BackgroundCommunity-based studies of patellofemoral pain (PFP) need a questionnaire tool that discriminates between those with and those without the condition. To overcome these issues, we have designed a self-report questionnaire which aims to identify people with PFP in the community.MethodsStudy designs: comparative study and cross-sectional study.Study population: comparative study: PFP patients, soft-tissue injury patients and adults without knee problems. Cross-sectional study: adults attending a science festival.Intervention: comparative study participants completed the questionnaire at baseline and two weeks later. Cross-sectional study participants completed the questionnaire once.The optimal scoring system and threshold was explored using receiver operating characteristic curves, test-retest reliability using Cohen’s kappa and measurement error using Bland-Altman plots and standard error of measurement. Known-group validity was explored by comparing PFP prevalence between genders and age groups.ResultsEighty-four participants were recruited to the comparative study. The receiver operating characteristic curves suggested limiting the questionnaire to the clinical features and knee pain map sections (AUC 0.97 95 % CI 0.94 to 1.00). This combination had high sensitivity and specificity (over 90 %). Measurement error was less than the mean difference between the groups. Test–retest reliability estimates suggest good agreement (N = 51, k = 0.74, 95 % CI 0.52–0.91). The cross-sectional study (N = 110) showed expected differences between genders and age groups but these were not statistically significant.ConclusionA shortened version of the questionnaire, based on clinical features and a knee pain map, has good measurement properties. Further work is needed to validate the questionnaire in community samples.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1097-5) contains supplementary material, which is available to authorized users.
BACKGROUND Arthroscopy is the established 'gold standard' diagnostic investigation for detection of shoulder disorders. We aimed to compare the diagnostic accuracy of arthroscopy with magnetic resonance arthrography (MRA) for detection of shoulder disorders. METHODS Patients who underwent arthroscopy by a single surgeon and preoperative MRA between February 2011 and March 2012 for shoulder instability were identified. MRAs were reported by experienced musculoskeletal radiologists. Labral tears, anterior labral tears, superior labral anterior posterior (SLAP) lesions, posterior labral tears, rotator-cuff tears (RCTs), osteoarthritis, loose bodies and Hill-Sachs lesions were identified. Sensitivity, specificity, positive predictive value and negative predictive value, positive likelihood ratio and negative likelihood ratio were calculated. RESULTS A total of 194 patients were identified. The sensitivity and specificity for anterior labral tears was 0.60 and 0.92, SLAP lesions was 0.75 and 0.81, posterior labral tears was 0.57 and 0.96, any labral tear was 0.87 and 0.76, Hill-Sachs lesions was 0.91 and 0.91, RCTs was 0.71 and 0.86, osteoarthritis was 0.72 and 0.95, and loose bodies was 0.22 and 0.96, respectively. The positive predictive value and negative predictive value for anterior labral tears were 0.88 and 0.71, SLAP lesions was 0.64 and 0.88, posterior labral tears was 0.74 and 0.45, any labral tear was 0.89 and 0.71, Hill-Sachs lesions was 0.66 and 0.98, RCTs was 0.47 and 0.95, osteoarthritis was 0.70 and 0.95, and loose bodies was 0.27 and 0.95, respectively. CONCLUSIONS MRA has high diagnostic accuracy for labral tears and Hill-Sachs lesions, but whether MRA should be the first-line imaging modality is controversial.
Elevated pre-operative inflammatory markers are inversely related to survival outcomes. They are relatively inexpensive, easy measurable parameters that could aid in the decision making process involved in the management of GBC. Sub-stratification of groups utilizing inflammatory markers may help guide surgical strategy. However, these studies are retrospective and of low to moderate quality. High quality, prospective studies with well-defined inclusion criteria and outcomes are needed to guide the role of inflammatory markers in the management of GBC.
Background Ulnocarpal impaction occurs when there is excessive loading between the ulnar carpus and the distal ulna. Ulnar shortening osteotomies (USOs) decompress the ulnocarpal joint. Many studies have evaluated USO but none have considered the effect of early active mobilization on union rate. Questions Does early active mobilization affect rate of union following USO? Does early active mobilization affect rate of complications following USO? Patients and Methods We performed a retrospective review of 15 consecutive patients that underwent 16 USOs between 2011 and 2015. There were seven males and eight females. Median age at time of shortening osteotomy was 47 years (range: 11–63 years). The median time of the procedure was 62 minutes (range: 45–105 minutes) and the median change in ulnar variance was 5.5 mm (range: 0–10.5 mm). Six patients were initially immobilized in incomplete plaster casts postoperatively, while the remainder had only wool and crepe dressings. Early active mobilization commenced after the first postoperative visit at 12 days. Results There was a 100% union rate in our series and 12 patients were pain-free at final follow-up. However, three of the patients with the longest times to union were smokers. Additionally, some patients may have achieved union between follow-up clinic visits. Conclusion Early active mobilization after USO does not affect union rate. Prospective, randomized studies are required to investigate the effect of early active mobilization in light of factors known to increase time to union, such as smoking. Level of Evidence This is a Level IV, case series.
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