Quadriceps Tendon Repair Using Double-Row Suture Anchor Fixation

Quadriceps tendon ruptures compromise the knee extensor mechanism and cause an inability to ambulate and significant functional limitations. Therefore, the vast majority of quadriceps tendon ruptures are indicated for operative intervention to restore patient mobility and function. Although these injuries were traditionally repaired using a transosseous repair technique, recent literature has shown that suture anchor repair may offer biomechanical advantages. Additionally, research in other areas of orthopaedics has found that a double-row suture anchor construct can offer additional biomechanical strength to tendinous repair. This technical note describes a safe and effective quadriceps tendon repair using a double-row suture anchor construct

PROMIS MCID and SCB Achievement in Rotator Cuff Repair

The purpose of this study was to establish threshold score changes to determine minimal clinically important difference (MCID) and substantial clinical benefit (SCB) in PROMIS computer adaptive test (CAT) scores following rotator cuff repair (RCR). Patients undergoing arthroscopic RCR were identified over a 24-month period. PROMIS CAT forms for upper extremity physical function (PROMIS-UE), pain interference (PROMIS-PI), and depression (PROMIS-D) were utilized. Analysis of variance testing with post hoc least significant difference pairwise comparisons and Tukey’s B subset analysis were used in determining if anchor question responses showed statistically significant differences between answers. These findings were used to establish two clinically significant outcome (CSO) groups, MCID and substantial clinical benefit (SCB). Patients were then dichotomized into two separate analyses, no MCID achievement compared with MCID achievement and no SCB achievement compared with SCB achievement. Of the 198 eligible patients, 168 patients (84.8%) were included in analysis. Receiver operating curve analysis determined delta PROMIS-UE values of 5.8 and 9.7 (area under the curve (AUC) = 0.906 and 0.949, respectively) and delta PROMIS-PI values of -11.4 and -12.9 (AUC = 0.875 and 0.938, respectively) to be excellent threshold predictors of MCID and SCB achievement. On average, 81.1%, 65.0%, and 54.5% of patients achieved MCID for PROMIS-UE, PROMIS-PI, and PROMIS-D while 70.7%, 60.7%, and 37.7% of patients in the cohort respectively achieved SCB

Associating Social Determinants of Health With PROMIS CAT Scores and Health Care Utilization After ACL Reconstruction

BACKGROUND: The term social determinants of health (SDOH) refers to social and economic factors that influence a patient\u27s health status. The effect of SDOH on the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive test (CAT) scores and postoperative resource utilization in patients with anterior cruciate ligament reconstruction (ACLR) have yet to be thoroughly studied. PURPOSE: To investigate the impact SDOH have on PROMIS CAT outcomes and postoperative resource utilization in patients with ACLR. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The electronic medical record was used to identify the SDOH for patients who underwent ACLR by 1 of 3 sports medicine fellowship-trained orthopaedic surgeons between July 2017 and April 2020. PROMIS CAT measures of Physical Function (PROMIS-PF), Pain Interference (PROMIS-PI), and Depression (PROMIS-D) were completed at the preoperative, 6-month postoperative, and 12-month postoperative time points. Postoperative health care utilization was recorded as well. Independent 2-group t tests and Wilcoxon rank-sum tests were used to analyze mean differences between patient groups based on SDOH. RESULTS: Two-hundred and thirty patients who underwent ACLR were included (mean age, 27 years; 59% male). Compared with White patients, Black patients were represented more frequently in the lowest median household income (MHI) quartile (63% vs 23%, respectively; P \u3c .001). White patients were represented more frequently in the highest area deprivation index (ADI) quartile when compared with Black patients (67% vs 12%, respectively; P = .006). Significantly worse PROMIS-PF, PROMIS-PI, and PROMIS-D scores at all 3 time points were found among patients who were Black, female, smokers, and in the lower MHI quartiles, with higher ADI and public health care coverage. In terms of resource utilization, Black patients attended significantly fewer postoperative physical therapy visits when compared with their respective counterparts. Those in the lower MHI quartiles attended significantly fewer postoperative imaging encounters, and female patients attended significantly more postoperative virtual encounters than male patients. CONCLUSION: Specific SDOH variables, particularly those that reflect racial and socioeconomic disparities, were associated with differences in postoperative health care utilization and ACLR outcomes as measured by PROMIS CAT domains

Athletes Perceive Weighted Baseballs to Carry a Notable Injury Risk, yet Still Use Them Frequently: A Multicenter Survey Study

INTRODUCTION: Weighted baseball use in throwing programs is widespread; however, their use remains controversial. Prior research shows that weighted baseball programs can increase ball velocity but potentially increase throwing arm injuries. This study aims to ascertain perceptions of weighted baseballs among elite baseball players. METHODS: A created online survey questioned common practices, throwing regimens, injury risk factors, and weighted baseball program use. The questions were modeled to ascertain the perceptions of elite baseball players to understand their experience with weighted baseballs. Descriptive statistical analysis was conducted. RESULTS: Three hundred seventy-six baseball players with a mean age of 20 ± 2 years completed the survey; 64% of the players (239/376) were pitchers. 71% (267/376) reported the use of weighted baseballs. Of those, 75% (199/267) thought it made them a better player. Overall, 73% (275/377) thought weighted baseballs are a risk for injury. 17% (46/267) attributed their injury to using weighted baseballs. Overall, participants reported a mean 72% ± 30% likelihood of future weighted baseball use. CONCLUSION: Most of the participating elite adult baseball players reported prior weighted baseball use with a corresponding improvement in pitching performance despite a perceived increased injury risk. Nearly 20% of the players attributed pain or injury to weighted baseball use. Moreover, the players surveyed intend to continue using weighted baseballs because of the perceived performance benefit

Patient-Reported Outcomes Measurement Information System physical function instruments compare favorably to legacy patient reported outcome measures in spine patients: a systematic review of the literature

BACKGROUND CONTEXT: Preliminary evidence has suggested favorable correlation between National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) assessments and traditional ( legacy ) patient reported outcome measures (PROMs) in spine surgery. There has been a significant increase in PROMIS research with regards to spinal conditions. PURPOSE: The purpose of this systematic review is to provide an assessment of PROMIS Physical Function (PF) measures in this patient population. STUDY DESIGN/SETTING: Systematic review. METHODS: A systematic search of the PubMed/MEDLINE and Embase databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify published articles that referenced the various PROMIS PF measures. Two authors independently reviewed selected studies. The search returned 1,060 studies, 124 of which were selected for independent review by two authors. Of these, 37 were selected for inclusion. Mixed linear models were performed to assess for differences between legacy PROMs and PROMIS measures. RESULTS: The combined sample size of all included studies yielded 10,296 total patients. Overall, PROMIS Physical Function (PF) measures demonstrated strong correlations with legacy PROMs when evaluating spine patients (weighted Pearson correlation, 0.589, standard error [SE] = 0.023; weighted Spearman correlation, 0.702, SE = 0.028). PROMIS questionnaires had significantly fewer questions than did legacy PROMs (4.2 ± 0.30 vs 9.53 ± 0.82, P = 0.015). In spine studies, the PROMIS PF forms were completed in significantly less time than legacy PROMs (48.1 ± 2.9 vs 174.7 ± 12.6 seconds, P \u3c 0.001). The differences for the reliability measures and the floor and ceiling effects were not significant. CONCLUSIONS: Patient-Reported Outcomes Measurement Information System PF forms compare favorably with legacy PROMs with regard to correlations, ease of use, and quality criteria in the field of spine surgery. PROMIS PF scores correlate strongly with commonly used legacy PROMs, particularly in spine patients. Patient-Reported Outcomes Measurement Information System PF forms can be administered efficiently and to a broad patient population while remaining highly reliable

Characterizing MCID and assessing the role of preoperative PROMIS scores in predicting outcomes for reverse total shoulder arthroplasty at 2-year follow-up

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) has gained more ground as a reliable and efficient means of collecting patient outcomes in different shoulder surgeries. The purpose of this study is to determine if preoperative PROMIS scores are able to predict improvement in postoperative PROMIS scores and anchor this data to determine if a patient will achieve MCID after reverse total shoulder arthroplasty (RTSA). We hypothesize that preoperative PROMIS will significantly correlate, with anchor questions allowing clinicians to predict which patients are most likely to achieve MCID after RTSA. Methods: Three PROMIS CAT forms (PROMIS Upper Extremity Physical Function CAT v2.0 (“PROMIS-UE”), PROMIS Pain Interference v1.1 (“PROMIS-PI”), and PROMIS Depression v1.0 (“PROMIS-D”)) were provided to all patients scheduled to undergo RTSA by board-certified shoulder and elbow surgeons at 1 institution. Demographic data was collected, including age, median household income, zip code, body mass index, sex, smoking status, and race. All patients enrolled in the study were contacted and asked the same 3 anchor questions pertaining to the 3 PROMIS CAT forms above. Results: A total of 71 patients (52.1% male) were included in our cohort with an average age of 67.8 years (standard deviation, 8.4). Mean follow-up time point was 21.4 months (standard deviation, 9.9) after surgery. Neither preoperative PROMIS-UE, nor preoperative PROMIS-PI showed any significant predictive ability to achieve their respective domain MCIDs (AUC: 0.564 and 0.631, respectively). PROMIS-UE and PROMIS-PI improved to a significant degree at an average 21.4 months postoperatively from 29.2 ± 5.8 and 63.8 ± 4.8 to 39.8.9 ± 8.9 and 50.0 ± 9.7, respectively. Improvements in PRMOIS-D scores were insignificant at average 21.4 months (Baseline: 49.8 ± 8.0 vs. 44.5 ± 9.4 at final follow-up). Using anchor-based analysis to determine MCID, we found the following MCID values for PROMIS-UE, PROMIS-PI, and PROMIS-D: 7.0, -6.6, and -3.9, respectively. ROC analysis revealed MCID values for PROMIS-UE, PI, and D as 7.0, -6.6, and -3.9 respectively (AUC: 0.743, 0.805, 0.601). SCB values for PROMIS-UE, PI, and D were identified as 8.4, -12.1, and -4.0, respectively (AUC: 0.883, 0.932, 0.652). Conclusions: PROMIS-UE and PROMIS-PI questionnaires can adequately assess the symptoms and outcomes of RTSA patients out to two years postoperatively. Preoperative baseline PROMIS-UE, PROMIS-PI, and PROMIS-D scores cannot adequately predict achievement of MCID in patients indicated for primary RTSA when using anchor-based methods at final follow-up, and should not be used to counsel patients on surgery or guide postoperative treatment. Level of Evidence: Level I

PROMIS Physical Function Instruments Compare Favorably to Legacy Patient Reported Outcome Measures in Upper and Lower Extremity Orthopedic Patients: A Systematic Review of the Literature.

PURPOSE: The purpose of this systematic review is to compare Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) with traditional ( legacy ) patient reported outcome measures (PROMs) in regard to correlations, ease of use, and quality criteria for upper (UE) and lower extremity (LE) orthopedic conditions. METHODS: A systematic search of the PubMed/MEDLINE database was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify published articles that referenced the various PROMIS PF measures. Two authors independently reviewed selected studies. The search returned 857 studies, 85 of which were selected for independent review by two authors. Of these, 54 were selected for inclusion. Mixed linear models were performed to assess for differences between legacy PROMs and PROMIS measures. RESULTS: The combined sample size of all included studies yielded 6,074 UE and 9,366 LE patients. Overall, PROMIS PF measures demonstrated strong correlations with legacy PROMs among UE (weighted Pearson correlation, 0.624, standard error [SE] = 0.042; weighted Spearman correlation, 0.566, SE = 0.042) and LE patients (weighted Pearson correlation, 0.645, SE = 0.062; weighted Spearman correlation, 0.631, SE = 0.041). PROMIS PF questionnaires completed by UE patients had fewer questions than legacy PROMs (5.9 vs 17.7, P = 0.0093) and were completed in less time (90.5 vs 223.8 seconds, P = 0.084). PROMIS PF questionnaires completed by LE patients had fewer questions than legacy PROMs (4.81 vs 15.33, P \u3c 0.001) and were completed in less time (63.6 vs 203.2 seconds, P = 0.0063). The differences for the reliability measures were not significant. CONCLUSIONS: PROMIS PF scores correlate strongly with commonly used legacy PROMs in orthopedics, particularly in UE and LE patients. PROMIS PF forms can be administered efficiently and to a broad patient population while remaining highly reliable. Therefore, they can be justified for standardized use among orthopedic patients with UE and LE conditions, improving the ability to aggregate and compare outcomes in orthopedic research

Race and Socioeconomic Status are Associated with Inferior Patient Reported Outcome Measures Following Rotator Cuff Repair

PURPOSE: To investigate the impact Social Determinants of Health (SDOH) have on National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Test (CAT) scores and postoperative health care utilization in rotator cuff repair (RCR) patients. METHODS: All patients who underwent RCR surgery by 3 shoulder and/or sports medicine fellowship-trained orthopedic surgeons between July 2017 and January 2020 were included. The electronic medical record (EMR) was used to identify SDOH for each patient. PROMIS CAT measures of Upper Extremity function ( PROMIS UE ), Pain Interference ( PROMIS PI ), and Depression ( PROMIS D ) were completed preoperatively and postoperatively (6-months and 1-year). Postoperative health care utilization (clinical visits, virtual encounters, imaging encounters and physical therapy visits) were recorded as well. Univariate associations, multiple linear regressions, and Wilcoxon rank-sum tests were used to analyze mean differences between patient groups based on SDOH. RESULTS: Three hundred thirty-eight RCR patients were included. Patients who were Black, in lower median household income (MHI) quartiles, had public insurance, and female reported lower PROMIS scores compared to their counterparts. Smokers and white patients attended fewer postoperative office visits while Black patients attended greater physical therapy (PT) and non-visit encounters compared to their respective counterparts. CONCLUSION: Black race and lower socioeconomic status are associated with worse function and pain outcomes post-RCR compared to whites. Similarly, Black race and positive smoking status are associated with differential utilization of health care following RCR. Further attention may be required for these patients to address healthcare disparities. LEVEL OF EVIDENCE: Level III, Retrospective Cohort Study

Social Determinants of Health Influence Access to Care and Outcomes in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review

PURPOSE: To investigate the impact social determinants of health (SDOH) have on accessing orthopaedic treatment after an anterior cruciate ligament injury, as well as patient-reported and surgical outcomes after anterior cruciate ligament reconstruction (ACLR). METHODS: A systematic search of the PubMed, MEDLINE, Epub Ahead of Print, Embase, and Web of Science databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies that reported at least 1 SDOH and its effect on patient-reported outcomes or surgical outcomes after anterior cruciate ligament reconstruction. Our search identified 937 studies. After eliminating 273 duplicates, 2 authors screened 664 articles on the basis of title and abstract. After this initial screening, 76 studies were evaluated for data extraction. Studies were categorized based on the social determinant(s) of health reported. RESULTS: Twenty-two articles published between 2002 and 2020 were included in this study, encompassing 15 retrospective cohort studies, 3 prospective cohort studies, 3 cross-sectional studies, and 1 case-control study from 9 journals across 3 countries. Of these articles, 9 investigated race/ethnicity, 8 investigated insurance status, 4 investigated income, 5 investigated education level, 2 investigated employment status, and 5 investigated socioeconomic status. Reported outcomes included time to treatment, concomitant knee injury, patient-reported outcome measurement scores, postoperative complications, need for additional surgery, and postoperative healthcare utilization. CONCLUSIONS: Certain SDOH, including black race, Hispanic ethnicity, public health insurance, and lower socioeconomic status contribute to a delay in access to care, which may result in increased severity of concomitant knee injuries encountered at the time of anterior cruciate ligament reconstruction and inferior outcomes. STUDY DESIGN: Level III, systematic review of level I-III evidence

Preoperative Opioid Use Is Associated With Inferior Patient-Reported Outcomes Measurement Information System Scores Following Rotator Cuff Repair

PURPOSE: To determine the influence of preoperative opioid use on Patient-Reported Outcomes Measurement Information System (PROMIS) scores pre- and postoperatively in patients undergoing arthroscopic rotator cuff repair (RCR). METHODS: A retrospective review of all RCR patients aged \u3e18 years old was performed. PROMIS pain interference ( PROMIS PI ), upper extremity function ( PROMIS UE ), and depression ( PROMIS D ) scores, were reviewed. These measures were collected at preoperative, 6-month, and 1-year postoperative time points. A prescription drug-monitoring program was queried to track opioid prescriptions. Patients were categorized as chronic users, acute users, and nonusers based on prescriptions filled. Comparison of means were carried out using analysis of variance and least squares means. Effect sizes and 95% confidence intervals were calculated. RESULTS: In total, 184 patients who underwent RCR were included. Preoperatively, nonusers (n = 92) had superior PROMIS UE (30.6 vs 28.9 vs 26.1; P \u3c .05) and PI scores (61.5 vs 64.9 vs 65.3; P \u3c .001) compared with acute users (n = 65) and chronic users (n = 27), respectively. At 6 months postoperatively; nonusers demonstrated significantly greater PROMIS UE (41.7 vs 35.6 vs. 33.5; P \u3c .001), lower PROMIS D (41.6 vs 45.8 vs 51.1; P \u3c .001), and lower PROMIS PI scores (50.7 vs 56.3 vs 58.1; P \u3c .01) when compared with acute and chronic users, respectively. Nonusers had lower PROMIS PI (47.9 vs 54.3 vs 57.4; P \u3c .0001) and PROMIS D (41.6 vs 48.3 vs 49.2; P = .0002) scores compared with acute and chronic users at 1-year postoperatively. Nonusers experienced a significantly greater magnitude of improvement in PROMIS D 6 months postoperatively compared with chronic opioid users (-5.9 vs 0.0; P \u3c .01). CONCLUSIONS: Patients undergoing RCR demonstrated superior PROMIS scores pre- and postoperatively if they did not use opioids within 3 months before surgery. LEVEL OF EVIDENCE: III, retrospective comparative trial