Sports Medicine Commons^™

A Biomechanical Comparison Of A Subacromial Balloon Spacer, Superior Capsular Reconstruction, And A Rigid Subacromial Spacer In A Massive Irreparable Rotator Cuff Cadaveric Model, Devin Ferguson

Electronic Thesis and Dissertation Repository

Massive irreparable rotator cuff tears are a common cause of pain and disability. Several different treatments exist; however, they are associated with poor clinical outcomes and survivorship in younger patients without glenohumeral arthritis. The purpose of this thesis was to compare the impact of a subacromial balloon spacer, superior capsular reconstruction, and a rigid subacromial implant on the glenohumeral kinematics and mechanical efficiency of a massive rotator cuff deficient shoulder. The results indicate that each surgical state improves the glenohumeral kinematics of a massive irreparable rotator cuff tear. The subacromial implant leads to mild overcorrection of humeral head translation. No …

A Long-Term Follow-Up Of The Stability Study: Multicenter Rct Comparing Anterior Cruciate Ligament Reconstruction With And Without Lateral Extra-Articular Tenodesis In Individuals At High Risk Of Graft Failure, Katelyn M. Inch

Electronic Thesis and Dissertation Repository

One hundred and ninety-six patients at the Fowler Kennedy Sport Medicine Clinic (FKSMC) undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) were randomized as part of the multi-center STABILITY study to receive either an isolated ACLR or ACLR with a lateral extra-articular tenodesis (LET). The STABILITY study followed these patients up to two years postoperative, and a long-term follow-up protocol was initiated afterwards. Eighty-two patients from this center were seen at three, five and seven years postoperative as part of a long-term follow-up. Our primary outcome was a composite outcome of instability and graft failure. Secondary outcomes included patient-reported outcome measures …

The Clinical Value Of Oculomotor Assessments Across The Continuum Of Concussion, Dillon Richards

Electronic Thesis and Dissertation Repository

Concussions are complex conditions that are difficult to manage medically. Variations in symptom presentation, intricate neurophysiological processes, and the availability of a variety of possible assessment tools may contribute to this complexity. Clinicians must use a broad approach, employing both subjective symptom assessment and objective assessments to confirm a diagnosis and/or monitor progression and recovery. Oculomotor function after concussion may be an important indicator of injury, given the interconnectedness of oculomotor function, vestibulo-ocular and visual systems, and even cognition. Oculomotor function may be assessed objectively or indirectly using patient-reported symptom checklists as part of subjective assessments. One way of objectively …

Assessment Of Landing Biomechanics And Rehabilitation After Anterior Cruciate Ligament Reconstruction, Sheila S. Gagnon

Electronic Thesis and Dissertation Repository

Aberrant landing biomechanics increase the risk of anterior cruciate ligament (ACL) injury and are a focus of rehabilitation after ACL reconstruction. The purpose of the present thesis was to develop and evaluate methods of assessing landing mechanics and investigate the effects of different rehabilitation strategies after ACL reconstruction. Three studies were conducted. The first study used a Delphi process to develop the content of a Clinician-Rated Drop Vertical Jump Scale to evaluate jump landing mechanics during rehabilitation after ACL reconstruction. Twenty experts participated in four rounds of questioning, resulting in 92% agreement for knee valgus collapse, lateral trunk lean, insufficient …

Interpreting Patient Reported Outcomes In Orthopaedic Surgery: A Systematic Review, Shgufta Docter, Zina Fathalla, Michael Lukacs, Michaela Khan, Morgan Jennings, Shu-Hsuan Liu, Dong Zi, Dianne Bryant

Western Research Forum

Background: Reporting methods of patient reported outcome measures (PROMs) vary in orthopaedic surgery literature. While most studies report statistical significance, the interpretation of results would be improved if authors reported confidence intervals (CIs), the minimally clinically important difference (MCID), and number needed to treat (NNT).

Objective: To assess the quality and interpretability of reporting the results of PROMs. To evaluate reporting, we will assess the proportion of studies that reported (1) 95% CIs, (2) MCID, and (3) NNT. To evaluate interpretation, we will assess the proportion of studies that discussed results using the MCID or the effect sizes and how …

The Feasibility Of Gathering Patient-Reported Outcome Measures On Individuals With Acute Ankle Sprains In A Busy Clinic Environment, Ryan Reeson

Electronic Thesis and Dissertation Repository

Ankle sprains are the most common sports injury and can lead to long-term deficits. Patient-reported outcome measures (PROMs) may assist clinicians in evaluating the recovery trajectory of patients with ankle sprains. However, before a large-scale study can be performed, it is necessary to determine whether it is feasible to collect PROMs in a busy clinic environment. This study had a narrow recruitment window but the consent rate was 100%. Ten patients at Fowler Kennedy Sport Medicine Clinic were followed for up to six visits. Three PROMs that characterized lower extremity function were measured. The measurement completion rate decreased from 100% …

Reliability And Validity Of The Star Excursion Balance Test For Patients With Chronic Patellar Instability, Andrew D. Firth

Electronic Thesis and Dissertation Repository

The Star Excursion Balance Test (SEBT) is an eight-direction, maximal-reach balance test whose measurement properties are unknown in participants with chronic patellar instability. We designed an observational study with repeated measures to evaluate the test-retest reliability, cross-sectional and longitudinal construct validity, sensitivity to change and responsiveness of the SEBT in this population. Fifteen patients completed the SEBT and reported outcomes at baseline and two weeks and four patients completed testing three months later at the Fowler Kennedy Sports Medicine Clinic.

Intra-class correlation coefficients (ICC) for the SEBT were fair to good, ranging from 0.66-0.84. The SEBT demonstrates good cross-sectional construct …

Platelet Rich Plasma In Musculoskeletal Pathologies, Nicole L. Kaniki

Electronic Thesis and Dissertation Repository

Purpose: To evaluate the effectiveness of platelet rich plasma (PRP) in musculoskeletal injuries.

Methods: We completed a review of the literature on the use of PRP in tendon, muscle, bone, and intra-articular injuries (Chapter 2). We completed a systematic review and meta-analysis on the effectiveness of PRP in ultrasound guided versus palpation guided injections of PRP in non-operative treatment of tendon and muscle injuries using an indirect analysis method (Chapter 3). We conducted a randomized controlled trial to determine the effectiveness of PRP versus corticosteroid (CS) injections in patients with plantar fasciitis (Chapter 4).

Results: Most studies …

Optimizing The Rehabilitation Of Elbow Lateral Collateral Ligament Injuries, Ranita Harpreet Kaur Manocha

Electronic Thesis and Dissertation Repository

Elbow lateral collateral ligament (LCL) injuries frequently arise following trauma, and can result in disabling instability. Typically such injuries are managed with immobilization followed by a graduated exercise regime; however there is minimal biomechanical evidence to support current treatment protocols. This investigation examines the in vitro effectiveness of several rehabilitation techniques using a custom elbow motion simulator. It was found that active range of motion is safest in the overhead position (n = 7). Early motion in this position may reduce the incidence of elbow stiffness without compromising ligament healing following LCL injury. Forearm pronation and active motion stabilize …

A Randomized Clinical Trial To Compare The Effect Of Non Operative Treatment With And Without Autologous Conditioned Plasma (Acp) On Healing And Function In Patients With Achilles Tendon Ruptures, Tyler M. Pratt

Electronic Thesis and Dissertation Repository

The purpose of this study was to determine whether there is evidence to support conducting a larger randomized control trial (RCT) to compare the non-operative treatment of Achilles tendon (AT) ruptures with or without Autologous Conditioned Plasma (ACP®). Twenty-four patients were randomized to receive an ACP® or saline injection within seven days and again at two weeks post-rupture. Tendon healing was longitudinally evaluated using ultrasound (US) and magnetic resonance imaging (MRI). Functional and patient-reported quality of life measures were also assessed. A small sample size limited our ability to detect statistically significant differences. The mean rankings of healing were slightly …

A Clinically Relevant Relevant Post-Traumatic Osteoarthritis Mouse Model, Chantel P. Arce

Electronic Thesis and Dissertation Repository

Osteoarthritis affects 13-20% of Canadians with the majority being under 65years of age. Post-traumatic osteoarthritis (PTOA) is of great concern in young athletes following knee injury. Current research attempts at modeling the disease fall short. This study aimed to incorporate two important aspects of injury, the nature of the injury and the post-injury standard of care in humans, to a model of PTOA in mice. The study validated a non-invasive protocol to elicit an anterior cruciate ligament (ACL) injury at varying loading speeds addressing the closed capsule nature of an ACL injury that occurs in humans. Secondly, we proposed a …