No abstract

Patient-reported outcomes (PROs) are a measure of health care quality that reflect the patient’s perceptions of their own health status. Recently, there has been a renewed interest in implementation of PROs into everyday clinical practice. There are many dozens of PROs available to foot and ankle surgeons with little consensus on which measures are most appropriate for a given condition. These measures vary widely in length, validity, and content. When integrating PROs into clinical practice, we recommend that clinicians should collect, at a minimum, validated PRO scores that assess pain, function, and general health. Furthermore, concise instruments should be used wherever possible to minimize patient burden, maximize patient engagement, and ensure meaningful data are collected. In the near future, outcomes registries employing computer adaptive testing will facilitate the routine collection of PRO data from all patients. Level of Evidence: Level V, expert opinion.

Background: Two common operative fixation techniques for insertional Achilles tendinopathy are the use of all-soft suture anchors vs synthetic anchors with a suture bridge. Despite increasing emphasis on early postoperative mobilization, the biomechanical profile of these repairs is not currently known. We hypothesized that the biomechanical profiles of single-row all-soft suture anchor repairs would differ when compared to double-row suture bridge repairs. Methods: Achilles tendons were detached from their calcaneal insertions on 6 matched-pair, fresh-frozen cadaver through-knee amputation specimens. Group 1 underwent a single-row repair with all-soft suture anchors. Group 2 was repaired with a double-row bridging suture bridge construct. Achilles-calcaneal displacement was tracked while specimens were cyclically loaded from 10 to 100 N for 2000 cycles and then loaded to failure. Linear mixed models were used to analyze the independent effects of age, body mass index, tendon morphology, repair construct, and footprint size on clinical and ultimate failure loads, Achilles-calcaneal displacement, and mode of failure. Results: The suture bridge group was independently associated with an approximately 50-N increase in the load to clinical failure (defined as more than 5 mm tendon displacement). There was no difference in ultimate load to failure or tendon/anchor displacement between the 2 groups. Conclusion: This cadaveric study found that a double-row synthetic bridge construct had less displacement during cyclic loading but was not able to carry more load before clinical failure when compared to a single-row suture anchor construct for the operative repair of insertional Achilles tendinopathy. Clinical Relevance: Our data suggest that double-row suture bridge constructs increase the load to clinical failure for operative repairs of insertional Achilles tendinopathy. It must be noted that these loads are well below what occurs during gait and the repair must be protected postoperatively without early mobilization. This study also identified several clinical factors that may help predict repair strength and inform further research.

Category: Sports, Outcomes Introduction/Purpose: Injuries are a major part of elite sports and patient-reported outcomes tools (PROs) are becoming commonplace for the assessment of injury and treatment outcomes. The National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) is a validated set of assessment tools with increasing popularity. The PROMIS metrics utilize computerized adaptive testing (CAT) to capture health status measurements through individualized assessments, with minimal user burden, and without the loss of precision or content validity. The purpose of this study was to evaluate elite athletes using PROMIS scores and assess the impact of injury on those scores in order to gain insight into how participation and injury can impact the health of NCAA Division 1 athletes participating in a variety of sports. Methods: Over a six-month period, athletes from 11 sports at a single Division 1 Athletics program were recruited to participate in longitudinal prospective data collection using four PROMIS CAT scales/domains: Pain Interference (PI), Physical Function (PF), Depression, and Ability to Participate in Social Roles and Activities (PSRA). Using REDCap (Research Electronic Data Capture), athletes completed an assesment that included the PROMIS tools prior to participation in their respective sport’s season for the 2018-2019 academic year and following the completion of their season. Athletes suffering a season-ending injury were asked to complete the PROMIS survey within a week following the injury. De-identified data was analyzed using Student’s T-test. PROMIS outcome measures were analyzed using linear mixed model regression. A p-value of < 0.05 was considered statistically significant. Results: A total of 315 pre-season surveys were collected and of those 139 post-season surveys have been completed at this point in the academic year. PF, Depression and PSRA scores were significantly different in athletes than in the general age-matched population. PI scores were similar to the normal population. The distribution of PI and PF scores were significantly different pre and post-season with a difference in means of 2.2 and -3.2 respectively (p<.01). No significant difference was observed in the Depression and PSRA scores at the end of the season. A total of 23 significant injuries were reported up to this point in the season, resulting in a significant change from both pre-season scores and post-season in uninjured controls (Figure 1). Conclusion: We found significantly worse PI and PF scores after a full season compared to preseason, suggesting that athletic participation alone impacts the athlete’s overall function and condition. Season-altering injuries resulted in clinically significant differences in all four domains, suggesting that injuries greatly affect athletes not only physically, but mentally and socially. These data indicate that consideration should be given to pre-season PROMIS surveys for individual athletes to ensure that subsequent scores are properly interpreted. Additional study will elucidate the impact of specific sports and injuries, providing data to physicians, trainers, and coaches to inform treatment and return to sport protocols.

Category: Sports Introduction/Purpose: Since its introduction into clinical practice, the Patient-Reported Outcome Measurement Information System (PROMIS) has become commonplace across multiple different orthopaedic sub-specialties for a wide variety of patient populations. PROMIS computer adaptive tests (CATs) are increasingly administered following injury and/or surgical intervention. Yet, a gap in the literature remains with regard to the results of PROMIS scores in populations that may not conform to mean normal values in the NIH PROMIS scoring database. Examples include young, healthy patients and young, elite athletes. Our objective was to evaluate the performance of scoring tools in six PROMIS domains in young, healthy non-athlete individuals and young, uninjured elite athletes, comparing both to National Institute of Health (NIH) developed normal PROMIS means and Standard deviations. Methods: In an IRB approved prospective cohort study, healthy subjects were recruited from a large University with a National Collegiate Athletic Association (NCAA) Division 1 athletics program between May and November 2017. Subjects were administered a one-time survey, including the following six PROMIS domains: Pain Interference CAT, Physical Functioning CAT, Mobility CAT, Social Functioning CAT, Depression CAT, and Global Health Short Form. Demographics included age, gender, sport and level of participation (where applicable), self-reported health status, history of recent orthopaedic injury, and history of foot/ankle surgery. Elite athletes were defined as participants > 18 years old actively participating in NCAA Division 1 athletics. Young people were defined as non-NCAA Division 1 athletes ages 18 to 35 years old. Following completion of data collection, results were analyzed using SAS 9.4. Results: The final cohort consisted of a total of 206 participants, which included 39 elite athletes, and 167 healthy non-athletes. All six PROMIS domains demonstrated statistically significant differences (p-value < 0.01) comparing elite athletes to NIH normal values. Compared to healthy non-athletes, elite athletes’ scores were all significant different (p-value < 0.01) except for the PROMIS Social Functioning CAT (p = 0.0766) and PROMIS Global Health Short Form Physical Functioning T-score (p = 0.0916). Furthermore, when elite athletes were compared to similar age undergraduates students (n = 25) only PROMIS Depression CAT and Global Health Short Form Mental Health T-score were statistically significant (p-value < 0.01). Conclusion: Elite athletes’ baseline PROMIS scores are significantly different than both the NIH normal values, and young healthy non-athletes across PROMIS domains. This highlights the need to interpret the results of elite athletes’ scores in the context of normal values for this specific population, and taking this into account over the of course of care following injury and/or surgery. There is a need for further research to establish baseline normal values for PROMIS scores for elite athletes and ot...