie, D Gallacher, P Craig, J Griffin, J Kozdryk, J Mason, P D H Wall, J M Wilkinson, A Metcalfe, P Foguet","doi":"10.2106/JBJS.24.00589","DOIUrl":"10.2106/JBJS.24.00589","url":null,"abstract":"<p><strong>Background: </strong>Computer navigation and patient-specific instrumentation have been in use over the past 2 decades for total knee replacement (TKR). However, their effects on implant survival and patient-reported outcomes remain under debate. We aimed to investigate their influence on implant survival, outcomes of the Oxford Knee Score (OKS) and health-related quality of life (EQ-5D-3L), intraoperative complications, and postoperative mortality compared with conventional instrumentation, across a real-world population.</p><p><strong>Methods: </strong>This observational study used National Joint Registry (NJR) data and included adult patients who underwent primary TKR for osteoarthritis between April 1, 2003, and December 31, 2020. The primary analysis evaluated revision for all causes, and secondary analyses evaluated differences in the OKS and EQ-5D-3L at 6 months postoperatively, and mortality within 1 year postoperatively. Weights based on propensity scores were generated, accounting for several covariates. A Cox proportional hazards model was used to assess revision and mortality outcomes. Generalized linear models were used to evaluate differences in the OKS and EQ-5D-3L. Effective sample sizes were computed and represent the statistical power comparable with an unweighted sample.</p><p><strong>Results: </strong>Compared to conventional instrumentation, the hazard ratios (HRs) for all-cause revision following TKR performed using computer navigation and patient-specific instrumentation were 0.937 (95% confidence interval [CI], 0.860 to 1.021; p = 0.136; effective sample size [ESS] = 91,607) and 0.960 (95% CI, 0.735 to 1.252; p = 0.761; ESS = 13,297), respectively. No differences were observed in the OKS and EQ-5D-3L between conventional and computer-navigated TKR (OKS, -0.134 [95% CI, -0.331 to 0.063]; p = 0.183; ESS = 29,135; and EQ-5D-3L, 0.000 [95% CI, -0.005 to 0.005]; p = 0.929; ESS = 28,396) and between conventional TKR and TKR with patient-specific instrumentation (OKS, 0.363 [95% CI, -0.104 to 0.830]; p = 0.127; ESS = 4,412; and EQ-5D-3L, 0.004 [95% CI, -0.009 to 0.018]; p = 0.511; ESS = 4,285). Mortality within 1 year postoperatively was similar between conventional instrumentation and either computer navigation or patient-specific instrumentation (HR, 1.020 [95% CI, 0.989 to 1.052]; p = 0.212; ESS = 110,125).</p><p><strong>Conclusions: </strong>On the basis of this large registry study, we conclude that computer navigation and patient-specific instrumentation have no statistically or clinically meaningful effect on the risk of revision, patient-reported outcomes, or mortality following primary TKR.</p><p><strong>Level of evidence: </strong>Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"829-839"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical, Functional, Sports Participation, and Osteoarthritis Outcomes After ACL Injury: Ten-Year Follow-up Study of the Delaware-Oslo ACL Cohort Treatment Algorithm.","authors":"Anouk P Urhausen, Marie Pedersen, Hege Grindem, Naoaki Ito, Elanna K Arhos, Ragnhild Gunderson, Arne Kristian Aune, Lars Engebretsen, Michael J Axe, Karin Grävare Silbernagel, Inger Holm, Lynn Snyder-Mackler, May Arna Risberg","doi":"10.2106/JBJS.24.00243","DOIUrl":"10.2106/JBJS.24.00243","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament reconstruction (ACLR) is often recommended for treatment of an ACL injury; however, the literature reports similar outcomes for those undergoing rehabilitation alone. We assessed the clinical, functional, sports participation, and osteoarthritis outcomes following our treatment algorithm, and compared 10-year outcomes among participants who chose progressive rehabilitation alone, early ACLR, or delayed ACLR.</p><p><strong>Methods: </strong>We included 276 participants who had a unilateral ACL injury without substantial concomitant knee injuries in a prospective cohort study. Treatment choice was based on shared decision-making after a 5-week progressive rehabilitation program. At the 10-year follow-up, we assessed patient-reported outcomes (International Knee Documentation Committee Subjective Knee Form [IKDC-SKF], Knee injury and Osteoarthritis Outcome Score [KOOS], and patient acceptable symptom state [PASS] achievement), quadriceps strength, hop performance, sports participation, and weight-bearing radiographs.</p><p><strong>Results: </strong>Sixty-nine percent of the participants (191 participants; 99 male and 92 female; 6 African American, 7 Asian, 59 Caucasian, 119 unknown) attended the 10-year follow-up, including 98% (53) of 54 participants who had rehabilitation alone, 68% (114) of 167 with early ACLR, and 69% (24) of 35 with delayed ACLR. Among the entire cohort, 78% (126 of 162) reported having a PASS, 72% (109 of 151) had symmetrical quadriceps strength, ≥85% (≥116 of ≤137) had a symmetrical hop performance, 93% (162 of 174) were still engaged in some kind of sports, only 1% (1 of 139) had symptomatic osteoarthritis, and 12% (17 of 139) had radiographic evidence of osteoarthritis. We found similar outcomes after rehabilitation alone and early ACLR. The participants who underwent delayed ACLR had similar outcomes to the other 2 groups except for significantly lower KOOS Sports scores, KOOS Quality of Life scores, and hop performance (p ≤ 0.03). Participants who had rehabilitation alone were older, less active, and more likely to have concomitant lateral meniscal injuries than those who underwent ACLR.</p><p><strong>Conclusions: </strong>Participants who followed our treatment algorithm after ACL injury had high percentages of satisfaction and of symmetrical quadriceps strength and hop performance, high sports participation rates, and low prevalences of osteoarthritis. Participants who chose progressive rehabilitation alone, despite being older and less active, had similar clinical, functional, sports participation, and osteoarthritis outcomes compared with those who chose early ACLR. Participants who underwent delayed ACLR scored lower on KOOS Sports, KOOS Quality of Life, and hop performance compared with both other groups.</p><p><strong>Level of evidence: </strong>Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"840-848"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}