Economic Decision Model for First-Time Traumatic Patellar Dislocations in Adolescents

Nwachukwu, Benedict U.; So, Conan; Schairer, William W.; Stein, Beth E. Shubin; Strickland, Sabrina M.; Green, Daniel W.; Dodwell, Emily

doi:10.1177/0363546517703347

Cited by 24 publications

(17 citation statements)

References 42 publications

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“…28 To date, no studies have been able to justify early stabilization of all first-time patellofemoral dislocations. Nwachukwu et al 34 recently published an economic analysis concluding that immediate patellofemoral stabilization after a first-time dislocation provides the highest quality-adjusted life-year gains with a 10-year horizon. These data are consistent with the findings of this study, which demonstrate decreased quality of life outcomes for each 10-year increase in age at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

Age at Time of Surgery but Not Sex Is Related to Outcomes After Medial Patellofemoral Ligament Reconstruction

Hiemstra

Kerslake

2019

Am J Sports Med

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Background: Medial patellofemoral ligament (MPFL) reconstruction has become a well-accepted procedure for recurrent patellofemoral instability. Despite a growing volume of research assessing surgical results, the relationship of age and sex to outcomes after MPFL reconstruction surgery is unclear. Purpose: To investigate whether age at the time of surgery or sex influenced patient-reported quality of life and clinical outcome after MPFL reconstruction for recurrent lateral patellofemoral instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2010 and May 2016, 328 patients underwent primary patellofemoral stabilization. Demographic and clinical data were collected preoperatively. Patients completed the Banff Patellofemoral Instability Instrument (BPII) at the pre- and postoperative visits and were assessed clinically at 12 and 24 months. To assess the effects of age at surgery and sex on BPII, multiple linear regression models were fit predicting BPII at 12 and 24 months. An unadjusted regression was applied with the predictors being age at the time of surgery and sex. A second regression model was applied adjusting for age at first dislocation, grade of trochlear dysplasia, knee hyperextension, and the WARPS/STAID score—a measure of the risky patellofemoral instability characteristics of the patient. Results: Of 328 patients, 298 (91%) had complete data and minimum 12-month BPII scores available for analysis. There were 11 redislocations in the cohort (3.4%), all in female patients. When stratified by sex, baseline characteristics were not statistically different except for higher age at first dislocation ( P = .022) as well as higher WARPS/STAID scores ( P = .006) for males. Age at the time of surgery was statistically significant for each postoperative follow-up, with lower BPII scores apparent for each 10-year increase in age at the time of surgery. In the adjusted model, the WARPS/STAID score was significantly associated with the preoperative BPII score. For the 24-month postoperative BPII scores, age at time of surgery and preoperative WARPS/STAID score were both significant. Lower BPII scores were apparent for each 10-year increase in age at the time of surgery, as well as for lower scores on the WARPS/STAID classification. Conclusion: This study demonstrated that when adjusted for risky pathoanatomy, neither age at first dislocation nor sex influences patient-reported quality of life outcomes after MPFL reconstruction. Age at the time of surgery was correlated with outcome, with lower BPII scores apparent for each 10-year increase in age at the time of MPFL reconstruction.

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Section: Discussionmentioning

confidence: 99%

Age at Time of Surgery but Not Sex Is Related to Outcomes After Medial Patellofemoral Ligament Reconstruction

Hiemstra

Kerslake

2019

Am J Sports Med

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“…Utilities obtained from the feeling thermometer (0-100) were converted to a score from 0 to 1 by dividing by 100 to convert utilities into the standardized format presented in previous studies. 9,18,29,38 Vignettes were presented in simple, pediatric patient–friendly language. For example,Imagine that you had a painful knee, were having a hard time walking or running, felt there was occasional clicking or locking of the knee, and that you felt it got worse when you were being more active and limited your activity.…”

Section: Methodsmentioning

confidence: 99%

“…27 Utilities are the underpinnings of cost-effectiveness analysis and have been a valuable source of clinical and economic guidance in sports medicine. 28–30…”

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confidence: 99%

“…27 Utilities are the underpinnings of cost-effectiveness analysis and have been a valuable source of clinical and economic guidance in sports medicine. [28][29][30] HRQoL is presented as a health state utility, with a scaled score between 0 and 1, where 0 is death (or the worst possible outcome) and 1 is perfect health. 6,9,19,30,38,43 HRQoL can be measured with health preference instruments, which incorporate patient personal preferences among health states and have the ability to capture additional quality-of-life dimensions not captured by standard patient-reported outcome measures (PROMs).…”

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confidence: 99%

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Health State Utilities in Children and Adolescents With Osteochondritis Dissecans of the Knee

Adjei

Nwachukwu

Zhang

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: The impact of osteochondritis dissecans (OCD) lesions of the knee on a child’s health-related quality of life has not previously been quantified. Preference-based health utility assessment allows patients to assign quality-of-life valuations (utilities) to different health states and conditions. Purpose: To determine (1) patient-reported utility scores for health states associated with pediatric OCD lesions of the knee and (2) whether these scores are associated with patient demographics or disease severity. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Children, adolescents, and young adults being treated for OCD of the knee were interviewed to assess utilities for each of the 6 health states commonly encountered in the treatment of OCD: (1) symptomatic lesion, (2) nonoperative rehabilitation, (3) postoperative rehabilitation, (4) intermediate treatment success, (5) early degenerative knee changes, and (6) successful treatment (asymptomatic). Patients were asked to assign health utilities to each state using a standardized feeling thermometer (scale, 0-100), which were converted to a health state utility (scale, 0-1 [1 = perfect health]). Utilities were reported with descriptive statistics, and comparative analyses were performed to test whether assignments were associated with patient age, sex, or whether the OCD lesion required surgical intervention. Results: A total of 100 participants treated or undergoing treatment for OCD were prospectively enrolled; 74% were male (n = 74). The median age at the time of survey was 15 years (interquartile range, 13-16.5 years). Utility scores were as follows: symptomatic OCD lesion, 0.15; nonoperative rehabilitation, 0.30; postoperative rehabilitation, 0.30; early degenerative changes, 0.58; intermediate treatment success, 0.65; and successful treatment, 1.0. Utility scores were not associated with age, sex, or whether the participant underwent surgical treatment for the OCD lesion. Conclusion: The current study quantified patient-reported utilities for 6 OCD lesion health states, which may be used for future health-related quality of life, decision analysis, and quality/safety/value studies. These utility scores were stable and not affected by patient age, sex, or treatment strategy.

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“…According to our study, surgery may effectively help a patient with the former concern, while patients plagued by the latter should be informed of the risk of a poor prognosis in the short term and carefully weigh the pros and cons of surgery. Given the invasiveness and cost of surgery, 21 this consideration can maximize the benefits and reduce the risks of surgery for adolescents with PPDs. 12 , 14 , 32 …”

Section: Discussionmentioning

confidence: 99%

Comparison Between Surgical and Nonsurgical Treatment for Primary Patellar Dislocations in Adolescents: A Systematic Review and Meta-analysis of Comparative Studies

Zhang

Jiang

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Whether surgical or nonsurgical management is more appropriate for primary patellar dislocations (PPDs) in adolescents (younger than 18 years) remains controversial. Purpose: To compare the clinical outcomes of surgical versus nonsurgical treatment for adolescents and children with PPDs. Study Design: Systematic review; Level of evidence, 3. Methods: There were 2 reviewers who independently searched the PubMed, Embase, Ovid, and Cochrane databases for English-language studies of randomized controlled trials (RCTs), quasi-RCTs, and observational studies comparing surgical with nonsurgical treatment for PPDs. The primary outcomes were redislocations, the Kujala score, and the Knee injury and Osteoarthritis Outcome Score (KOOS), and the secondary outcome was subsequent surgery. Results: A total of 6 studies were included in our systematic review and meta-analysis. Among patients younger than 18 years, surgery was associated with a lower redislocation rate compared with nonsurgical treatment within 5 years of treatment (risk ratio [RR], 0.58 [95% CI, 0.37-0.91]; P = .02; I 2 = 47%) but not beyond 5 years (RR, 0.80 [95% CI, 0.59-1.07]; P = .14; I 2 = 34%). However, surgery resulted in worse Kujala and KOOS scores compared with nonsurgical treatment. Yet, the treatment difference between the 2 groups tended to decrease over time. Conclusion: The available evidence suggests that for adolescents with PPDs, surgery was superior to nonsurgical treatment in the short term to reduce the redislocation rate but resulted in poorer outcomes of knee function based on the Kujala and KOOS scores. However, the superiority of either surgical or nonsurgical treatment in adolescents did not appear to persist in the long term.

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Economic Decision Model for First-Time Traumatic Patellar Dislocations in Adolescents

Cited by 24 publications

References 42 publications

Age at Time of Surgery but Not Sex Is Related to Outcomes After Medial Patellofemoral Ligament Reconstruction

Age at Time of Surgery but Not Sex Is Related to Outcomes After Medial Patellofemoral Ligament Reconstruction

Health State Utilities in Children and Adolescents With Osteochondritis Dissecans of the Knee

Comparison Between Surgical and Nonsurgical Treatment for Primary Patellar Dislocations in Adolescents: A Systematic Review and Meta-analysis of Comparative Studies

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