Determining the Patient Acceptable Symptomatic State for Patients Undergoing Arthroscopic Partial Meniscectomy in the Knee.

BACKGROUND: Arthroscopic partial meniscectomy is one of the most common procedures in orthopaedic surgery. The patient acceptable symptomatic state (PASS), which defines a level of symptoms above which patients consider themselves well, remains to be well-defined in this population. PURPOSE: Using an anchor-based approach, our goal was to determine the 1-year PASS for the Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee (IKDC) Subjective Knee Form, the Western Ontario Meniscal Evaluation Tool (WOMET), and the Marx Activity Scale (MAS) in patients who were treated with partial knee meniscectomy. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A consecutive series of patients with knee meniscal tears and a Kellgren-Lawrence grade of 0 to 2 treated with arthroscopic partial meniscectomy were eligible. The KOOS (0-100), IKDC (0-100), WOMET (0-100), and MAS (0-16) were administered at baseline and 12 months postoperatively. An external anchor question at 1 year postoperatively was used to determine PASS values. A receiver operating characteristic curve (ROC) analysis was used to determine the PASS value at which patients considered their status to be satisfactory. RESULTS: The study included 110 patients (mean ± SD age, 53.8 ± 12.0 years), 57.3% were male, and the follow-up rate was 82%. In total, 70% of patients had an Outerbridge arthroscopic grade of 2 or lower. Based on ROC analysis, the 1-year postoperative PASS values (sensitivity, specificity) were 64.3 (47.8, 100.0) for KOOS Symptoms, 81.6 (71.6, 100.0) for KOOS Pain, 82.4 (82.1, 86.4) for KOOS Function in Daily Living, 71.0 (62.7, 81.8) for KOOS Function in Sport and Recreation, 51.0 (83.6, 95.5) for KOOS Knee-Related Quality of Life, 56.2 (82.1, 100.0) for IKDC, 58.5 (79.1, 100.0) for WOMET, and 7.0 (44.8, 68.2) for MAS. Baseline scores did not affect the PASS threshold across the different instruments. However, patients with higher baseline scores were more likely to achieve the PASS for the KOOS Symptoms (odds ratio [OR], 2.808; P = .047), IKDC (OR, 4.735; P = .006), and WOMET (OR, 2.985; P = .036). Age, sex, and cartilage status were not significantly related to the odds of achieving the PASS for any of the patient-reported outcome measures. CONCLUSION: These findings allow researchers and clinicians to determine whether partial meniscectomy is meaningful to patients at the individual level and will be helpful for responder analysis in future trials related to the treatment of meniscal abnormality.

Risk of Ankle Fusion or Arthroplasty After Operatively and Nonoperatively Treated Ankle Fractures: A Matched Cohort Population Study.

OBJECTIVES: To define the risk and incidence of post-traumatic ankle arthritis requiring ankle arthroplasty or fusion after ankle fracture in a large cohort and compare that rate to matched healthy patients from the general population. DESIGN: Multiple databases were used to identify patients either treated surgically or nonsurgically for ankle fractures. Each patient was matched to 4 individuals from the general population (13.5 million) with no previous treatment for ankle fracture. Ankle fusion and replacement incidence was compared using the Kaplan-Meier analysis. MAIN OUTCOME MEASUREMENT: Incidence of arthroplasty or fusion in all patients managed for rotational ankle fractures. RESULTS: We identified 44,133 and 88,266 patients who had undergone operative management of ankle fracture (OAF) or nonoperative management of ankle fracture (NOAF) by an orthopaedic surgeon, respectively. Three hundred six (0.65%) patients who had OAF eventually underwent fusion or arthroplasty after a median 2.8 and 6.9 years, respectively. Among NOAF, n = 236 (0.17%) patients underwent fusion or arthroplasty after a median of 3.2 and 5.6 years, respectively. Surgical treatment, older age, comorbidity, and postinjury infection significantly increased the risk of fusion/arthroplasty. Compared with matched controls, the risk of fusion/arthroplasty was not independent of time, following an exponential decay pattern. OAF patient risk of fusion/arthroplasty was >20 times the general population in the 3 years after injury and approached the risk of NOAF by 14 years. CONCLUSIONS: Compared with a matched control group, and after adjustment for medical comorbidity, rotational ankle fractures requiring surgical open reduction internal fixation increased the likelihood of arthroplasty or fusion by 3.5 times. This study allows for accurate prognostication of patient risk of arthroplasty or fusion, using patient- and injury-specific risk factors, both immediately after the initial injury and then subsequently during the follow up. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Rate of and Risk Factors for Intermediate-Term Reoperation After Ankle Fracture Fixation: A Population-Based Cohort Study.

OBJECTIVE: Establish baseline rates of and risk factors for reoperation within 1 or 2 years of ankle open reduction internal fixation (ORIF). DESIGN: Retrospective, population-based cohort study. SETTING: Two hundred two hospitals in Ontario, Canada (approximate population 13.6 million in 2014). PATIENTS/PARTICIPANTS: Forty five thousand four hundred forty-four patients who underwent ankle ORIF performed by 710 different surgeons between January 1, 1994, and December 31, 2011. MAIN OUTCOME MEASUREMENTS: Intermediate-term reoperation because of isolated implant removal, repeat ORIF, irrigation and debridement (I&D) for infection, or amputation. Multivariable logistic regression related potential prognostic factors (patient, provider, and injury) to reoperation. RESULTS: There were 8906 patients who underwent at least one subsequent operation (19.6%). The most common procedure was isolated implant removal (18.1%); odds of removal being higher for females [odds ratio (OR), 1.53; 95% confidence interval (CI), 1.45-1.62; P < 0.001]. N = 674 patients (1.5%) underwent reoperation for another reason. The odds of repeat ORIF and I&D infection were greater for open fractures (OR 2.17; 95% CI, 1.22-3.86; P = 0.008 and OR 3.12; 95% CI, 1.94-5.03; P < 0.001). Odds of amputation was highest for diabetics (OR 7.42; 95% CI, 3.73-14.86; P < 0.001). CONCLUSIONS: Isolated implant removal accounts for the vast majority of intermediate-term reoperations after ankle ORIF. Reoperation for other reasons (repeat ORIF, I&D, or amputation) was extremely rare, even among the highest risk patients. Concerns regarding reoperation for these reasons should not preclude operative treatment in any patient, provider, or injury group we considered. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

The effect of hand cooling during intermittent training of elite swimmers.

BACKGROUND: The aim of this paper was to determine the effects of using intermittent hand cooling during high intensity, intermittent training on thermoregulatory, performance and psychophysical variables in elite level swimmers in a training pool (30.5±0.5 °C). METHODS: Randomized cross-over design. Following a standard warm-up, ten male swimmers (20.3±3.2 years) were instructed to maintain the fastest 100-m time (on average) for an 8 x 100 m freestyle swimming set performed either in a training pool with cooling (TPC) or a training pool with no-cooling (TPNC). Time at 100 m, core temperature (Tc), heart rate (HR), ratings of perceived exertion (RPE), thermal comfort (ThC) and thermal sensation (ThS) were recorded following each repetition. Participants were cooled during the 90 s rest interval between repetitions using the Rapid Thermal Exchange System (RTX) (AVAcore Technologies Inc., Ann Arbor, MI, USA). RESULTS: There was a better performance when comparing 100 m time (1.50±1.98 s faster) for the final repetition in the TPC condition compared to the final repetition in the TPNC condition (P<0.05). There was no significant difference between Tc, HR, RPE, ThC and ThS (P<0.05). CONCLUSIONS: There was a performance benefit in the last set of the training block in the TPC condition that could not be attributed to any of the physiological and psychophysical measures used in the study.

Effects of varying post-warm-up recovery time on 200-m time-trial swim performance.

CONTEXT: Warm-up before athletic competition might enhance performance by affecting various physiological parameters. There are few quantitative data available on physiological responses to the warm-up, and the data that have been reported are inconclusive. Similarly, it has been suggested that varying the recovery period after a standardized warm-up might affect subsequent performance. PURPOSE: To determine the effects of varying post-warm-up recovery time on a subsequent 200-m swimming time trial. METHODS: Ten national-caliber swimmers (5 male, 5 female) each swam a 1500-m warm-up and performed a 200-m time trial of their specialty stroke after either 10 or 45 min of passive recovery. Subjects completed 1 time trial in each condition separated by 1 wk in a counterbalanced order. Blood lactate and heart rate were measured immediately after warm-up and 3 min before, immediately after, and 3 min after the time trial. Rating of perceived exertion was measured immediately after the warm-up and time trial. RESULTS: Time-trial performance was significantly improved after 10 min as opposed to 45 min recovery (136.80 +/- 20.38 s vs 138.69 +/- 20.32 s, P < .05). There were no significant differences between conditions for heart rate and blood lactate after the warm-up. Pre-time-trial heart rate, however, was higher in the 10-min than in the 45-min rest condition (109 +/- 14 beats/min vs 94 +/- 21 beats/min, P < .05). CONCLUSIONS: A post-warm-up recovery time of 10 min rather than 45 min is more beneficial to 200-m swimming time-trial performance.