Longitudinal Invariance Testing Of The Knee Injury Osteoarthritis Outcome Score For Joint Replacement Scale (KOOS-JR)

# Background The Knee Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) is a seven-item patient reported outcome measure used to assess perceived knee health. Though commonly used, the longitudinal psychometric properties of the KOOS-JR have not been established and further characterization of its structural validity and multi-group invariance properties is warranted. # Purpose The purpose of this study was to evaluate psychometric properties of the KOOS-JR in a large sample of patients who received care for knee pathology. # Study Design Original research. # Methods Longitudinal data extracted from the Surgical Outcome System (SOS) database of 13,470 knee pathology patients who completed the KOOS-JR at baseline, three-months, six- months, and one-year. Scale structure was assessed with confirmatory factor analysis (CFA), while multi-group and longitudinal invariance properties were assessed with CFA-based procedures. Latent group means were compared with statistical significance set at α ≤ .05 and Cohen’s d effect size as d = 0.2 (small), d = 0.5 (medium), and d = 0.8 (large). # Results CFA results exceeded goodness-of-fit indices at all timepoints. Multi-group invariance properties passed test requirements. Longitudinal analysis identified a biased item resulting in removal of item #1; the retained six-item model (KOOS-JR-6) passed longitudinal invariance requirements. KOOS-JR-6 scores significantly changed over time (p ≤ .001, Mdiff = 1.08, Cohen’s d = 0.57): the highest scores were at baseline examination and the lowest at 12-month assessment. # Conclusions The KOOS-JR can be used to assess baseline differences between males and females, middle and older aged adults, and patients receiving total knee arthroplasty or non-operative care. Caution is warranted if the KOOS-JR is used longitudinally due to potential measurement error associated with item #1. The KOOS-JR-6 may be a more viable option to assess change over time; however, more research is warranted. # Level of Evidence 3 © The Author(s

Evaluating Psychometric Properties of the International Knee Documentation Committee Subjective Knee Form in a Heterogeneous Sample of Post-Operative Patients

# Background The International Knee Document Committee Subjective Knee Form (IKDC-SKF) is a patient-reported outcome measure used in orthopedics and sports medicine. Further psychometric assessment is necessary to confirm measurement properties in a large, heterogenous sample. # Purpose The purpose of the study was to assess the psychometric properties of the IKDC-SKF in a large, heterogenous sample. # Study Design Cross-Sectional Study # Methods An exploratory factor analysis (EFA) was conducted to identify a sound latent structure and to assess internal consistency in a large sample of patients who underwent knee arthroscopy. A confirmatory factor analysis (CFA) was conducted to confirm structural validity. Multi-group invariance was conducted to assess factorial stability across sex and age groups, while longitudinal invariance procedures were performed to assess stability over time. # Results A 3-factor, 9-item IKDC-SKF short form was identified with EFA procedures. The model was confirmed with CFA (CFI = 0.983; TLI = 0.975; IFI = 0.983; RMSEA = 0.057), while a sound 2-factor, 6-item model was also identified (CFI = 1.0; TLI = 0.999; IFI = 1.0; RMSEA = 0.11). The 9-item IKDC-SKF short form was invariant across groups but not time; removal of a single item (i.e., 8-item IKDC-SKF short form) resulted in longitudinal invariance. The 6-item IKDC-SKF short form was invariant across groups and time. # Conclusion The 6-item, 8-item, and 9-item short form versions of the IKDC-SKF exceed contemporary fit recommendations and present as plausible alternatives to the IKDC-SKF with improved measurement properties, reduced scale response burden, and evidence of multi-group and longitudinal invariance. Further, the 6- and 8-item IKDC-SKF short forms may be used to assess group differences or change across time. # Level of evidence here Level 3 ©The Author(s

High-resolution Infrared Imaging and Spectroscopy of the Z Canis Majoris System during Quiescence and Outburst

We present adaptive optics photometry and spectra in the JHKL bands along with high spectral resolution K-band spectroscopy for each component of the Z Canis Majoris system. Our high angular resolution photometry of this very young (≾1 Myr) binary, comprised of an FU Ori object and a Herbig Ae/Be star, was gathered shortly after the 2008 outburst while our high-resolution spectroscopy was gathered during a quiescent phase. Our photometry conclusively determines that the outburst was due solely to the embedded Herbig Ae/Be member, supporting results from earlier works, and that the optically visible FU Ori component decreased slightly (~30%) in luminosity during the same period, consistent with previous works on the variability of FU Ori type systems. Further, our high-resolution K-band spectra definitively demonstrate that the 2.294 μm CO absorption feature seen in composite spectra of the system is due solely to the FU Ori component, while a prominent CO emission feature at the same wavelength, long suspected to be associated with the innermost regions of a circumstellar accretion disk, can be assigned to the Herbig Ae/Be member. These findings clarify previous analyses of the origin of the CO emission in this complex system

Assessing the Structural Validity of the Knee Injury and Osteoarthritis Outcome Score Scale

Background: The Knee Injury and Osteoarthritis Outcome Score (KOOS) scale is used to assess patient perspectives on knee health. However, the structural validity of the KOOS has not been sufficiently tested; therefore, our objective was to assess the KOOS in a large, multi-site database of patient responses who were receiving care for knee pathology. Methods: A cross-sectional study was conducted using the Surgical Outcome System (SOS) database. A confirmatory factor analysis (CFA) was conducted to assess the proposed five-factor KOOS using a priori cut-off values. Because model fit indices were not met, a subsequent exploratory factor analysis (EFA) was conducted to identify a parsimonious model. The resulting four-factor structure (i.e., KOOS SF-12) was then assessed using CFA and subjected to multigroup invariance testing. Results: The original KOOS model did not meet rigorous CFA fit recommendations. The KOOS SF-12 did meet model fit recommendations and passed all invariance testing between intervention procedure, sex, and age groups. Conclusion: The KOOS failed to meet model fit recommendations. The KOOS SF-12 met model fit recommendations, maintained a multi-factorial structure, and was invariant across all tested groups. The KOOS did not demonstrate sound structural validity. A refined KOOS SF-12 model that met recommended model fit indices and invariance testing criteria was identified. Our findings provide initial support for a multidimensional KOOS structure (i.e., KOOS SF-12) that is a more psychometrically sound instrument for measuring patient-reported knee health

Endoscopic Implantation of Bioinductive Patch for Chronic Partial Retearing After Hamstring Repair

Proximal hamstring tendon avulsions are a relatively rare type of hamstring injury associated with persistent morbidity, including pain, weakness, and functional limitations. Open or endoscopic surgical repair is the standard treatment for complete tendon avulsions or partial tears that remain symptomatic despite conservative management in relatively young, healthy, and active patients. However, complications known to occur include retearing of the hamstring, infection, nerve injury, inability to return to work or sport, subjective persistent weakness, and subjective persistent pain. In the case of persistent pain where the repair is partially retorn, a careful history, physical examination, and scrutiny of radiologic studies can help guide management. We describe a technique for using revision endoscopy and augmentation with a bovine bioinductive patch in a case of chronic persistently painful partial retear after a proximal hamstring repair

Psychometric analysis of the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS-JR)

Objective: Centers for Medicare and Medicaid Services (CMS) has requested hospitals collect and report patient-reported outcomes (PROs) beginning in 2024 including the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS-JR). However, scale structural validity of the HOOS-JR has minimally been assessed. The purpose of this study was to assess internal consistency, structural validity, and multi-group invariance properties of the HOOS-JR in a large sample of patients who underwent a total hip arthroplasty (THA). Methods: A cross-sectional study using the Surgical Outcomes System was retrospectively queried for patients who underwent a THA. Internal consistency was assessed using Cronbach's alpha and McDonald's Omega. A confirmatory factor analysis (CFA) was performed on the HOOS-JR using a priori cut-off values. Multi-group invariance testing was also performed on the sample of patients across sex and age groups. Results: Internal consistency was acceptable for 6-item (alpha ​= ​0.88; omega ​= ​0.88) and 5-item (alpha ​= ​0.86; omega ​= ​0.86) HOOS-JR. The one-factor, 6-item CFA did not meet the recommended fit indices. The one-factor, 5-item CFA had acceptable fit for the sample data. Invariance testing criteria were met between the age groups; however, scalar invariance was not met for sex. Conclusion: The 6-item HOOS-JR did not meet contemporary model fit indices indicating that scale refinement is warranted. The 5-item met most goodness-of-fit indices and invariance criteria. However, further scale refinement may be warranted as localized fit issues were identified

Outside-In Capsulotomy of the Hip for Arthroscopic Pincer Resection

Hip surgical techniques have evolved significantly, transitioning from open techniques to arthroscopic techniques. Hip arthroscopy has many advantages over open techniques, including reduced trauma to surrounding tissues, reduced risk of infection, and improved patient-reported outcome measures. Hip arthroscopic techniques are now commonly used for pathologies such as femoroacetabular impingement (FAI). FAI can include cam, pincer, or mixed impingement. Through hip arthroscopy, FAI may be treated with a femoroplasty and acetabuloplasty along with addressing any labral pathology that may exist. Owing to the capsule playing an integral role in hip stability, surgeons are now mindful of the initial approach and closure on completion of the intra-articular procedure. The most common approach for capsulotomy is the inside-out approach. However, this approach can be difficult in patients with a large pincer deformity. The authors describe an outside-in approach to arthroscopic hip capsulotomy. This capsular approach helps protect the labrum and articular cartilage while preserving capsular tissue