Preoperative Oswestry Disability Index Cannot Reliably Predict Patient Satisfaction After Single and Double Level Lumbar Transforaminal Interbody Fusion Surgery.

Introduction: The role of patient-reported outcomes in preoperative assessment is not well studied. There is recent interest in studying whether Patient-reported outcomes scores can be used either independently, or in conjunction with clinical findings, in the assessment of patients for surgery. Aims: To investigate if improvement in clinically significant scores correlate with post-operative patient satisfaction in 1-2 level transforaminal lumbar interbody fusion (TLIF) surgery. We also aim to define a threshold Oswestry Disability Index (ODI) which correlate with achieving post-operative MCID and patient satisfaction. Methods: 1001 patients who underwent single or double level TLIF (Minimally invasive and Open) in our institution with at least 2 years follow up were included in this study. We studied self-reported measures including patient satisfaction and ODI score. Results: At 2-year follow-up, the overall mean ODI score improved from 49.7 ± 18.3 to 13.9 ± 15.2 (P < 0.001) with 74.6% of patients meeting the MCID. Patient satisfaction was achieved in 95.3% of all patients. In the MIS group, the preoperative cut-off was determined to be 37.2 at maximal Youden index associated with AUC of 0.72 (95% CI 0.65-0.86). In the open group, the preoperative cut-off was determined to be 37.2 at maximal Youden index associated with AUC of 0.70 (95% CI 0.62-0.77). Using the preoperative cut-offs found, there was no significant difference in patient satisfaction in both MIS and open groups. Conclusions: Overall, our patients undergoing TLIF had good 2-year ODI score improvement and patient satisfaction after surgery. While meeting the MCID for ODI score correlates with patients' satisfaction postoperatively, 75% of patients not meeting the MCID for ODI score remained satisfied with the surgery. We are unable to define a threshold pre-operative ODI which correlates with achieving post-operative MCID and patient satisfaction.

Effect of leg dominance on early functional outcomes and return to sports after anterior cruciate ligament reconstruction.

INTRODUCTION: The effect of leg dominance on anterior cruciate ligament (ACL) injuries has been studied with some studies noting a propensity for injuries in the non-dominant leg. Its effect on post-ACL reconstruction recovery, however, is not well known. The authors hypothesize that dominant limb injuries undergo rehabilitation faster and positively affect early functional outcome scores and return to sports and set about studying these effects. METHODS: This is a retrospective study of 254 patients from a single institution who underwent ACL reconstruction for acute ACL ruptures and the results were compared between patients with dominant and non-dominant limb injuries. Objective measurements including the KT-1000, single-leg hop distance and Biodex knee extension peak torque were used to evaluate recovery. Pre- and post-operative functional outcome scores such as the International Knee Documentation Committee (IKDC), Tegner activity score and Lysholm knee scale were documented. RESULTS: Early functional outcomes were similar. Minimal clinically important difference (MCID) improvement in IKDC scores was achieved in 69.7% of the dominant versus 66.0% of the non-dominant injury group (p = 0.99), 75.2% versus 79.6% (p = 0.45) for the Lysholm knee scale, and 81.6% versus 84.9% (p = 0.50) for the Tegner activity score. The majority of patients in both subgroups had a return of at least 80% of peak knee flexion and extension peak torque at 5.4 months post-operatively; 92.9% of subjects with a non-dominant leg injury and 87.2% with a dominant leg injury had returned to their pre-injury sports 1 year from surgery. CONCLUSIONS: Results from this study suggest that despite theoretical differences, leg dominance does not have a significant impact on short-term functional outcomes and return to sports. Objective measurements suggest that limb strength recovers at a comparable rate. Injuries to either leg demonstrate equally positive improvement post-ACL reconstruction given the same post-operative rehabilitation. LEVEL OF EVIDENCE: III, retrospective comparative study. LEVEL OF EVIDENCE: III, retrospective cohort study.

A Biomechanical Study Comparing Cerclage Wiring Performed with a Power Tool versus the Manual Method.

INTRODUCTION: We conducted a biomechanical study comparing cerclage wiring using a power tool with the traditional manual method. MATERIALS AND METHODS: Our study consisted of 4 experimental arms based on the method of fixation and diameter of wires. The 4 arms were: 1) power tool method using 0.8 mm cerclage wires, 2) power tool method using 1.0 mm cerclage wires, 3) conventional manual method using 0.8 mm cerclage wires, and 4) conventional manual method using 1.0 mm cerclage wires. Synthetic femur bones were employed in our study. Six specimens were prepared for each arm. Each specimen was cut lengthwise and pressure sensors were placed in between. For the power tool method, while maintaining tension, wires were coiled using the Colibri power tool until just before secondary coiling occurred. For the conventional manual method, each specimen was compressed by plier twisting for 10 rounds, while maintaining tension. Cerclaging and data recording was done thrice for each specimen, giving a total of 18 readings per arm. Peak and steady-state forces were recorded. RESULTS: There was no significant difference between the peak forces recorded between the power drill and manual methods. The steady-state forces achieved using the power tool method were significantly higher than that achieved in the manual fixation method (0.8 mm wires: 54.89N vs 27.26N, P = 0.037; 1.0 mm wires: 71.59N vs 39.66N, P = 0.025). CONCLUSION: The power tool method achieved a superior steady-state force of compression across the fracture site for both 0.8 mm and 1 mm wires.