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Freychet B, Bouguennec N, Berard E, Hardy A, Herce C, Kajetanek C, Lutz C, Neri T, Ollivier M, Cavaignac E. Impact of preoperative measures on postoperative results in combined anterior cruciate and medial collateral ligament injuries: an analysis from the registry of the francophone arthroscopic society. Orthop Traumatol Surg Res 2025:104185. [PMID: 39952318 DOI: 10.1016/j.otsr.2025.104185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 01/30/2025] [Accepted: 02/11/2025] [Indexed: 02/17/2025]
Abstract
BACKGROUND Combined injuries of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) are frequent in knee trauma. Treatment approaches vary widely, including surgical and conservative methods. However, the impact of preoperative measures on postoperative outcomes remains unclear. HYPOTHESIS Preoperative measures influence on postoperative outcomes for cases involving combined anterior cruciate and medial collateral ligament injuries. PATIENTS AND METHODS A prospective, multicenter study was conducted in 8 French surgical centers specializing in knee surgery. Data were collected on patients undergoing ACL reconstruction with concomitant MCL injury over a 12-month period. Inclusion criteria were primary ACL injury associated with MCL injury (Grade I, II or III) and requiring ACL reconstruction, patients aged ≥ 15 years. The use and type of preoperative brace, weight-bearing and the time between injury and surgery were assessed. A functional assessment of the IKDC, ACL-RSI, TEGNER and SKV scores was performed at final follow-up. Patients were evaluated with regards of iterative ACL rupture, contralateral ACL rupture and reoperation. RESULTS The study included 408 patients with a mean follow-up of 18.5 months. Time between injury and surgery did not significantly affect the risk of iterative rupture, contralateral rupture, or reoperation. No significant impact of preoperative brace type or weight-bearing status on postoperative outcomes was observed. However, patients with higher grade MCL injuries underwent surgery earlier (p < 0.0001) and had lower preoperative weight-bearing allowances (p < 0.05). Patients with Grade 2-3 MCL injuries had lower functional scores compared to those with Grade 1 injuries (p < 0.05). DISCUSSION Preoperative measures, including time between injury and surgery, showed no significant influence on postoperative outcomes in combined ACL-MCL injuries. The type of preoperative brace and weight-bearing status did not significantly impact postoperative results. A functional approach with immediate full weight-bearing/recovery of full range of motion and with the use of bracing according to pain and patient apprehension is recommended. Further research is needed to refine preoperative treatment strategies for such injuries. LEVEL OF EVIDENCE IV; prospective study.
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Affiliation(s)
- Benjamin Freychet
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
| | | | - Emilie Berard
- Department of Epidemiology, Health Economics and Public Health, UMR 1295 CERPOP, University of Toulouse, INSERM, UPS, Toulouse University Hospital (CHU), Toulouse, France
| | | | - Corentin Herce
- Clinique du Sport de Bordeaux Merignac, 4, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Charles Kajetanek
- Institut Locomoteur de l'Ouest, 7 Boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Christian Lutz
- Institut de Chirurgie Orthopédique Et Sportive, Strasbourg (ICOSS), Strasbourg, France
| | - Thomas Neri
- Department of Orthropedics and Traumatology, University Hospital Saint-Etienne, Saint-Etienne, France
| | - Matthieu Ollivier
- Department of Orthopaedics and Traumatology, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Aix Marseille University, Marseille, France
| | - Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Pierre Paul Riquet University Hospital, Toulouse, France; I2R - Institut de Recherche Riquet, Toulouse, France
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Tata TK, Ohene LA, Dzansi GA, Aziato L. Factors influencing nurses' pain assessment and management of road traffic casualties: a qualitative study at a military hospital in Ghana. BMC Emerg Med 2024; 24:100. [PMID: 38886656 PMCID: PMC11184758 DOI: 10.1186/s12873-024-01016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Evidence shows that patients who visit the surgical and trauma emergency units may be discharged with untreated or increased pain levels. This study explored nurses' pain assessment and management approaches at a trauma-surgical emergency unit in Ghana. METHODS Seventeen nurses who work in the trauma department participated in this qualitative exploratory descriptive study. In-depth individual interviews were conducted, and the thematic analysis was utilized to identify emerging themes and subthemes. RESULTS Three main themes were identified: patient pain indicators, pain management, and institutional factors influencing pain management. The study revealed that nurses rely on verbal expressions, non-verbal cues, physiological changes, and the severity of pain communicated. The findings highlighted staff shortage, inadequate resources, and lack of standardized guidelines as factors affecting pain and management. CONCLUSIONS Although the study offers critical new perspectives on nurses' experiences regarding pain related issues at the trauma-surgical emergency units, its small sample size limited its generalizability.
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Affiliation(s)
- Thomas Kwame Tata
- 37 Military Hospital, Neghelli Barracks Liberation Rd 37, Accra, Ghana
| | - Lillian Akorfa Ohene
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Ghana, P. O Box LG 43, Legon, Accra, Ghana.
| | - Gladys Akorfa Dzansi
- Department of Adult Health Nursing, School of Nursing and Midwifery of Ghana, P. O Box LG 43, Legon, Accra, Ghana
| | - Lydia Aziato
- University of Health and Allied Sciences, PMB 31, Volta Region, Ho, Ghana
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Hickie K, Qiu Y, Baptiste JJ, Salipas A, Nathanail S, Westover L, Sommerfeldt M. A comparison of stiffness of six knee braces with application for posterolateral corner reconstructions. Proc Inst Mech Eng H 2023; 237:985-990. [PMID: 37477414 PMCID: PMC10466962 DOI: 10.1177/09544119231188009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2023] [Indexed: 07/22/2023]
Abstract
Posterolateral corner knee injuries are clinically significant, and often require surgical reconstruction. The optimal knee brace following posterolateral corner reconstructions has not yet been determined via clinical nor biomechanical study. We sought to evaluate the stiffness of six types of knee braces to determine the ideal brace type for reducing varus forces, which may have clinical utility for posterolateral corner knee reconstruction rehabilitation. Six different groups of knee braces underwent mechanical testing: cruciate braces, cruciate braces with a valgus bend, medial unloaders, articulating sleeves, hinged braces, and tri-panel immobilizers. Each brace was fitted to the same fiberglass leg model and was secured to the testing apparatus. Force was applied under four-point bending to generate a varus moment about the artificial knee. The stiffness in Newtons per millimeter (N/mm) of each brace was calculated from the slope of the force-displacement curve. The cruciate brace with a valgus bend had the highest average stiffness at 192.61 N/mm (SD 28.53). The articulating sleeve was the least stiff with an average stiffness of 49.86 N/mm (SD 8.99). Stiffness of the cruciate brace was not statistically different compared to cruciate valgus (p = 0.083) or medial unloader (p = 0.098). In this experimental design, a cruciate brace with a valgus bend was shown to have the highest overall stiffness, while an articulating sleeve had the lowest stiffness. Future work will investigate whether this translates into clinical performance.
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Affiliation(s)
- Kirsten Hickie
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Yuelin Qiu
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Jonelle Jn Baptiste
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Andrew Salipas
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Lindsey Westover
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Mark Sommerfeldt
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Zhou H. Embryonic movement stimulates joint formation and development: Implications in arthrogryposis multiplex congenita. Bioessays 2021; 43:e2000319. [PMID: 33634512 DOI: 10.1002/bies.202000319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 12/22/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) is a heterogeneous syndrome where multiple joints have reduced range of motion due to contracture formation prior to birth. A common cause of AMC is reduced embryonic movement in utero. This reduction in embryonic movement can perturb molecular mechanisms and signaling pathways involved in the formation of joints during development. The absence of mechanical stimuli can impair joint cavitation, resulting in joint fusion, and ultimately eliminate function. In turn, mechanical stimuli are critical for proper joint formation during development and for mitigating AMC. Studies in experimental animal models have provided a greater understanding on the molecular pathophysiology of congenital contracture formation as a consequence of embryonic immobilization. Elucidation of how the mechanical signaling environment is transduced to initiate a biological response will be necessary to gain a deeper understanding of how mechanical stimuli are intertwined in the molecular regulation of joint development.
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Affiliation(s)
- Haodong Zhou
- Faculty of Science, Department of Biology, University of Ottawa, Ottawa, Ontario, Canada
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Min BC, Yoon JS, Chung CY, Park MS, Sung KH, Lee KM. Patients’ perspectives on the conventional synthetic cast vs a newly developed open cast for ankle sprains. World J Orthop 2020; 11:492-498. [PMID: 33269215 PMCID: PMC7672803 DOI: 10.5312/wjo.v11.i11.492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/30/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Orthopedic physicians typically apply a cast to immobilize a body part that has been injured. There have been no significant structural changes or advances in synthetic casts since the development of the modern cast. The Opencast® is a recently developed type of cast that allows ventilation and direct visual inspection of the skin to avoid cast-related complications. Although this novel cast appears to have more benefits than the conventional synthetic cast, its clinical efficacy and advantages have not been established.
AIM To investigate the clinical efficacy and advantages of the newly developed Opencast® based on patients’ perspectives in those with ankle inversion injury.
METHODS A specifically designed questionnaire consisting of 19 items was used to compare patients’ opinions and concerns of the Opencast® and the conventional synthetic cast. The items were focused on subjective patient satisfaction, discomfort, and adverse effects while wearing the cast. Patients with an ankle inversion injury diagnosed as a high-grade ankle sprain were enrolled. The subjects were randomized and instructed to fill the questionnaire after wearing a synthetic cast or an Opencast® for 2 wk. They were then required to fill the questionnaire again, after switching to the alternative type of cast for 2 more weeks.
RESULTS A total of 22 subjects participated in the study. The synthetic cast appeared to be more rigid and stable than the Opencast®, but there was no significant difference in the amount of pain relief. The likelihood of adverse effects when wearing the synthetic cast was significantly higher. Patient satisfaction tended to be rated higher after wearing the Opencast®. Opencast® showed more subjective vulnerability than the synthetic cast, but there was no significant difference in the redo rate. Patients were more anxious about removal of the synthetic cast than of the Opencast®.
CONCLUSION The results indicate that the Opencast® could replace the conventional synthetic cast as it offers increased patient satisfaction, which would in turn increase compliance to treatment.
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Affiliation(s)
- Byung Cho Min
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 463-707, Gyeonggi, South Korea
| | - Ji Soo Yoon
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 463-707, Gyeonggi, South Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 463-707, Gyeonggi, South Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 463-707, Gyeonggi, South Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 463-707, Gyeonggi, South Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 463-707, Gyeonggi, South Korea
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ZHOU HAODONG, TRUDEL GUY, UHTHOFF HANSK, LANEUVILLE ODETTE. Range of Extension Correlates with Posterior Capsule Length after Knee Remobilization. Med Sci Sports Exerc 2018; 50:2401-2408. [DOI: 10.1249/mss.0000000000001741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T. Review article: Best practice management of common knee injuries in the emergency department (part 3 of the musculoskeletal injuries rapid review series). Emerg Med Australas 2017; 30:327-352. [PMID: 29243880 DOI: 10.1111/1742-6723.12870] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/01/2017] [Accepted: 08/15/2017] [Indexed: 11/30/2022]
Abstract
Knee injuries are a common presentation to the ED and are often difficult to assess and definitively diagnose due to the patient's acute pain, effusion and guarding. The quality of ED care provided to patients with fractures or soft tissue injuries of the knee is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common knee injuries in the ED. Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites. Primary studies, systematic reviews and guidelines were considered for inclusion. English-language articles published in the past 12 years that addressed the acute assessment, management, follow-up plan or prognosis were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 2250 articles, of which 54 were included in the review (n = 8 primary articles, n = 28 systematic reviews, n = 18 guidelines). This rapid review provides clinicians managing fractures and soft tissue injuries of the knee in the ED, a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. There is consistent evidence to support undertaking a thorough history and physical examination, including the application of special tests and clinical decision rules for imaging. In the undifferentiated knee injury, expedited follow up and further imaging is recommended to improve patient outcomes and cost-effectiveness.
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Affiliation(s)
- Kirsten Strudwick
- Emergency Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Megan McPhee
- Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Anthony Bell
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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