The Journal of Bone & Joint Surgery最新文献

{"title":"Treatment of Unreduced Elbow Dislocations with Hinged External Fixation","authors":"J. Jupiter, D. Ring","doi":"10.2106/00004623-200209000-00017","DOIUrl":"https://doi.org/10.2106/00004623-200209000-00017","url":null,"abstract":"Background: The results of operative treatment of an unreduced elbow dislocation have been regarded with pessimism. Suggested procedures have included tendon-lengthening, tendon transfer, or reconstruction of ligament or bone.Methods: Three women and two men (average age, forty-nine years) with an unreduced dislocation of the elbow without associated fractures were treated with open relocation of the joint and hinged external fixation at an average of eleven weeks (range, six to thirty weeks) after the initial injury. The lateral soft tissues, including the origin of the lateral collateral ligament complex, were reattached to the lateral epicondyle in three patients, but no attempt was made to reconstruct the ligaments, tendons, or bone. A passive worm gear incorporated into a hinged external fixator was used to mobilize the elbow initially, and active mobilization was gradually introduced. The hinge was removed at an average of five weeks after the procedure.Results: At an average of thirty-eight months (range, twelve to ninety-eight months), a stable, concentric reduction had been maintained in all five patients, with radiographic signs of mild arthrosis in four. The average arc of flexion was 123×, and all patients had full forearm rotation. The average score on the Mayo Elbow Performance Index was 89 points, with two excellent and three good results. The average scores on the Disabilities of the Arm, Shoulder and Hand (DASH) and American Shoulder and Elbow Surgeons outcome instruments (13 and 92 points, respectively) reflected mild residual pain and disability.Conclusions: Treatment of unreduced elbow dislocations with open reduction and hinged external fixation as much as thirty weeks after the injury can restore a stable, mobile joint without the need for tendon-lengthening or transfer, ligament reconstruction, or deepening of the trochlear notch of the ulna.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81666582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of Needle Placement into the Intra-Articular Space of the Knee","authors":"D. Jackson, Nicholas A Evans, B. M. Thomas","doi":"10.2106/00004623-200209000-00003","DOIUrl":"https://doi.org/10.2106/00004623-200209000-00003","url":null,"abstract":"Background: To achieve their potential therapeutic benefit, hyaluronic acid derivatives should be injected directly into the knee joint space and not into the anterior fat pad or the subsynovial tissues. In the absence of a knee effusion, reproducible needle placement into the intra-articular space presents a challenge to the clinician.Methods: The accuracy of needle placement was assessed in a prospective series of 240 consecutive injections in patients without clinical knee effusion. The injections were performed by one orthopaedic surgeon using a 2.0-in (5.1-cm) 21-gauge needle through three commonly employed knee joint portals: anteromedial, anterolateral, and lateral midpatellar. Accuracy rates for needle placement were confirmed with fluoroscopic imaging to document the dispersion pattern of injected contrast material.Results: Of eighty injections performed through an anterolateral portal, fifty-seven were confirmed to have been placed in the intra-articular space on the first attempt (an accuracy rate of 71%). Sixty of eighty injections performed through an anteromedial approach were intra-articular on the first attempt (75% accuracy rate), as were seventy-four of eighty injections performed through a lateral midpatellar portal (93% accuracy rate).Conclusions: Using real-time fluoroscopic imaging with contrast material, we demonstrated the difficulty of accurately placing a needle into the intra-articular space of the knee when an effusion is not present. This study revealed that a lateral midpatellar injection (an injection into the patellofemoral joint) was intra-articular 93% of the time and was more accurate than injections performed by the same orthopaedic surgeon using either of the other two portals. This study highlights the need for clinicians to refine injection techniques for delivering intra-articular therapeutic substances that are intended to coat the articular surfaces of the knee joint.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77181219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surface Damage in Machined Ram-Extruded and Net-Shape Molded Retrieved Polyethylene Tibial Inserts of Total Knee Replacements","authors":"A. Bērziņš, J. Jacobs, R. Berger, Chris Ed, R. Natarajan, T. Andriacchi, J. Galante","doi":"10.2106/00004623-200209000-00005","DOIUrl":"https://doi.org/10.2106/00004623-200209000-00005","url":null,"abstract":"Background: Polyethylene wear has emerged as a major determining factor in the long-term clinical performance of total knee replacements. This study addresses the in vivo wear performance of two types of polyethylene tibial inserts used in similar total knee arthroplasty designs.Methods: A surface damage assessment of retrieved specimens was performed for twenty-six net-shape molded tibial inserts manufactured from H1900 resin without calcium stearate additive (Miller-Galante) and forty-three machined ram-extruded tibial inserts manufactured from GUR 4150 resin with calcium stearate additive (Miller-Galante II). Stereomicroscopic inspection and digital image analysis were used to quantify the extent and severity of pitting, dimensional change, and delamination.Results: Pitting and dimensional change were the most common modes of damage in both groups, with the prevalence ranging from 77% to 92% for pitting and from 51% to 81% for dimensional change. Delamination was the least common mode of damage, with the prevalence ranging from 21% to 35%. The severity of pitting was higher in association with the cemented implant-bone interface. The extent and severity of delamination increased with implantation time. No severe delamination was observed before sixty months after implantation in the net-shape molded group, whereas severe delamination was present as early as ten months after implantation in the machined ram-extruded group. The time between surgery and the discovery of damage was longer in the net-shape molded group for all modes of damage except for medial dimensional change.Conclusions: On the basis of the components available in our implant retrieval pool, we found that at equivalent levels of surface damage, the net-shape molded H1900 resin tibial inserts demonstrated longer service life than did the machined ram-extruded GUR 4150 components. The superior performance of the net-shape molded components may be related to the resin type, the absence of calcium stearate, the consolidation method, or the method of final geometry shaping. This superior damage resistance is expected to contribute to superior long-term clinical performance of net-shape molded ultra-high molecular weight polyethylene in total knee arthroplasty.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88477714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a Femoral Stem with Reduced Stiffness: A Randomized Study with Use of Radiostereometry and Bone Densitometry","authors":"J. Kärrholm, Christian Anderber, F. Snorrason, J. Thanner, N. Langeland, H. Malchau, P. Herberts","doi":"10.2106/00004623-200209000-00020","DOIUrl":"https://doi.org/10.2106/00004623-200209000-00020","url":null,"abstract":"Background: Femoral stems with reduced stiffness were introduced in total hip arthroplasty to facilitate proximal load transfer and thereby reduce periprosthetic bone loss. Poor fixation and unacceptably high revision rates turned out to be a major problem with these prostheses. The purpose of the present study was to evaluate the early performance of a low-modulus stem (one that is less stiff) with the potential to address the problem of fixation by the use of a surface coating. The coating consisted of a titanium porous mesh proximally covered with a mixture of hydroxyapatite and tricalcium phosphate.Methods: Thirty-nine men and twenty-six women (sixty-eight hips) with noninflammatory arthritis were studied. The patients were randomized to receive either a porous-coated composite stem with reduced stiffness (Epoch) or a stiff stem with a porous coating (Anatomic). Both stems were inserted without cement, had a ceramic coating on the proximal two-thirds, and were supplied with tantalum beads. At the time of the operation, tantalum markers were also placed into the proximal part of the femur. The patients were followed for up to two years after the operation and were evaluated with use of repeated radiostereometric measurements, measurements of bone-mineral density, conventional radiography, and Harris hip scores.Results: Both stems showed optimum fixation with median subsidence and stem rotations that were close to zero. Repeated measurements of bone-mineral density revealed early loss of bone mineral in all Gruen regions in both treatment groups. The loss of bone mineral around the Epoch stems was significantly reduced at two years in Gruen regions 1, 2, 6, and 7 (p < 0.0005 to 0.04). Measurements on postoperative radiographs showed no difference in stem positioning or fill, but the Epoch stems had significantly more endocortical contact on both the anteroposterior (p < 0.0005) and the lateral radiograph (p = 0.02).At two years postoperatively, the Epoch stems had fewer sclerotic lines surrounding the stem (p £ 0.002) and less sclerosis at the tip of the prosthesis (p = 0.001) compared with the Anatomic stems. The clinical results in terms of the Harris hip score, which was determined in all hips, and pain or discomfort, which was evaluated in thirty-seven hips treated at the same hospital, were not found to be different, with the numbers available.Conclusions: Contrary to previous studies of other designs with reduced stiffness, the Epoch stem achieved excellent primary fixation. Despite this rigid fixation, the proximal loss of bone-mineral density was less than that associated with the stem with a stiffer design. These results should encourage additional long-term studies with a larger patient population.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91408880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redislocation of the Shoulder During the First Six Weeks After a Primary Anterior Dislocation: Risk Factors and Results of Treatment","authors":"C. Robinson, M. Kelly, A. Wakefield","doi":"10.2106/00004623-200209000-00007","DOIUrl":"https://doi.org/10.2106/00004623-200209000-00007","url":null,"abstract":"Background: After an anterior dislocation, shoulder instability may occur with disruption of the soft-tissue or osseous restraints, leading to early redislocation. The aim of the present study was to clarify the risk factors for this complication within the first six weeks after a first-time anterior traumatic dislocation and to assess the outcome of treatment with immediate operative stabilization.Methods: A three-year, prospective, observational cohort study of 538 consecutive patients with a first-time anterior dislocation of the shoulder was carried out. Reassessment of shoulder function was performed at a dedicated shoulder clinic, and suspected early redislocations were assessed with additional radiographs. All medically fit patients with a confirmed acute redislocation were treated with repeat closed reduction under anesthesia. Patients with unstable reductions were treated operatively. Functional and radiographic assessment of outcome was carried out during the first year after dislocation.Results: Seventeen (3.2%) of the 538 patients sustained an early redislocation within the first week after the original dislocation. Patients at increased risk of early redislocation included those who sustained the original dislocation as the result of a high-energy injury (relative risk = 13.7), those who had a neurological deficit (relative risk = 2.0), those in whom a large rotator cuff tear occurred in conjunction with the dislocation (relative risk = 29.8), those in whom the original dislocation was associated with a fracture of the glenoid rim (relative risk = 7.0), and those who had a fracture of both the glenoid rim and the greater tuberosity (relative risk = 33.5). Following operative reconstruction, the outcome at one year after the injury was favorable in terms of function, general health, and radiographic findings. None of the patients had a redislocation or symptoms of instability at one year.Conclusion: All patients who have substantial pain, a visible shoulder deformity, or restriction of movement at one week after reduction of a first-time dislocation should be evaluated with repeat radiographs to exclude a redislocation. Patients in whom this complication develops usually have either (1) severe disruption of the soft-tissue envelope due to a large rotator cuff tear or (2) disruption of the normal osseous restraints to dislocation due to either an isolated fracture of the glenoid rim or fractures of both the glenoid rim and the greater tuberosity. Early operative stabilization is justified for patients in whom the dislocation is associated with these coexisting conditions and who have evidence of gross instability.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91399829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rattlesnake Bites in Children: Antivenin Treatment and Surgical Indications","authors":"B. Shaw, H. Hosalkar","doi":"10.2106/00004623-200209000-00016","DOIUrl":"https://doi.org/10.2106/00004623-200209000-00016","url":null,"abstract":"Background: Orthopaedic surgeons working in the Americas may be consulted in the care of patients bitten by venomous rattlesnakes (genus Crotalus ), particularly with regard to the possibilities of compartment syndrome and soft-tissue destruction. Despite considerable evidence regarding the safety and efficacy of antivenin in the treatment of rattlesnake bites in adults, controversy persists regarding the roles of antivenin and surgery in the treatment of rattlesnake envenomations in children. Our hypothesis is that aggressive use of antivenin is just as effective and safe for children as it is for adults.Methods: We retrospectively reviewed the charts of twenty-four consecutive patients who had been managed at our hospital because of a bite from a western diamondback rattlesnake. Nineteen of the twenty-four patients had been envenomated. The uniformity of collected data was facilitated by the use of an intensive-care-unit protocol during the ten-year period that was reviewed. A questionnaire was developed for long-term follow-up.Results: Aggressive use of polyvalent equine antivenin safely prevented the need for surgery in sixteen of the nineteen envenomated patients. Of the three patients who had surgical treatment, two were managed with limited soft-tissue débridement and one was managed with a fasciotomy of the leg because of a compartment syndrome that occurred when adequate antivenin was withheld. No serious adverse effects were noted in association with the antivenin, and no functional impairments were noted at the time of discharge.Conclusion: Antivenin, rather than surgery, is the proper initial treatment of severe rattlesnake envenomations in children.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78378403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Frequency of Acute Local Reaction to Intra-Articular Hylan GF-20 (Synvisc) in Patients Receiving More Than One Course of Treatment","authors":"S. Leopold, W. Warme, Patrick D Pettis, S. Shott","doi":"10.2106/00004623-200209000-00015","DOIUrl":"https://doi.org/10.2106/00004623-200209000-00015","url":null,"abstract":"Background: Intra-articular knee injections with hylan GF-20 (Synvisc) have been shown to provide temporary relief of osteoarthritic symptoms. Several studies have suggested that repeated courses of treatment with this product may be administered without an increase in the likelihood of an adverse reaction. The present study was performed to test the hypothesis that the likelihood of a painful reaction to hylan GF-20 does not increase in patients who receive more than one course of treatment.Methods: The records of all patients who had received more than one course of treatment with hylan GF-20 were compared with a group of patients who had received only one course of treatment during the same fifteen-month period at a single center. The single-course group was prospectively enrolled and followed, as part of an ongoing randomized trial. The two groups were compared with respect to several demographic and clinical parameters as well as with respect to the frequency of painful acute local reactions following injections of hylan GF-20.Results: Local reactions to hylan GF-20 occurred significantly more often in patients who had received more than one course of treatment than they did in patients who had received only a single course of treatment; the reactions occurred in four (21%) of nineteen patients in the former group and in one (2%) of the forty-two patients in the latter (p = 0.029). All of the reactions were severe enough to cause the patient to seek unscheduled care. Following corticosteroid injection, the reactions abated without apparent sequelae. With the numbers available, no significant differences were detected between the multiple-course and single-course groups in terms of age, gender, body-mass index, or severity or bilaterality of the disease.Conclusions: The present study suggests that it may be reasonable to counsel patients who have been treated with a course of hylan GF-20 and who desire an additional course that the likelihood of a painful acute local reaction to the medication appears to be increased. Additional study of the frequency of acute local reactions following repeated courses of hylan GF-20 and investigation of the mechanisms of those reactions are warranted.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78920110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"User's Guide to the Orthopaedic Literature: How to Use a Systematic Literature Review","authors":"M. Bhandari, G. Guyatt, V. Montori, P. Devereaux, M. Swiontkowski","doi":"10.2106/00004623-200209000-00024","DOIUrl":"https://doi.org/10.2106/00004623-200209000-00024","url":null,"abstract":"• Investigators who perform a systematic review address a focused clinical question, conduct a thorough search of the literature, apply inclusion and exclusion criteria to each potentially eligible study, critically appraise the relevant studies, conduct sensitivity analyses, and synthesize the information to draw conclusions relevant to patient care or additional study.\u0000\u0000• A meta-analysis is a quantitative (or statistical) pooling of results across eligible studies with the aim of increasing the precision of the final estimates by increasing the sample size.\u0000\u0000• The current increase in the number of small randomized trials in orthopaedic surgery provides a strong argument in favor of meta-analysis; however, the quality of the primary studies included ultimately reflects the quality of the pooled data from a meta-analysis.\u0000\u0000The conduct and publication of systematic reviews of the orthopaedic literature, which often include statistical pooling or meta-analysis, are becoming more common. This article is the third in a series of guides evaluating the validity of the surgical literature and its application to clinical practice. It provides a set of criteria for optimally interpreting systematic literature reviews and applying their results to the care of surgical patients.\u0000\u0000Authors of traditional literature reviews provide an overview of a disease or condition or one or more aspects of its etiology, diagnosis, prognosis, or management, or they summarize an area of scientific inquiry. Typically, these authors make little or no attempt to be systematic in formulating the questions that they are addressing, in searching for relevant evidence, or in summarizing the evidence that they consider. Medical students and clinicians seeking background information nevertheless often find these reviews very useful for obtaining a comprehensive overview of a clinical condition or area of inquiry.\u0000\u0000When traditional expert reviewers make recommendations, they often disagree with one another, and their advice frequently lags behind, or …","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77470154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periacetabular Osteotomy Through a Modified Ollier Transtrochanteric Approach for Treatment of Painful Dysplastic Hips","authors":"J. Ko, Ching‐Jen Wang, C. Lin, C. Shih","doi":"10.2106/00004623-200209000-00012","DOIUrl":"https://doi.org/10.2106/00004623-200209000-00012","url":null,"abstract":"Background: Elimination of abnormally high joint-loading resulting in excessive contact stresses may prevent or reduce the onset of osteoarthrosis in a dysplastic hip. A number of periacetabular osteotomies have been shown to be effective in restoring normal hip-joint mechanics. We treat acetabular dysplasia with a periacetabular osteotomy performed through a modified Ollier transtrochanteric approach. In this report, we describe the operative technique and the clinical and radiographic results.Methods: Thirty-six patients (thirty-eight hips) in whom a painful dysplastic hip had been treated with a periacetabular osteotomy between March 1991 and June 1999 were included in the study. There were thirty-five female patients and one male patient with a mean age (and standard deviation) at the operation of 29.42 ± 9.1 years. The technique utilizes a u-shaped skin incision, and a routine osteotomy of the greater trochanter with distal transfer if needed, and allows excellent visualization enabling the surgeon to perform the periacetabular osteotomy without penetrating the joint.Results: At a mean of five years and six months postoperatively, the mean modified Harris hip score had improved from 59.1 ± 15.8 points preoperatively to 87.97 ± 14.3 points. Radiographically, the degree of osteoarthrosis had decreased in eleven hips, remained unchanged in twenty-four, and worsened in three. The mean anterior center-edge angle had increased from 22.0° ± 12.9° to 36.1° ± 12.3°, the mean lateral center-edge angle had increased from -2.7° ± 14.4° to 26.6° ± 14.1°, the mean acetabular index angle had improved from 23.4° ± 6.6° to 12.7° ± 4.6°, and the mean acetabular head index had increased from 48.2% ± 12.7% to 73.1% ± 16.0%. The Shenton line was restored in eleven hips. Thirty patients (thirty-two hips; 84%) had a satisfactory result. A poor preoperative functional score was associated with an unsatisfactory outcome (p = 0.00191). Complications included prolonged limping (eleven hips); numbness in the distribution of the lateral femoral cutaneous nerve (four); osteonecrosis of the rotated acetabular fragment (two); and acetabulofemoral impingement, heterotopic ossification, and a defect on the rotated ilium (one hip each).Conclusions: Painful dysplastic hips should be treated before function becomes seriously impaired. We believe that periacetabular osteotomy through a modified Ollier approach, which allows osseous cuts to be made under direct vision, can be learned readily. It provides improved femoral head coverage and relief of symptoms in most painful dysplastic hips in adolescents and young adults.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88845308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of Patient Satisfaction with Outcome After Anterior Cruciate Ligament Reconstruction","authors":"M. Kocher, J. Steadman, K. Briggs, D. Zurakowski, W. Sterett, R. Hawkins","doi":"10.2106/00004623-200209000-00008","DOIUrl":"https://doi.org/10.2106/00004623-200209000-00008","url":null,"abstract":"Background: The purpose of this study was to identify the determinants of patient satisfaction with the outcome after reconstruction of the anterior cruciate ligament.Methods: A cohort of 201 patients undergoing primary reconstruction of the anterior cruciate ligament was studied prospectively. All patients were followed for a minimum of two years (mean, 35.9 months). The dependent variable was patient satisfaction with the outcome, graded ordinally on a scale of 1 to 10. Nonparametric univariate analysis and multivariable modeling were performed to identify determinants of satisfaction.Results: The demographic variables were not found to have a significant association (p > 0.05) with patient satisfaction. The variables at surgery demonstrated a significant association (p < 0.05) with patient satisfaction only with respect to the status of the lateral meniscus, the presence of osteophytes, and concurrent plica excision. The objective variables at follow-up revealed that patients were significantly less satisfied (p < 0.05) if they had a flexion contracture, increased laxity of the involved leg on the manual maximum test as measured on a KT-1000 device, an abnormal result on the pivot-shift examination, effusion, or tenderness at the medial joint line or patella. With regard to the subjective symptoms at follow-up, patients were found to be significantly (p < 0.05) less satisfied with the outcome if they had symptoms of pain, swelling, partial giving-way, full giving-way, locking, noise, stiffness, or a limp. Analysis of the subjective function at follow-up demonstrated that patients were significantly less satisfied (p < 0.05) with the outcome if they had a lower level of activity, sports activity, strenuous work, activities of daily living, overall knee function, sports participation, or symptom-free activity; if they were unemployed; or if they had difficulty with walking, squatting, ascending or descending stairs, running, jumping, cutting, or twisting. Patient satisfaction was significantly associated (p < 0.05) with the Lysholm knee score, overall International Knee Documentation Committee (IKDC) knee score, IKDC subjective subscore, IKDC symptoms subscore, and IKDC range-of-motion subscore. The seven independent multivariate determinants (adjusted R 2 = 0.83, p < 0.001) of patient satisfaction included the Lysholm score, overall subjective knee function, IKDC range-of-motion subscale, patellar tenderness, full giving-way, flexion contracture, and swelling.Conclusions: Univariate and multivariate determinants of patient satisfaction with the outcome after reconstruction of the anterior cruciate ligament were established. Although some specific surgical and objective variables were important, subjective variables of symptoms and function had the most robust associations with patient satisfaction. In assessing the outcome of reconstruction from the perspective of patient satisfaction with the outcome, we should emphasize patient-derived subjec","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78784791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}