Compliance with Electronic Patient Reported Outcome Measure System Data Collection Is 51% Two-years After Shoulder Arthroscopy.

Objective: To determine patient compliance in completing electronic patient-reported outcome measures (PROMs) following arthroscopic shoulder surgery and identify risk factors for noncompliance. Methods: A retrospective review of compliance data was performed for patients who underwent arthroscopic shoulder surgery by a single surgeon in a private practice setting from June 2017 to June 2019. All patients were enrolled in Surgical Outcomes System (Arthrex) as a part of routine clinical care, and outcome reporting was integrated into our practice electronic medical record. Patient compliance with PROMs was calculated at preoperative, three-month, 6-month, 1-year, and 2-year follow-up time points. Compliance was defined as a complete patient response to each assigned outcome module in the database over time. Logistic regression for compliance at the one-year timepoint was performed to assess for factors associated with survey compliance. Results: Compliance with PROMs was highest preoperatively (91.1%) and decreased at each subsequent time point. The largest decrease in compliance with PROMs occurred between the preoperative and 3-month follow-up time points. Compliance was 58% at 1 year and 51% at 2 years after surgery. Overall, 36% of patients were compliant at all individual time points. There were no significant predictors of compliance with regard to age, sex, race, ethnicity, or procedure. Conclusions: Patient compliance with PROMs decreased over time with the lowest percentage of patients completing electronic surveys at the traditional 2-year follow-up for shoulder arthroscopy. In this study, basic demographic factors were not predictive of patient compliance with PROMs. Clinical Relevance: PROMs are commonly collected after arthroscopic shoulder surgery; however, low patient compliance may affect their utility in research and clinical practice.

Hypoxia-induced carbonic anhydrase mediated dorsal horn neuron activation and induction of neuropathic pain.

ABSTRACT: Neuropathic pain, such as that seen in diabetes mellitus, results in part from central sensitisation in the dorsal horn. However, the mechanisms responsible for such sensitisation remain unclear. There is evidence that disturbances in the integrity of the spinal vascular network can be causative factors in the development of neuropathic pain. Here we show that reduced blood flow and vascularity of the dorsal horn leads to the onset of neuropathic pain. Using rodent models (type 1 diabetes and an inducible endothelial-specific vascular endothelial growth factor receptor 2 knockout mouse) that result in degeneration of the endothelium in the dorsal horn, we show that spinal cord vasculopathy results in nociceptive behavioural hypersensitivity. This also results in increased hypoxia in dorsal horn neurons, depicted by increased expression of hypoxia markers such as hypoxia inducible factor 1α, glucose transporter 3, and carbonic anhydrase 7. Furthermore, inducing hypoxia through intrathecal delivery of dimethyloxalylglycine leads to the activation of dorsal horn neurons as well as mechanical and thermal hypersensitivity. This shows that hypoxic signalling induced by reduced vascularity results in increased hypersensitivity and pain. Inhibition of carbonic anhydrase activity, through intraperitoneal injection of acetazolamide, inhibited hypoxia-induced pain behaviours. This investigation demonstrates that induction of a hypoxic microenvironment in the dorsal horn, as occurs in diabetes, is an integral process by which neurons are activated to initiate neuropathic pain states. This leads to the conjecture that reversing hypoxia by improving spinal cord microvascular blood flow could reverse or prevent neuropathic pain.

Influence of the composition of artificial turf on rotational traction and athlete biomechanics.

Artificial turf advances have enabled surfaces to behave like natural grass, however, debate remains as to whether artificial turf is as safe as natural grass. To reduce injury risk, sport surfaces should have low rotational traction with artificial surfaces having a potential advantage as components can be manipulated to change surface properties and traction. The purpose of this study was to investigate the influence that different components of artificial turf have on rotational traction and athlete lower extremity joint loading. Twelve surfaces underwent mechanical testing to determine the influence of fibre density, fibre length, infill composition and compaction on rotational traction. Following mechanical testing, Control, Low and High Traction surfaces were selected for biomechanical analysis, where sixteen athletes performed maximum effort v-cuts while kinematic/kinetic data were recorded on each surface. Mechanically, fibre density, type of infill and compaction of the surface each independently influenced traction. The traction differences were substantial enough to alter the athlete kinematics and kinetics. Low traction surfaces reduced ankle and knee loading, while high traction surfaces increased ankle and knee loading . Reducing the rotational traction of sport surfaces is possible through alterations of individual components, which may reduce the joint loading at the knee and ankle joint.

Foot structure and knee joint kinetics during walking with and without wedged footwear insoles.

The relationship between static foot structure characteristics and knee joint biomechanics during walking, or the biomechanical response to wedged insoles are currently unknown. In this study, 3D foot scanning, dual X-ray absorptiometry and gait analysis methods were used to determine structural parameters of the foot and assess their relation to knee joint loading and biomechanical response to wedged insoles in 30 patients with knee osteoarthritis. In multiple linear regression models, foot fat content, height of the medial longitudinal arch and static hind foot angle were not associated with the magnitude of the knee adduction moment (R2 = 0.24, p = 0.060), knee adduction angular impulse (R2 = 0.21, p = 0.099) or 3D resultant knee moment (R2 = 0.23, p = 0.073) during gait. Furthermore, these foot structure parameters were not associated with the patients' biomechanical response to medial or lateral wedge footwear insoles (all p < 0.01). These findings suggest that static foot structure is not associated with gait mechanics at the knee, and that static foot structure alone cannot be utilized to predict an individual's biomechanical response to wedged footwear insoles in patients with knee osteoarthritis.

Influence of Compression and Stiffness Apparel on Vertical Jump Performance.

Compression apparel alters both compression of the soft tissues and the hip joint stiffness of athletes. It is not known whether it is the compression elements, the stiffness elements, or some combination that increases performance. Therefore, the purpose of this study was to determine how systematically increasing upper leg compression and hip joint stiffness independently from one another affects vertical jumping performance. Ten male athletes performed countermovement vertical jumps in 8 concept apparel conditions and 1 control condition (loose fitting shorts). The 8 apparel conditions, 4 that specifically altered the amount of compression exerted on the thigh and 4 that altered the hip joint stiffness by means of elastic thermoplastic polyurethane bands, were tested on 2 separate testing sessions (one testing the compression apparel and the other testing the stiffness apparel). Maximum jump height was measured, while kinematic data of the hip, knee, and ankle joint were recorded with a high-speed camera (480 Hz). Both compression and stiffness apparel can have a positive influence on vertical jumping performance. The increase in jump height for the optimal compression was due to increased hip joint range of motion and a trend of increasing the jump time. Optimal stiffness also increased jump height and had the trend of decreasing the hip joint range of motion and hip joint angular velocity. The exact mechanisms by which apparel interventions alter performance is not clear, but it may be due to alterations to the force-length and force-velocity relationships of muscle.

The effect of compressive loading magnitude on in situ chondrocyte calcium signaling.

Chondrocyte metabolism is stimulated by deformation and is associated with structural changes in the cartilage extracellular matrix (ECM), suggesting that these cells are involved in maintaining tissue health and integrity. Calcium signaling is an initial step in chondrocyte mechanotransduction that has been linked to many cellular processes. Previous studies using isolated chondrocytes proposed loading magnitude as an important factor regulating this response. However, calcium signaling in the intact cartilage differs compared to isolated cells. The purpose of this study was to investigate the effect of loading magnitude on chondrocyte calcium signaling in intact cartilage. We hypothesized that the percentage of cells exhibiting at least one calcium signal increases with increasing load. Fully intact rabbit femoral condyle and patellar bone/cartilage samples were incubated in calcium-sensitive dyes and imaged continuously under compressive loads of 10-40 % strain. Calcium signaling was primarily associated with the dynamic loading phase and greatly increased beyond a threshold deformation of about 10 % nominal tissue strain. There was a trend toward more cells exhibiting calcium signaling as loading magnitude increased (p = 0.133). These results provide novel information toward identifying mechanisms underlying calcium-dependent signaling pathways related to cartilage homeostasis and possibly the onset and progression of osteoarthritis.

Chondrocyte deformation under extreme tissue strain in two regions of the rabbit knee joint.

Articular cartilage and its native cells-chondrocytes-are exposed to a wide range of mechanical loading. Chondrocytes are responsible for maintaining the cartilage matrix, yet relatively little is known regarding their behavior under a complete range of mechanical loads or how cell mechanics are affected by region within the joint. The purpose of this study was to investigate chondrocyte deformations in situ under tissue loads ranging from physiological to extreme (0-80% nominal strain) in two regions of the rabbit knee joint (femoral condyles and patellae). Local matrix strains and cell compressive strains increased with increasing loads. At low loads the extracellular matrix (ECM) strains in the superficial zone were greater than the applied tissue strains, while at extreme loads, the local ECM strains were smaller than the applied strains. Cell compressive strains were always smaller than the applied tissue strains and, in our intact, in situ preparation, were substantially smaller than those previously found in hemi-cylindrical explants. This resulted in markedly different steady-state cell volume changes in the current study compared to those working with cartilage explants. Additionally, cells from different regions in the knee exhibited striking differences in deformation behavior under load. The current results suggest: (i) that the local extracellular and pericellular matrix environment is intimately linked to chondrocyte mechanobiology, protecting chondrocytes from potentially damaging strains at high tissue loads; and (ii) that cell mechanics are a function of applied load and local cartilage tissue structure.

In situ chondrocyte viscoelasticity.

It has been proposed, based on theoretical considerations, that the strain rate-dependent viscoelastic response of cartilage reduces local tissue and cell deformations during cyclic compressions. However, experimental studies have not addressed the in situ viscoelastic response of chondrocytes under static and dynamic loading conditions. In particular, results obtained from experimental studies using isolated chondrocytes embedded in gel constructs cannot be used to predict the intrinsic viscoelastic responses of chondrocytes in situ or in vivo. Therefore, the purpose of this study was to investigate the viscoelastic response of chondrocytes in their native environment under static and cyclic mechanical compression using a novel in situ experimental approach. Cartilage matrix and chondrocyte recovery in situ following mechanical compressions was highly viscoelastic. The observed in situ behavior was consistent with a previous study on in vivo chondrocyte mechanics which showed that it took 5-7 min for chondrocytes to recover shape and volume following virtually instantaneous cell deformations during muscular loading of the knee in live mice. We conclude from these results that the viscoelastic properties of cartilage minimize chondrocyte deformations during cyclic dynamic loading as occurs, for example, in the lower limb joints during locomotion, thereby allowing the cells to reach mechanical and metabolic homeostasis even under highly dynamic loading conditions.