1
|
Lyng J, Morissette M, Ogborn D, Leiter J, MacDonald P, Longstaffe R. The impact of COVID-19 on national hockey league players' return to play. PHYSICIAN SPORTSMED 2024; 52:84-88. [PMID: 36744406 DOI: 10.1080/00913847.2023.2177080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/31/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Evaluate the on-ice performance and return to play (RTP) rate following COVID-19 for National Hockey League (NHL) players during the 2020-21 season. METHODS Players with COVID-19 during the abbreviated 2020-21 season were identified using publicly accessible online sources. Demographics and on-ice metrics were accessed using the NHL's online statistics website. The length of time, rate of RTP, and games missed due to COVID-19 were analyzed. Primary outcomes included average time on ice (TOI) per game (TOI/G), average TOI per shift (TOI/S), and points per game (PPG) compared at different timepoints including pre- and post-COVID-19. RESULTS A total of 73 players (47 forwards, 18 defensemen, 8 goalies) had a documented COVID-19 diagnosis during the abbreviated 2020-21 season. Players missed an average of 5.6 games (14.7 days) due to COVID-19. The post-COVID-19 RTP rate was 97.3%, including playoffs. No differences were found in TOI/G between the pre- (15.7 ± 3.9 min) and post-COVID-19 (15.8 ± 3.4 min, p = 0.874) or in the first (15.8 ± 4.0 min) and second week (15.9 ± 3.8 min, p = 0.925) returned. TOI/shift did not change from pre- (45.6 ± 5.3 sec) to post-COVID-19 (46.7 ± 4.6 sec, p = 0.035) or in first (46.2 ± 5.4 sec) and second week post-COVID-19 (46.2 ± 4.8 sec, p = .854). No differences were identified for PPG between career, pre-COVID-19, and post-COVID-19 (0.44 vs 0.38 vs 0.41; p = 0.274). CONCLUSION RTP post-COVID was markedly high for NHL players. While the effects of COVID-19 on specific physiological measures remains to be elucidated, this study found NHL players do not have reduced performance following COVID-19.
Collapse
Affiliation(s)
- Jasmine Lyng
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Dan Ogborn
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Peter MacDonald
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada
| | - Robert Longstaffe
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada
| |
Collapse
|
2
|
Larose G, Leiter J, Peeler J, McRae S, Stranges G, Rollins M, Davidson M, MacDonald P. Quality of life during the wait for ruptured anterior cruciate ligament reconstruction: a randomized controlled trial. Can J Surg 2022; 65:E269-E274. [PMID: 35414527 PMCID: PMC9007442 DOI: 10.1503/cjs.007820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background: There is a lack of prospective evidence to guide surgeons when making recommendations about the appropriate timing of surgical intervention for ruptured anterior cruciate ligament (ACL), activity modifications to reduce the risk of secondary injury before surgery, and the short- and long-term risks associated with delayed ACL reconstruction. This study aimed to determine whether longer wait times are associated with a prolonged decrease in quality of life and an increased incidence of secondary joint injury after ACL rupture. Methods: We recruited 53 patients who presented between 2013 and 2017 at a single sports medicine minor injury clinic with a suspected acute ACL rupture, based on clinical examination; ACL rupture was confirmed on magnetic resonance imaging. Patients were randomly allocated to undergo early reconstruction (< 12 wk after injury) or reconstruction after a regular wait time (≥ 12 wk). We compared scores on the ACL quality of life measure (ACL-QOL) and the incidence of secondary knee injury at baseline and at surgery between the 2 groups. Participants also completed the Tegner scale (level of activity) at the time of consent and within 7 days before surgery. Results: Twenty-eight patients were randomly assigned to the early surgery group and 25 patients to the regular wait time group. There was no difference in mean age between the 2 groups. There were no between-group differences in mean ACL-QOL score at the time of injury (28.5 [standard deviation (SD) 12.5] v. 28.5 [SD 12.6]) or at surgery (34.9 [SD 17.5] v. 38.0 [SD 17.5]). The mean wait time was significantly longer in the regular wait time group than in the early surgery group (29.6 wk [SD 13.2 wk] v. 10.6 wk [SD 5.1 wk], p = 0.001). In both groups, Tegner scale scores were significantly lower after than before ACL rupture (p < 0.001) and remained low while patients waited for surgery. There were no between-group differences in the incidence of chondral or meniscal injury at surgery, although the study was not adequately powered to draw any statistical conclusions. Conclusion: Wait time for ACL reconstruction may affect patients’ quality of life, as it remained diminished for a longer period when surgery was delayed. A low activity level during the waiting period was observed in both groups; this low activity level may be one reason why no between-group differences in the incidence of secondary injury were observed. The findings suggest that patients with a limited activity level during the waiting period have a low risk of secondary injuries.
Collapse
Affiliation(s)
- Gabriel Larose
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Larose, Stranges, MacDonald, Rollins, Leiter, McRae); the Department of Radiology, University of Manitoba, Winnipeg, Man. (Davidson); the Department of Anatomy, University of Manitoba, Winnipeg, Man. (Peeler); the Pan Am Clinic Foundation, Winnipeg, Man. (Leiter, McRae); and the Pan Am Clinic, Winnipeg, Man. (Stranges, Davidson, MacDonald)
| | - Jeff Leiter
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Larose, Stranges, MacDonald, Rollins, Leiter, McRae); the Department of Radiology, University of Manitoba, Winnipeg, Man. (Davidson); the Department of Anatomy, University of Manitoba, Winnipeg, Man. (Peeler); the Pan Am Clinic Foundation, Winnipeg, Man. (Leiter, McRae); and the Pan Am Clinic, Winnipeg, Man. (Stranges, Davidson, MacDonald)
| | - Jason Peeler
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Larose, Stranges, MacDonald, Rollins, Leiter, McRae); the Department of Radiology, University of Manitoba, Winnipeg, Man. (Davidson); the Department of Anatomy, University of Manitoba, Winnipeg, Man. (Peeler); the Pan Am Clinic Foundation, Winnipeg, Man. (Leiter, McRae); and the Pan Am Clinic, Winnipeg, Man. (Stranges, Davidson, MacDonald)
| | - Sheila McRae
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Larose, Stranges, MacDonald, Rollins, Leiter, McRae); the Department of Radiology, University of Manitoba, Winnipeg, Man. (Davidson); the Department of Anatomy, University of Manitoba, Winnipeg, Man. (Peeler); the Pan Am Clinic Foundation, Winnipeg, Man. (Leiter, McRae); and the Pan Am Clinic, Winnipeg, Man. (Stranges, Davidson, MacDonald)
| | - Gregory Stranges
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Larose, Stranges, MacDonald, Rollins, Leiter, McRae); the Department of Radiology, University of Manitoba, Winnipeg, Man. (Davidson); the Department of Anatomy, University of Manitoba, Winnipeg, Man. (Peeler); the Pan Am Clinic Foundation, Winnipeg, Man. (Leiter, McRae); and the Pan Am Clinic, Winnipeg, Man. (Stranges, Davidson, MacDonald)
| | - Meaghan Rollins
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Larose, Stranges, MacDonald, Rollins, Leiter, McRae); the Department of Radiology, University of Manitoba, Winnipeg, Man. (Davidson); the Department of Anatomy, University of Manitoba, Winnipeg, Man. (Peeler); the Pan Am Clinic Foundation, Winnipeg, Man. (Leiter, McRae); and the Pan Am Clinic, Winnipeg, Man. (Stranges, Davidson, MacDonald)
| | - Mike Davidson
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Larose, Stranges, MacDonald, Rollins, Leiter, McRae); the Department of Radiology, University of Manitoba, Winnipeg, Man. (Davidson); the Department of Anatomy, University of Manitoba, Winnipeg, Man. (Peeler); the Pan Am Clinic Foundation, Winnipeg, Man. (Leiter, McRae); and the Pan Am Clinic, Winnipeg, Man. (Stranges, Davidson, MacDonald)
| | - Peter MacDonald
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Larose, Stranges, MacDonald, Rollins, Leiter, McRae); the Department of Radiology, University of Manitoba, Winnipeg, Man. (Davidson); the Department of Anatomy, University of Manitoba, Winnipeg, Man. (Peeler); the Pan Am Clinic Foundation, Winnipeg, Man. (Leiter, McRae); and the Pan Am Clinic, Winnipeg, Man. (Stranges, Davidson, MacDonald)
| |
Collapse
|
3
|
Ahmed Z, Lau CH, Poole M, Arshinoff D, El-Andari R, White A, Johnson G, Doucet VM, Yilmaz R, Shi G, Natheir S, Hampshire J, Fazlollahi AM, Ramazani F, Elfaki L, Wang L, Desrosiers T, Lee M, Nisar M, Parapini ML, Larrivée S, White A, Dhillon J, Deng SX, Balamane S, Lee-Wing V, White A, Lee D, Gibert Y, Gervais V, Daniel R, Minor S, Ko G, Nguyen MA, Zablotny S, Lemieux V, Roach E, Ho J, Aggarwal I, Solish M, Lee JM, Rajendran L, Datta S, Gariscsak P, Johnson G, Del Fernandes R, Daud A, Fahey B, Zafar A, Worrall AP, Kheirelseid E, McHugh S, Moneley D, Naughton P, Fazlollahi AM, Bakhaidar M, Alsayegh A, Yilmaz R, Del Maestro RF, Harley JM, Ungi T, Fichtinger G, Zevin B, Stolz E, Bozso SJ, Kang JJ, Adams C, Nagendran J, Li D, Turner SR, Moon MC, Zheng B, Vergis A, Unger B, Park J, Gillman L, Petropolis CJ, Winkler-Schwartz A, Mirchi N, Fazlollahi A, Natheir S, Del Maestro R, Wang E, Waterman R, Kokavec A, Ho E, Harnden K, Nayak R, Malthaner R, Qiabi M, Christie S, Yilmaz R, Winkler-Schwarz A, Bajunaid K, Sabbagh AJ, Werthner P, Del Maestro R, Bratu I, Noga M, Bakhaidar M, Alsayegh A, Winkler-Schwartz A, Harley JM, Del Maestro RF, Côté D, Mortensen-Truscott L, McKellar S, Budiansky D, Lee M, Henley J, Philteos J, Gabinet-Equihua A, Horton G, Levin M, Saleem A, Monteiro E, Lin V, Chan Y, Campisi P, Meloche-Dumas L, Patocskai E, Dubrowski A, Beniey M, Bélanger P, Khondker A, Kangasjarvi E, Simpson J, Behzadi A, Kuluski K, Scott TM, Sidhu R, Karimuddin AA, Beaudoin A, McRae S, Leiter J, Stranges G, O’Brien D, Singh G, Zheng B, Moon MC, Turner SR, Salimi A, Zhu A, Tsang M, Greene B, Jayaraman S, Brown P, Zelt D, Yacob M, Keijzer R, Shawyer AC, Muller Moran HR, Ryan J, Mador B, Campbell S, Turner S, Ng K, Behzadi A, Benaskeur YI, Kasasni SM, Ammari N, Chiarella F, Lavallée J, Lê AS, Rosca MA, Semsar-Kazerooni K, Vallipuram T, Grabs D, Bougie É, Salib GE, Bortoluzzi P, Tremblay D, Kruse CC, McKechnie T, Eskicioglu C, Posel N, Fleiszer D, Berger-Richardson D, Brar S, Lim DW, Cil TD, Castelo M, Greene B, Lu J, Brar S, Reel E, Cil T, Diebel S, Nolan M, Bartolucci D, Rheault-Henry M, Abara E, Doyon J, Lee JM, Archibald D, Wadey V, Maeda A, Jackson T, Okrainec A, Leclair R, Braund H, Bunn J, Kouzmina E, Bruzzese S, Awad S, Mann S, Appireddy R, Zevin B, Gariscsak P, Liblik K, Winthrop A, Mann S, Abankwah B, Weinberg M, Cherry A, Lemieux V, Doyon J, Hamstra S, Nousiainen M, Wadey V, Marini W, Nadler A, Khoja W, Stoehr J, Aggarwal I, Liblik K, Mann S, Winthrop A, Lowy B, Vergis A, Relke N, Soleas E, Lui J, Zevin B, Nousiainen M, Simpson J, Musgrave M, Stewart R, Hall J. Canadian Conference for the Advancement of Surgical Education (C-CASE) 2021: Post-Pandemic and Beyond Virtual Conference AbstractsBlended learning using augmented reality glasses during the COVID-19 pandemic: the present and the futureActivating emotions enhance surgical simulation performance: a cluster analysisTraining in soft-tissue resection using real-time visual computer navigation feedback from the Surgery Tutor: a randomized controlled trialSonoGames: delivering a point of care ultrasound curriculum through gamificationTeaching heart valve surgery techniques using simulators: a reviewPortable, adjustable simulator for cardiac surgical skillsDesign and validity evidence for a unique endoscopy simulator using a commercial video gameComparison of a novel silicone flexor tendon repair model to a porcine tendon repair modelAssessment system using deep learningChallenges addressed with solutions, simulation in undergraduate and postgraduate surgical education, innovative education or research in surgical educationMachine learning distinguishes between skilled and less-skilled psychological performance in virtual neurosurgical performanceA powerful new tool for learning anatomy as a medical studentDevelopment and effectiveness of a telementoring approach for neurosurgical simulation training of medical studentsA team based learning approach to general otolaryngology in undergraduate medical educationStudent-led surgery interest group outreach for high school mentorship: a diversity driven initiativeRetrospective evaluation of novel case-based teaching series for first year otolaryngology residentsHarassment in surgery: assessing differences in perceptionFactors associated with medical student interest in pursuing a surgical residency: a cross-sectional survey studyUnderstanding surgical education experiences: an examination of 2 mentorship modelsLeadership development programs for surgical residents: a narrative review of the literatureValidation of knee arthroscopy simulator scoring system against subjective video analysis scoringCharacterizing the level of autonomy in Canadian cardiac surgery residentsMentorship patterns among medical students successfully matched to a surgical specialityStaying safe with laparoscopic cholecystectomy: the use of landmarking and intraoperative time-outsEndovascular aneurysm repair has changed the training paradigm of vascular residentsImplementation of a standardized handover in pediatric surgeryProcedure-specific assessment in cardiothoracic and vascular surgery: a scoping reviewLongitudinal mentorship-based programs for junior medical students increases exposure, confidence, and interest in surgeryCreating a green-shift in surgical education: a scoping review of initiatives and methods to make perioperative care more sustainableA novel plastic surgery residency bootcamp: structure and utilityVideo-based coaching for surgical residents: a systematic review and meta-analysisVirtual patient cases aligned with EPAs provide innovative e-learning strategiesAchieving competency in the CanMEDS roles for surgical trainees in the COVID-19 era: What have we learned and where do we go?Profiles of burnout and response to the COVID-19 pandemic among general surgery residents at a large academic training programLearner-driven telemedicine curriculum during the COVID-19 pandemicCentralized basic orthopaedic surgery virtual examinations — assessment of examination environmentEffects of the COVID-19 pandemic on surgical resident training: a nationwide survey of Canadian program directorsExploring the transition to virtual care in surgery and its impact on clinical exposure, teaching, and assessment during the COVID-19 pandemiecImpact of COVID-19 on procedural skills training and career preparation of medical studentsVirtual surgical shadowing for undergraduate medical students amidst the COVID-19 pandemicEducational impact of the COVID-19 third wave on a competency-based orthopedic surgery programVirtualization of postgraduate residency interviews: a ransforming practice in health care educationAn informational podcast about Canadian plastic surgery training programs: “Doctority Canada: Plastic Surgery.”Virtual versus in-person suture training: an evaluation of synchronous and asynchronous teaching paradigmsMerged virtual reality teaching of the fundamentals of laparoscopic surgery: a randomized controlled trialShould surgical skills be evaluated during virtual CaRMS residency interviews? A Canadian survey of CaRMS applicants and selection committee members during the COVID-19 pandemicImpact of the COVID-19 pandemic on surgical education for medical students: perspectives from Canada’s largest faculty of medicine. Can J Surg 2021. [PMCID: PMC8628843 DOI: 10.1503/cjs.018821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
4
|
Ogborn D, McRae S, Larose G, Leiter J, Brown H, MacDonald P. Knee flexor strength and symmetry vary by device, body position and angle of assessment following ACL reconstruction with hamstring grafts at long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 31:1658-1664. [PMID: 34477895 DOI: 10.1007/s00167-021-06712-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Persistent deficits in knee flexor strength following harvest of semitendinosus and gracilis for anterior cruciate ligament reconstruction are inconsistent in the literature. Variation in methodology, including measuring torque at higher knee flexion angles may partially explain these discrepant findings. The objective of this study was to determine whether positioning (seated vs supine), consideration of peak or joint-angle-specific torque or device (Isokinetic Dynamometer vs NordBord Hamstring Dynamometer) impact the magnitude of knee flexor strength differences between limbs. METHODS Participants (n = 31, 44.2 ± 10.7 years,) who were at 14 ± 4.4 years follow-up for unilateral ACL reconstruction with semitendinosus/gracilis grafts completed the ACL Quality of Life outcome and an assessment including isokinetic concentric knee extensor and flexor strength in seated and supine with peak torque and torque at 60° (T60) and 75° (T75) knee flexion measured, followed by an eccentric Nordic Hamstring Curl. RESULTS Isokinetic concentric knee flexor torque was reduced in supine relative to seated, on the reconstructed limb against the unaffected, and at higher degrees of knee flexion relative to peak torque (T60 and T75 against peak torque). Limb symmetry varied by methodology (F(6,204) = 8.506, p = 0.001) with reduced symmetry in supine T75 against all measures (71.1 ± 16.5%, p < 0.05), supine T60 against seated peak torque (82.7 ± 14.2%, p < 0.05), and the NordBord was lower than seated peak torque that was not statistically significant (83.9 ± 12.8%, n.s.). Knee extensor peak (r2 = 0.167 (F(1,27) = 5.3, p = 0.03) and Nordic curl eccentric torque (r2 = 0.267, F(2,26) = 4.736, p = 0.02) were predictors of ACL-QoL score, although a combined model did not improve over Nordic torque alone. CONCLUSION Limb symmetry cannot be assumed in clinical practice across differing assessment methods for knee flexor strength as deficits are greatest in the supine position with torque measured at 75° knee flexion. Isokinetic knee extensor and eccentric knee flexor torque during the Nordic hamstring curl were predictors of ACL-QoL scoring and should be considered alongside patient-reported outcomes for patients following ACL reconstruction with hamstring grafts. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Dan Ogborn
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada. .,College of Rehabilitation Sciences, Rady Faculty of Health Sciences, Winnipeg, MB, Canada.
| | - Sheila McRae
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada.,College of Rehabilitation Sciences, Rady Faculty of Health Sciences, Winnipeg, MB, Canada.,Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Gabriel Larose
- Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Jeff Leiter
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada
| | - Holly Brown
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada
| | - Pete MacDonald
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada.,Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| |
Collapse
|
5
|
Rodrigues D, Amadeo RJJ, Wolfe S, Girling L, Funk F, Fidler K, Brown H, Leiter J, Old J, MacDonald P, Dufault B, Mutter TC. Analgesic duration of interscalene block after outpatient arthroscopic shoulder surgery with intravenous dexamethasone, intravenous dexmedetomidine, or their combination: a randomized-controlled trial. Can J Anaesth 2021; 68:835-845. [PMID: 33598889 DOI: 10.1007/s12630-021-01942-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Both intravenous dexamethasone and dexmedetomidine prolong the analgesic duration of interscalene blocks (ISB) after arthroscopic shoulder surgery. This study compared their relative effectiveness and the benefit of their use in combination. METHODS This single-centre, double-blinded, parallel three-group superiority trial randomized 198 adult patients undergoing ambulatory arthroscopic shoulder surgery. Patients received preoperative ISB with 30 mL 0.5% bupivacaine and 50 µg dexmedetomidine or 4 mg dexamethasone or both of these agents as intravenous adjuncts. The primary outcome was analgesic block duration. Secondary outcomes included the quality of recovery 15 score (range: 0-150) on day 1 and postoperative neurologic symptoms in the surgical arm. RESULTS Block durations (n = 195) with dexamethasone (median [range], 24.5 [2.0-339.5] hr) and both adjuncts (24.0 [1.5-157.0] hr) were prolonged compared with dexmedetomidine (16.0 [1.5-154.0] hr). When analyzed by linear regression after an unplanned log transformation because of right-skewed data, the corresponding prolongations of block duration were 59% (95% confidence interval [CI], 28 to 97) and 46% (95% CI, 18 to 80), respectively (both P < 0.001). The combined adjuncts were not superior to dexamethasone alone (-8%; 95% CI, -26 to 14; P = 0.42). Median [IQR] quality of recovery 15 scores (n = 197) were significantly different only between dexamethasone (126 [79-149]) and dexmedetomidine (118.5 [41-150], P = 0.004), but by an amount less than the 8-point minimum clinically important difference. CONCLUSION Dexamethasone is superior to dexmedetomidine as an intravenous adjunct for prolongation of bupivacaine-based ISB analgesic duration. There was no additional benefit to using both adjuncts in combination. TRIAL REGISTRATION www.clinicaltrials.gov (NCT03270033); registered 1 September 2017.
Collapse
Affiliation(s)
- Daniel Rodrigues
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, MB, R3E 0Z2, Canada
| | - Ryan J J Amadeo
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, MB, R3E 0Z2, Canada
| | - Scott Wolfe
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, MB, R3E 0Z2, Canada
| | - Linda Girling
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, MB, R3E 0Z2, Canada
| | - Faylene Funk
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, MB, R3E 0Z2, Canada
| | - Kelsi Fidler
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, MB, R3E 0Z2, Canada
| | - Holly Brown
- Department of Orthopedic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Jeff Leiter
- Department of Orthopedic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Jason Old
- Department of Orthopedic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Peter MacDonald
- Department of Orthopedic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Brenden Dufault
- George and Fay Yee Centre for Healthcare Innovation, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas C Mutter
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, MB, R3E 0Z2, Canada.
| |
Collapse
|
6
|
MacDonald P, McRae S, Old J, Marsh J, Dubberley J, Stranges G, Koenig J, Leiter J, Mascarenhas R, Prabhakar S, Sasyniuk T, Lapner P. Arthroscopic Bankart repair with and without arthroscopic infraspinatus remplissage in anterior shoulder instability with a Hill-Sachs defect: a randomized controlled trial. J Shoulder Elbow Surg 2021; 30:1288-1298. [PMID: 33373683 DOI: 10.1016/j.jse.2020.11.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/03/2020] [Accepted: 11/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare patient-reported and clinic outcomes between arthroscopic Bankart repair with (REMP) and without (NO REMP) arthroscopic infraspinatus remplissage in patients with recurrent anterior shoulder instability with a Hill-Sachs lesion and minimal glenoid bone loss. METHODS Patients 14 years or older with a recurrent anterior shoulder instability with the presence of an engaging Hill-Sachs defect (of any size) confirmed on computed tomography or magnetic resonance imaging were eligible to participate. Consented patients were randomized intraoperatively to NO REMP or REMP. Study visits were conducted preoperatively and 3, 6, 12, and 24 months postoperatively. The primary outcome was the Western Ontario Shoulder Instability score. Secondary outcomes included incidence of postoperative recurrent shoulder instability, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, range of motion, complications, and revision surgery. To compare groups, a mixed-effects linear model was used for continuous variables and a χ2 or Fisher's exact test for categorical data. A Kaplan-Meier survival analysis assessed survival distribution between groups. RESULTS One hundred and eight patients were randomized to Bankart repair with (n = 54) or without (n = 54) remplissage. The mean follow-up was 26.5 months (21-53 months) and 24.3 months (23-64 months) for the REMP and NO REMP groups, respectively. Rates of postoperative recurrent instability were higher (P = .027) in the NO REMP group with 9 of 50 (18%) vs. 2 of 52 (4%) postoperative dislocations in the REMP group. There were no significant differences in patient-reported outcomes between groups at any time point. Survival curve distributions were also significantly different favoring REMP (χ2 = 5.255, P = .022). There was a significant difference in rate of revision surgery between groups with 6 in the NO REMP and none in the REMP groups (P = .029). Post hoc, patients were noted to have a higher risk for re-dislocation if their Hill-Sachs lesion was ≥20 mm in width or ≥15% of humeral head diameter. One intraoperative complication was reported in the REMP group. CONCLUSIONS There is significantly greater risk of postoperative recurrent instability in patients who did not have a remplissage performed in conjunction with an arthroscopic Bankart repair for the treatment of traumatic recurrent anterior shoulder instability with Hill-Sachs lesions of any size and minimal glenoid bone loss (<15%) at 2 years postoperatively. Otherwise, there are no differences in patient-reported outcomes, complications, or shoulder function at 2 years postoperatively. In addition, the remplissage procedure has significantly lower rates of re-dislocation in high-risk patients with Hill-Sachs lesions ≥20 mm and/or ≥15% in size.
Collapse
Affiliation(s)
- Peter MacDonald
- Pan Am Clinic, Winnipeg, MB, Canada; Department of Surgery, Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, MB, Canada.
| | - Sheila McRae
- Department of Surgery, Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, MB, Canada; Department of Research, Pan Am Clinic Foundation, Winnipeg, MB, Canada
| | - Jason Old
- Pan Am Clinic, Winnipeg, MB, Canada; Department of Surgery, Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Jonathan Marsh
- Pan Am Clinic, Winnipeg, MB, Canada; Department of Surgery, Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Jamie Dubberley
- Pan Am Clinic, Winnipeg, MB, Canada; Department of Surgery, Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Greg Stranges
- Pan Am Clinic, Winnipeg, MB, Canada; Department of Surgery, Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - James Koenig
- Pan Am Clinic, Winnipeg, MB, Canada; Department of Surgery, Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Jeff Leiter
- Department of Surgery, Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, MB, Canada; Department of Research, Pan Am Clinic Foundation, Winnipeg, MB, Canada
| | - Randy Mascarenhas
- Department of Orthopedic Surgery, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | | | - Treny Sasyniuk
- Department of Research, Pan Am Clinic Foundation, Winnipeg, MB, Canada
| | - Peter Lapner
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| |
Collapse
|
7
|
Beaudoin A, Larrivée S, McRae S, Leiter J, Stranges G. Module-Based Arthroscopic Knee Simulator Training Improves Technical Skills in Naive Learners: A Randomized Trial. Arthrosc Sports Med Rehabil 2021; 3:e757-e764. [PMID: 34195642 PMCID: PMC8220613 DOI: 10.1016/j.asmr.2021.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 01/24/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose To compare the effectiveness, in comparison to a control group (C), of module-based training (MBT) and traditional learning (TL) as a means of acquiring arthroscopic skills on an arthroscopic surgery simulator. Methods Thirty health sciences students with no previous arthroscopy experience were recruited and randomized into 1 of 3 groups: MBT, TL, or C (1:1:1 ratio). Participants in MBT were required to independently practice on a VirtaMed ArthroS simulator (VirtaMed AG, Zurich, Switzerland) for a minimum of 2 hours per week, whereas TL received one-on-one coaching by a senior orthopaedic resident for 15 minutes per week. The control group received no training. All groups were assessed at baseline and at 4 weeks based on objective measures generated by the surgical simulator (procedure time, camera path length, meniscus cutting score, detailed visualization, safety score and total score), and subjective ratings scales (Objective Assessment of Arthroscopic Skill [OAAS] global assessment form, and Competency-Based Assessment form). Results Participants in the MBT group trained on average 113 min/week whereas the TL group trained on average 24 min/week. Three-way repeated-measures analysis of variance showed significant group by time interactions for procedure time (P = .006), camera path length (P = .008), safety score (P = .013), total score (P = .003), OAAS form (P < .001), and Competency-Based Assessment form (P < .001). MBT group was superior to C group for procedure time (P = .02), camera path length (P = .003), total score (P = .004), and OAAS form (P = .021), but there were no significant post-hoc differences between MBT and TL groups, or TL and C groups after Bonferroni correction. Total practice time explained 37.5% of the final simulator total score variance. Conclusions Knee arthroscopy simulation training with self-learning modules can improve skills in areas such as procedure time, camera path length, and total score in untrained participants compared with a control group. Clinical Relevance Module-based simulation training provides additional training time and improves technical skills in naive health science students. It is hoped that this effect can be preserved and applied to junior resident developing in a busy residency program.
Collapse
Affiliation(s)
| | | | - Sheila McRae
- University of Manitoba, Pan Am Clinic Foundation, Winnipeg
| | - Jeff Leiter
- University of Manitoba, Oak Bluff, Manitoba, Canada
| | | |
Collapse
|
8
|
Matthewson G, Kooner S, Rabbani R, Gottschalk T, Old J, Abou-Setta AM, Zarychanski R, Leiter J, MacDonald P. Does a Delay in Anterior Cruciate Ligament Reconstruction Increase the Incidence of Secondary Pathology in the Knee? A Systematic Review and Meta-Analysis. Clin J Sport Med 2021; 31:313-320. [PMID: 31743219 DOI: 10.1097/jsm.0000000000000762] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 02/22/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Previous systematic reviews looking at timing of anterior cruciate ligament reconstruction (ACLR) examined the functional outcomes and range of motion; however, few have quantified the effect of timing of surgery on secondary pathology. The goal of this study was to analyze the effects of early ACLRs versus delayed ACLR on the incidence of meniscal and chondral lesions. DATA SOURCES We searched MEDLINE, EMBASE, and CINAHL on March 20, 2018, for randomized control trials (RCTs) that compared early and delayed ACLR in a skeletally mature population. Two reviewers independently identified trials, extracted trial-level data, performed risk-of-bias assessments using the Cochrane Risk of Bias tool, and evaluated the study methodology using the Detsky scale. A meta-analysis was performed using a random-effects model with the primary outcome being the total number of meniscal and chondral lesions per group. RESULTS Of 1887 citations identified from electronic and hand searches, we included 4 unique RCTs (303 patients). We considered early reconstruction as <3 weeks and delayed reconstruction as >4 weeks after injury. There was no evidence of a difference between early and late ACLR regarding the incidence of meniscal [relative risk (RR), 0.98; 95% confidence interval (CI), 0.74-1.29] or chondral lesions (RR, 0.88; 95% CI, 0.59-1.29), postoperative infection, graft rupture, functional outcomes, or range of motion. CONCLUSIONS We found no evidence of benefit of early ACLR. Further studies may consider delaying surgery even further (eg, >3 months) to determine whether there are any real benefits to earlier reconstruction.
Collapse
Affiliation(s)
- Graeme Matthewson
- Department of Orthopedic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Sahil Kooner
- Department of Orthopedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Rasheda Rabbani
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Tania Gottschalk
- Neil John Mclean Library, University of Manitoba, Winnipeg, MB, Canada
| | - Jason Old
- Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada; and
| | - Ryan Zarychanski
- George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada; and
- Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada
| | - Jeff Leiter
- Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | | |
Collapse
|
9
|
Ogborn DI, Bellemare A, Bruinooge B, Brown H, McRae S, Leiter J. Comparison of Common Methodologies for the Determination of Knee Flexor Muscle Strength. Int J Sports Phys Ther 2021; 16:350-359. [PMID: 33842031 PMCID: PMC8016447 DOI: 10.26603/001c.21311] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Knee flexion strength may hold important clinical implications for the determination of injury risk and readiness to return to sport following injury and orthopedic surgery. A wide array of testing methodologies and positioning options are available that require validation prior to clinical integration. The purpose of this study was to 1) investigate the validity and test-retest reliability of isometric knee flexion strength measured by a fixed handheld dynamometer (HHD) apparatus compared to a Biodex Dynamometer (BD), 2) determine the impact of body position (seated versus supine) and foot position (plantar- vs dorsiflexed) on knee flexion peak torque and 3) establish the validity and test-retest reliability of the NordBord Hamstring Dynamometer. STUDY DESIGN Validity and reliability study, test-retest design. METHODS Forty-four healthy participants (aged 27 ± 4.8 years) were assessed by two raters over two testing sessions separated by three to seven days. Maximal isometric knee flexion in the seated and supine position at 90o knee flexion was measured with both a BD and an externally fixed HHD with the foot held in maximal dorsiflexion or in plantar flexion. The validity and test-retest reliability of eccentric knee flexor strength on the NordBord hamstring dynamometer was assessed and compared with isometric strength on the BD. RESULTS Level of agreement between HHD and BD torque demonstrated low bias (bias -0.33 Nm, SD of bias 13.5 Nm; 95% LOA 26.13 Nm, -26.79 Nm). Interrater reliability of the HHD was high, varying slightly with body position (ICC range 0.9-0.97, n=44). Isometric knee flexion torque was higher in the seated versus supine position and with the foot dorsiflexed versus plantarflexed. Eccentric knee flexion torque had a high degree of correlation with isometric knee flexion torque as measured via the BD (r=0.61-0.86). The NordBord had high test-retest reliability (0.993 (95%CI 0.983-0.997, n=19) for eccentric knee flexor strength, with an MDC95 of 26.88 N and 28.76 N for the left and right limbs respectively. CONCLUSION Common measures of maximal isometric knee flexion display high levels of correlation and test-retest reliability. However, values obtained by an externally fixed HHD are not interchangeable with values obtained via the BD. Foot and body position should be considered and controlled during testing. LEVEL OF EVIDENCE 2b.
Collapse
Affiliation(s)
- Dan I Ogborn
- Department of Physical Therapy, University of Manitoba; Pan Am Clinic Foundation
| | - Alix Bellemare
- Pan Am Clinic Foundation; Faculty of Kinesiology and Recreation Management, University of Manitoba
| | - Brittany Bruinooge
- Department of Physical Therapy, University of Manitoba; Pan Am Clinic Foundation
| | | | - Sheila McRae
- Department of Physical Therapy, University of Manitoba; Pan Am Clinic Foundation
| | - Jeff Leiter
- Pan Am Clinic Foundation; Faculty of Kinesiology and Recreation Management, University of Manitoba
| |
Collapse
|
10
|
Larrivée S, Avery E, Leiter J, Old J. Accelerometry as an objective measure of upper-extremity activity. Med Biol Eng Comput 2021; 59:187-194. [PMID: 33411268 DOI: 10.1007/s11517-020-02293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/27/2020] [Indexed: 11/25/2022]
Abstract
Most studies evaluating the effectiveness of treatments targeting shoulder pathologies use subjective outcome measures such as self-administered questionnaires. To date, there are no validated tools that objectively measure shoulder-specific functional activity. The purpose of this study was to validate wearable accelerometers as an objective proxy for shoulder activity. Ten healthy volunteers wore accelerometers placed at both wrists, the dominant upper arm and the chest while performing standardised shoulder and non-shoulder activities. Recorded tridimensional acceleration was computed into activity counts for epochs of 10 s. Receiver operating characteristics (ROC) curves were built to determine the optimal configuration to classify shoulder-type activities. For single accelerometer placement, the area under the ROC curve (AUC) was optimal for the 10-s epoch (AUC = 0.779) using the wrist placement, with a sensitivity of 94.1% and specificity of 67.5%. The combined upper arm and chest placement had an AUC of 0.985 (94.8% sensitivity, 94.8% specificity). Dual-accelerometer placement (upper arm and chest) is the optimal configuration to classify shoulder activity. However, a sole wrist-based accelerometer can be used as an objective proxy for shoulder activity in long-term unsupervised monitoring with excellent sensitivity and acceptable specificity.
Collapse
Affiliation(s)
- Samuel Larrivée
- Department of Surgery, Section of Orthopaedic Surgery, Rady Faculty of Health Sciences, University of Manitoba, AD4 - 820 Sherbrook St., Winnipeg, MB, R3A 1R9, Canada.
| | - Emma Avery
- Department of Surgery, Section of Orthopaedic Surgery, Rady Faculty of Health Sciences, University of Manitoba, AD4 - 820 Sherbrook St., Winnipeg, MB, R3A 1R9, Canada
| | - Jeff Leiter
- Department of Surgery, Section of Orthopaedic Surgery, Rady Faculty of Health Sciences, University of Manitoba, AD4 - 820 Sherbrook St., Winnipeg, MB, R3A 1R9, Canada.,Pan Am Clinic Foundation, 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada
| | - Jason Old
- Department of Surgery, Section of Orthopaedic Surgery, Rady Faculty of Health Sciences, University of Manitoba, AD4 - 820 Sherbrook St., Winnipeg, MB, R3A 1R9, Canada.,Pan Am Clinic Foundation, 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada
| |
Collapse
|
11
|
Cordingley DM, Leiter J, McRae S. Changes In Step Time And Length Between Kilometer Eleven And Thirty-nine Of A Marathon. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000675944.89026.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
12
|
Longstaffe R, Leiter J, Gurney-Dunlop T, McCormack R, MacDonald P. Return to Play and Career Length After Anterior Cruciate Ligament Reconstruction Among Canadian Professional Football Players. Am J Sports Med 2020; 48:1682-1688. [PMID: 32379980 DOI: 10.1177/0363546520918224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND For many athletes, a tear of the anterior cruciate ligament (ACL) represents a significant injury that requires a prolonged period away from the sport with substantial rehabilitation. HYPOTHESIS There will be no difference in return to play (RTP) and career length after hamstring tendon (HT) ACL reconstruction in a group of Canadian Football League professional players as compared with what has been already been reported in the literature among professional football players. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data on athletes who sustained an ACL injury were collected by team physicians and head athletic trainers from 2002 to 2017 from 2 Canadian Football League teams. Patient details included age at the time of injury, initial injury date, position, practice versus game injury, and primary versus rerupture with injury-specific data, such as affected limb, concomitant injuries, graft choice, and procedure performed. RTP rates and career length data were collected through publically available internet sources. Comparisons between the non-RTP and RTP groups were made with independent-sample t tests. Binomial logistic regression was performed to determine variables (ie, games preinjury, graft type, meniscal injury, collateral ligament injury) that contributed to players not being able to RTP. RESULTS A total of 44 ACL reconstructions were performed over the study period (HT, n = 32 [72.7%]; bone-patellar tendon-bone [BPTB], n = 8 [18.2%]; allograft, n = 4 [9.1%]). Overall, 69.8% (n = 30) were able to RTP in at least 1 game, while 30.2% (n = 13) did not return. Mean time to return was 316.1 days (range, 220-427 days), or 10.4 months. For those players who did RTP, mean career length after ACL reconstruction was 2.8 seasons, or 34.4 games. The majority (56.8%) of injuries occurred early in the season. Breakdown by graft type demonstrated RTP rates among HT, BPTB, and allograft of 64.5% (n = 20), 87.5% (n = 7), and 75% (n = 3), respectively. Career length among HT, BPTB, and allograft was 2.9, 2.4, and 3 seasons. Logistic regression analysis found only concomitant medial collateral ligament (MCL) injuries to be a negative predictor for RTP. Meniscal injuries were associated with a decreased RTP rate and career length, but this was not statistically significant. CONCLUSION The RTP rates after ACL reconstruction in this study are similar to those reported in National Football League players. A concomitant injury to the MCL injury was a negative predictor of RTP. Meniscal injuries demonstrated a trend for decreased RTP rate and career length, but this was not a significant predictor. A large portion of injuries occur early in the season, and further study should be done to examine potential preventative strategies to reduce ACL injuries.
Collapse
Affiliation(s)
| | - Jeff Leiter
- Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Robert McCormack
- University of British Columbia, New Westminster, British Columbia, Canada
| | - Peter MacDonald
- Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
13
|
MacDonald P, Verhulst F, McRae S, Old J, Stranges G, Dubberley J, Mascarenhas R, Koenig J, Leiter J, Nassar M, Lapner P. Biceps Tenodesis Versus Tenotomy in the Treatment of Lesions of the Long Head of the Biceps Tendon in Patients Undergoing Arthroscopic Shoulder Surgery: A Prospective Double-Blinded Randomized Controlled Trial. Am J Sports Med 2020; 48:1439-1449. [PMID: 32223645 DOI: 10.1177/0363546520912212] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The biceps tendon is a known source of shoulder pain. Few high-level studies have attempted to determine whether biceps tenotomy or tenodesis is the optimal approach in the treatment of biceps pathology. Most available literature is of lesser scientific quality and shows varying results in the comparison of tenotomy and tenodesis. PURPOSE To compare patient-reported and objective clinical results between tenotomy and tenodesis for the treatment of lesions of the long head of the biceps brachii. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients aged ≥18 years undergoing arthroscopic surgery with intraoperative confirmation of a lesion of the long head of the biceps tendon were randomized. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) score, while secondary outcomes included the Western Ontario Rotator Cuff Index (WORC) score, elbow and shoulder strength, operative time, complications, and the incidence of revision surgery with each procedure. Magnetic resonance imaging was performed at postoperative 1 year to evaluate the integrity of the procedure in the tenodesis group. RESULTS A total of 114 participants with a mean age of 57.7 years (range, 34 years to 86 years) were randomized to undergo either biceps tenodesis or tenotomy. ASES and WORC scores improved significantly from pre- to postoperative time points, with a mean difference of 32.3% (P < .001) and 37.3% (P < .001), respectively, with no difference between groups in either outcome from presurgery to postoperative 24 months. The relative risk of cosmetic deformity in the tenotomy group relative to the tenodesis group at 24 months was 3.5 (95% CI, 1.26-9.70; P = .016), with 4 (10%) occurrences in the tenodesis group and 15 (33%) in the tenotomy group. Pain improved from 3 to 24 months postoperatively (P < .001) with no difference between groups. Cramping was not different between groups, nor was any improvement in cramping seen over time. There were no differences between groups in elbow flexion strength or supination strength. Follow-up magnetic resonance imaging at postoperative 12 months showed that the tenodesis was intact for all patients. CONCLUSION Tenotomy and tenodesis as treatment for lesions of the long head of biceps tendon both result in good subjective outcomes but there is a higher rate of Popeye deformity in the tenotomy group. REGISTRATION NCT01747902 ( ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Peter MacDonald
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Fleur Verhulst
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheila McRae
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason Old
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Greg Stranges
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jamie Dubberley
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Randy Mascarenhas
- McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - James Koenig
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeff Leiter
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark Nassar
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter Lapner
- Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
14
|
Larrivée S, Rodger R, Larouche P, Leiter J, Jelic T, MacDonald P. Orthopaedic residents demonstrate retention of point of care ultrasound knowledge after a brief educational session: a quasi experimental study. BMC Med Educ 2019; 19:474. [PMID: 31888601 PMCID: PMC6937626 DOI: 10.1186/s12909-019-1916-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Musculoskeletal point of care ultrasound (MSK POCUS) has many uses for orthopaedic surgeons, but orthopaedic trainees are rarely exposed to this modality. The purpose of this project was to assess the usefulness in clinical education of a newly implemented MSK POCUS course in an orthopaedic surgery program. METHODS An MSK POCUS course for orthopaedic surgery residents was developed by an interdisciplinary team. Online videos were created to be viewed by residents prior to a half-day long practical course. An online survey covering the level of training of the resident and their previous use of ultrasound (total hours) was completed by the participants prior to the course. Resident's knowledge acquisition was measured with written pre-course, same-day post-course and six-month follow-up tests. Residents were also scored on a practical shoulder examination immediately after the course and at six-month follow-up. Changes in test scores between time points were evaluated using Wilcoxon signed-rank tests. RESULTS Ten orthopaedic surgery residents underwent the MSK POCUS curriculum. Pre-course interest in MSK-POCUS was moderate (65%) and prior exposure was low (1.5 h mean total experience). Written test scores improved significantly from 50.7 ± 17.0% before to 84.0 ± 10.7% immediately after the course (p < 0.001) and suffered no significant drop at 6 months (score 75.0 ± 8.7%; p = 0.303). Average post-course practical exam score was 78.8 ± 3.1% and decreased to 66.2 ± 11.3% at 6 months (p = 0.012). Residents significantly improved their subjective comfort level with all aspects of ultrasound use at 6 months (p = 0.007-0.018) but did not significantly increase clinical usage frequency. CONCLUSION An MSK POCUS curriculum was successfully developed and implemented using an interdisciplinary approach. The course succeeded in improving the residents' knowledge, skills, and comfort with MSK POCUS. This improvement was maintained at 6 months on the written test but did not result in higher frequency of use by the residents.
Collapse
Affiliation(s)
- Samuel Larrivée
- Department of Surgery, Section of Orthopaedic Surgery, Rady Faculty of Health Sciences, University of Manitoba, AD4 - 820 Sherbrook St, Winnipeg, Manitoba, R3A 1R9, Canada.
| | - Robyn Rodger
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Patricia Larouche
- Department of Surgery, Section of Orthopaedic Surgery, Rady Faculty of Health Sciences, University of Manitoba, AD4 - 820 Sherbrook St, Winnipeg, Manitoba, R3A 1R9, Canada
| | - Jeff Leiter
- Department of Surgery, Section of Orthopaedic Surgery, Rady Faculty of Health Sciences, University of Manitoba, AD4 - 820 Sherbrook St, Winnipeg, Manitoba, R3A 1R9, Canada
| | - Tomislav Jelic
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Peter MacDonald
- Department of Surgery, Section of Orthopaedic Surgery, Rady Faculty of Health Sciences, University of Manitoba, AD4 - 820 Sherbrook St, Winnipeg, Manitoba, R3A 1R9, Canada
| |
Collapse
|
15
|
Huynh T, Leiter J, MacDonald PB, Dubberley J, Stranges G, Old J, Marsh J. Outcomes and Complications After Repair of Complete Distal Biceps Tendon Rupture with the Cortical Button Technique. JB JS Open Access 2019; 4:JBJSOA-D-19-00013. [PMID: 31592499 PMCID: PMC6766377 DOI: 10.2106/jbjs.oa.19.00013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Numerous surgical techniques have been described for the repair of complete distal biceps tendon ruptures. However, the outcome of repair with cortical button fixation has not been extensively evaluated. The hypothesis of the present study was that elbow strength and range of motion would be less than normal after repair but that ongoing disability would be minimal as measured with use of the Disabilities of the Arm, Shoulder and Hand (DASH) score. Methods We performed a retrospective cohort study of patients with complete distal biceps tendon rupture that was repaired with cortical button fixation via a 1-incision anterior approach. Outcome was assessed on the basis of elbow range-of-motion and strength measurements, DASH scores, and radiographs of the operatively treated elbow. Descriptive statistics were generated for patient demographics and outcome variables. Strength was assessed with limb-symmetry index, and range of motion was evaluated with paired t tests. Results Sixty male patients consented to this study. The average age at the time of follow-up was 49.6 ± 7.8 years, and the average time from injury to follow-up was 3.7 ± 1.7 years. The mechanism of injury included lifting heavy objects (62%) and sporting activities (25%). Elbow flexion and supination range of motion were not different between the operatively treated and contralateral arms. The operatively treated elbow demonstrated decreased flexion strength (96% of that on the contralateral side) and supination strength (91% of that on the contralateral side). The findings did not change when controlling for hand dominance. The mean DASH score was 7.9 ± 11.4, which is not significantly different from the normative value for the general population. Postoperative complications included heterotopic ossification (Brooker class I [29 patients] or II [5 patients]), neurapraxia (7 patients), and rerupture (3 patients). Conclusions The repair of complete distal biceps tendon ruptures with cortical button fixation was associated with decreased strength in elbow flexion and forearm supination compared with the contralateral arm, although the differences were small and likely were not clinically important. The complication rate was relatively high; however, most complications were minor and were associated with minimal disability, as reflected by the DASH scores. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
| | - Jeff Leiter
- University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Peter B MacDonald
- University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - James Dubberley
- University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Gregory Stranges
- University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Jason Old
- University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Jonathon Marsh
- University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic, Winnipeg, Manitoba, Canada
| |
Collapse
|
16
|
Cordingley DM, McRae S, Leiter J, Stranges G, MacDonald P. Cardiovascular Fitness In Recreational Athletes Prior To And After Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563265.56766.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
17
|
Matthewson G, Kooner S, Kwapisz A, Leiter J, Old J, MacDonald P. The effect of subscapularis repair on dislocation rates in reverse shoulder arthroplasty: a meta-analysis and systematic review. J Shoulder Elbow Surg 2019; 28:989-997. [PMID: 30827833 DOI: 10.1016/j.jse.2018.11.069] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 11/19/2018] [Accepted: 11/30/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty is an effective treatment for patients with rotator cuff arthropathy; however, complication rates are relatively high (19%-50%), with implant instability and infection being particularly devastating to overall outcomes. The objective of this study was to analyze the highest level of data comparing dislocation rates and outcomes in reverse total shoulder arthroplasty with and without the subscapularis tendon repaired. METHODS The databases MEDLINE, Embase, and CINAHL were searched using a sensitive search strategy for this meta-analysis/systematic review. Eligibility included any studies in which patients were treated with a reverse total shoulder arthroplasty in which the status of the subscapularis tendon could be determined. A data extraction form was developed to collect select data from the included studies. A meta-analysis was performed on pooled data of 5 studies comparing dislocation rates and 3 studies comparing postoperative forward elevation, rate of infection, overall complication rates, and fractures. RESULTS Two independent researchers reviewed 1008 studies. Seven studies met inclusion criteria. A meta-analysis was performed on all level III studies, resulting in 1306 patients being analyzed. Results demonstrated lower dislocation rates in the subscapularis repair group (odds ratio, 0.19; P < .001). However, in patients without a subscapularis repair, lateralized center of rotation (COR) resulted in a significantly lower dislocation rate compared with medialized COR (odds ratio, 0.24; P < .001). CONCLUSION The results of our meta-analysis of the available data demonstrated a decrease in dislocation risk when the subscapularis tendon was repaired in medialized and lateralized designs. When subscapularis repair is not performed, lateralized COR, regardless of humeral socket design, may reduce the dislocation rates.
Collapse
Affiliation(s)
- Graeme Matthewson
- Orthopaedic Surgery, Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada.
| | - Sahil Kooner
- Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Adam Kwapisz
- Orthopaedic Surgery, Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada; Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Poland
| | - Jeff Leiter
- Orthopaedic Surgery, Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | - Jason Old
- Orthopaedic Surgery, Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | - Peter MacDonald
- Orthopaedic Surgery, Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|
18
|
Leddy JJ, Haider MN, Ellis MJ, Mannix R, Darling SR, Freitas MS, Suffoletto HN, Leiter J, Cordingley DM, Willer B. Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatr 2019; 173:319-325. [PMID: 30715132 PMCID: PMC6450274 DOI: 10.1001/jamapediatrics.2018.4397] [Citation(s) in RCA: 235] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Sport-related concussion (SRC) is a significant public health problem without an effective treatment. OBJECTIVE To assess the effectiveness of subsymptom threshold aerobic exercise vs a placebo-like stretching program prescribed to adolescents in the acute phase of recovery from SRC. DESIGN, SETTING, AND PARTICIPANTS This multicenter prospective randomized clinical trial was conducted at university concussion centers. Male and female adolescent athletes (age 13-18 years) presenting within 10 days of SRC were randomly assigned to aerobic exercise or a placebo-like stretching regimen. INTERVENTIONS After systematic determination of treadmill exercise tolerance on the first visit, participants were randomly assigned to a progressive subsymptom threshold aerobic exercise or a progressive placebo-like stretching program (that would not substantially elevate heart rate). Both forms of exercise were performed approximately 20 minutes per day, and participants reported daily symptoms and compliance with exercise prescription via a website. MAIN OUTCOMES AND MEASURES Days from injury to recovery; recovery was defined as being asymptomatic, having recovery confirmed through an assessment by a physician blinded to treatment group, and returning to normal exercise tolerance on treadmill testing. Participants were also classified as having normal (<30 days) or delayed (≥30 days) recovery. RESULTS A total of 103 participants were included (aerobic exercise: n = 52; 24 female [46%]; stretching, n = 51; 24 female [47%]). Participants in the aerobic exercise group were seen a mean (SD) of 4.9 (2.2) days after the SRC, and those in the stretching group were seen a mean (SD) of 4.8 (2.4) days after the SRC. There were no differences in age, sex, previous concussions, time from injury, initial symptom severity score, or initial exercise treadmill test and physical examination results. Aerobic exercise participants recovered in a median of 13 (interquartile range [IQR], 10-18.5) days, whereas stretching participants recovered in 17 (IQR, 13-23) days (P = .009 by Mann-Whitney test). There was a nonsignificant lower incidence of delayed recovery in the aerobic exercise group (2 participants [4%] in the aerobic group vs 7 [14%] in the placebo group; P = .08). CONCLUSIONS AND RELEVANCE This is, to our knowledge, the first RCT to show that individualized subsymptom threshold aerobic exercise treatment prescribed to adolescents with concussion symptoms during the first week after SRC speeds recovery and may reduce the incidence of delayed recovery. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02710123.
Collapse
Affiliation(s)
- John J. Leddy
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo
| | - Mohammad N. Haider
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo,Department of Neuroscience, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo
| | - Michael J. Ellis
- Section of Neurosurgery, Division of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada,Pan Am Concussion Program, Pan Am Clinic Foundation, Children’s Hospital Research Institute of Manitoba, and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Scott R. Darling
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo
| | - Michael S. Freitas
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo
| | - Heidi N. Suffoletto
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo
| | - Jeff Leiter
- Pan Am Clinic Foundation, Winnipeg, Manitoba, Canada
| | | | - Barry Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo
| |
Collapse
|
19
|
Atesok K, MacDonald P, Leiter J, McRae S, Singh M, Stranges G, Old J. The effect of deep shoulder infections on patient outcomes after arthroscopic rotator cuff repair: a retrospective comparative study. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2018.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- K. Atesok
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Alabama, USA
| | - P. MacDonald
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J. Leiter
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S. McRae
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - M. Singh
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - G. Stranges
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J. Old
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
20
|
Atesok K, MacDonald P, Leiter J, McRae S, Singh M, Stranges G, Old J. The effect of deep shoulder infections on patient outcomes after arthroscopic rotator cuff repair: a retrospective comparative study. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.04.2017.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- K. Atesok
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - P. MacDonald
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J. Leiter
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S. McRae
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - M. Singh
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - G. Stranges
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J. Old
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
21
|
Clark T, McRae S, Leiter J, Zhang Y, Dubberley J, MacDonald P. Arthroscopic Versus Open Lateral Release for the Treatment of Lateral Epicondylitis: A Prospective Randomized Controlled Trial. Arthroscopy 2018; 34:3177-3184. [PMID: 30509427 DOI: 10.1016/j.arthro.2018.07.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 06/27/2018] [Accepted: 07/05/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this randomized clinical trial was to determine whether quality of life and function, as measured using subjective questionnaires and clinical assessment, are different after open versus arthroscopic debridement of the pathologic extensor carpi radialis brevis origin in the treatment of lateral epicondylitis at 1 year postoperatively. METHODS Patients older than 16 years with a minimum of 6 months of nonoperative management for lateral epicondylitis were recruited into this prospective, single-blinded randomized clinical trial. Patients were randomized intraoperatively to undergo open or arthroscopic release. Scores on the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure; visual analog scale (VAS); and Patient-Rated Tennis Elbow Evaluation (PRTEE) were recorded preoperatively and 3, 6, and 12 months postoperatively. Grip strength was assessed by an independent assessor. All patients followed the same physiotherapy regimen. RESULTS Between 2002 and 2014, we randomized 37 patients to the open technique and 38 to the arthroscopic technique. Both groups improved significantly from preoperatively to 12 months postoperatively (P < .001). There were no significant differences between the 2 groups when comparing the DASH score, VAS score, PRTEE score, or grip strength at any time point. The only significant difference between study groups was that the arthroscopic technique resulted in a longer surgery time: 34.0 minutes (standard error of the mean, 2.9 minutes) versus 22.5 minutes (standard error of the mean, 1.3 minutes) (P = .005). CONCLUSIONS Comparing the open versus arthroscopic technique in the surgical management of lateral epicondylitis through a randomized clinical trial, we determined that there was no difference between the 2 operative modalities when examining the DASH score, VAS score, PRTEE score, grip strength, or complication rate at 12 months postoperatively. A shorter operative time coupled with potentially less setup time may favor open release. LEVEL OF EVIDENCE Level II, lower-quality randomized trial.
Collapse
|
22
|
Shea JR, Shay BL, Leiter J, Cowley KC. Energy Expenditure as a Function of Activity Level After Spinal Cord Injury: The Need for Tetraplegia-Specific Energy Balance Guidelines. Front Physiol 2018; 9:1286. [PMID: 30283348 PMCID: PMC6156377 DOI: 10.3389/fphys.2018.01286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/27/2018] [Indexed: 01/08/2023] Open
Abstract
The World Health Organization recognizes obesity as a global and increasing problem for the general population. Because of their reduced physical functioning, people with spinal cord injury (SCI) face additional challenges for maintaining an appropriate whole body energy balance, and the majority with SCI are overweight or obese. SCI also reduces exercise capacity, particularly in those with higher-level injury (tetraplegia). Tetraplegia-specific caloric energy expenditure (EE) data is scarce. Therefore, we measured resting and exercise-based energy expenditure in participants with tetraplegia and explored the accuracy of general population-based energy use predictors. Body composition and resting energy expenditure (REE) were measured in 25 adults with tetraplegia (C4/5 to C8) and in a sex-age-height matched group. Oxygen uptake, carbon dioxide production, heart rate, perceived exertion, and exercise intensity were also measured in 125 steady state exercise trials. Those with motor-complete tetraplegia, but not controls, had measured REE lower than predicted (mean = 22% less, p < 0.0001). REE was also lower than controls when expressed per kilogram of lean mass. Nine had REE below 1200 kcal/day. We developed a graphic compendium of steady state EE during arm ergometry, wheeling, and hand-cycling. This compendium is in a format that can be used by persons with tetraplegia for exercise prescription (calories, at known absolute intensities). EE was low (55–450 kcal/h) at the intensities participants with tetraplegia were capable of maintaining. If people with tetraplegia followed SCI-specific activity guidelines (220 min/week) at the median intensities we measured, they would expend 563–1031 kcal/week. Participants with tetraplegia would therefore require significant time (4 to over 20 h) to meet a weekly 2000 kcal exercise target. We estimated total daily EE for a range of activity levels in tetraplegia and compared them to predicted values for the general population. Our analysis indicated that the EE values for sedentary through moderate levels of activity in tetraplegia fall well below predicted sedentary levels of activity for the general population. These findings help explain sub-optimal responses to exercise interventions after tetraplegia, and support the need to develop tetraplegia-specific energy-balance guidelines that reflects their unique EE situation.
Collapse
Affiliation(s)
- Jessie R Shea
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Barbara L Shay
- Department of Physical Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jeff Leiter
- Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Pan Am Clinic Foundation, Winnipeg, MB, Canada
| | - Kristine C Cowley
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|
23
|
Atesok K, MacDonald P, Leiter J, McRae S, Singh M, Stranges G, Old J. The effect of deep shoulder infections on patient outcomes after arthroscopic rotator cuff repair: a retrospective comparative study. Muscles Ligaments Tendons J 2018; 7:590-597. [PMID: 29721461 DOI: 10.11138/mltj/2017.7.4.590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The purpose of this study was to evaluate the effects of deep shoulder infections after RCR on patient outcomes. Methods A retrospective chart review was conducted involving all patients with deep shoulder infections after arthroscopic RCR (study group). Another group of patients who were matched with the study group by age, gender and rotator cuff tear size, and did not develop deep shoulder infections after arthroscopic RCR were randomly identified (control group). The two groups were compared in terms of time to start physiotherapy, shoulder function, and delay in return to work. Results There were 10 patients in each group. The mean time to start physiotherapy after surgery was 145.3 (SD=158.8) days for the study group and 40.0 (SD=13.7) days for the control group (p=.051). The average forward elevation of the operated shoulder was 133 (SD=33.4) degrees for the study group, and 172 (SD=12.0) degrees for the control group (p=0.003). The average time to return to work at preoperative level was 5.6 months for the study group and 3 months for the control group. Conclusion Deep shoulder infections after RCR significantly impedes time to start physiotherapy, shoulder function, and patients' ability to return to work. Level of evidence III b [retrospective comparative (case-control) study].
Collapse
Affiliation(s)
- Kivanc Atesok
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter MacDonald
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeff Leiter
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheila McRae
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mandip Singh
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Greg Stranges
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason Old
- Section of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
24
|
MacDonald P, Kim C, McRae S, Leiter J, Khan R, Whelan D. No clinical differences between anteromedial portal and transtibial technique for femoral tunnel positioning in anterior cruciate ligament reconstruction: a prospective randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc 2018; 26:1335-1342. [PMID: 28801704 DOI: 10.1007/s00167-017-4664-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/28/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE The anteromedial (AMP) portal technique was introduced to position the femoral tunnel in anterior cruciate ligament (ACL) reconstruction to more closely replicate the original ACL footprint compared to the transtibial (TT) approach. Few randomized trials have evaluated differences in these techniques with respect to clinical outcomes. The purpose of this study was to determine if there are any differences in clinical outcome between the AMP and TT approaches. METHODS This is a single-blinded, prospective, randomized controlled trial. Participants were randomized to undergo ACL reconstruction using the AMP or TT approach. The primary outcome measure was the ACL quality of life (ACL-QOL), and secondary outcomes were the IKDC knee assessment, side-to-side difference in anterior-posterior knee laxity (KT-1000) and tunnel orientation (X-ray findings) at preoperative, 3, 6, 12, and 24 months postoperative. Statistical comparisons were performed using a series of t tests for independent groups with equal variance. RESULTS Ninety-six participants were consented and randomized between 2007 and 2011 with eight excluded postrandomization. Mean (SD) preoperative ACL-QOL was 33 (13) for TT and 36 (17) for AMP and improved significantly (p < 0.001) in both groups to 79 (18) and 78 (18) at 24 months postoperative, respectively. The preoperative median IKDC grade for both groups was C and improved similarly in both groups at 24 months (n.s.). There was no side-to-side difference in knee laxity based on KT-1000 measurements with a mean (SD) 1 (3) mm between affected and unaffected limbs in the TT group compared to 1 (3) mm for the AMP group. A significant difference was found in femoral tunnel orientation with the AMP group at 43° (7) and the TT group 58° (8) in the coronal plane (p < 0.001). CONCLUSION No differences in clinical outcome were found when comparing AMP to TT in primary ACL reconstruction using a STG graft. This prospective randomized controlled trial suggests surgeons can use either method without significantly compromising clinical outcome. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Peter MacDonald
- Department of Surgery, Pan Am Clinic, University of Manitoba, Orthopaedics 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada.
| | - Chris Kim
- Department of Surgery, Pan Am Clinic, University of Manitoba, Orthopaedics 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada
| | - Sheila McRae
- Department of Surgery, Pan Am Clinic, University of Manitoba, Orthopaedics 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada
| | - Jeff Leiter
- Department of Surgery, Pan Am Clinic, University of Manitoba, Orthopaedics 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada
| | - Ryan Khan
- St. Michael's Hospital, St. Michael's Orthpaedic Associates, 55 Queen St E., Suite 800, Toronto, ON, M5C 1R6, Canada
| | - Daniel Whelan
- St. Michael's Hospital, St. Michael's Orthpaedic Associates, 55 Queen St E., Suite 800, Toronto, ON, M5C 1R6, Canada
| |
Collapse
|
25
|
Holland D, Amadeo RJJ, Wolfe S, Girling L, Funk F, Collister M, Czaplinski E, Ferguson C, Leiter J, Old J, MacDonald P, Dufault B, Mutter TC. Effect of dexamethasone dose and route on the duration of interscalene brachial plexus block for outpatient arthroscopic shoulder surgery: a randomized controlled trial. Can J Anaesth 2017; 65:34-45. [DOI: 10.1007/s12630-017-0989-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 08/28/2017] [Accepted: 10/10/2017] [Indexed: 11/28/2022] Open
|
26
|
Atesok K, MacDonald P, Leiter J, McRae S, Stranges G, Old J. Postoperative deep shoulder infections following rotator cuff repair. World J Orthop 2017; 8:612-618. [PMID: 28875126 PMCID: PMC5565492 DOI: 10.5312/wjo.v8.i8.612] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/06/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
Rotator cuff repair (RCR) is one of the most commonly performed surgical procedures in orthopaedic surgery. The reported incidence of deep soft-tissue infections after RCR ranges between 0.3% and 1.9%. Deep shoulder infection after RCR appears uncommon, but the actual incidence may be higher as many cases may go unreported. Clinical presentation may include increasing shoulder pain and stiffness, high temperature, local erythema, swelling, warmth, and fibrinous exudate. Generalized fatigue and signs of sepsis may be present in severe cases. Varying clinical presentation coupled with a low index of suspicion may result in delayed diagnosis. Laboratory findings include high erythrocyte sedimentation rate and C-reactive protein level, and, rarely, abnormal peripheral blood leucocyte count. Aspiration of glenohumeral joint synovial fluid with analysis of cell count, gram staining and culture should be performed in all patients suspected with deep shoulder infection after RCR. The most commonly isolated pathogens are Propionibacterium acnes, Staphylococcus epidermidis, and Staphylococcus aureus. Management of a deep soft-tissue infection of the shoulder after RCR involves surgical debridement with lavage and long-term intravenous antibiotic treatment based on the pathogen identified. Although deep shoulder infection after RCR is usually successfully treated, complications of this condition can be devastating. Prolonged course of intravenous antibiotic treatment, extensive soft-tissue destruction and adhesions may result in substantially diminished functional outcomes.
Collapse
|
27
|
Hayward-Ellis J, Alexander MJL, Glazebrook CM, Leiter J. Ground reaction forces produced by two different hockey skating arm swing techniques. Eur J Sport Sci 2017; 17:1153-1160. [PMID: 28816618 DOI: 10.1080/17461391.2017.1357757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The arm swing in hockey skating can have a positive effect on the forces produced by each skate, and the resulting velocity from each push off. The main purpose of this study was to measure the differences in ground reaction forces (GRFs) produced from an anteroposterior versus a mediolateral style hockey skating arm swing. Twenty-four elite-level female hockey players performed each technique while standing on a ground-mounted force platform, and all trials were filmed using two video cameras. Force data was assessed for peak scaled GRFs in the frontal and sagittal planes, and resultant GRF magnitude and direction. Upper limb kinematics were assessed from the video using Dartfish video analysis software, confirming that the subjects successfully performed two distinct arm swing techniques. The mediolateral arm swing used a mean of 18.38° of glenohumeral flexion/extension and 183.68° of glenohumeral abduction/adduction while the anteroposterior technique used 214.17° and 28.97° respectively. The results of this study confirmed that the mediolateral arm swing produced 37% greater frontal plane and 33% less sagittal plane GRFs than the anteroposterior arm swing. The magnitudes of the resultant GRFs were not significantly different between the two techniques; however, the mediolateral technique produced a resultant GRF with a significantly larger angle from the direction of travel (44.44°) as compared to the anteroposterior technique (31.60°). The results of this study suggest that the direction of GRFs produced by the mediolateral arm swing more closely mimic the direction of lower limb propulsion during the skating stride.
Collapse
Affiliation(s)
| | - Marion J L Alexander
- b Faculty of Kinesiology and Recreation Management , University of Manitoba , Winnipeg , Canada
| | - Cheryl M Glazebrook
- b Faculty of Kinesiology and Recreation Management , University of Manitoba , Winnipeg , Canada
| | | |
Collapse
|
28
|
Rozbacher A, Selci E, Leiter J, Ellis M, Russell K. The Effect of Concussion or Mild Traumatic Brain Injury on School Grades, National Examination Scores, and School Attendance: A Systematic Review. J Neurotrauma 2017; 34:2195-2203. [PMID: 28084891 DOI: 10.1089/neu.2016.4765] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Concussion often results in symptoms, including difficulty concentrating, focusing, and remembering, that are typically managed with cognitive and physical rest. Often, the school environment is not conducive to cognitive rest and may lead to worsening or prolonged symptoms that can contribute to impaired academic performance. The objective of the review was to identify and summarize literature concerning the effects of concussion or mild traumatic brain injury (mTBI) on academic outcomes. MEDLINE, Embase, Scopus, and CINAHL were searched until June 1, 2016. Studies must have been primary literature examining students enrolled in primary, secondary, or post-secondary education, have received a physician diagnosis of concussion or mTBI, and have post-injury academic outcomes assessed in numeric or alphabet grade/grade point average (GPA), school attendance records, or national examination scores. Data were extracted and checked by a second reviewer for accuracy and completeness. Nine studies were included. Among four studies that examined grades, one found a significant difference in pre- and post-grades only in the subject Afrikaans. Three examined national test scores and no significant differences were found between cases and controls. Four examined school absenteeism and found that students who developed post-concussion syndrome missed significantly more school days and took longer to return to school than students with extremity injuries. Although mTBI or concussion is associated with missed school, the results demonstrate minimal impact on school grades and national examination scores at a group level. Further research is needed to identify risk factors for impaired school functioning following mTBI and concussion in individual patients.
Collapse
Affiliation(s)
- Adrian Rozbacher
- 1 Max Rady College of Medicine, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Erin Selci
- 3 Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada
- 6 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
| | - Jeff Leiter
- 2 Department of Surgery, University of Manitoba , Winnipeg, Manitoba, Canada
- 5 Pan Am Concussion Program , Winnipeg, Manitoba, Canada
- 7 Canada North Concussion Network , Winnipeg, Manitoba, Canada
| | - Michael Ellis
- 1 Max Rady College of Medicine, University of Manitoba , Winnipeg, Manitoba, Canada
- 2 Department of Surgery, University of Manitoba , Winnipeg, Manitoba, Canada
- 3 Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada
- 4 Section of Neurosurgery, University of Manitoba , Winnipeg, Manitoba, Canada
- 5 Pan Am Concussion Program , Winnipeg, Manitoba, Canada
- 6 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
- 7 Canada North Concussion Network , Winnipeg, Manitoba, Canada
| | - Kelly Russell
- 3 Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada
- 6 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
- 7 Canada North Concussion Network , Winnipeg, Manitoba, Canada
| |
Collapse
|
29
|
Leiter J, Hrubeniuk TJ. Changes in Cerebral Oxygenation Following Anaerobic Exercise. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000518842.02323.8c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
30
|
Hrubeniuk TJ, Leiter J. Differences in Cerebral Oxygenation Following Aerobic and Resistance Exercise. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000518843.09946.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
31
|
Atesok K, MacDonald P, Leiter J, Dubberley J, Satava R, VanHeest A, Hurwitz S, Marsh JL. Orthopaedic education in the era of surgical simulation: Still at the crawling stage. World J Orthop 2017; 8:290-294. [PMID: 28473955 PMCID: PMC5396012 DOI: 10.5312/wjo.v8.i4.290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/18/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Surgical skills education is in the process of a crucial transformation from a master-apprenticeship model to simulation-based training. Orthopaedic surgery is one of the surgical specialties where simulation-based skills training needs to be integrated into the curriculum efficiently and urgently. The reason for this strong and pressing need is that orthopaedic surgery covers broad human anatomy and pathologies and requires learning enormously diverse surgical procedures including basic and advanced skills. Although the need for a simulation-based curriculum in orthopaedic surgery is clear, several obstacles need to be overcome for a smooth transformation. The main issues to be addressed can be summarized as defining the skills and procedures so that simulation-based training will be most effective; choosing the right time period during the course of orthopaedic training for exposure to simulators; the right amount of such exposure; using objective, valid and reliable metrics to measure the impact of simulation-based training on the development and progress of surgical skills; and standardization of the simulation-based curriculum nationwide and internationally. In the new era of surgical education, successful integration of simulation-based surgical skills training into the orthopaedic curriculum will depend on efficacious solutions to these obstacles in moving forward.
Collapse
|
32
|
Abstract
BACKGROUND Rugby is a popular collision sport where participants are at risk of sustaining concussions. Most research focuses on elite-level or youth divisions. Comparatively, little is known about adult community rugby. The aim of this research was to estimate the risk of sustaining a concussion during participation in community-level rugby and summarize the collective knowledge and attitudes toward concussions. HYPOTHESIS Concussion symptoms will be reported frequently among community-level rugby players and a substantial proportion will report a willingness to continue participation despite the risk. STUDY DESIGN Cross-sectional analysis. LEVEL OF EVIDENCE Level 3. METHODS An anonymous, voluntary survey was administered to all 464 senior rugby players registered in the province of Manitoba in 2015. Two primary domains were assessed: (1) concussion history from the preceding season including occurrence, symptomatology, and impact on daily activities and (2) knowledge and attitudes toward concussion risks and management. RESULTS In total, 284 (61.2%) rugby players responded. Concussive symptoms were reported by 106 (37.3%). Of those, 87% were formally diagnosed with a concussion and 27% missed school and/or work as a result. The danger of playing while symptomatic was recognized by 93.7% of participants, yet 29% indicated they would continue while symptomatic. Furthermore, 39% felt they were letting others down if they stopped playing due to a concussion. CONCLUSION Concussive symptoms were common among the study cohort and had a notable impact on daily activities. A high proportion of players were willing to continue while experiencing symptoms despite recognizing the danger. The observed discord between knowledge and attitudes implicates a culture of "playing injured." CLINICAL RELEVANCE Understanding the risk of injury may affect an individual's decision to participate in community-level rugby. Moreover, evidence of discord between the knowledge and attitudes of players may direct future research initiatives and league governance.
Collapse
Affiliation(s)
- R Kyle Martin
- Pan Am Clinic, Winnipeg, Manitoba, Canada.,Section of Orthopaedics, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Travis J Hrubeniuk
- Pan Am Clinic, Winnipeg, Manitoba, Canada.,Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Peter MacDonald
- Pan Am Clinic, Winnipeg, Manitoba, Canada.,Section of Orthopaedics, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeff Leiter
- Pan Am Clinic, Winnipeg, Manitoba, Canada.,Section of Orthopaedics, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
33
|
Ellis MJ, Cordingley DM, Vis S, Reimer KM, Leiter J, Russell K. Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion. J Neurosurg Pediatr 2017; 19:38-45. [PMID: 27689244 DOI: 10.3171/2016.7.peds16310] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There were 2 objectives of this study. The first objective was to identify clinical variables associated with vestibulo-ocular dysfunction (VOD) detected at initial consultation among pediatric patients with acute sports-related concussion (SRC) and postconcussion syndrome (PCS). The second objective was to reexamine the prevalence of VOD in this clinical cohort and evaluate the effect of VOD on length of recovery and the development of PCS. METHODS A retrospective review was conducted for all patients with acute SRC and PCS who were evaluated at a pediatric multidisciplinary concussion program from September 2013 to May 2015. Acute SRS was defined as presenting < 30 days postinjury, and PCS was defined according to the International Classification of Diseases, 10th Revision criteria and included being symptomatic 30 days or longer postinjury. The initial assessment included clinical history and physical examination performed by 1 neurosurgeon. Patients were assessed for VOD, defined as the presence of more than 1 subjective vestibular and oculomotor complaint (dizziness, diplopia, blurred vision, etc.) and more than 1 objective physical examination finding (abnormal near point of convergence, smooth pursuits, saccades, or vestibulo-ocular reflex testing). Poisson regression analysis was used to identify factors that increased the risk of VOD at initial presentation and the development of PCS. RESULTS Three hundred ninety-nine children, including 306 patients with acute SRC and 93 with PCS, were included. Of these patients, 30.1% of those with acute SRC (65.0% male, mean age 13.9 years) and 43.0% of those with PCS (41.9% male, mean age 15.4 years) met the criteria for VOD at initial consultation. Independent predictors of VOD at initial consultation included female sex, preinjury history of depression, posttraumatic amnesia, and presence of dizziness, blurred vision, or difficulty focusing at the time of injury. Independent predictors of PCS among patients with acute SRC included the presence of VOD at initial consultation, preinjury history of depression, and posttraumatic amnesia at the time of injury. CONCLUSIONS This study identified important potential risk factors for the development of VOD following pediatric SRC. These results provide confirmatory evidence that VOD at initial consultation is associated with prolonged recovery and is an independent predictor for the development of PCS. Future studies examining clinical prediction rules in pediatric concussion should include VOD. Additional research is needed to elucidate the natural history of VOD following SRC and establish evidence-based indications for targeted vestibular rehabilitation.
Collapse
Affiliation(s)
- Michael J Ellis
- Departments of 1 Surgery and.,Pediatrics and Child Health, and.,Section of Neurosurgery, University of Manitoba.,Pan Am Concussion Program, and.,Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | | | | | | | - Jeff Leiter
- Departments of 1 Surgery and.,Pan Am Concussion Program, and
| | - Kelly Russell
- Pediatrics and Child Health, and.,Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, Canada
| |
Collapse
|
34
|
Saithna A, Longo A, Leiter J, MacDonald P, Old J. Biceps Tenoscopy: Arthroscopic Evaluation of the Extra-articular Portion of the Long Head of Biceps Tendon. Arthrosc Tech 2016; 5:e1461-e1465. [PMID: 28560144 PMCID: PMC5439186 DOI: 10.1016/j.eats.2016.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/23/2016] [Indexed: 02/03/2023] Open
Abstract
The recent literature shows that imaging modalities, physical examination tests, and glenohumeral arthroscopy all have low sensitivities and specificities with respect to the diagnosis of the long head of biceps tendon pathology. Biceps tenoscopy is a strategy that aims to reduce the rate of missed diagnoses by improving visualization of the extra-articular part of the tendon. This is an area of predilection of pathology that is not adequately visualized with conventional arthroscopic techniques. This technical note presents the surgical technique for biceps tenoscopy.
Collapse
Affiliation(s)
- Adnan Saithna
- Department of Orthopaedic Surgery, Pan Am Clinic, Winnipeg, Manitoba, Canada
- Department of Clinical Engineering, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, England
- Department of Orthopaedic Surgery, Southport and Ormskirk Hospitals NHS Trust, Southport, England
- Address correspondence to Adnan Saithna, B.Med.Sci.(Hons), M.B.Ch.B., Dip.S.E.M., M.Sc., F.R.C.S.(Tr & Orth), Southport and Ormskirk Hospitals NHS Trust, Town Lane, Southport PR8 6PN, England.Southport and Ormskirk Hospitals NHS TrustTown LaneSouthportPR8 6PNEngland
| | - Alison Longo
- Department of Orthopaedic Surgery, Pan Am Clinic, Winnipeg, Manitoba, Canada
- Department of Human Anatomy & Cell Science, College of Medicine, University of Manitoba, Manitoba, Canada
| | - Jeff Leiter
- Department of Orthopaedic Surgery, Pan Am Clinic, Winnipeg, Manitoba, Canada
- Section of Orthopaedic Surgery, College of Medicine, University of Manitoba, Manitoba, Canada
| | - Peter MacDonald
- Department of Orthopaedic Surgery, Pan Am Clinic, Winnipeg, Manitoba, Canada
- Section of Orthopaedic Surgery, College of Medicine, University of Manitoba, Manitoba, Canada
| | - Jason Old
- Department of Orthopaedic Surgery, Pan Am Clinic, Winnipeg, Manitoba, Canada
- Section of Orthopaedic Surgery, College of Medicine, University of Manitoba, Manitoba, Canada
| |
Collapse
|
35
|
Cordingley D, Girardin R, Reimer K, Ritchie L, Leiter J, Russell K, Ellis MJ. Graded aerobic treadmill testing in pediatric sports-related concussion: safety, clinical use, and patient outcomes. J Neurosurg Pediatr 2016; 25:693-702. [PMID: 27620871 DOI: 10.3171/2016.5.peds16139] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objectives of this study were 2-fold: 1) to evaluate the safety, tolerability, and clinical use of graded aerobic treadmill testing in pediatric patients with sports-related concussion (SRC), and 2) to evaluate the clinical outcomes of treatment with a submaximal aerobic exercise program in patients with physiological post-concussion disorder (PCD). METHODS The authors conducted a retrospective chart review of pediatric patients (age < 20 years) with SRC who were referred to a multidisciplinary pediatric concussion program and underwent graded aerobic treadmill testing between October 9, 2014, and February 11, 2016. Clinical assessments were carried out by a single neurosurgeon and included clinical history taking, physical examination, and recording specific patient-reported concussion-related symptoms using the Post-Concussion Symptom Scale (PCSS). Graded aerobic treadmill testing using a modified Balke protocol for incremental increases in intensity was used as a diagnostic tool to assess physiological recovery, classify post-concussion syndrome (PCS) subtype, and reassess patients following treatment. Patients with a symptom-limited threshold on treadmill testing (physiological PCD) were treated with an individually tailored submaximal exercise prescription and multidisciplinary targeted therapies. RESULTS One hundred six patients (mean age 15.1 years, range 11-19 years) with SRC underwent a total of 141 treadmill tests. There were no serious complications related to treadmill testing in this study. Overall, 138 (97.9%) of 141 tests were well tolerated and contributed valuable clinical information. Treadmill testing confirmed physiological recovery in 63 (96.9%) of 65 patients tested, allowing successful return to play in 61 (93.8%). Treadmill testing was used to diagnose physiological PCD in 58 patients and cervicogenic PCD in 1 patient. Of the 41 patients with physiological PCD who had complete follow-up and were treated with tailored submaximal exercise prescription, 37 (90.2%) were classified as clinically improved and 33 (80.5%) successfully returned to sporting activities. Patients who did not respond or experienced an incomplete response to submaximal aerobic exercise treatment included 7 patients with migraine headaches and 1 patient with a postinjury psychiatric disorder. CONCLUSIONS Graded aerobic treadmill testing is a safe, tolerable, and clinically valuable tool that can assist in the evaluation and management of pediatric SRC. Future research is needed to confirm the clinical value of this tool in return-to-play decision making. Studies are also needed to understand the pathophysiology of physiological PCD and the effects of targeted treatment.
Collapse
Affiliation(s)
| | | | - Karen Reimer
- Pan Am Concussion Program.,Canada North Concussion Network;,Section of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba; and
| | - Lesley Ritchie
- Pan Am Concussion Program.,Canada North Concussion Network;,Departments of 3 Clinical Health Psychology
| | - Jeff Leiter
- Pan Am Concussion Program.,Canada North Concussion Network;,Surgery
| | - Kelly Russell
- Canada North Concussion Network;,Pediatrics and Child Health.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael J Ellis
- Pan Am Concussion Program.,Canada North Concussion Network;,Surgery.,Pediatrics and Child Health.,Section of Neurosurgery, and.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
36
|
Russell K, Hutchison MG, Selci E, Leiter J, Chateau D, Ellis MJ. Academic Outcomes in High-School Students after a Concussion: A Retrospective Population-Based Analysis. PLoS One 2016; 11:e0165116. [PMID: 27764223 PMCID: PMC5072608 DOI: 10.1371/journal.pone.0165116] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 10/06/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many concussion symptoms, such as headaches, vision problems, or difficulty remembering or concentrating may deleteriously affect school functioning. Our objective was to determine if academic performance was lower in the academic calendar year that students sustain a concussion compared to the previous year when they did not sustain a concussion. METHODS Using Manitoba Health and Manitoba Education data, we conducted a population-based, controlled before-after study from 2005-2006 to 2010-2011 academic years. Grade 9-12 students with an ICD9/10 code for concussion were matched to non-concussed controls. Overall changes in grade point average (GPA) were compared for the academic year prior to the concussion to the academic year the concussion occurred (or could have occurred among non-concussed matched students). RESULTS Overall, 8240 students (1709 concussed, 6531 non-concussed students) were included. Both concussed and non-concussed students exhibited a lower overall GPA from one year to the next. Having sustained a concussion resulted in a -0.90% (95% CI: -1.88, 0.08) reduction in GPA. Over the same period, non-concussed matched students' GPA reduced by -0.57% (95% CI: -1.32, 0.19). Students who sustained a concussion during high school were just as likely to graduate within four years as their non-concussed peers (ORadj: 0.84; 95% CI: 0.73, 1.02). CONCLUSIONS We found that, at a population level, a concussion had minimal long-term effects on academic performance during high school. While academic accommodations and Return-to-Learn programs are an important component of pediatric concussion management, research is needed to identify risk factors for poor academic performance after a concussion and who should receive these programs.
Collapse
Affiliation(s)
- Kelly Russell
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
- Canada North Concussion Network, Winnipeg, Canada
| | - Michael G. Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
| | - Erin Selci
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Jeff Leiter
- Canada North Concussion Network, Winnipeg, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Daniel Chateau
- Manitoba Center for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Michael J. Ellis
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
- Canada North Concussion Network, Winnipeg, Canada
- Department of Surgery, Section of Neurosurgery, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
37
|
Abstract
BACKGROUND Previously validated knee arthroscopy evaluation tools have used human cadaveric knees. This is unsustainable because of the cost and scarcity of these specimens. Porcine (pig) knees are anatomically similar, affordable, and easily obtainable; however, whether porcine knees represent a suitable alternative to human specimens has not been evaluated. QUESTIONS/PURPOSES The purpose of this study was to determine whether porcine knees are similar to human cadaveric knees for the assessment of knee arthroscopy skills by evaluating (1) the validity of the porcine model (whether trainees of the same level of ability scored similarly when using the two models) and (2) the reliability of the porcine model (whether surgeons with experience achieved higher scores than surgeons with less experience in the porcine model). METHODS Eleven orthopaedic surgery residents (five junior residents and six senior residents), one orthopaedic sports medicine fellow, and three attending orthopaedic surgeons were enrolled. Participants were provided instructions for a proper arthroscopic examination of the knee and asked to identify, and then probe, the listed anatomic structures on both the human and porcine knee specimens. Each participant was asked to demonstrate the following skills: joint manipulation, instrument control and triangulation, fluid management, maintenance of field of view, economy of movement, and efficiency. The Objective Assessment of Arthroscopic Skills (OAAS) and checklist for diagnostic arthroscopy of the knee were used for skills assessment by one observer. Internal consistency, a measure of how well the assessment tool measures the skills being studied, was determined by Cronbach's α and group differences investigated by paired t-test and Wilcoxon signed-rank tests where appropriate. Based on a sample size calculation, a total of 37 subjects would be required for the full-scale research study to achieve a power of 0.80, with α set at 0.05, to detect a difference in OAAS score of 4.73 (25%). This value is outside of the 95% confidence intervals for the human knee. RESULTS We found the porcine model to have a high level of face validity. There was no difference with the numbers available in total OAAS scores (mean ± SD; 95% confidence interval [CI]) within subjects between the human (18.93 ± 7.54; 14.76-23.11) and porcine (17.87 ± 6.36; 14.34-21.39) knees (p = 0.433). There was also no difference (p = 0.234) with the numbers available in overall OAAS score among participants working on either human (2.60 ± 1.35; 1.85-3.35) or porcine (2.33 ± 0.90; 1.84-2.83) specimens. Internal consistency of the simulation for both the human and porcine knees was high and did not differ between groups (Cronbach's α was 0.919 in the human knee and 0.954 in the porcine knee), suggesting the OAAS outcome score specifically assesses arthroscopic skill of participants in both the human and porcine models. More experienced arthroscopists scored higher than did less experienced trainees; there was high correlation (Pearson's correlation coefficient r, 95% CI) between years of experience and total OAAS scores in human (0.78; 0.46-0.92) and porcine (0.80; 0.49-0.93) diagnostic arthroscopy models. CONCLUSIONS The porcine cadaveric knee model was a valid surrogate for the human knee in arthroscopic skills assessment. CLINICAL RELEVANCE Trainees can be objectively evaluated using an affordable model that allows summative and formative feedback in the laboratory at a fraction of the cost of previously validated methods.
Collapse
Affiliation(s)
- R Kyle Martin
- Orthopaedic Surgery, University of Manitoba, 75 Poseidon Bay, Winnipeg, MB, R3M 0H3, Canada.
| | - Danny Gillis
- Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Jeff Leiter
- Orthopaedic Surgery, University of Manitoba, 75 Poseidon Bay, Winnipeg, MB, R3M 0H3, Canada
| | | | - Peter MacDonald
- Orthopaedic Surgery, University of Manitoba, 75 Poseidon Bay, Winnipeg, MB, R3M 0H3, Canada
| |
Collapse
|
38
|
Abstract
Background: Pulling the long head of the biceps tendon into the joint at arthroscopy is a common method for evaluation of tendinopathic lesions. However, the rate of missed diagnoses when using this technique is reported to be as high as 30% to 50%. Hypothesis: Tendon excursion achieved using a standard arthroscopic probe does not allow adequate visualization of extra-articular sites of predilection of tendinopathy. Study Design: Descriptive laboratory study. Methods: Seven forequarter amputation cadaveric specimens were evaluated. The biceps tendon was tagged to mark the intra-articular length and the maximum excursions achieved using a probe and a grasper in both beach-chair and lateral positions. Statistical analyses were performed using analysis of variance to compare means. Results: The mean intra-articular and extra-articular lengths of the tendons were 23.9 and 82.3 mm, respectively. The length of tendon that could be visualized by pulling it into the joint with a probe through the anterior midglenoid portal was not significantly different when using either lateral decubitus (mean ± SD, 29.9 ± 3.89 mm; 95% CI, 25.7-34 mm) or beach-chair positions (32.7 ± 4.23 mm; 95% CI, 28.6-36.8 mm). The maximum length of the overall tendon visualized in any specimen using a standard technique was 37 mm. Although there was a trend to greater excursion using a grasper through the same portal, this was not statistically significant. However, using a grasper through the anterosuperior portal gave a significantly greater mean excursion than any other technique (46.7 ± 4.31 mm; 95% CI, 42.6-50.8 mm), but this still failed to allow evaluation of Denard zone C. Conclusion: Pulling the tendon into the joint with a probe via an anterior portal does not allow visualization of distal sites of predilection of pathology. Surgeons should be aware that this technique is inadequate and can result in missed diagnoses. Clinical Relevance: This study demonstrates that glenohumeral arthroscopy does not allow visualization of common areas of pathology of the long head of the biceps tendon.
Collapse
Affiliation(s)
- Adnan Saithna
- The Pam Am Clinic Foundation, Winnipeg, Manitoba, Canada.; Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.; Southport and Ormskirk Hospitals NHS Trust, Lancashire, UK
| | - Alison Longo
- The Pam Am Clinic Foundation, Winnipeg, Manitoba, Canada
| | - Jeff Leiter
- The Pam Am Clinic Foundation, Winnipeg, Manitoba, Canada.; Southport and Ormskirk Hospitals NHS Trust, Lancashire, UK
| | - Jason Old
- The Pam Am Clinic Foundation, Winnipeg, Manitoba, Canada
| | - Peter M MacDonald
- The Pam Am Clinic Foundation, Winnipeg, Manitoba, Canada.; Southport and Ormskirk Hospitals NHS Trust, Lancashire, UK
| |
Collapse
|
39
|
Ellis MJ, Ritchie LJ, Koltek M, Hosain S, Cordingley D, Chu S, Selci E, Leiter J, Russell K. Psychiatric outcomes after pediatric sports-related concussion. J Neurosurg Pediatr 2015; 16:709-18. [PMID: 26359916 DOI: 10.3171/2015.5.peds15220] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECT The objectives of this study were twofold: (1) to examine the prevalence of emotional symptoms among children and adolescents with a sports-related concussion (SRC) who were referred to a multidisciplinary pediatric concussion program and (2) to examine the prevalence, clinical features, risk factors, and management of postinjury psychiatric outcomes among those in this clinical population. METHODS The authors conducted a retrospective chart review of all patients with SRC referred to a multidisciplinary pediatric concussion program between September 2013 and October 2014. Clinical assessments carried out by a single neurosurgeon included clinical history, physical examination, and Post-Concussion Symptom Scale (PCSS) scoring. Postinjury psychiatric outcomes were defined as a subjective worsening of symptoms of a preinjury psychiatric disorder or new and isolated suicidal ideation or diagnosis of a novel psychiatric disorder (NPD). An NPD was defined as a newly diagnosed psychiatric disorder that occurred in a patient with or without a lifetime preinjury psychiatric disorder after a concussion. Clinical resources, therapeutic interventions, and clinical and return-to-play outcomes are summarized. RESULTS One hundred seventy-four patients (mean age 14.2 years, 61.5% male) were included in the study. At least 1 emotional symptom was reported in 49.4% of the patients, and the median emotional PCSS subscore was 4 (interquartile range 1-8) among those who reported at least 1 emotional symptom. Overall, 20 (11.5%) of the patients met the study criteria for a postinjury psychiatric outcome, including 14 patients with an NPD, 2 patients with isolated suicidal ideation, and 4 patients with worsening symptoms of a preinjury psychiatric disorder. Female sex, a higher initial PCSS score, a higher emotional PCSS subscore, presence of a preinjury psychiatric history, and presence of a family history of psychiatric illness were significantly associated with postinjury psychiatric outcomes. Interventions for patients with postinjury psychiatric outcomes included pharmacological therapy alone in 2 patients (10%), cognitive behavioral therapy alone in 4 (20%), multimodal therapy in 9 (45%), and no treatment in 5 (25%). Overall, 5 (25%) of the patients with postinjury psychiatric disorders were medically cleared to return to full sports participation, whereas 5 (25%) were lost to follow-up and 9 (45%) remained in treatment by the multidisciplinary concussion program at the end of the study period. One patient who was asymptomatic at the time of initial consultation committed suicide. CONCLUSIONS Emotional symptoms were commonly reported among pediatric patients with SRC referred to a multidisciplinary pediatric concussion program. In some cases, these symptoms contributed to the development of an NPD, isolated suicidal ideation, and worsening symptoms of a preexisting psychiatric disorder. Future research is needed to clarify the prevalence, pathophysiology, risk factors, and evidence-based management of postinjury psychiatric outcomes after pediatric SRC. Successful management of these patients requires prompt recognition and multidisciplinary care by experts with clinical training and experience in concussion and psychiatry.
Collapse
Affiliation(s)
- Michael J Ellis
- Departments of 1 Surgery.,Pediatrics and Child Health.,Section of Neurosurgery, University of Manitoba;,Pan Am Concussion Program;,Childrens Hospital Research Institute of Manitoba; and.,Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | - Lesley J Ritchie
- Clinical Health Psychology, and.,Pan Am Concussion Program;,Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | - Mark Koltek
- Psychiatry, and.,Pan Am Concussion Program;,Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | - Shahid Hosain
- Psychiatry, and.,Pan Am Concussion Program;,Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | - Dean Cordingley
- Pan Am Concussion Program;,Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | - Stephanie Chu
- Pediatrics and Child Health.,Childrens Hospital Research Institute of Manitoba; and.,Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | - Erin Selci
- Pediatrics and Child Health.,Childrens Hospital Research Institute of Manitoba; and.,Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | - Jeff Leiter
- Departments of 1 Surgery.,Pan Am Concussion Program;,Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | - Kelly Russell
- Pediatrics and Child Health.,Childrens Hospital Research Institute of Manitoba; and.,Canada North Concussion Network, Winnipeg, Manitoba, Canada
| |
Collapse
|
40
|
Abstract
BACKGROUND Poor interprofessional collaboration has been shown to negatively affect patient care within many fields of medicine. Growing evidence is suggesting that improved interprofessional collaboration can positively affect patient care. Postoperative rehabilitation of many orthopedic conditions necessitates the combined efforts of surgeons, and therapists. There is a paucity of literature examining collaboration among orthopedic surgeons and therapists regarding postoperative rehabilitation. OBJECTIVES The following study examines the perceived quality of communications between orthopedic surgeons and therapists employing an online survey. We hypothesized that collaborative practice patterns result in improved perceptions of communication. METHODS Ethics board approval was obtained. Subjects consisted of orthopedic surgeons, licensed physiotherapists and certified athletic therapists. The online survey was distributed through the Canadian Orthopaedic Association (COA), the Canadian Physiotherapy Association (CPA) and the Canadian Athletic Therapists Association (CATA). Data analysis was performed using Stata/IC 12.1 (Stata Corp, College Station, TX, USA). Descriptive statistics were calculated to determine the median responses and ranges. Median responses were compared using the Kruskal-Wallis one-way analysis of variance. Qualitative analysis regarding text responses was performed by three reviewers. RESULTS Responses were received from all specialties (COA 164, CPA 524, CATA 163). There were significant differences in the perceived quality of communication by quantitative and qualitative analysis (p < 0.001). Analysis of communication within practice patterns of stand-alone versus collaborative revealed improved perception of communication quality with increased contact. 65.6% of responders that practiced as stand-alone had a negative view of interprofessional communication. 48.4% of responders in a collaborative practice had a positive view of interprofessional communication. Analysis of the preferred form of communication found that orthopedic surgeons felt the most useful referral information was a pre-printed consult sheet (odds ratio [OR] = 1.56, p < 0.001), whereas therapists were more likely to rank consult notes (OR = 1.27, p < 0.042) and operative reports (OR = 1.20, p < 0.092) as a more useful form of communication. CONCLUSIONS Collaborative practice shows improved perceptions of communication between specialties. Orthopedic surgeons perceive a higher quality of communication than therapists. Therapists and orthopedic surgeons also do not agree on the information that should be relayed between the specialties regarding postoperative rehabilitation.
Collapse
Affiliation(s)
- Robert Longstaffe
- a 1 Department of Orthopaedics, University of Manitoba, Orthopaedic Surgery Resident , Winnipeg, MB. Canada
| | - Jesse Slade Shantz
- b 2 Orthopedic Trauma Institute, San Francisco General Hospital , San Francisco, California, USA
| | - Jeff Leiter
- c 3 Department of Research, Albrechtsen Research Chair, Pan Am Clinic Foundation , Winnipeg, MB. Canada
| | - Jason Peeler
- d 4 Department of Human Anatomy & Cell Science, University of Manitoba , Winnipeg, MB. Canada
| |
Collapse
|
41
|
Whelan D, Leiter J, Sasyniuk T, Litchfield R, Randle J, Hughes S, MacDonald P. Double-row repair of the distal attachment of the superficial medial collateral ligament: a basic science pilot study. Knee Surg Sports Traumatol Arthrosc 2015; 23:2820-4. [PMID: 26342694 DOI: 10.1007/s00167-015-3773-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/25/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a novel repair for tibial-sided superficial medial collateral ligament (sMCL) lesions and determine whether it restores medial joint opening to uninjured state. Agreement among experienced knee surgeons when evaluating medial joint laxity was also explored. METHODS On a series of eight human cadaveric knees, surgical elevation of the distal insertion of the sMCL was performed to replicate injury. The cut ligament was repaired using a novel double-row 'suture-bridge' technique. Valgus stress fluoroscopic images were taken with the ligament in three states: (I)ntact, (C)ut and (R)epaired, in two positions: 0 and 20° flexion. Joint opening was measured on calibrated fluoroscopic images (in mm) based on methods described by LaPrade. Joint space opening was also estimated by three experienced knee surgeons without fluoroscopy. RESULTS On fluoroscopy, no significant differences in mean joint opening were observed between an intact versus repaired ligament in 0 and 20° flexion [0.5 mm (95 % CI -1.6, 0.73; n.s.) and 0.3 mm (95 % CI -1.17, 1.71; n.s.)], respectively. Agreement among surgeons was substantial (ICC = 0.622, 95 % CI 0.52, 0.73). CONCLUSION The surgical technique adequately restored joint opening to an intact state with response to valgus stress. Agreement among surgeons when quantifying joint opening in mm was substantial. This paper addresses a technically difficult problem and provides pragmatic and practical information for surgeons who manage complicated multi-ligament knee injuries.
Collapse
Affiliation(s)
| | - Jeff Leiter
- Pan Am Clinic, University of Manitoba, Winnipeg, MN, Canada
| | | | - Robert Litchfield
- Fowler Kennedy Clinic, University of Western Ontario, London, ON, Canada
| | - John Randle
- Southlake Regional Hospital, Newmarket, ON, Canada
| | - Scott Hughes
- Pan Am Clinic, University of Manitoba, Winnipeg, MN, Canada
| | | |
Collapse
|
42
|
Abstract
OBJECT The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. METHODS The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. RESULTS A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16). CONCLUSIONS Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort.
Collapse
Affiliation(s)
- Michael J Ellis
- Departments of 1 Surgery and.,Pediatrics and Child Health and.,Section of Neurosurgery, University of Manitoba.,Pan Am Clinic, and.,Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | | | | | | | - Jeff Leiter
- Departments of 1 Surgery and.,Pan Am Clinic, and
| | - Kelly Russell
- Pediatrics and Child Health and.,Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, Canada
| |
Collapse
|
43
|
Abstract
OBJECT The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age ≤ 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.
Collapse
Affiliation(s)
- Michael J Ellis
- Departments of 1 Surgery.,Pediatrics and Child Health, and.,Section of Neurosurgery, University of Manitoba.,Pan Am Clinic, and.,Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | - Jeff Leiter
- Departments of 1 Surgery.,Pan Am Clinic, and
| | | | - Patrick J McDonald
- Departments of 1 Surgery.,Pediatrics and Child Health, and.,Section of Neurosurgery, University of Manitoba.,Pan Am Clinic, and.,Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | - Scott Sawyer
- Pediatrics and Child Health, and.,Health Sciences Centre Children's Hospital
| | - Norm Silver
- Pediatrics and Child Health, and.,Health Sciences Centre Children's Hospital
| | | | | |
Collapse
|
44
|
Hrubeniuk TJ, Cordingley D, McRae S, Leiter J. Physiological Predictors Of On-ice Hockey Performance In Elite Adolescent Hockey Players. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000479356.85706.1d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
45
|
Mascarenhas R, Raleigh E, McRae S, Leiter J, Saltzman B, MacDonald PB. Iliac crest allograft glenoid reconstruction for recurrent anterior shoulder instability in athletes: Surgical technique and results. Int J Shoulder Surg 2014; 8:127-32. [PMID: 25538432 PMCID: PMC4262868 DOI: 10.4103/0973-6042.145269] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Performing a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of the iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>25% of glenoid diameter). All athletes with recurrent anterior shoulder instability and a large glenoid defect that underwent open anterior shoulder stabilization and glenoid reconstruction with the iliac crest allograft were followed over a 4-year period. Preoperatively, a detailed history and physical exam were obtained along with standard radiographs and magnetic resonance imaging of the affected shoulder. All patients also completed the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) evaluation forms preoperatively. A computed tomography scan was obtained postoperatively to assess osseous union of the graft and the patient again went through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI) forms. 10 patients (9 males, 1 female) were followed for an average of 16 months (4–36 months) and had a mean age of 24.4 years. All patients exhibited a negative apprehension/relocation test and full shoulder strength at final follow-up. Eight of 10 patients had achieved osseous union at 6 months (80.0%). ASES scores improved from 64.3 to 97.8, and SST scores improved from 66.7 to 100. Average postoperative WOSI scores were 93.8%. The use of the iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency.
Collapse
Affiliation(s)
- Randy Mascarenhas
- University of Texas Health Sciences Center at Houston, Houston, TX, Australia
| | | | | | | | | | | |
Collapse
|
46
|
Peppler W, Leiter J, Shay B, Cowley K. Electromyography And Metabolic Responses To Arm Ergometry In Spinal Cord Injured Persons. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000496199.92025.c6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
47
|
Gigliotti D, Upadhaya R, Macek B, MacDonald P, Leiter J, Anderson J. Bridging the gap: a cell and molecular study of muscle after rotator cuff injury (731.12). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.731.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
48
|
McRae S, Leiter J, McCormack R, Old J, MacDonald P. Ipsilateral versus contralateral hamstring grafts in anterior cruciate ligament reconstruction: a prospective randomized trial. Am J Sports Med 2013; 41:2492-9. [PMID: 24001575 DOI: 10.1177/0363546513499140] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Benefits of graft harvest from the side contralateral to the anterior cruciate ligament (ACL)-deficient leg have been identified when using bone-patellar tendon-bone autografts in ACL reconstruction (ACLR). As hamstring tendon autografts are becoming more commonly used, a study examining the effect of contralateral graft harvest of semitendinosus gracilis (STG) tendons on patient quality of life was conducted. PURPOSE To evaluate if ACLR using a hamstring tendon autograft results in better patient quality of life if the graft is harvested from the leg contralateral to the ACL rupture compared with the ipsilateral leg. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 100 participants between 16 and 50 years of age with a complete ACL tear were randomly assigned to undergo ACLR using either the ipsilateral or contralateral leg as the STG graft donor. Primary outcome measures were the ACL Quality of Life questionnaire (ACL-QOL), concentric knee flexion and extension strength at 60 and 240 deg/s, International Knee Documentation Committee (IKDC) knee assessment form, early postoperative pain and diary of analgesic use, and rate of reruptures. Outcome measures were evaluated before surgery and at 3, 6, 12, and 24 months after surgery. RESULTS The ACL-QOL score improved over time for both groups (P < .001), and there were no significant differences between groups at any time point (P = .528). Significant differences in knee flexion and extension strength were found at 3 months after surgery. There were no differences between groups in IKDC knee assessment scores or rerupture rates. CONCLUSION There does not appear to be any measurable benefit or drawback in quality of life to the use of an STG graft from the unaffected limb. In light of this finding, further research to examine other possible effects on agility and balance as well as time and ability to return to sport should be conducted. Longer term follow-up beyond 2 years would allow for a more thorough evaluation of the risk of reruptures or contralateral reruptures using this novel approach.
Collapse
Affiliation(s)
- Sheila McRae
- Peter MacDonald, FRCS, Section of Orthopaedics, Department of Surgery, Pan Am Clinic/University of Manitoba, 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada.
| | | | | | | | | |
Collapse
|
49
|
Slade Shantz JA, Vernon J, Morshed S, Leiter J, Stranges G. Sutures versus staples for wound closure in orthopaedic surgery: a pilot randomized controlled trial. Patient Saf Surg 2013; 7:6. [PMID: 23394586 PMCID: PMC3598732 DOI: 10.1186/1754-9493-7-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 02/01/2013] [Indexed: 11/24/2022] Open
Abstract
Background In the spectrum of surgical decision-making, wound closure material is often an afterthought. However, the findings of a recent meta-analysis suggest that the rate of surgical site infections (SSIs) is increased by using staples to close surgical wounds. Less clear is the effect of closure material on the incidence of non-infectious wound complications. The aim of this study was to compare sutures and staples in terms of: incidence of wound complications to determine the sample size for a definitive trial comparing wound closure methods. Methods Eligible adult orthopaedic patients were randomized to have wounds closed with sutures or staples. Time for skin closure was recorded. Wounds were assessed for complications for six weeks. The incidence of complications was compared using Fisher’s exact test. Time to close and pain with removal of closure material were compared using a Student’s t-test. Results The total number of patients reporting a wound complication was 59 of 148 patients completing six-week followup (41%), with no differennce between sutures and staples (RR = 0.77, CI = 0.52–1.14). The time to close wounds was shorter in the staple group (mean=4.8 min, CI = 2.6–7.1) than the suture group (mean=12 min, CI = 7.9–16). Patients in the staple group (mean=3.7, CI =2.8–4.6) reported more pain with removal than suture group (mean=2.5, CI =1.6–3.4). Conclusions This study suggests that 42% of patients report a wound complication with no difference between sutures and staples. It was demonstrated that suturing skin requires more time and staples are more painful to remove. Trial registration Clinicaltrials.gov identifier NCT01146236 (registered June 14, 2010)
Collapse
Affiliation(s)
- Jesse A Slade Shantz
- Orthopedic Trauma Institute, University of California, 2550 23rd Street, Building 9, 2nd Floor, 94110, San Francisco, CA, USA.
| | | | | | | | | |
Collapse
|
50
|
Peeler J, Leiter J. Using digital photography to document rectus femoris flexibility: A reliability study of the modified Thomas test. Physiother Theory Pract 2012; 29:319-27. [DOI: 10.3109/09593985.2012.731140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|