Do MRI Results Represent Functional Outcomes Following Arthroscopic Repair of an Isolated Meniscus Tear in Young Patients?-A Prospective Comparative Cohort Study.

BACKGROUND: The use of postoperative MRI to assess the healing status of repaired menisci is a long-standing issue. This study evaluates and compares functional and MRI outcomes following an arthroscopic meniscus repair procedure with the aim of postoperative MRI diagnostic accuracy clarification in young patients. METHODS: A total of 35 patients under 18 years old who underwent isolated meniscus repair were included. The Pedi-IKDC score, Lysholm score, and Tegner activity index (TAS) were compared between the groups formed according to the Stroller and Crues three-grade classification of postoperative MRI-based evaluations. Grade 3 MRI views were classified as unhealed, grade 2 as partially healed, and grade 1 as fully healed within the repaired meniscus, whereas grade 3 cases were considered unsuccessful due to MRI evaluation. RESULTS: MRI assessment revealed 4 cases of grade 1 (11.4%), 14 cases of grade 2 (40.8%), and 17 cases of grade 3 (48.0%) lesions. Pedi-IKDC and TAS scores were significantly higher among MRI grade 2 patients than among MRI grade 3 patients (p < 0.05). Weak negative correlations between MRI grades and all functional scales were found (p < 0.05). ROC analysis showed that Pedi-IKDC and TAS scores could correctly classify 77% and 71% of MRI grade 3 patients, respectively. The optimal cut-off values to detect grade 3 patients were 88.74 for the Pedi-IKDC score and 4.5 for the TAS score. CONCLUSIONS: To conclude, established functional score cut-off values may help identify unhealed meniscus repair patients.

The efficacy comparison of on-demand boluses with and without basal infusion of 0.1 % bupivacaine via perineural femoral catheter after arthroscopic ACL reconstruction.

PURPOSE: Optimal postoperative analgesia after anterior cruciate ligament repair remains challenging. The objective of this prospective experimental clinical study was to compare the postoperative analgesic efficacy of two infusion regimens of 0.1 % bupivacaine administered via perineural femoral catheter. METHODS: Forty adult ASA I and II patients undergoing anterior cruciate ligament reconstruction were enrolled. Surgery was performed under spinal anesthesia combined with femoral nerve block. A perineural femoral catheter was connected to the patient controlled analgesia infusion pump filled with 0.1 % bupivacaine for postoperative pain control. Subjects were assigned to one of two groups according to the bupivacaine infusion regimen: (1) 5 mL/h basal infusion with on-demand 5 mL boluses and 30-min refractive periods, and (2) only on-demand 5 mL boluses and 15-min refractive periods. Quality of postoperative analgesia, adjunctive analgesic consumption, and overall patient satisfaction were recorded for 48 h. RESULTS: Pain control was better in Group I on the day of surgery (P = 0.001) and on the first postoperative day at rest and during mobilization (P = 0.02 and P = 0.009). On the second postoperative day, only pain control during mobilization was better in Group I (P = 0.047). Adjunctive analgesic consumption and patient satisfaction were similar. CONCLUSION: Perineural femoral infusion of on-demand 5 mL boluses of 0.1 % bupivacaine combined with 5 mL/h basal infusion was more efficient than on-demand regimen alone for postoperative pain management after reconstruction of anterior cruciate ligament of the knee. LEVEL OF EVIDENCE: II.

The Significance of Selecting an Appropriate Patient-Reported Outcome Measure (PROM): A Cross-Cultural Adaptation of the Specific Paediatric International Documentation Committee Subjective (Pedi-IKDC) Knee Form.

INTRODUCTION: The selection of an appropriate PROM is a crucial aspect in assessing outcomes. Questionnaires that have not been designed or validated for a paediatric population are routinely used. Using a questionnaire requires translation, cultural adaptation, and testing the psychometric properties of the translated questionnaire. There is no applicable questionnaire in our country for children with knee-specific conditions in sports orthopaedics. Therefore, this study aims to translate, culturally adapt, and assess the psychometric properties of the Paediatric IKDC (Pedi-IKDC) questionnaire within the Lithuanian paediatric population. METHODS: The translation was conducted in accordance with international standards. Patients aged 11-17 years with various knee disorders participated in three surveys and completed the Pedi-IKDC, Lysholm, and PedsQL questionnaires. Interviews with patients following the translation process, in addition to floor and ceiling effects, were used to assess content validity. Cronbach alpha (α) statistics and the intraclass correlation coefficient (ICC) were applied to measure internal consistency and reproducibility, respectively. The standard error of measurement (SEM) and smallest detectable change (SDC) were calculated to assess reliability. Pearson correlations were calculated between Pedi-IKDC and Lysholm PedsQL scores to determine criteria validity. The effect size (ES) and standardised response mean (SRM) were calculated to assess the responsiveness to change. RESULTS: Cronbach's alpha (α) was 0.91 for the total score, 0.75 for symptoms, and 0.92 for the sport/function component. The ICC for overall scores was 0.98, with each question ranging from 0.87 to 0.98. The SEM was 2.97, and the SDC was 8.23. Lysholm and PedsQL physical functioning domain scores had moderate correlations (0.8 > r > 0.5), and the overall PedsQL score had a weak correlation (0.5 > r > 0.2) to the Pedi-IKDC score. The floor and ceiling effects were 3.3% and 1.6%, respectively. The SRM was 1.72 and the ES was 1.98. CONCLUSIONS: The Lithuanian Pedi-IKDC version is an appropriate evaluation instrument for assessing outcomes in children with knee disorders. All of the psychometric features produced acceptable results.