Trends in PROMIS Scores in the Early Post-operative Period following Various Lateral Ankle Ligament Reconstructive Techniques

Introduction/Purpose: Lateral ankle ligament injuries are common conditions accounting for 25% of musculoskeletal injuries. When conservative management fails and chronic instability ensues, operative treatment is often sought. Though surgical outcomes are generally good following lateral ankle ligament reconstruction, literature suggests current scoring systems for evaluating outcomes and monitoring progression have deficiencies. Patient Reported Outcomes Measurement Information (PROMIS) scores have recently been established as a method of monitoring patient outcomes. The purpose of this study was to evaluate the trends in post-operative PROMIS physical function (PF), pain interference (PI), and depression scores in patients undergoing lateral ankle ligament reconstruction

Subtle Cavus Deformities: Is Isolated Lateral Ankle Ligament Reconstruction Enough for Improved Patient-reported Outcomes?

Introduction/Purpose: Lateral ankle ligament injuries are common conditions accounting for 25% of musculoskeletal injuries. Prior reports have found increased risk of failed lateral ankle reconstruction in those with a subtle cavus deformity, and therefore, correcting the deformity is often advocated. However, other studies have been unable to identify subtle cavus deformity as a clear risk factor for recurrent injury. The purpose of this study was to 1) compare PROMIS physical function (PF), pain interference (PI), and depression scores in patients with subtle cavus deformities to those without deformity who underwent lateral ankle ligament reconstruction, 2) compare PROMIS scores in allograft and modified Brostrom-Gould (BG) reconstructions in those with subtle cavus, and 3) to evaluate for any post-operative complications in those with subtle cavus

When are the Patients Satisfied with Their Outcome? Correlation of PROMIS Values with Patient Acceptable Symptom State (PASS) Scores in Foot and Ankle Patients

Introduction/Purpose: PROMIS values are being adopted due to ease of use and influence on clinical decision making. Studies support the use of PROMIS physical function (PF), pain interference (PI), and Depression (D) for pre-surgical decision making. Patient Acceptable Symptom State (PASS) is a validated outcome measure commonly used in other areas of medicine and surgery that captures when patient’s symptoms reach a daily acceptable level. Knowing what PROMIS scores are associated with a patient’s PASS(Yes)/(No) rating would further enhance the use of PROMIS scales. The purpose of this study: 1) association of PROMIS scales with a PASS rating, 2) threshold values of PROMIS PF, PI, D associated with PASS rating, and 3) whether PROMIS, and patient demographics are predictive of a PASS rating

Land Use Planning & Historic Preservation Property Assessment Tool in New Orleans: The Algiers Main Street Demonstration Project

Service-learning is a critical component of the student-centered education model at the University of New Orleans (UNO). For students to apply their knowledge activities within, classes are developed to provide technical service and experiential knowledge for community organizations. In the fall of 2017 students in the MURP 4050/5050 “Urban Land Use Planning & Plan Making” course combined their recently acquired knowledge of how policy affects the use of applying new planning tools in practice. Specifically, the course focused on the application of Federal and State policies for identifying and evaluating the significance of properties under Historic Preservation (HP) guidelines. This training was complemented with the WhoData property survey (PS) methodology & image inventory which evaluated the use, condition, location in combination with public data identification sources. In the fall of 2016 an initial field study in the French Quarter consolidated the HP and PS models but not in a consolidated fashion. The Algiers Historic Preservation Assessment & Land Use Planning Survey demonstration project is the first study which integrates the tools and techniques from two fields of study into a single model that can be replicated nationally. The students in MURP 4050/5050 aided in using, evaluating and improving the tools by applying their knowledge to an active project. Initially the demonstration project was aimed at providing the initial documentation and an implementation plan to expand the existing Algiers Historic District. However, the scope of work had to be changed. The ability to create the resources necessary would not be developed properly without additional training by the course team without further training on historic preservation theory and application. As a result, additional teaching resources were obtained which provided guidance on how to conduct historic property research (The New Orleans Historic Collection), conducting HP & LUP surveys in Algiers (Jennie Garcia, MURP ’17) and State/Federal Historic Preservation guidelines (LA State Historic Preservation Office). The students moved to the role of Planning Analyst in order to complete the research and reporting required to complete the preliminary analysis necessary for community organizations, such as the Algiers Main Street Corporation, to consider the benefits of historic district expansion and the cost of developing the documents to do s

Pattern of Recovery and Outcomes of Patient Reported Physical Function and Pain Interference After Ankle Fusion: A Retrospective Cohort Study

Background: Research on outcomes after ankle fusion focuses on basic activities of daily living, fusion rates, and gait parameters. Little has been reported on the patient’s perspective after surgery. The purpose of this study was to determine the change in patient reported physical function and pain interference after ankle fusion surgery to guide patient expectations and improve provider communication. Methods: This was a retrospective review of prospectively collected patient reported outcome measurement information system (PROMIS) data in 88 ankle arthrodesis procedures performed from May 2015 to March 2018. The PROMIS Physical function (PF) and pain interference (PI) measures were collected as routine care. Linear mixed models were used to assess differences at each follow-up point for PF and PI. Preoperative to last follow-up in the 120–365 day interval was assessed using analysis of variance. Outcomes included T-scores, z-scores, and PROMISPreference (PROPr) utility scores for PF and PI and the percentage of patients improving by at least 4 T-score points. Results: The linear mixed model analysis for PF after the 120–149 days, and for PI, after 90–119 days, indicated recovery plateaued at 39–40 for PF and 57–59 for PI T-scores. The change in the PI T-score was the greatest with a mean T-score improvement of − 5.4 (95% CI − 7.7 to − 3.1). The proportion of patients improving more than 4 points was 66.2% for either PF or PI or both. The change in utility T-scores for both PF (0.06, 95% CI 0.02 to 0.11) and PI (0.15, 95% CI 0.09 to 0.20) was significantly improved, however, only PI approached clinical significance. Conclusion: Average patients undergoing ankle fusion experience clinically meaningful improvement in pain more so than physical function. Average patient recovery showed progressive improvement in pain and function until the four-month postoperative time point. Traditional dogma states that recovery after an ankle fusion maximizes at a year, however based on the findings in this study, 4 months is a more accurate marker of recovery. A decline in function or an increase in pain after 4 months from surgery may help to predict nonunion and other complications after ankle arthrodesis. Level of evidence: Level II, prospective single cohort study

Clinical Utilization of Patient Reported Outcome (PROMIS) Scores for Surgical Reconstruction of Posterior Tibialis Tendon Dysfunction

Introduction/Purpose: Previous studies have demonstrated that preoperative Patient Reported Outcome Instrumentation System (PROMIS) scores effectively predict improvement in foot and ankle surgery. Adult acquired flatfoot deformity (AAFD) and Posterior Tibialis Tendon Dysfunction (PTTD) are a common surgical problem, but it is unclear if the specific thresholds for the physical function (PF), pain interference (PI) and depression published previously for all foot and ankle surgeries apply to a specific diagnosis. Furthermore, the interplay of PROMIS scores and clinical variables has not been evaluated. The purpose of this study was: 1) to investigate the change in PROMIS scales and radiographic measurements from pre- to postoperative follow up in AAFD/PTTD patients, 2) to determine if preoperative PROMIS scales predict post-surgical improvement, 3) to determine if demographic, clinical variables combined with pre-operative PROMIS scales predict post-surgical improvement

Determining Success or Failure After Foot and Ankle Surgery Using Patient Acceptable Symptom State (PASS) and Patient Reported Outcome Information System (PROMIS)

Background: As the role of generic patient-reported outcomes (PROs) expands, important questions remain about their interpretation. In particular, how the Patient Reported Outcome Measurement Instrumentation System (PROMIS) t score values correlate with the patients’ perception of success or failure (S/F) of their surgery is unknown. The purposes of this study were to characterize the association of PROMIS t scores, the patients’ perception of their symptoms (patient acceptable symptom state [PASS]), and determination of S/F after surgery. Methods: This retrospective cohort study contacted patients after the 4 most common foot and ankle surgeries at a tertiary academic medical center (n = 88). Patient outcome as determined by phone interviews included PASS and patients’ judgment of whether their surgery was a S/F. Assessment also included PROMIS physical function (PF), pain interference (PI), and depression (D) scales. The association between S/F and PASS outcomes was evaluated by chi-square analysis. A 2-way analysis of variance (ANOVA) evaluated the ability of PROMIS to discriminate PASS and/or S/F outcomes. Receiver operator curve (ROC) analysis was used to evaluate the ability of pre- (n = 63) and postoperative (n = 88) PROMIS scores to predict patient outcomes (S/F and PASS). Finally, the proportion of individuals classified by the identified thresholds were evaluated using chi-square analysis. Results: There was a strong association between PASS and S/F after surgery (chi-square \u3c0.01). Two-way ANOVA demonstrated that PROMIS t scores discriminate whether patients experienced positive or negative outcome for PASS (P \u3c .001) and S/F (P \u3c .001). The ROC analysis showed significant accuracy (area under the curve \u3e 0.7) for postoperative but not preoperative PROMIS t scores in determining patient outcome for both PASS and S/F. The proportion of patients classified by applying the ROC analysis thresholds using PROMIS varied from 43.0% to 58.8 % for PASS and S/F. Conclusions: Patients who found their symptoms and activity at a satisfactory level (ie, PASS yes) also considered their surgery a success. However, patients who did not consider their symptoms and activity at a satisfactory level did not consistently consider their surgery a failure. PROMIS t scores for physical function and pain demonstrated the ability to discriminate and accurately predict patient outcome after foot and ankle surgery for 43.0% to 58.8% of participants. These data improve the clinical utility of PROMIS scales by suggesting thresholds for positive and negative patient outcomes independent of other factors. Level of Evidence: II, prospective comparative series

PROMIS Pain Interference Is Superior vs Numeric Pain Rating Scale for Pain Assessment in Foot and Ankle Patients

Background: The Numeric Pain Rating Scale (NPRS) is a popular method to assess pain. Recently, the Patient-Reported Outcomes Measurement Information System (PROMIS) has been suggested to be more accurate in measuring pain. This study aimed to compare NPRS and PROMIS Pain Interference (PI) scores in a population of foot and ankle patients to determine which method demonstrated a stronger correlation with preoperative and postoperative function, as measured by PROMIS Physical Function (PF). Methods: Prospective PROMIS PF and PI and NPRS data were obtained for 8 common elective foot and ankle surgical procedures. Data were collected preoperatively and postoperatively at a follow-up visit at least 6 months after surgery. Spearman correlation coefficients were calculated to determine the relationship among NPRS (0-10) and PROMIS domains (PI, PF) pre- and postoperatively. A total of 500 patients fit our inclusion criteria. Results: PROMIS PF demonstrated a stronger correlation to PROMIS PI in both the pre- and postoperative settings (preoperative: ρ = −0.66; postoperative: ρ = −0.69) compared with the NPRS (preoperative: ρ = −0.32; postoperative: ρ = −0.33). Similar results were found when data were grouped by Current Procedural Terminology (CPT) code. Conclusion: PROMIS PI was a superior tool to gauge a patient’s preoperative level of pain and functional ability. This information may assist surgeons and patients in setting postoperative functional expectations and pain management. Level of Evidence: Level II, prognosti

Is there a Difference in Outcomes between Patients who Received a Double or Triple Arthrodesis for Hindfoot Arthritis?

Introduction/Purpose: Triple arthrodesis has historically been considered the standard of treatment for arthritis of the hindfoot with or without deformity. The complications of this surgery including non-union, malunion, nerve injury, infection and wound healing problems can occur at any of the three joints. Double arthrodesis is capable of producing a similar reduction in degrees of motion and correction of foot deformity but may also cause less patient morbidity in regard to these complications due to one less joint being incorporated into the fusion procedure. What is unknown is the patient reported outcomes, specifically physical function (PF) and pain interference (PI) between these two procedures. The purpose of this study is to evaluate the clinical outcomes for hindfoot deformity using a triple compared to a double arthrodesis

Percentage of Articular Surface Debridement is Equivalent in Arthroscopic and Open Ankle Fusions

Category: Ankle Arthritis, Arthroscopy Introduction/Purpose: Tibiotalar arthrodesis is a reliable option in the treatment of end-stage ankle arthritis and both open and arthroscopically assisted techniques are well described. When compared head to head, multiple studies have demonstrated advantages of arthroscopic arthrodesis over open fusions including decreased morbidity, and shorter hospital stays while achieving equivalent or increased rates of fusion. It is unclear why arthroscopic fusion may be favorable to open surgery, however, it is hypothesized that patient selection and soft tissue trauma may play a role. No study, however, has evaluated the extent of articular debridement afforded by each technique. The purpose of this study was to evaluate the amount of articular cartilage denuded via open arthrodesis and via arthroscopic arthrodesis with time of procedure evaluated as a secondary measure. Methods: Six matched sets of fresh frozen cadaver lower extremities were acquired for study. One limb from each set was randomly assigned to open articular debridement while the other limb was assigned to arthroscopic debridement. The duration of each procedure was timed. The tibiotalar joints were disarticulated following debridement and the talus was dissected free of all soft tissue attachments. Photographs of the weight bearing portion of the articular surfaces were then taken and residual cartilage was mapped using ImageJ software. The percentage of the joint debrided was determined by the area of denuded bone divided by the total area of the articular surface to allow for comparison across specimens. The mapping process was blinded to the type of debridement undertaken. Repeated measurements were taken to determine intra- and inter-reliability of the measurements. Student t-tests were used to compare the percentage of joint debrided and differences in time of the procedure. Results: The average percentage of cartilage debrided in the arthroscopic procedure was 88.99+11.19% for the tibial plafond and 88.84.08+5.45% for the talar dome. For the open procedure, 82.93+6.91% of the tibial plafond was debrided and 84.08+5.45% of the talar dome was debrided. There were no significant differences of the tibia or talus between the open and arthroscopic procedures (p>0.05). Inter- and intra-reliability were calculated for all measurements with r>.8. There was a significant difference in the time of the procedure with the arthroscopic debridement taking 50.17+5.57 minutes to complete while the open debridement took 30.67+5.16 minutes to complete (p<0.01). Conclusion: There were no differences in the percentage of articular surface debrided when comparing arthroscopic versus open arthrodesis of the ankle joint in cadaver specimens. The arthroscopic debridement took significantly longer, however this difference may be offset by a decrease in time required for wound closure. Furthermore, an increased time of debridement may be warranted if it results in decreased wound complications and pain. The results of this study support previous clinical findings that arthroscopic debridement can yield fusion rates comparable to, or better, than open debridement of the ankle joint