7 research outputs found
Cartilage restoration of patellofemoral lesions: a systematic review
Purpose
This study aimed to systematically analyze the postoperative clinical, functional, and imaging outcomes, complications, reoperations, and failures following patellofemoral cartilage restoration surgery.
Methods
This review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, EMBASE, and Cochrane Library databases were searched up to August 31, 2018, to identify clinical studies that assessed surgical outcomes of patellofemoral cartilage restoration surgery. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess study quality.
Results
Forty-two studies were included comprising 1,311 knees (mean age of 33.7 years and 56% males) and 1,309 patellofemoral defects (891 patella, 254 trochlear, 95 bipolar, and 69 multiple defects, including the patella or trochlea) at a mean follow-up of 59.2 months. Restoration techniques included autologous chondrocyte implantation (56%), particulated juvenile allograft cartilage (12%), autologous matrix-induced chondrogenesis (9%), osteochondral autologous transplantation (9%), and osteochondral allograft transplantation (7%). Significant improvement in at least one score was present in almost all studies and these surpassed the minimal clinically important difference threshold. There was a weighted 19%, 35%, and 6% rate of reported complications, reoperations, and failures, respectively. Concomitant patellofemoral surgery (51% of patients) mostly did not lead to statistically different postoperative outcomes.
Conclusion
Numerous patellofemoral restoration techniques result in significant functional improvement with a low rate of failure. No definitive conclusions could be made to determine the best surgical technique since comparative studies on this topic are rare, and treatment choice should be made according to specific patient and defect characteristics
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Wednesday, September 26, 2018 2:00 PM – 3:00 PM Integrating Technology into Practice: 58. Validity of the Fundamental of Spinal Surgery (FOSS) simulator as a teaching tool for orthopedic and neurosurgical trainees
While all surgical disciplines require years of study to acquire knowledge and experience, surgical trainees must also develop the necessary psychomotor skills to perform surgical procedures. To date, there are limited validated tools to objectively assess trainees as they progress through their education. Pedicle screw placement is a demanding surgical skill set to learn and teach as challenges such as variations in pedicle morphology and spinal deformities can be encountered. Available CT simulators for pedicle placement can be costly and hands on cadaver courses are limited by specimen availability.
We sought to develop a cost-effective training tool that could be used by all orthopedic and neurosurgical residencies.
Multicenter study (four academic institutions).
Orthopedic and neurosurgery residents and spine attending surgeons are recruited.
Outcomes measures include the scores for all three tasks and the time taken to complete the tasks.
After IRB approval, a low cost spine simulator ($30.00) was created to test three main skill sets all pertaining to the task of placing a pedicle screw: ability to find appropriate trajectory, ability to navigate down the isthmus of a pedicle, and ability to recognize wall penetrations. Residents as well as spine attending surgeons were recruited to participate from four different institutions. Each participant was given three tasks to complete. Task 1 entails creation of the pedicle screw path with a standard gearshift probe, with the number of “cortical breaks” being recorded. Task 2 entails testing the ability to palpate for the presence or absence of wall defects. Task 3 is the ability to determine the location of wall defects. The number of correct answers for task 2 and 3 are recorded.
The ability to differentiate between surgical residents and master spine surgeons was obtained. In all tasks, spine attending surgeons scored higher than residents. Attending surgeons reported that FOSS simulator is a good tool which can be beneficial for training surgical residents in terms of tactile feedback and directionality of probe and pedicle placement. Moreover, the FOSS stimulator also allowed participants the ability to feel the difference between young cortical bone versus osteoporotic bone. Eighty-one percent of the spine attending surgeons reported that they would use this educational technology in the future for training purposes. Eighty-four percent of all residents, and 100% of PGY1 residents reported that they would use FOSS simulator for training.
Recent published work has demonstrated the role of low cost tools for teaching and testing psychomotor skills in orthopedic surgery. Here, we developed the next tool to be used for spine surgery. FOSS is an invaluable asset as it will allow surgical trainees to engage and enhance their visual, auditory and proprioceptive feedback safely during pedicle screw placement outside of the operating room.
This abstract does not discuss or include any applicable devices or drugs
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Establishing validity of the fundamentals of spinal surgery (FOSS) simulator as a teaching tool for orthopedic and neurosurgical trainees
Pedicle screw placement is a demanding surgical skill as a spine surgeon can face challenges including variations in pedicle morphology and spinal deformities. Available CT simulators for spine pedicle placement can be very costly and hands-on cadaver courses are limited by specimen availability and are not readily accessible.
To conduct validation of a simulated training device for essential spine surgery skills.
Cross-sectional, empirical study of physician performance on a surgical simulator model.
Spine attending physicians and residents from four different academic institutions across the United States.
Performance metrics on two surgical simulator tasks.
After IRB approval, an inexpensive ($30) simulator was developed to test two main psychomotor tasks (1) creation of the pedicle screw path with a standard gearshift probe without cortical breaks and (2) the ability to palpate for the presence or absence of cortical breaches as well as determine the location of wall defects. Orthopedic and neurosurgery residents (N=72) as well as spine attending surgeons (N=26) participated from four different institutions. To test construct validity, performance metrics were compared between participants of different training status through one-way analysis of variance and linear regression analysis, with significance set at p<.05.
Spine attending surgeons consistently scored higher than the residents, in the screw trajectory task with triangular base (p=.0027) and defect probing task (p=.0035). In defect probing, performance improved with linear trend by number of residency training years with approaching significance (p=.0721). In that task, independent of institutional affiliation, PGY-2 residents correctly identified an average of 1.25±0.43 fewer locations compared with attending physicians (p=.0049). More than 80% of the spine attendings reported they would use the simulator for training purposes.
This low-cost fundamentals of spine surgery simulator detected differences in performances between spine attending surgeons and surgical residents. Programs should consider implementing a simulator such as fundamentals of spine surgery to assess and develop pedicle screw placement ability outside of the operating room
Correction to: At the US Epicenter of the COVID-19 Pandemic, an Orthopedic Residency Program Reorganizes.
[This corrects the article DOI: 10.1007/s11420-020-09765-5.]