Investigating the PROMIS Physical Function and Pain Interference Domains in Elite Athletes

Particulated Juvenile Articular Cartilage Allograft Transplantation for Patellofemoral Defects Shows Favorable Return-to-Sport Rates and Patient-Reported Outcomes

PURPOSE

To report return-to-sport rates, postoperative patient-reported outcomes (PROs), complication rates, and reoperation rates of a cohort of patients undergoing particulated juvenile articular cartilage (PJAC) allograft transplantation for patellofemoral articular cartilage defects.

METHODS

We performed a single-institution retrospective review of all patients with patellofemoral articular cartilage defects who received PJAC allograft transplantation from 2014 to 2022. Baseline demographic characteristics and surgical data, including concomitant surgical procedures, were collected. Clinical outcomes recorded included return-to-sport rates, complications, reoperations, and the following PRO scores: Kujala knee score, Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference score, and PROMIS Physical Function score.

RESULTS

Forty-one knees with a mean age of 23.4 ± 9.7 years and mean follow-up period of 30.3 months (range, 12-107 months) were included. The mean postoperative PROMIS Pain Interference, PROMIS Physical Function, and Kujala knee scores were 47.4 ± 7.7, 52.2 ± 10.8, and 81.7 ± 16.1, respectively, reflecting low residual anterior knee pain and a return to normal function. For patients playing organized sports at the high school and collegiate levels, the overall return-to-sport rate was 100% (17 of 17). During follow-up, complications developed in 12 knees (29.3%), the most common of which was anterior-based knee pain, and 6 knees (14.6%) required a total of 8 reoperations, which occurred from 6 to 32 months postoperatively.

CONCLUSIONS

The 100% return-to-sport rate and satisfactory PRO scores in our study suggest that PJAC allograft transplantation can effectively address patellofemoral cartilage defects in many patients. The complication and reoperation rates of 29.3% and 14.6%, respectively, are consistent with the challenging and heterogeneous etiology and treatment of patellofemoral articular defects.

LEVEL OF EVIDENCE

Level IV, case series.

Significant Factors of High Performance Outcomes for Tibial Plafond Fractures

BACKGROUND

Limited research exists about high performance postsurgical tibial plafond fractures. This study aimed to identify aspects of the plafond fracture injury and care associated with "high performance" based on Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) scores.

METHODS

Tibial plafond fracture patients with minimum 12-month follow-up treated at a level 1 trauma center from 2006 to 2019 were categorized into high (top 25%) vs average-low (AL) (bottom 75%) performers based on PROMIS PF scores. Demographics and fracture characteristics of high and AL performers were compared. Variables with a P value less than .1 were used in stepwise logistic regressions.

RESULTS

The final cohort of 198 patients was divided into high (n=51) and AL (n=147) performers based on PF scores. The mean PF scores for the high and AL groups were 58 (SD=5.3) and 41.9 (SD=6.5), respectively. The mean PROMIS Pain Interference scores for the high performers and AL were 43.3 (SD=4.9) and 56.8 (SD=8.6) (P < .001), respectively. FAAM activities of daily living (high 95.4 [SD=5.5] vs AL 70.4 [SD=19.8], P < .001) and FAAM sports (high 76.8 [SD=21.3] vs AL 27.3 [SD=28.9], P < .001) subscale scores were significantly greater in the high-performing group. Sex, age, marital status, and diabetes were nonsignificant factors in univariate analysis. Significant demographic factors associated with high performance from univariate analysis were Caucasian race, private insurance, no tobacco use, lower body mass index (BMI), and mechanism of injury. Patients with fracture characteristics of OTA 43C (complete articular) fractures, bone loss, open fractures, or nonexcellent reduction were significantly less likely to be high performers. Additionally, less than excellent reductions were more common in more complex fracture patterns. Multivariable regression modeling showed that higher BMI, OTA/AO 43-C (complete articular) fracture classification, and open fracture were significant independent risk factors for reducing likelihood of high performance.

CONCLUSION

Significant independent factors associated with high performance after tibial plafond fracture are lower BMI, closed fracture, and OTA/AO 43-B (partial articular) fracture.

A workplace wellness program at an academic health center influences employee health, satisfaction, productivity and the rate of workplace injury

PURPOSE

Workplace wellness (WP) programs are an employer strategy to improve employee health and satisfaction. Their impact on productivity and benefit expense remains unclear. This study examines the association of a voluntary WP at an academic health center with both employee metrics and employer costs.

METHODS

We retrospectively reviewed prospectively collected data from January 2016 to April 2018 for employees who voluntarily underwent screening for a WP at an academic medical center. We used their demographic, social, work, and clinical data to address the central research question. The primary outcomes included wellness measures from the Patient-Reported Outcomes Measurement Information System (PROMIS), secondary wellness outcomes such as body mass index, job-related outcomes such as job satisfaction, and workers' compensation metrics such as the claim amount. The key independent variables were whether an observation was from before or after the WP. For workers' compensation metrics, additional key independent variables were intervention/control group, and an interaction between the before/after and intervention/control variables. We conducted univariate and bivariate/unadjusted analyses, and estimated multivariable linear, logistic, and gamma regression models that also controlled for confounders.

RESULTS

The study included 370 employees. Participation in the program was associated with significant improvements in the PROMIS pain interference, fatigue and sleep quality domains. Hip circumference diminished, and functional movement outcomes were improved. Job satisfaction improved by 4.4 percentage points (95% Confidence Interval [CI]: 0.3-8.5, p = 0.04) and self-reported productivity by 14.5 percentage points (95% Confidence Interval [CI]: 9.5-19.5, p < 0.001). The likelihood of a new compensation claim during the 12-month follow-up period fell by 10.1% (95% Confidence Interval [CI]: - 15.5 to - 4.7, p < 0.001). However, the value of a new claim was unchanged.

CONCLUSION

Employees who completed a WP at an academic medical center demonstrated improvements in several recognized patient-reported outcome measures, in job satisfaction and self-reported productivity, a decrease in hip circumference, an improvement in functional motion and a decreased rate of compensable injury.