2024 CASEM Podium Presentation Abstracts

Long-Term Quality of Life and Clinical Outcomes of a Randomized Clinical Trial Comparing Patellar Tendon, Hamstring Tendon, and Double-Bundle Hamstring ACL Reconstructions at 10 Years Postoperatively Nicholas Mohtadi, MD, MSc, FRCSC, Denise Chan, MBT, MSc, and Dana Hunter, MSc Affiliation: University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada. Objective: To compare disease-specific quality of life and clinical outcomes at 10 years after reconstruction for ACL deficiency using a patellar tendon (PT), single-bundle quadruple-stranded hamstring tendon (HT), or double-bundle (DB) hamstring tendon construct. Study Design: Prospective, double-blind randomized clinical trial. Subjects: Three hundred and thirty patients (183 male patients; 14-50 years), with confirmed anterior cruciate ligament deficiency. Intervention: Patients (110/group) were intraoperatively randomized (computer-generated, varied block) to anatomic ACL reconstruction with: PT (mean age 28.7 years), HT (mean age 28.5 years), or DB (mean age 28.3 years) autografts. Patients and an independent trained examiner were blinded to treatment allocation. Outcome Measures: Outcomes were measured at baseline and 2, 5, and 10 years postoperatively. Primary: Anterior Cruciate Ligament Quality of Life (ACL-QOL). Secondary: IKDC subjective and objective scores, pivot shift, kneeling pain, Tegner activity, Cincinnati Occupational Scale, Single Leg Hop. Proportions of complete reruptures, partial reruptures, and combined total traumatic reinjuries were compared. An analysis of variance for repeated measures compared continuous data; χ2 analyses compared categorical data, with a 5% significance level. Results: Two hundred and eighty seven patients (87%) completed 10-year follow-up (mean 10.2 ± 1.2 years), 6 withdrawals, 1 deceased, 36 lost to follow-up. Demographic characteristics of patients with 10-year follow-up were not different between groups. ACL-QOL scores increased from baseline to 10 years for all groups (P < 0.001). The mean 10-year ACL-QOL scores were not different (P = 0.912): PT = 76.4 ± 21.0 (95% CI 72.1-80.7); HT = 77.7 ± 20.5 (95% CI 73.4-81.9); DB = 77.3 ± 21.5 (95% CI: 73.0-81.7). The proportion of patients with a pivot shift grade ≥2 (PT = 18%; HT = 25%; DB = 24%) was not statistically significant between groups (P = 0.866) but is clinically important. None of the secondary outcomes at 10 years were different between groups, including kneeling pain (PT = 6%; HT = 4%; DB = 7%; P = 0.637). There were more complete traumatic graft ruptures in the HT and DB groups (HT = 16%; DB = 15%) compared with patellar tendon reconstructions (PT = 7%; P = 0.142). Revision ACL reconstruction was performed on 36 of these 37 patients. Twelve additional patients had partial graft reruptures (PT = 1; HT = 5; DB = 6) with cumulatively less traumatic reinjuries in the PT group (PT = 8/95; HT = 21/93; DB = 21/99, P = 0.023). Conclusions: At 10 years, there was no difference in disease-specific ACL quality of life outcome between the three ACL reconstructions, but significantly more traumatic reinjuries in the HT and DB than the PT group. Acknowledgements: Workers' Compensation Board–Alberta; Calgary Orthopaedic Research and Education Fund funding support. Is There a ‘Doug Henning Placebo Effect’ Associated With Platelet-Rich Plasma Knee Injections For Osteoarthritis? A Randomized, Controlled Trial Danielle Dagher, BHSc1, Steve Phillips, MSc2, Alex Rabinovich, MD3, Mohit Bhandari, MD, PhD1, and Moin Khan, MD, MSc1 Affiliations:1McMaster University, Hamilton, ON, Canada;2ENCORE Research Inc., Burlington, ON, Canada;3Arthrobiologix Inc., Hamilton, ON, Canada. Objective: To evaluate the therapeutic effect and perceived efficacy in patients who observe the procedural preparation of a PRP injection in full in comparison with patients who do not observe preparation before injection. Study Design: Prospective, single-center, randomized controlled trial Subjects: We included 120 participants older than 40 years with a diagnosis of symptomatic knee OA. Patients with inflammatory OA, open wounds or sores over the knee joint, and/or previous PRP injection were excluded. Interventions: Participants in the treatment group watched the centrifugation and detailed extraction of blood separated components to reveal PRP injection fraction, after which an injection was given. Patients in the control group left the room during preparation procedures and received the injection only. Outcome measures: The primary outcome was the between-group difference in pain as measured by the Visual Analog Scale (VAS) at the 3- and 6-month time points. Secondary outcomes were also assessed at 3- and 6-month postinjection and included (1) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), (2) SF-12 questionnaire, (3) knee range of motion, and (4) return to previous level of activity. Patients were also asked to report on their belief regarding the ability of the treatment to successfully relieve pain before and immediately after the injection (at the initial visit only). Results: Overall, no significant between-group differences were observed in any of the outcome measures. There was a 2.3-fold increase in positive perception of a major effect in patients who observed PRP preparation compared with those who did not (17% vs 7.4%); however, this did not reach statistical significance. A significant decrease in VAS pain and WOMAC pain scores was seen in both groups, as well as a significant improvement in WOMAC functional and total scores and SF-12 physical scores at 3 and 6 months. Conclusions: We did not identify any between-group differences in patient-reported outcome measures or knee range of motion; however, a larger sample size is likely required to draw definitive conclusions on the impact of the Doug Henning Placebo Effect. Transforming Musculoskeletal Care for Albertans Using Standardized Clinical Decision-Making Pathways for Shoulder, Low Back, and Soft Tissue Knee Conditions Breda H.F. Eubank, PhD, CAT(C)1, David M. Sheps, MD, MSc, MBA2, Colleen Kuntz, PT3, Ryan Shields, MD, MSc4, Tim Takahashi, MSc, CAT(C)5, Ken Thomas, MD4, Geoff Schneider, PhD, PT4, Gord McMorland, DC3, Sebastian Lackey, PhD6, Jason Martyn, MScPT3, Jason Werle, MD3,4, Mel Slomp, MA3, Jill Robert, MSc3, and Catherine Hui, MD2 Affiliations:1Mount Royal University, Calgary, Alberta, Canada;2University of Alberta, Calgary, Alberta, Canada;3Bone and Joint Health Strategic Clinical Network, Alberta, Canada;4University of Calgary, Calgary, Alberta, Canada;5University of Lethbridge, Calgary, Alberta, Canada;6Alberta Bone and Joint Health Institute, Calgary, Alberta. Objective: To develop standardized provincial, evidence-informed primary care decision-making pathways for optimizing assessment, diagnosis, and management of shoulder, low back, and soft tissue knee conditions in Alberta, respectively. Study Design: Systematic rapid reviews to inform modified Delphi consensus methods. Subjects: Subject matter experts were invited to participate in the development of three clinical pathways. Experts were purposively selected to represent a range of disciplines/expertise (eg, family medicine, sports medicine, orthopaedic surgery, radiology, physiatry, athletic therapy, physical therapy, occupational therapy, public policy, and healthcare administration) and geographic health regions across Alberta. Intervention: Development of the clinical pathways underwent (1) completion of a rapid review, (2) selection of experts, and (3) implementation of a four-round modified Delphi voting process. Outcome: Consensus was reached for three standardized provincial primary care decision-making clinical pathways. Results: Each pathway outlines the steps in the clinical decision-making process for primary care providers practicing in both public and private settings. Each pathway consists of clinical examination algorithms, triage decision-making aids that include history-taking and physical examination criteria, appropriate use criteria for diagnostic imaging, and treatment/management recommendations. Conclusions: Clinical pathways improve patient access and quality of care by providing guidance on best practice and decreasing variance in practice across the continuum of care, while reducing unnecessary wait times and healthcare expenditures. Pathway development was an initiative of Alberta Health Services' Bone and Joint Health Strategic Clinical Network's (BJH SCN) MSK Transformation Program. Acknowledgements: The authors would like to thank the members of the Provincial Expert Delphi Groups who contributed to the development of the clinical decision-making pathways. Randomized Clinical Feasibility Trial: Comparing a Restrictive and Protective Range of Motion Brace for the Nonsurgical Management of the Medial Collateral Ligament of the Knee Dana J. Hunter, MSc1,2, Katie McGregor, MD, Dip. Sport Med (CASEM), CCFP CAC (SEM), Ryan Shields, MSc, MD, CCFP(SEM)1,2, Amanda M. Black, CAT(C), PhD3,4,5, Alexander Rezansoff, MD, FRCSC1,2,7, and Nicholas G. Mohtadi, MSc, MD, FRCSC1,2,6,7 Affiliations: 1Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.2Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada;3Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada;4Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada;5O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada;6McCaig Institute for Bone and Joint Health, University of Calgary;7Department of Surgery, Cumming School of Medicine, University of Calgary;University of Calgary Sport Medicine Centre, Calgary, AB, Canada. Objectives: (1) Determine differences in medial collateral ligament (MCL) laxity in patients with acute MCL injuries treated nonoperatively using one of two range of motion (ROM) knee brace settings. (2) Examine differences in knee ROM, brace satisfaction, overall knee score, adherence, pain, quality of life, and knee function. Study Design: Prospective, randomized, single-blinded feasibility clinical trial. Subjects: 60 adult patients (27 males, 33 females) with acute moderate-to-severe isolated MCL or combined ACL-MCL injuries seen at the University of Calgary Sport Medicine Centre (SMC). Intervention Technique: Patients were randomly assigned to (1) the protected brace group (0-90° (°)) or (2) the restricted brace group (30-90 degrees). Patients were prescribed constant brace wearing for four weeks and then daytime wear only until brace discontinuation at six weeks. Rehabilitation exercises were prescribed from two weeks onward. Patients were followed for 12 weeks. Outcome Measures: The primary clinical measures were side to side differences (SSD) in MCL laxity (mm) at 0° and 30-degree knee flexion and knee ROM. Patient-reported outcome measures included pain on a VAS (Visual Analog Scale), overall knee score (Single Assessment Numeric Evaluation (SANE)), brace satisfaction (modified Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0)), and brace adherence (daily online log), collected at baseline, 2, 4, 6, 8, and 12 weeks. Patients completed the ACL-QOL and the IKDC subjective questionnaires at baseline and 12 weeks. The outcome assessor was blinded to treatment group allocation. Results: At 12 weeks, 73% of patients had less than 1-mm SSD valgus laxity at 30-degree knee flexion, with a greater proportion in the restricted group at 82% compared with the protected group at 67%. This approached statistical significance at P = 0.13. All patients reported improved pain, and none suffered a loss of knee ROM at 12 weeks. Patients braced 30 to 90 degrees reported greater adherence, brace satisfaction, function, overall knee scores, and QOL (quality of life). Conclusions: This feasibility trial favors bracing moderate and severe MCL injuries at 30 to 90 degrees for 6 weeks. Acknowledgments: This project was supported by the 2018 CASEM New Investigator Grant. The authors thank the sport medicine physicians and nonphysician experts at the SMC and additional support from the Simpson Family Endowment. The Clinical Utility of a Novel Multimodal Neurological Assessment Battery in Detecting Physiological Impairment In Athletes Sustaining an Acute Sport-Related Concussion Jalena Bertagnolli, Bkin1, Sean P. Dukelow, MD, PhD2, David J. Smith, PhD1, Lawrence Richer, MD3, and Brian W. Benson, MD, PhD1,2,4 Affiliations:1Canadian Sport Institute Calgary, Calgary, AB, Canada;2Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada;3Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada;4Benson Concussion Institute, Calgary, AB, Canada. Objective: To determine the clinical utility of a novel, multimodal, neurological assessment battery in detecting acute postconcussion physiological impairment relative to healthy baseline. Study Design: Prospective observational cohort study. Subjects: Four hundred thirty-one elite ice hockey, alpine and freestyle ski, and luge athletes (mean age: 15.7 years (range: 14-36 years), male: 349, female: 82) over one athletic season (2022-2023). Observation Technique: Standardized multimodal baseline assessments including electroencephalography (EEG), postural sway, sustained grip and were completed in the and then repeated for any a seven of Outcome Measures: and for using were to in between baseline and postconcussion for the four primary assessments of (1) and and (2) assessment of postural with open and using a physiological (3) on a during a assessment, and (4) in during a grip Results: athletes were with a for or a significant group difference between baseline and postconcussion Athletes a significant group difference in postural with a moderate effect size = using the between baseline and postconcussion time for mean ± ± P = of the athletes postconcussion assessments with three additional athletes to to significant (P < effect size = no significant difference was observed for in during the grip Conclusions: A motion postural and standardized assessment clinical utility in detecting physiological impairment of an acute A Study of followed by for This Outcomes and With MSc, MD, and Affiliation: Sport and Medicine, of Family Medicine, University of Alberta, Canada. Objective: To compare outcomes for patients with with who received to a group who received care We that would to improved functional outcomes and pain scores at follow-up compared with patients. Study Design: from a Sport & Medicine from to patients with or and who received or patient were included the and in the groups and had of the by a of with or followed by physical 6 or care at to All patients were seen in follow-up by their at to weeks for of patient reported pain and function. range of motion (ROM) measured in pain scores, and the Index at baseline and at follow-up Results: There were no significant differences between groups regarding or (P At pain at scores was and observed ROM was less for the however, this was not statistically The improvement in from to the follow-up for the group compared with the was statistically significant (P < Conclusions: that for with clinical difference and reducing patients pain to to differences in and of in ROM and pain at more is to determine the of the Acute and and at the M. MSc M. PhD, and MD, Affiliation: School of Medicine & Dentistry, Western University, ON, Canada. Objective: To determine the of and at the Study Design: Subjects: hundred eighty participants 3 Observation Technique: Four online on and during and before Outcome Measures: primary outcome was and Secondary outcome measures included acute to and between and Results: hundred eighty from completed the mean age ± the an in the four weeks before athletes reported in the in the and in the Knee pain was the followed by low pain athletes reported acute in the in the and 12 in the The was the reported acute injuries during followed by participants suffered an while at athletes in the four weeks the by There were no significant differences in or the level between and Athletes who reported an also reported significantly in the weeks to the than those who did not (P = Conclusions: This is the to the of and in and The of was the of acute and athletes reported that their injuries during the development of and to health and of for Long-Term Patients Anterior Cruciate Ligament and A Study P. PhD1, and Affiliations: of Public Health, University of Alberta, Edmonton, Alberta, Medicine of Orthopaedic Surgery, of Surgery, University of Alberta, Edmonton, Alberta, Canada;3Department of Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada. Objective: patients anterior cruciate ligament reconstruction and characteristics with of We We also assessed the effect of initial and on Study Design: cohort using collected Subjects: Patients from in Alberta, Canada. Observation Technique: were using We care, and characteristics and were from 1 to 1 between and outcomes were using were for the as well as for the of patients who were both and who received their 30 Outcome Measures: Three outcome measures: (1) during 1 to (2) at three with any from 3 to and (3) at 1 between to Results: from patients; to patients; the with all outcome CI with increased included patient age older than years, use of or of use or and ACL from ACL patients of and greater than were with increased Conclusions: We with increased patients use a to ACL do to of Osteoarthritis and do to A Systematic and MSc, M. MSc, M. PhD, M. J. MD, M. PhD, MSc, PhD, and MD, Affiliation: Sport Medicine Western University, ON, Canada. Objective: We to evaluate and physical in with anterior cruciate ligament reconstruction and compare with and to Study Design: Systematic of and were for cohort and randomized controlled that measured physical years after in of physical or of from were included collected at baseline or follow-up assessments in an observational group. Two a and of using and were and quality assessments using the of and Evaluation were Results: We with physical for with were ± and ± In the proportion of with those using with in less physical than = (95% CI = to P < The quality of was low to Conclusions: but not after and in less physical than the of this of a of the after represent a and the development of physical for after and of physical after ACL the of moderate in knee The and Clinical in Geoff M. Schneider, PhD, and Schneider, Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada;2Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Research Institute, University of Calgary, Calgary, Alberta, Institute, University of Calgary, Calgary, Alberta, Sport Concussion Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Sport and Calgary, Alberta, Canada. Objective: To evaluate the between and and outcomes in ice Study Design: Subjects: and ice Observation Technique: Participants with a cohort completed a baseline questionnaire, clinical assessments of and with the of the included pain, and clinical (mean of side to side flexion or clinical Assessment Outcome Measures: The outcome was the time A complete for age group and for by and was completed to evaluate the of clinical measures with Results: In performed baseline and all clinical measures. For increase in (range: were (95% CI: on with positive CI: to or reported CI: to were but these were not statistically to CI: and CI: were significantly than (95% CI: as did in elite of relative to were (95% CI: than Conclusions: was with in ice A of the between and clinical for Acknowledgements: The Sport Research Centre is one of the Research for of and of Health supported by the We the funding from of Health Alberta Health Institute, and Alberta Concussion Research a Research in We would like to Edmonton, Calgary, and all and for their time and support in this Novel for Assessment of in A Study MSc, PhD1, Nicholas Mohtadi, MSc Sport Geoff Schneider, PT PhD, Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Research Institute, University of Calgary, Calgary, Alberta, Institute for Bone and Joint Health, University of Institute for Public Health, University of Calgary, Calgary, Alberta, of Orthopaedic & University School of Centre for and Osteoarthritis Research University of of Calgary Sport Medicine Centre, Calgary, Alberta, of University of Calgary, Calgary, Alberta, Canada. Objective: To the and of a at of Study Design: study. A sample of 10 years) with no or of Observation Technique: Two completed a to of Participants completed all components with one A was completed with with a The included range of motion in degrees and knee flexion, and of range and anterior continuous Outcome Measures: were to and for all continuous outcome measures. (mean difference and of were to and and were for Results: For of the had the CI: this from to for and to for continuous from to = on and to = to on For from to between for continuous measured in from to on outcome from to = and for was to = to the in both and = = Conclusions: The for in range of motion and in patients to 30 of all reported in this and previous from clinical assessment of between and between Trial to the of on in MSc, J. PhD2, and MD, PhD1,2,4 for Clinical Institute, University, Canada;2Department of and University, Canada;3Department of and University, Canada;4Department of Family Medicine, University, Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada. Objective: trial is a for using observational objective was to use this to the effect of using the on ice Study Design: Secondary analysis of from a cohort including ice in Alberta and were collected on practice and and injuries for Subjects: In 10 to years weeks. For a to for the the not in the previous weeks. Intervention: with measured as in and The acute was the in the while the was the over the previous weeks. Outcome Measures: during the or in time For trial and weeks and the between and We a with to for repeated measures. The outcomes for were different We and relative to = We to Results: There were observed The for was their = and increased to = CI: for a increase in = in in of = CI: at = and = CI: at = in in to at = = CI: Conclusions: for in ice

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