ABSTRACT
BACKGROUND: Previous studies have examined the impact of resiliency on postoperative outcomes in other orthopedic domains, but none to date have done so for hand surgery. METHODS: We performed a retrospective analysis of prospectively collected data of patients undergoing hand surgery at a single institution. We included patients with complete preoperative outcomes scores and 6-month follow-up. All patients completed the Brief Resilience Scale (BRS), Disabilities of the Arm, Shoulder, and Hand (DASH) Score, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Veterans RAND 12-Item Health Survey (VR-12), and Numeric Rating Scale (NRS) for pain. Patients were stratified into high-resiliency (HR) and low-resiliency (LR) groups based on the preoperative BRS score, and outcomes between groups were compared. RESULTS: We identified 91 patients who underwent hand procedures and completed full preoperative and postoperative outcomes measures. There were no observed preoperative differences between the groups in all outcomes scores except the VR-12 Mental Component Score. Postoperatively, the HR group had superior DASH, QuickDASH, and VR-12 (mental and physical component) scores than the LR group. Postoperative pain, as measured by the NRS, was significantly lower in the HR group despite there being no preoperative difference. A larger percentage of patients in the HR group met the minimal clinically important difference in all outcomes except for the VR-12 Mental Component Scores. CONCLUSIONS: Patients with high preoperative resilience appear to have significantly better clinical outcomes following hand surgery with superior DASH, QuickDASH, and VR-12 scores at 6-month follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic study/Level IV evidence.
ABSTRACT
BACKGROUND: It is not known how peroneal tendon exploration influences results after modified Broström for lateral ankle instability. We propose peroneal exploration at the time of modified Broström will have similar outcomes as no peroneal exploration. METHODS: A retrospective analysis was performed of patients undergoing modified Broström with and without peroneal exploration. Foot and Ankle Outcome scores and data regarding military retention were gathered and compared. RESULTS: Seventeen patients were identified in the modified Broström only cohort and 24 in the peroneal exploration cohort. Patients had mean follow-up of 5 years in both cohorts. The mean FAOS in the modified Broström only cohort was 68 and 72 in the cohort with peroneal exploration (P = .541). When each FAOS subcategory was analyzed, no difference was identified in any subcategory. Eight of 17 patients (47%) in the modified Broström only cohort remained active duty compared with 8 of 24 patients (33%) in the modified Broström with peroneal exploration cohort (P = .518). One patient medically discharged in the modified Broström only cohort versus 6 in peroneal exploration cohort (P = .109). Overall satisfaction with the procedure was 12 of 17 (71%) in the modified Broström only cohort and 19 of 24 (79%) in the peroneal exploration cohort (P = .529). CONCLUSIONS: No significant difference was identified between patients undergoing modified Broström alone or modified Broström with peroneal exploration. There was no significant difference in return to duty, medical discharge or patient satisfaction. LEVELS OF EVIDENCE: Level III: retrospective case-control study with prospectively collected data.
ABSTRACT
INTRODUCTION: Resilience is a psychometric construct of a patient's ability to recover from adversity and has been used to predict outcomes but its use in orthopedics has been limited. The purpose of this study was to examine the association between resilience and outcomes. MATERIALS AND METHODS: We performed a retrospective analysis of prospectively collected data of patient who underwent sports knee surgery at a single institution performed by 6 orthopedic surgeons from January 2017 to December 2017. We included active-duty patients with complete preoperative outcomes and a minimum of 6 month follow-up. All patients completed the Brief Resilience Scale (BRS), Veteran's Rand-12 (VR-12), Patient-Reported Outcomes Measurement Information System 43 (PROMIS-43), International Knee Documentation Committee function score (IKDC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Patients were divided into low resilience (LR) and high resilience (HR) groups based on a score of less than 24 for low and greater than or equal to 24 according to BRS. Outcomes were then compared. RESULTS: We identified 50 active-duty patients who had complete preoperative and postoperative outcomes at a minimum of 6 months. Mean preoperative and postoperative BRS were significantly different (25.8 HR v 18.6 LR, p < 0.001). We found a difference in postop KOOS in pain, sports, and short form (pain 70.9 HR v 55.7 LR, p = 0.03; sports 50.3 HR v 32.2 LR, p = 0.03; short form (72.1 HR v 62.5 LR, p = 0.04). Similarly, there was a significant difference in postoperative IKDC score (58.0 HR v 44.0 LR, p = 0.03). Similarly we found significant differences in postoperative PROMIS-43 (anxiety 44.4 HR v 60.3 LR, p = 0.004; depression 41.6 HR v 58.1 LR, p = 0.004; fatigue 45.1 HR v 58.6 LR, p = 0.001; sleep 52.6 HR v 62.5 LR, p = 0.02; social participation 36.2 HR v 47.6 LR, p < 0.001). Postoperative VR-12 mental was also statistically different between the two groups (53.5 HR v 41.6 LR; p = 0.01). In addition, 2.3% of the HR group changed MOS as a result of their sports knee surgery compared to 22.2% of the LR group. CONCLUSIONS: Active-military patients with high preoperative resilience appear to have significantly better early postoperative outcomes following sports knee surgery in terms of PROMIS-43, KOOS, and IKDC. There was also a lower rate of changing MOS secondary to sports knee surgery in patients with high resilience.
