Determine the vertical ground reaction forces and knee mechanics with different gait inclinations in the sheep model.

Our current understanding of knee mechanics and anterior cruciate ligament (ACL) function is predominately based on data recorded during simulations of clinical examinations or the application of nonphysiologic loads and motions. These methodologies provide little information on knee and ACL mechanics during activities of daily living (ADLs). Additionally, researchers have not directly measured knee kinetics, knee contact pressures, and ACL forces, and it is unknown how these parameters change with different activities. This study quantified the effects of activity level on vertical ground reaction forces, knee kinematics, and joint and ligament forces during in vivo motions. Five female Suffolk sheep were walked twice weekly on a treadmill during level (0°), inclined (+6°), and declined (-6°) gait for 12 weeks. Electromagnetic (EM) trackers were surgically implanted onto the left distal femur and the left proximal tibia, and in vivo motions were recorded for all activities. Following sacrifice, the in vivo motions were applied to their respective knees using a serial robot with a multi-axis load cell. In vitro simulations were repeated to measure (a) total knee forces, (b) contact pressure maps, and (c) ACL-only forces. Declining the gait surface led to increased posterior translation during the swing phase and decreased flexion at hoof-strike, decreased medial contact pressure at push-off, decreased ACL force at hoof-strike and increased ACL force at push-off. This study established a system that can be used to examine knee mechanics and ACL forces during ADLs for different knee states to define design requirements for ACL reconstruction techniques.

Knee Sepsis after Suprapatellar Nailing of an Open Tibia Fracture: Treatment with Acute Deformity and External Fixation.

CASE: A 31-year-old male was involved in a dirt bike accident and sustained an isolated type II open mid-distal tibia fracture. The patient underwent suprapatellar intramedullary nailing and subsequently developed knee sepsis. CONCLUSION: This patient was managed with irrigation and debridements of the knee, fracture site, and intramedullary canal. A resultant soft-tissue defect over the fracture site obviated primary closure. Creation of an acute deformity stabilized by a Taylor spatial frame allowed primary wound closure. After soft tissue healing occurred, the frame was used to correct the intentional deformity and maintain reduction until full healing occurred.

Treatments of Choice for Isolated, Full-Thickness Tears of the Posterior Cruciate Ligament: A Nationwide Survey of Orthopaedic Surgeons.

The ideal treatment for isolated, full-thickness tears of the posterior cruciate ligament (PCL) is uncertain. The purpose of this study was to determine how the majority of orthopaedic surgeons treat isolated, full-thickness tears of the PCL. In July 2017, a 17-question multiple-choice survey regarding the treatment of isolated, full-thickness tears of the PCL was emailed to 3,500 orthopaedic sports medicine surgeons with membership in the American Orthopaedic Society for Sports Medicine. Responders answered multiple-choice questions related to indications, technique, graft choice, bracing, and weight-bearing status following reconstruction. Answer choices were then analyzed against surgeon-specific variables. The survey was completed by 663 orthopaedic surgeons. Of the responders, 93% were fellowship trained in sports medicine with an average practice duration of 13 years. The total number of PCLs reconstructed per surgeon was low, 11.6. On average, surgeons estimate they reconstruct the PCL in only 22% of patients with full-thickness tears. The two most common surgical indications were functional limitations and failure of physical therapy. The reconstruction of choice involves a transtibial approach (63%) with a single bundle (87%) allograft (83%) of the Achilles tendon (51%). The postoperative brace is typically locked in extension (66%), and weight-bearing is delayed for 3.8 weeks. Of the surgeons with the fewest years of experience, 39% use all-inside, 89% use allograft, and 24% use dynamic bracing. Compared with surgeons with the most years of experience, only 16% use all-inside (p < 0.01), 57% use allograft (p < 0.01), and 11% use dynamic bracing (p = 0.01). Isolated, full-thickness tears of the PCL are rare injuries that are infrequently reconstructed. The most common indications for reconstruction are functional limitations and failure of conservative management. Most surgeons' treatment of choice for reconstruction involves a transtibial approach with a single bundle Achilles allograft and a postoperative brace locked in extension. On average, weight-bearing is prolonged for 3.8 weeks. The all-inside technique, allograft, and dynamic bracing are becoming more popular.

Poor Readability of AOSSM Patient Education Resources and Opportunities for Improvement.

BACKGROUND: Appropriate education on the disease processes associated with orthopaedic pathology can affect patient expectations and functional outcome. HYPOTHESIS: Patient education resources from the American Orthopaedic Society for Sports Medicine (AOSSM) are too complex for comprehension by the average orthopaedic patient. STUDY DESIGN: Cross-sectional study. METHODS: Patient education resources provided by the AOSSM were analyzed with software that provided 10 readability scores as well as opportunities for improving readability. The readability scores were compared with the recommended eighth-grade reading level. RESULTS: A total of 39 patient education resources were identified and evaluated. The mean ± SD reading grade-level scores were as follows: Coleman-Liau Index, 12.5 ± 1.11; New Dale-Chall Readability Formula, 10.9 ± 1.37; Flesch-Kincaid Grade Level, 9.9 ± 1.06; FORCAST Readability Formula, 11.4 ± 0.51; Fry Readability Formula, 12.8 ± 2.79; Gunning Fog Index, 11.9 ± 1.37; Raygor Readability Index, 13.1 ± 2.37; Simple Measure of Gobbledygook, 12.3 ± 0.90; Automated Readability Index, 11.2 ± 1.18; and New Automated Readability Index, 10.6 ± 1.27. After averaging the reading grade-level scores, only 1 patient education resource was found to be written at an 8th- to 9th-grade level, and 14 (36%) were written above a 12th-grade level. All scores were significantly different from the eighth-grade level (P < .0065). The percentage of complex words and long words were 19.6% ± 2.67% and 41.4% ± 3.18%, respectively. CONCLUSION: Patient education resources provided by the AOSSM are at a significantly higher reading level than recommended. Simple changes can drastically improve these scores to increase health literacy and possibly outcome.

Readability of Sports Injury and Prevention Patient Education Materials From the American Academy of Orthopaedic Surgeons Website.

INTRODUCTION: The purpose of this study is to evaluate the readability of 114 Sports Injury and Prevention patient education materials provided by the American Academy of Orthopaedic Surgeons (AAOS). METHODS: We evaluated all articles written in English posted under the Sports Injury and Prevention section of the AAOS website using readability software to compute six readability scores, which we compared with the eighth-grade level using a two-tailed one-sample Student t-test. RESULTS: The mean reading grade level calculated by each readability test was markedly higher than the eighth-grade level. We reported mean ± SD for each test: Flesch-Kincaid grade level (8.95 ± 1.51; P < 0.001), Simple Measure of Gobbledygook (11.53 ± 1.18; P < 0.001), Coleman-Liau index (11.16 ± 1.33; P < 0.001), Gunning Fog index (11.06 ± 1.63; P < 0.001), New Dale-Chall (9.49 ± 1.66; P < 0.001), and FORCAST formulas (10.96 ± 0.60; P < 0.001). DISCUSSION: This study shows that patient education materials provided by the AAOS concerning sports injury and prevention are written at a readability level too high for patients to understand. On average, patient materials are written at least 2.5 grade levels higher than national recommendations. Only 7% of the 114 articles had readability scores in line with national recommendations. These findings indicate a need for revised patient education materials geared toward bringing the readability level down to the recommended eighth-grade level.

Correlation of Patient-Reported Outcome Measurement Information System Physical Function Upper Extremity Computer Adaptive Testing, With the American Shoulder and Elbow Surgeons Shoulder Assessment Form and Simple Shoulder Test in Patients With Shoulder Pain.

PURPOSE: To evaluate the Patient-Reported Outcome Measurement Information System Physical Function Upper Extremity Computer Adaptive Testing (PROMIS PFUE CAT) measurement tool against the already validated American Shoulder and Elbow Surgeons Shoulder Assessment Form (ASES) and the Simple Shoulder Test (SST) in patients presenting with shoulder pain and determine the responder burden for each of the 3 surveys. METHODS: Ninety patients presenting with shoulder pain were asked to fill out the ASES, SST, and PROMIS PFUE CAT. The time for completion of each survey was measured to determine responder burden, and the Pearson correlation between the 3 instruments was defined as excellent (r > 0.7), excellent-good (0.61 ≤ r ≤ 0.7), good (0.31 ≤ r ≤ 0.6), and poor (0.2 ≤ r ≤ 0.3). RESULTS: The PROMIS PFUE CAT showed an excellent correlation with the SST (r = 0.82, P < .001) and ASES (r = 0.72, P < .001). The average time to complete SST, ASES, and PROMIS PFUE CAT was 92.8 ± 35.8, 142.3 ± 60.1, and 61.3 ± 28.8 seconds, respectively. The time to complete the PROMIS PFUE CAT was significantly less than both the SST (P < .001) and ASES (P < .001). CONCLUSIONS: The PROMIS PFUE CAT showed an excellent correlation with the previously validated ASES and SST in patients with shoulder pain. The time saving of the PROMIS PFUE CAT was found to be smaller than that of the ASES and SST but shows that moving forward, using the PROMIS PFUE CAT would not place any additional burden on the patient filling out the survey. The lack of ceiling or floor effects with the PROMIS PFUE CAT indicates its ability to differentiate both high and low functioning patients. All of these findings indicate that the PROMIS PFUE CAT is an adequate tool for the evaluation of patients with shoulder pain and should be used in these patients going forward. LEVEL OF EVIDENCE: Level II, diagnostic study.

Readability assessment of American Shoulder and Elbow Surgeons patient brochures with suggestions for improvement.

BACKGROUND: Many Americans have limited literacy skills, and the National Institutes of Health (NIH) suggests patient educational material be written below the 8th grade level. Many orthopedic organizations provide print material for patients, but whether these documents are written at an appropriate reading level is not clear. This study assessed the readability of patient education brochures provided by the American Shoulder and Elbow Surgeons (ASES). MATERIALS AND METHODS: In May 2017, 6 ASES patient education brochures were analyzed using readability software. The reading level was calculated for each brochure using 9 different tests. The mean reading level for each article was compared with the NIH-recommended 8th grade level using 2-tailed, 1-sample t tests assuming unequal variances. RESULTS: For each of the 9 tests, the mean reading level was higher than the NIH-recommended 8th grade (test, grade level): Automated Readability Index, 14.1 (P < .05); Coleman-Liau, 14.2 (P < .05); New Dale-Chall, 13.2 (P < .05); Flesch-Kincaid, 13.7 (P < .05); FORCAST, 11.8 (P < .05); Fry, 15.8 (P < .05); Gunning Fog, 16.5 (P < .05); Raygor Estimate, 15.4 (P < .05); and Simple Measure of Gobbledygook (SMOG), 15.1 (P < .05). CONCLUSIONS: The ASES patient education brochures are written well above the NIH-recommended 8th grade reading level. These findings are similar to other investigations concerning orthopedic patient education material. Supplementary brochures and websites could be a useful source of information, particularly for patients who are deterred from asking questions in the office. Printed material designed for patient education should be edited to a more reasonable reading level. Further review of patient education materials is warranted.

Correlation of PROMIS Physical Function Upper Extremity Computer Adaptive Test with American Shoulder and Elbow Surgeons shoulder assessment form and Simple Shoulder Test in patients with shoulder arthritis.

BACKGROUND: The purpose of this study was to evaluate the Patient-Reported Outcomes Measurement Informative System Physical Function Upper Extremity Computer Adaptive Test (PROMIS PFUE CAT) measurement tool against the already validated American Shoulder and Elbow Surgeons (ASES) shoulder assessment form and the Simple Shoulder Test (SST) in patients with shoulder arthritis. METHODS: Fifty-two patients with the primary diagnosis of shoulder arthritis were asked to fill out the ASES, SST, and PROMIS PFUE CAT. The time for completion of each survey was measured to determine responder burden, and correlation between the 3 instruments was defined as excellent (>0.7), strong-moderate (0.61-0.7), moderate (0.31-0.6), and poor (0.2-0.3). RESULTS: The PROMIS PFUE CAT showed a strong-moderate correlation with the SST (r = 0.64; P < .001) and a moderate correlation with the ASES (r = 0.57; P < .001). The average times to complete the SST, ASES, and PROMIS PFUE CAT were determined to be 96.9 ± 25.1 seconds, 160.6 ± 51.5 seconds, and 62.6 ± 22.8 seconds, respectively. The time to complete the PROMIS PFUE CAT was significantly less than the time to complete the SST (P < .001) and the ASES (P < .001). CONCLUSION: In patients with shoulder arthritis, The PROMIS PFUE CAT demonstrated strong-moderate correlation with the SST and moderate correlation with the ASES. The time savings of the PROMIS PFUE CAT were small compared with the ASES and SST but demonstrate that moving forward, using the PROMIS PFUE CAT would not place any additional burden on the patient filling out the survey. These findings indicate that the PROMIS PFUE CAT is an appropriate measurement tool for patients with shoulder arthritis.