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Heckman JD, Swiontkowski M, Katz JN, Losina E, Schoenfeld AJ, Bedard NA, Bono CM, Carey JL, Graham B, Hensinger RN, Gebhardt MC, Mallon WJ, Rossi MJ, Matzkin E, Pinzur MS. Pain Management Research. Foot Ankle Int 2020; 41:761-762. [PMID: 32538196 PMCID: PMC7294527 DOI: 10.1177/1071100720925494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Heckman JD, Swiontkowski M, Katz JN, Losina E, Schoenfeld AJ, Bedard NA, Bono CM, Carey JL, Graham B, Hensinger RN, Gebhardt MC, Mallon WJ, Rossi MJ, Matzkin E, Pinzur MS. Pain Management Research. J Bone Joint Surg Am 2020; 102:855. [PMID: 32433323 PMCID: PMC7508273 DOI: 10.2106/jbjs.20.00289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Petrie K, Matzkin E. Can pharmacological and non-pharmacological sleep aids reduce post-operative pain and opioid usage? A review of the literature. Orthop Rev (Pavia) 2019; 11:8306. [PMID: 31897280 PMCID: PMC6912139 DOI: 10.4081/or.2019.8306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/27/2019] [Indexed: 12/16/2022] Open
Abstract
Sleep is important for our health and well-being and is especially pertinent to orthopedic surgery because it has been shown to play a role in pain tolerance. Knowing the benefits of sleep, one way to positively impact patients’ pain and recovery post-surgery is to encourage sleep. Zolpidem, a pharmacologic sleep aid, has been shown to decrease opioid consumption, reduce pain, and increase quality of life when briefly used after orthopedic procedures. Cognitive Behavioral Therapy for Insomnia (CBT-I), a nonpharmacologic sleep aid, has been shown to increase the quality of sleep and sleep time, decrease sleep onset latency, decrease pain, and help patients maintain those gains. Because of the dangers of opioids, it is important for physicians to search for alternative methods to manage their patients’ pain, like zolpidem and CBT-I. More research is needed to determine which method may be the most efficacious and how these can be integrated into patient care.
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Matzkin E. Medial Patellofemoral Ligament Reconstruction: Indications, Technique, and Outcomes. Arthroscopy 2019; 35:2970-2972. [PMID: 31699243 DOI: 10.1016/j.arthro.2019.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 02/02/2023]
Abstract
The medial patellofemoral ligament is the primary static restraint to lateral patellar translation. It is injured in 96% to 100% of patellar dislocations that affect approximately 6 to 29 of 100,000 patients and is more common in patients younger than 20 years of age. Risk factors for patellar dislocation include patella alta, trochlear dysplasia, genu valgus, increased Q angle, and hyperlaxity. The treatment for patellar instability depends on the clinical and radiographic findings and can be nonoperative for first-time dislocations (bracing, proximal strengthening, and progressive return to sport) or operative for recurrent dislocations. It is critical for medial patellofemoral ligament reconstruction to reproduce the anatomy and isometry of the native ligament. Graft choice and methods of fixation are less critical to achieve successful outcomes. Studies have reported successful outcomes and improved Kujala scores, with recurrent instability ranging from 1% to 5%. Careful surgical technique can avoid complications, including fracture, graft failure, loss of range of motion, persistent anterior knee pain, medial instability, and recurrent instability. The role of the medial quadriceps tendon femoral ligament also should be considered more in future research.
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Jain NB, Ayers GD, Fan R, Kuhn JE, Warner JJ, Baumgarten KM, Matzkin E, Higgins LD. Comparative Effectiveness of Operative Versus Nonoperative Treatment for Rotator Cuff Tears: A Propensity Score Analysis From the ROW Cohort. Am J Sports Med 2019; 47:3065-3072. [PMID: 31518155 PMCID: PMC7325686 DOI: 10.1177/0363546519873840] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The evidence to support operative versus nonoperative treatment for rotator cuff tears is sparse and inconclusive. PURPOSE To assess pain and functional outcomes in patients undergoing operative and nonoperative treatments for rotator cuff tears. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS From March 2011 to February 2015, a multicenter cohort of patients with rotator cuff tears undergoing operative and nonoperative treatments was recruited. Patients completed a detailed history questionnaire, the Shoulder Pain and Disability Index (SPADI), and the American Shoulder and Elbow Surgeons (ASES) standardized form and underwent magnetic resonance imaging. In addition to baseline assessments, patients received follow-up questionnaires at 3, 6, 12, and 18 months. Propensity score weighting was used to balance differences in characteristics of the operative and nonoperative groups. RESULTS Adjusted for propensity scores, the operative (n = 50) and nonoperative (n = 77) groups had similar characteristics, as evidenced by the small standardized mean differences between the groups. Adjusted mean differences in the SPADI and ASES scores between the operative and nonoperative groups were -22.0 points (95% CI, -32.1 to -11.8) and -22.2 points (95% CI, -32.8 to -11.6) at 18 months, respectively. The operative group had a significantly higher proportion of patients who showed ≥30% (P = .002) and ≥50% (P < .0001) improvement in SPADI and ASES scores as compared with the nonoperative group. CONCLUSION In this prospective cohort study, patients undergoing operative treatment had significantly better pain and functional outcomes as compared with patients undergoing nonoperative treatment for rotator cuff tears. Differences between the 2 groups in SPADI and ASES scores at the 6- to 18-month time points met the minimal clinically important difference (depending on the threshold used). A large randomized controlled trial is needed to answer this question more definitively.
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Matzkin E, David Daniels S. Author Response to "Regarding 'Patient Satisfaction With Nonopioid Pain Management Following Arthroscopic Partial Meniscectomy and/or Chondroplasty'". Arthroscopy 2019; 35:2775-2776. [PMID: 31604493 DOI: 10.1016/j.arthro.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 08/02/2019] [Indexed: 02/02/2023]
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Dabija DI, Pennings JS, Archer KR, Ayers GD, Higgins LD, Kuhn JE, Baumgarten KM, Matzkin E, Jain NB. Which Is the Best Outcome Measure for Rotator Cuff Tears? Clin Orthop Relat Res 2019; 477:1869-1878. [PMID: 31335605 PMCID: PMC7000030 DOI: 10.1097/corr.0000000000000800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 04/11/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The American Shoulder and Elbow Surgeons Standardized Shoulder Form (ASES), the Shoulder Pain and Disability Index (SPADI), and the shortened Disability of the Arm, Shoulder, and Hand (quickDASH) are patient-reported upper extremity-specific outcome scales currently used to evaluate patients with rotator cuff tears. This heterogeneity does not allow for a uniform metric for research and patient care. QUESTIONS/PURPOSES Our objective was to determine psychometric properties (reliability, convergent and discriminant validity, and responsiveness) of five commonly used outcome instruments (the ASES, the SPADI, the quickDASH, the SF-12, and the EuroQol-5D) in a longitudinal study of patients undergoing treatment for rotator cuff tears. METHODS From February 2011 through June 2015, 120 patients completed a standardized history, the five outcome scales under study, a physical examination, and an MRI. Of these, 47 (39%) were lost to followup before 18 months, and another 24 (20%) were accounted for at 18 months but had missing data at one or more of the earlier prespecified followup intervals (3, 6, or 12 months). Reliability (the reproducibility of an outcome instrument between subjects; tested by Cronbach's alpha), convergent and discriminant validity (determining which outcome measures correlate most strongly with others; tested by Spearman's correlation coefficients), and responsiveness (the change in outcome scales over time based on percent improvement in shoulder functionality using the minimal clinically important difference [MCID] and the subjective shoulder value) were calculated. RESULTS All outcomes measures had a Cronbach's alpha above 0.70 (range, 0.74-0.94) and therefore were considered reliable. Convergent validity was demonstrated as the upper extremity-specific measures (SPADI, ASES, and quickDASH) were more strongly correlated with each other (rho = 0.74-0.81; p < 0.001) than with any of the other measures. Discriminant validity was demonstrated because the Spearman's correlation coefficients were stronger for the relationships between upper extremity measures compared with the correlations between upper extremity measures and general health measures for 53 of the 54 correlations that were compared. Both internal and external responsiveness of the measures was supported. Patients who achieved the MCID and at least a 30% change on the subjective shoulder value had more positive change in scores over time compared with those who did not. Mixed model linear regressions revealed that all three upper extremity-specific measures had a group by time interaction for the MCID, indicating that patients who achieved the MCID had greater change over time compared with those who did not achieve the MCID. Results showed that the measure with the best discrimination between groups, or best internal responsiveness, was the ASES (beta = -8.26, 95% confidence interval [CI], -11.39 to -5.14; p < 0.001; η = 0.089) followed by the SPADI (beta = 6.88, 95% CI, 3.78-9.97; p < 0.001; η = 0.088) then the quickDASH (beta = 3.43, 95% CI, 0.86-6.01; p = 0.009, η = 0.027). Measures with the best external responsiveness followed the same pattern of results. CONCLUSIONS All the upper extremity-specific scales had acceptable psychometric properties. Correlations were high and thus only one upper extremity-specific instrument is needed for outcome assessment. Given the overall psychometric assessment, we recommend SPADI be the shoulder-specific instrument used to assess outcomes in patients with rotator cuff tears. LEVEL OF EVIDENCE Level III, diagnostic study.
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Matzkin E. The Revision ACL Rehabilitation Conundrum: How Little We Know in 2019: Commentary on an article by the MARS Group: "Rehabilitation Predictors of Clinical Outcome Following Revision ACL Reconstruction in the MARS Cohort". J Bone Joint Surg Am 2019; 101:e40. [PMID: 31045679 DOI: 10.2106/jbjs.19.00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Dickinson RN, Ayers GD, Archer KR, Fan R, Page C, Higgins LD, Kuhn JE, Baumgarten KM, Matzkin E, Jain NB. Physical therapy versus natural history in outcomes of rotator cuff tears: the Rotator Cuff Outcomes Workgroup (ROW) cohort study. J Shoulder Elbow Surg 2019; 28:833-838. [PMID: 30553798 PMCID: PMC9186215 DOI: 10.1016/j.jse.2018.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND We compared the outcomes of patients who performed physical therapy versus those who did not in a longitudinal cohort of patients undergoing nonoperative treatment of rotator cuff tears. We also assessed whether there was a dose effect in which the pain and functional outcomes in patients performing physical therapy plateaued. METHODS From February 2011 to June 2015, a multicenter cohort of patients with rotator cuff tears undergoing nonoperative treatment completed a detailed health and demographic questionnaire and the Shoulder Pain and Disability Index (SPADI) at baseline and 3, 6, 12, and 18 months. Longitudinal mixed models were used to assess whether physical therapy in the first 3 months predicted SPADI scores and dose effect. RESULTS Among the 55 patients in our cohort, the performance of physical therapy within the first 3 months predicted better SPADI scores versus nonperformance of physical therapy at 3 months (P = .02). Scores were similar between groups at 6, 12, and 18 months. A threshold of 16 physical therapy sessions was observed for pain and functional improvement during follow-up, after which significant improvement was not seen. CONCLUSIONS Patients who performed physical therapy within the first 3 months had statistically significant improvements in pain and function as measured by the SPADI score at 3 months compared with patients who did not report performing physical therapy. Depending on the minimal clinically important difference used for the SPADI score, our results could be interpreted as meeting the minimal clinically important difference threshold or not. Improvement in outcomes was observed up to 16 sessions of physical therapy, after which outcomes plateaued.
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Abstract
Sex plays a role in mediating different susceptibilities and outcomes of disease and injury. Sports injuries are included in this phenomenon, as recent research demonstrates that males and females show differences in incidences of varying injuries, presentations of injury, and treatment outcomes. Incidence of certain sports injuries like anterior cruciate ligament injury or patellofemoral pain syndrome may vary widely between male and female athletes, with female athletes being more susceptible to anterior cruciate ligament injury and patellofemoral pain syndrome. Treatment outcomes for males and females may also vary widely. For example, males have a higher risk of recurrent shoulder instability compared with females. These variances among incidence and outcome following certain injuries highlight the necessity of understanding these differences to provide quality care. It is especially important for the school nurse to be aware of these sex differences as they are well positioned to make youth athletes and their families aware of the varying injury susceptibilities among them.
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Abstract
In the United States, there has been a steady increase in sports participation across all age groups. An estimated 27 million youths between the ages of 6 and 18 years participate in team sports, and 60 million participate in some form of organized athletics. While there are great benefits from sports participation, early single sport specialization carries an increased risk of overuse injuries and burnout. Specialization has become increasingly popular among parents and coaches due to the common belief that it is the best way to develop an elite athlete. However, for most sports, there is no evidence that specialization before puberty is necessary to achieve elite status and in fact, there is evidence to the contrary. A recent American Orthopaedic Society for Sports Medicine (AOSSM) consensus statement has highlighted the negative side effects of early sports specialization; these include increased risk for overuse injury and burnout. School nurses are well-positioned to affect this issue through providing education and raising awareness of the potential detrimental consequences associated with youth sport specialization.
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Jain NB, Ayers GD, Fan R, Kuhn JE, Baumgarten K, Matzkin E, Higgins LD. Predictors of Pain and Functional Outcomes After the Nonoperative Treatment of Rotator Cuff Tears. Orthop J Sports Med 2018; 6:2325967118788531. [PMID: 30094270 PMCID: PMC6080194 DOI: 10.1177/2325967118788531] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Optimal patient selection is key to the success of nonoperative treatment for rotator cuff tears. Purpose: To assess the predictors of pain and functional outcomes in a longitudinal cohort of patients undergoing nonoperative treatment. Study Design: Cohort study; Level of evidence, 2. Methods: A multicenter cohort of patients with rotator cuff tears undergoing nonoperative treatment was recruited from March 2011 to February 2015. Patients completed a detailed health questionnaire, completed standardized shoulder questionnaires including the Shoulder Pain and Disability Index (SPADI), and underwent magnetic resonance imaging. In addition to baseline assessments, patients received follow-up questionnaires at 3, 6, 12, and 18 months. Longitudinal mixed models were used to test predictors of the SPADI score, and interactions with time were assessed. Results: In our cohort of 70 patients, being married as compared with being single/divorced/widowed (P = .02), a shorter duration of symptoms (P = .02), daily shoulder use at work that included light or no manual labor versus moderate or heavy manual labor (P = .04), alcohol use of 1 to 2 times per week or more as compared with 2 to 3 times per month or less (P = .007), and absence of fatty infiltration (P = .0009) were significantly associated with decreased SPADI scores (improved shoulder pain and disability) over time. When interactions with time were assessed, having a college level of education or higher compared with less than a college education showed a differential effect over time, with those with a college level of education or more having lower SPADI scores (P = .004). Partial-thickness tear versus full-thickness tear also had an interaction with follow-up duration, such that those with a partial-thickness tear had lower SPADI scores (P = .0002). Conclusion: Longitudinal predictors of better outcomes of the nonoperative treatment of rotator cuff tears included being married, having at least a college education, shorter duration of symptoms, light or manual labor in daily work, alcohol use of 1 to 2 times per week or more, partial-thickness tear, and absence of fatty infiltration of the rotator cuff. Our results suggest that nonoperative treatment should be performed early for optimal outcomes. These data can be used to select optimal candidates for the nonoperative treatment of rotator cuff tears and to assist with patient education and expectations before treatment.
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Jain NB, Ayers GD, Fan R, Kuhn JE, Baumgarten KM, Matzkin E, Higgins LD. Predictors of pain and functional outcomes after operative treatment for rotator cuff tears. J Shoulder Elbow Surg 2018; 27:1393-1400. [PMID: 30016692 PMCID: PMC6085102 DOI: 10.1016/j.jse.2018.04.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/18/2018] [Accepted: 04/27/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Optimal patient selection is key to success of operative treatment for cuff tears. We assessed predictors of pain and functional outcomes in a longitudinal cohort of patients undergoing operative treatment. METHODS From March 2011 to January 2015, a cohort of patients with rotator cuff tears undergoing rotator cuff surgery was recruited. Patients completed a detailed health and demographic questionnaire, standardized shoulder questionnaires, including the Shoulder Pain and Disability Index (SPADI), and underwent a magnetic resonance imaging scan. Patients received follow-up questionnaires at 3, 6, 12, and 18 months. We assessed longitudinal predictors of SPADI using longitudinal mixed models. Interactions with follow-up duration after surgery were also assessed. RESULTS In our analysis (n = 50), a lower Fear-Avoidance Beliefs Questionnaire physical activity score (P = .001) predicted a lower SPADI score (better shoulder pain and function). Those consuming alcohol 1 to 2 times per week or more had lower SPADI scores than those consuming alcohol 2 to 3 times per month or less (P = .017). Both of these variables had a significant interaction with duration of follow-up. Variables that were not significant predictors of SPADI included sociodemographic characteristics, magnetic resonance imaging characteristics, such as tear size and muscle quality, shoulder strength, and variations in surgical techniques/performance of adjuvant surgical procedures. CONCLUSIONS Those with higher fear avoidance behavior and alcohol use of 1 to 2 times per week had worse shoulder pain and function at 18 months of follow-up. These data can be used to select optimal candidates for operative treatment of rotator cuff tears and assist with patient education and expectations before treatment.
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Matzkin E. Editorial Commentary: In a World of Endless Options, Is There a Single Solution? Management Options for Failed Anterior Instability Surgery in Athletes. Arthroscopy 2018; 34:1428-1429. [PMID: 29729753 DOI: 10.1016/j.arthro.2018.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 02/02/2023]
Abstract
There are many options to manage anterior instability of the shoulder. The management of athletes who have failed previous operative stabilization can make choosing a treatment solution difficult. A modified Latarjet without capsulolabral repair has been demonstrated to be a good choice when treating failed stabilization in a high-risk population with sufficient return to play and outcomes.
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Matzkin E. Make no bones about it! Cleve Clin J Med 2018; 85:321-322. [PMID: 29634464 DOI: 10.3949/ccjm.85a.17071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Curry EJ, Logan C, Suslavich K, Whitlock K, Berkson E, Matzkin E. Factors impacting arthroscopic rotator cuff repair operational throughput time at an ambulatory care center. Orthop Rev (Pavia) 2018; 10:7577. [PMID: 29770180 PMCID: PMC5937367 DOI: 10.4081/or.2018.7577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/18/2018] [Indexed: 11/29/2022] Open
Abstract
Identifying patient factors influencing operational throughput time is becoming more imperative due to an increasing focus on value and cost savings in healthcare. The primary objective of this study was to determine patient factors influencing throughput time for primary rotator cuff repairs. Demographic information, medical history and operative reports of 318 patients from one ambulatory care center were retrospectively reviewed. Operating room set up, incision to closure and recovery room time were collected from anesthesia records. Univariate analysis was performed for both continuous and categorical variables. A stepwise, multivariable regression analysis was performed to determine factors associated with operating room time (incision to closure) and recovery room time. Of the 318 patients, the mean age was 54.4±10.0 and 197 (61%) were male. Male patients had a significantly longer OR time than females (115.5 vs. 100.8 minutes; P<0.001) Furthermore, patients set up in the beach chair position had a significantly longer OR time than patients positioned lateral decubitus (115.8 vs. 89.6 mins, P<0.0001). Number of tendons involved, and inclusion of distal clavicle excision, biceps tenodesis and labral debridement also added significant OR time. Type and number of support staff present also significantly affected OR time. Recovery room time was significantly longer patients who had surgery in the beach chair position (+9.61 minutes) and for those who had a cardiac-related medical comorbidity (+11.7 minutes). Our study found that patients positioned in a beach chair spent significantly more time in the operating and recovery rooms. While ease of set up has been a stated advantage of beach chair position, we found the perceived ease of set up does not result in more efficient OR throughput.
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Vora M, Curry E, Chipman A, Matzkin E, Li X. Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology and treatment options. Orthop Rev (Pavia) 2018; 9:7281. [PMID: 29564075 PMCID: PMC5850065 DOI: 10.4081/or.2017.7281] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/08/2017] [Accepted: 10/08/2017] [Indexed: 12/16/2022] Open
Abstract
Patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain and is present in females disproportionately more relative to males. PFPS causes tend to be multifactorial in nature and are described in this review. From a review of the current literature, it is clear that there needs to be further research on PFPS in order to better understand the complex etiology of this disorder in both males and females. It is known that females with patellofemoral pain syndrome demonstrate a decrease in abduction, external rotation and extension strength of the affected side compared with healthy patients. Conservative management, including optimizing muscle balance between the vastus medialis and lateralis around the patella along with formal therapy should be the first line of treatment in patients presenting with PFPS. Surgery should be reserved for patients in which all conservative management options have failed. This review aims to guide physicians in accurate clinicaldecision making regarding conservative and surgical treatment options when specifically faced with PFPS in a female athlete. Furthermore, we will discuss the anatomic variants, incidence and prevalence, etiology, diagnosis and treatment of PFPS.
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Matzkin E. Can We Improve the Value of ACL Reconstruction by Studying the Rates of Return to Play and Satisfaction?: Commentary on an article by Benedict U. Nwachukwu, MD, MBA, et al.: "Return to Play and Patient Satisfaction After ACL Reconstruction. Study with Minimum 2-Year Follow-up". J Bone Joint Surg Am 2017; 99:e46. [PMID: 28463928 DOI: 10.2106/jbjs.16.01561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Almirol EA, Chi LY, Khurana B, Hurwitz S, Bluman EM, Chiodo C, Matzkin E, Baima J, LeBoff MS. Short-term effects of teriparatide versus placebo on bone biomarkers, structure, and fracture healing in women with lower-extremity stress fractures: A pilot study. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2016; 5:7-14. [PMID: 29067229 PMCID: PMC5644467 DOI: 10.1016/j.jcte.2016.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/15/2016] [Accepted: 05/17/2016] [Indexed: 12/11/2022]
Abstract
AIMS In this pilot, placebo-controlled study, we evaluated whether brief administration of teriparatide (TPTD) in premenopausal women with lower-extremity stress fractures would increase markers of bone formation in advance of bone resorption, improve bone structure, and hasten fracture healing according to magnetic resonance imaging (MRI). METHODS Premenopausal women with acute lower-extremity stress fractures were randomized to injection of TPTD 20-µg subcutaneous (s.c.) (n = 6) or placebo s.c. (n = 7) for 8 weeks. Biomarkers for bone formation N-terminal propeptide of type I procollagen (P1NP) and osteocalcin (OC) and resorption collagen type-1 cross-linked C-telopeptide (CTX) and collagen type 1 cross-linked N-telopeptide (NTX) were measured at baseline, 4 and 8 weeks. The area between the percent change of P1NP and CTX over study duration is defined as the anabolic window. To assess structural changes, peripheral quantitative computed topography (pQCT) was measured at baseline, 8 and 12 weeks at the unaffected tibia and distal radius. The MRI of the affected bone assessed stress fracture healing at baseline and 8 weeks. RESULTS After 8 weeks of treatment, bone biomarkers P1NP and OC increased more in the TPTD- versus placebo-treated group (both p ≤ 0.01), resulting in a marked anabolic window (p ≤ 0.05). Results from pQCT demonstrated that TPTD-treated women showed a larger cortical area and thickness compared to placebo at the weight bearing tibial site, while placebo-treated women had a greater total tibia and cortical density. No changes at the radial sites were observed between groups. According to MRI, 83.3% of the TPTD- and 57.1% of the placebo-treated group had improved or healed stress fractures (p = 0.18). CONCLUSIONS In this randomized, pilot study, brief administration of TPTD showed anabolic effects that TPTD may help hasten fracture healing in premenopausal women with lower-extremity stress fractures. Larger prospective studies are warranted to determine the effects of TPTD treatment on stress fracture healing in premenopausal women.
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Matzkin E. Editorial Commentary: Does Fatigue Alter Pitching Mechanics in Adolescent Males? Arthroscopy 2016; 32:772. [PMID: 27151449 DOI: 10.1016/j.arthro.2016.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 02/02/2023]
Abstract
Over the course of 90 pitches to simulate an adolescent male pitching in a baseball game, there is an increase in fatigue and pain, a decrease in velocity, and some changes indicative of lower extremity fatigue without any change in upper extremity kinematics.
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Weiss K, Curry E, Matzkin E. Assessment of medical school musculoskeletal education. AMERICAN JOURNAL OF ORTHOPEDICS (BELLE MEAD, N.J.) 2015; 44:E64-E67. [PMID: 25750952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Most medical fields require a basic knowledge of musculoskeletal medicine. Although many nonorthopedic clinicians treat musculoskeletal problems, this area of medicine is often given little time in medical school curricula. In the study reported here, a validated musculoskeletal cognitive evaluation was given to medical students before and after a new musculoskeletal module to determine the impact of the module on their competency in musculoskeletal medicine. Four hundred five students at a single medical school took the examination, which was corrected according to a validated scoring system, and the data were subsequently analyzed. Mean cognitive examination score was 40%. The recommended mean passing score for the examination is 73.1%. Scores were significantly (P < .05) higher for the premodule group (42.1%) than the postmodule group (39.1%). Statistical significance was set at P < .05. Students' overall mean score was far below passing, which demonstrates the inadequacy of musculoskeletal education within the medical school curriculum. That the postmodule group scored lower than the premodule group suggests that increasing musculoskeletal lecture time may not improve medical students' musculoskeletal knowledge.
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Curry E, Li X, Nguyen J, Matzkin E. Prevalence of internet and social media usage in orthopedic surgery. Orthop Rev (Pavia) 2014; 6:5483. [PMID: 25317312 PMCID: PMC4195991 DOI: 10.4081/or.2014.5483] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/09/2014] [Indexed: 12/14/2022] Open
Abstract
Prior studies in other specialties have shown that social networking and Internet usage has become an increasingly important means of patient communication and referral. The purpose of this study is to evaluate the prevalence of Internet or social media usage in new patients referred to a major academic orthopedics center and to identify new avenues to optimize patient recruitment and communication. New patients were surveyed (n=752) between December 2012 to January 2013 in a major academic orthopaedic center to complete a 15-item questionnaire including social media and Internet usage information. Data was collected for all orthopaedic sub-specialties and statistical analysis was performed. Fifty percent of patients use social networking sites, such as Facebook. Sports medicine patients tend to be higher social networking users (35.9%) relative to other services (9.8-17.9%) and was statistically higher when compared to the joints/tumor service (P<0.0001). Younger age was the biggest indicator predicting the use of social media. Patients that travelled between 120 to 180 miles from the hospital for their visits were significantly more likely to be social media users, as were patients that did research on their condition prior to their new patient appointment. We conclude that orthopedic patients who use social media/Internet are more likely to be younger, researched their condition prior to their appointment and undergo a longer average day’s travel (120-180 miles) to see a physician. In an increasingly competitive market, surgeons with younger patient populations will need to utilize social networking and the Internet to capture new patient referrals.
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Weiss J, Matzkin E, Flippin M, Pallis M, Rankin M. Get up, get out, get moving: an interactive tool for education at your local school. Clin Orthop Relat Res 2013; 471:1226-9. [PMID: 23079790 PMCID: PMC3586025 DOI: 10.1007/s11999-012-2647-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Childhood obesity is a growing problem in America. Orthopaedic surgeons have an opportunity to interact with communities to educate children about healthy eating and physical activity. The American Academy of Orthopedic Surgeons (AAOS) Leadership Fellows Program [1] Class of 2012 created a presentation for AAOS members to bring to local schools. The goal was to teach the children about the potential complications of childhood obesity and the benefits of healthy living. QUESTIONS/PURPOSES We describe a program in which orthopaedic surgeons gave presentations to elementary school students about healthy eating and activity and the effects that extra weight can have on their bones. METHODS Each of the five members of the Leadership Fellows Program [1] 2012 class (JW, EM, MP, MR, MF) presented to a school in his or her hometown. The program was presented to 210 fifth grade children throughout the country. Before and after the presentation, students took a six-question multiple-choice quiz and answers compared to assess improvement in knowledge. RESULTS The average number of answers correct before the presentation was 4.5 out of six, and the average after the presentation was six of six. The presentations were well received, and the students and their teachers invited each presenter back the next year. CONCLUSIONS The improvement in quiz scores demonstrated interest among the students in that they paid attention and understood the content. The children appeared enthusiastic to learn about this subject, and the schools were enthusiastic to include the curriculum.
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McClung MR, Zanchetta JR, Racewicz A, Roux C, Benhamou CL, Man Z, Eusebio RA, Beary JF, Burgio DE, Matzkin E, Boonen S, Delmas P. Efficacy and safety of risedronate 150-mg once a month in the treatment of postmenopausal osteoporosis: 2-year data. Osteoporos Int 2013; 24:293-9. [PMID: 22752050 PMCID: PMC3536944 DOI: 10.1007/s00198-012-2056-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 06/06/2012] [Indexed: 11/30/2022]
Abstract
UNLABELLED This study showed that risedronate 150-mg once a month provides similar efficacy and safety at 2 years compared with risedronate 5-mg daily for the treatment of postmenopausal osteoporosis. This adds to the range of risedronate dosing options and provides an alternative for patients who prefer once-a-month dosing. INTRODUCTION Risedronate is effective in the treatment of postmenopausal osteoporosis in oral daily, weekly, or on two consecutive days per month doses. This 2-year randomized, double-blind, multicenter study assesses the efficacy and safety of a single risedronate 150-mg once-a-month oral dose compared with the 5-mg daily regimen. METHODS Women with postmenopausal osteoporosis were randomly assigned to receive risedronate 5-mg daily (n = 642) or 150-mg once a month (n = 650) for 2 years. Bone mineral density (BMD), bone turnover markers, new vertebral fractures, and adverse events were evaluated. The primary efficacy endpoint was the mean percent change from baseline in lumbar spine BMD after 1 year. RESULTS Four hundred ninety-eight subjects in the daily group (77.6 %) and 513 subjects in the once-a-month group (78.9 %) completed the study. After 24 months, the mean percent change in lumbar spine BMD was 3.9 % (95 % confidence interval [CI], 3.43 to 4.42 %) and 4.2 % (95 % CI, 3.68 to 4.65 %) in the daily and once-a-month groups, respectively. The once-a-month regimen was determined to be non-inferior to the daily regimen. The mean percent changes in BMD at the hip were similar in both dose groups, as were changes in biochemical markers of bone turnover. The incidence of adverse events, adverse events leading to withdrawal, and upper gastrointestinal tract adverse events were similar in the two treatment groups. CONCLUSIONS After 2 years, treatment with risedronate 150-mg once a month provided similar efficacy and tolerability to daily dosing and provides an alternative for patients who prefer once-a-month oral dosing.
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Rajaee SS, Trofa D, Matzkin E, Smith E. National trends in primary total hip arthroplasty in extremely young patients: a focus on bearing surface usage. J Arthroplasty 2012; 27:1870-8. [PMID: 22658430 DOI: 10.1016/j.arth.2012.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 04/04/2012] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to present national trends in primary total hip arthroplasty (THA) and bearing surface usage for patients 30 years and younger. Using the Healthcare-Cost-and-Utilization-Project Nationwide Inpatient Sample for the years 2006 to 2009, 8919 primary THA discharges (4454 coded by bearing surface) were identified in patients 30 years and younger. The most commonly used bearing surface was metal-on-metal (MoM), representing 37.6% of cases, followed by ceramic-on-ceramic (CoC) (24.6%), metal-on-polyethylene (MoP) (22.1%) and ceramic-on-polyethylene (15.7%). From 2006 to 2009, the percentage of THAs that used hard-on-hard bearing surfaces decreased (MoM: 42.9%-29.4%; CoC: 34.0%-19.7%).This decrease in hard-on-hard bearing surface usage presents a challenge for surgeons treating young patients to find other acceptable durable bearings that do not have the potential problems associated with MoM or CoC.
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