PubMed Health⌕ Search

Biomedical subjects

Robert G Marx

Publications and source records attributed to Robert G Marx.

At least 19 recordsLinked to original sources
PubMed2007

Indications for rotator cuff repair: a systematic review.

Despite the popularity of surgical repair of rotator cuff tears, literature regarding the indications for and timing of surgery are sparse. We performed a systematic review of the literature to investigate factors influencing the decision to surgically repair symptomatic, full-thickness rotator cuff tears. Specifically, how do demographic variables, duration of symptoms, timing of surgery, physical examination findings, and size of tear affect treatment outcome and indications for surgery? We reviewed the best available evidence, which offers some guidelines for surgical decision making. Variables suggest earlier surgical intervention may be needed in the setting of weakness and substantial functional disability. With regard to demographic variables, the evidence is unclear regarding their association with treatment outcome. However, older chronological age does not seem to portend a worse outcome. Pending worker's compensation claims does seem to negatively affect treatment results. Further research is required to define the indications for surgery for full thickness rotator cuff tears. However, the design and conduct of an ethical study to obtain Level I evidence on this issue will be a major challenge.

Age Factors↗
PubMed2006

Patients undergoing knee surgery provided accurate ratings of preoperative quality of life and function 2 weeks after surgery.

OBJECTIVE: To evaluate patients' ability to recall their preoperative self-reported quality of life, function, and general health 2 weeks postoperatively. STUDY DESIGN AND SETTING: We randomized consecutive patients undergoing arthroscopic knee surgery to group I (assessments at 4 weeks preoperatively, on the day of surgery, and 2 weeks and 12 months postoperatively) or group II (assessments at 2 weeks and 12 months postoperatively). At each visit patients completed disease-specific, knee-specific, and generic health rating scales. At a median of 2 weeks postoperative (range, 0.6 to 14 weeks), patients completed questionnaires according to their recollection of their health 2 weeks before surgery. RESULTS: Agreement between actual and recalled data was excellent for disease-specific (ICC(WOMET)=0.88 (95% CI 0.82-0.91), ICC(ACL-QOL)=0.86 (95% CI 0.75-0.91)), knee-specific (ICC(IKDC)=0.92 (95% CI 0.90-0.94), ICC(KOOS)=0.93 (95% CI 0.91 to 0.95), and general physical health (ICC(SF-36(PCS))=0.81 (95% CI 0.75-0.86)) instruments. Agreement for general mental health was moderate (ICC(SF-36(MCS))=0.67 (95% CI 0.58-0.75). Greater error associated with recalled ratings contributed to small increases in sample size requirements or small decreases in power to detect differences between groups. CONCLUSION: Patients recalled their preoperative quality of life, function, and general health at 2 weeks postoperative with sufficiently high accuracy to warrant substituting prospectively collected baseline data with recalled ratings.

Adult↗
PubMed2006

High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique.

BACKGROUND: Knee articular cartilage injuries in athletes present a therapeutic challenge and have been identified as an important cause of permanent disability because of the high mechanical joint stresses in athletes. PURPOSE: To determine whether microfracture treatment of knee articular cartilage injuries can return athletes to high-impact sports and to identify the factors that affect the ability to return to athletic activity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-two athletes who regularly participated in high-impact, pivoting sports before articular cartilage injury were treated with microfracture for single articular cartilage lesions of the knee. Functional outcome was prospectively evaluated with a minimum 2-year follow-up by subjective rating, activity-based outcome scores, and the ability for postoperative participation in high-impact, pivoting sports. RESULTS: At last follow-up, 66% of athletes reported good or excellent results. Activity of daily living, Marx activity rating scale, and Tegner activity scores increased significantly after microfracture. After an initial improvement, score decreases were observed in 47% of athletes. Forty-four percent of athletes were able to regularly participate in high-impact, pivoting sports, 57% of these at the preoperative level. Return to high-impact sports was significantly higher in athletes with age <40 years, lesion size <200 mm(2), preoperative symptoms <12 months, and no prior surgical intervention. CONCLUSION: Microfracture is an effective first-line treatment to return young athletes with short symptomatic intervals and small articular cartilage lesions of the knee back to high-impact athletics.

Activities of Daily Living↗
PubMed2006

Surgical anatomy of the triceps brachii tendon: anatomical study and clinical correlation.

BACKGROUND: The triceps tendon has been described as a single unit with contribution from each of the 3 heads of the muscle. An observation at the time of surgical repair of a triceps tendon injury led to an anatomical study to further define the anatomy of this tendon as it inserts on the olecranon. HYPOTHESIS: The medial head of the triceps has a tendon that is distinct from, and deep to, the common tendon of the long and lateral heads. STUDY DESIGN: Descriptive laboratory study and case report. METHODS: Eight cadaveric elbows were dissected to examine the triceps tendon. None of the specimens had any evidence of prior injury or surgery to the elbow. All specimens were fresh-frozen and stored at -4 degrees C until they were thawed for use. Skin and subcutaneous tissue were removed, and the tendon of each head of the triceps was explored from the muscle to its bony insertion. RESULTS: In all 8 specimens, on gross inspection, the medial head had a separate insertion deep to the common insertion of the lateral and long heads. The muscle of the medial head extended further distally than did the long and lateral heads. The medial head was muscular to its deep insertion, with a small amount of tendon blended with the muscle distally. Histologic analysis demonstrated that the tendon of the medial head and that of the other 2 heads are confluent distally at their olecranon insertion. CONCLUSION: The medial head of the triceps has a tendon that is distinct from, and deep to, the common tendon of the long and lateral heads on gross inspection. Histologic studies show the insertion of these 2 tendons is confluent. CLINICAL RELEVANCE: This anatomy has important implications for surgical repair of these tendon injuries. Rupture of the deep triceps insertion alone can occur and lead to weakness of elbow extension with the elbow flexed beyond 90 degrees . Triceps strength should be tested with the elbow fully flexed when injury to the tendinous insertion is suspected.

Adult↗
PubMed2006

Prevalence and risk factors for symptomatic thromboembolic events after shoulder arthroplasty.

UNLABELLED: Deep venous thrombosis and pulmonary embolism after shoulder arthroplasty are not well described. We sought to identify the frequency of deep venous thrombosis and pulmonary embolisms in patients after shoulder arthroplasties to compare these rates with the frequency of deep venous thrombosis and pulmonary embolisms among patients who had total hip and total knee arthroplasties, and to identify associated risk factors. The New York State Department of Health Statewide Planning and Research Cooperative System database was used to identify hospital admissions of patients having shoulder, hip, or knee arthroplasties between 1985 and 2003 with or without an associated diagnostic code for deep venous thrombosis or pulmonary embolism. This resulted in a retrospective cohort of 328,301 procedures. The frequency of deep venous thrombosis was 5.0 per 1000 procedures for shoulder arthroplasties compared with 15.7 for hip arthroplasties and 26.9 for knee arthroplasties. The frequency of pulmonary embolisms was 2.3 for shoulder arthroplasties, 4.2 for hip arthroplasties, and 4.4 for knee arthroplasties. Increasing age, trauma, and cancer were risk factors for thromboembolic events after shoulder arthroplasties. Although the absolute rates of thromboembolic complications were less in patients who had shoulder arthroplasties compared with those of patients who had lower extremity procedures, a larger percentage of these complications were pulmonary embolisms. Perioperative antithrombotic prophylaxis may be beneficial to reduce the frequency of deep venous thrombosis and pulmonary embolisms among patients having shoulder arthroplasties, particularly in higher-risk groups. LEVEL OF EVIDENCE: Prognostic study, Level II (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2006

Sports fellowships.

Explore the source record for details and available documents.

Education, Medical, Graduate↗
PubMed2006

Chondral resurfacing of articular cartilage defects in the knee with the microfracture technique. Surgical technique.

BACKGROUND: Microfracture is a frequently used technique for the repair of articular cartilage lesions of the knee. Despite the popularity of the technique, prospective information about the clinical results after microfracture is still limited. The purpose of our study was to identify the factors that affect the clinical outcome from this cartilage repair technique. METHODS: Forty-eight symptomatic patients with isolated full-thickness articular cartilage defects of the femur in a stable knee were treated with the microfracture technique. Prospective evaluation of patient outcome was performed for a minimum follow-up of twenty-four months with a combination of validated outcome scores, subjective clinical rating, and cartilage-sensitive magnetic resonance imaging. RESULTS: At the time of the latest follow-up, knee function was rated good to excellent for thirty-two patients (67%), fair for twelve patients (25%), and poor for four (8%). Significant increases in the activities of daily living scores, International Knee Documentation Committee scores, and the physical component score of the Short Form-36 were demonstrated after microfracture (p < 0.05). A lower body-mass index correlated with higher scores for the activities of daily living and SF-36 physical component, with the worst results for patients with a body-mass index of >30 kg/m(2). Significant improvement in the activities of daily living score was more frequent with a preoperative duration of symptoms of less than twelve months (p < 0.05). Magnetic resonance imaging in twenty-four knees demonstrated good repair-tissue fill in the defect in thirteen patients (54%), moderate fill in seven (29%), and poor fill in four patients (17%). The fill grade correlated with the knee function scores. All knees with good fill demonstrated improved knee function, whereas poor fill grade was associated with limited improvement and decreasing functional scores after twenty-four months. CONCLUSIONS: Microfracture repair of articular cartilage lesions in the knee results in significant functional improvement at a minimum follow-up of two years. The best short-term results are observed with good fill grade, low body-mass index, and a short duration of preoperative symptoms. A high body-mass index adversely affects short-term outcome, and a poor fill grade is associated with limited short-term durability.

Activities of Daily Living↗
PubMed2005

An assessment of the methodological quality of research published in The American Journal of Sports Medicine.

BACKGROUND: Evidence-based medicine has become a popular topic in academic medicine during the past several decades and more recently in orthopaedics and sports medicine. HYPOTHESIS: Articles published in The American Journal of Sports Medicine have shown an improvement in methodological quality in 2001-2003, compared with 1991-1993. STUDY DESIGN: Systematic review. METHODS: All articles published in The American Journal of Sports Medicine during the periods 1991-1993 and 2001-2003 were reviewed and classified by type of study. The use of pertinent methodologies such as prospective data collection, randomization, blinding, and controlled studies was noted for each article. The frequency of each article type and the use of evidence-based techniques were compared across study periods. RESULTS: Case series and descriptive studies decreased during the study period, from 27.4% to 15.3% (P = .00003) and from 11.9% to 5.6% (P = .001), respectively, of articles published. Prospective cohort studies increased from 4.7% to 14.1% (P = .000005), and randomized, prospective clinical trials increased from 2.7% to 5.9% of articles (P = .04). More studies tested an explicit hypothesis (P = .0000002), used prospective data collection (P = .000003), and used blinding (P = .02), and more studies identified a funding source (P = .004). CONCLUSIONS: Overall, there was a shift toward more prospective and randomized research designs published in The American Journal of Sports Medicine during 2001-2003 compared to 1991-1993, demonstrating an improvement in the methodological quality of published research.

Case-Control Studies↗
PubMed2005

Multirater agreement of arthroscopic grading of knee articular cartilage.

BACKGROUND: Acute and chronic cartilage injury of the knee has an important impact on prognosis. The validity of the classification of such injuries is critical for prospective multicenter studies. The agreement among multiple surgeons at different institutions for articular cartilage lesions has not been established. HYPOTHESIS: Arthroscopic classification of articular cartilage lesions is reliable and reproducible and can be used for multicenter studies involving multiple surgeons. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 1. METHODS: A total of 6 surgeons from 5 centers reviewed 31 videos of articular cartilage lesions. With grade 2 and grade 3 combined for the analysis, observed agreement ranged from 81% to 94%, and kappa ranged from 0.34 to 0.87. An additional 22 videos comprising grade 2 and grade 3 lesions were analyzed, and the observed agreement was 80%, with an overall kappa of 0.47. CONCLUSION: Arthroscopic grading of articular cartilage lesions is reproducible among surgeons at different centers. CLINICAL RELEVANCE: Articular cartilage lesions can be reliably classified among surgeons at different sites. Such reliability is important for multicenter clinical research studies involving arthroscopic knee surgery.

Arthroscopy↗
PubMed2005

Complications following hamstring anterior cruciate ligament reconstruction with femoral cross-pin fixation.

Cross-pin fixation of hamstring grafts for anterior cruciate ligament reconstruction was developed with hopes of improving on potential problems associated with interference screw and button fixation methods. However, cross-pins are a relatively new method of graft fixation and there are limited data on this technique. We report 2 cases in which reoperation was necessary after complications associated with cross-pin fixation. In one case, the cross-pin was left too proud and in the other it penetrated the medial side of the femur and was prominent. Surgeons who use cross-pin fixation should pay close attention so as not to leave the cross-pin proud laterally or medially to avoid the necessity of reoperation for hardware removal.

Adult↗
PubMed2005

Osteoarthritis following shoulder instability.

The association between shoulder instability and the development of glenohumeral osteoarthritis has not been well studied in the literature. It is clear that some degree of chondral damage is associated with instability, and there appears to be an increased risk of developing symptomatic osteoarthritis and ultimately requiring a shoulder arthroplasty in patients with a history of instability. More study is needed to define the relationship between the early onset of radiographically or arthroscopically diagnosed arthritic changes and clinically significant osteoarthritis. Surgical procedures to correct instability are known to put patients at risk for glenohumeral arthritis if they limit external rotation or if hardware migrates into the joint. Total shoulder replacement is an appropriate treatment for advanced, symptomatic osteoarthritis arising in shoulders with a history of instability. Outcomes are generally satisfactory, although not as good as in patients with primary osteoarthritis, and there is a higher risk of revision surgery.

Arthroplasty↗
PubMed2005

Small area variation in orthopedics.

It is clear that small area variation exists in orthopedics, but there is still much to learn. Given the many unanswered questions regarding area variation, regulatory policy at this time would be premature. The biggest piece of the puzzle that needs to be solved is the influence of disease prevalence and severity. While it seems unlikely this will explain all of the variation, it is equally unlikely that musculoskeletal diseases are distributed evenly across geopolitical boundaries, hence, it likely accounts for some of the observed variation. More patient-level studies need to be conducted in non-Medicare populations. For example, the extent to which area variation exists in sports medicine and knee surgery for younger patients is unknown. Profiling is likely here to stay. In accord, it should be exploited by the orthopedic community for its strengths while keeping in mind its limitations. Orthopedic surgeons should be at the forefront of this research and consequently influential in its evolution rather than have the managed care industry or government dictate policy.

Health Services Needs and Demand↗
PubMed2005

Randomized controlled trials in knee surgery.

Randomized controlled trials are complex, require great effort and attention to detail by the investigator, and are expensive. This research methodology is important to allow us to base our decision-making for patients on solid evidence to ultimately improve patient care.

Humans↗
PubMed2005

The association between hospital volume and total shoulder arthroplasty outcomes.

The purpose of this study was to evaluate the relationship between increasing hospital volume and the following outcomes for total shoulder arthroplasties done in the state of New York: length of stay, hospital costs, readmission within 60 days, revision surgery within 24 months, and death within 60 days. The Statewide Planning and Research Cooperative System (SPARCS) database from the New York State Department of Health, a census of all hospital discharges in the state, was used to evaluate the relationship between hospital volume and outcomes for total shoulder arthroplasties for 1996 to 1999. One thousand three hundred seven total shoulder arthroplasties were done in New York from 1996 to 1999. Nearly (1/2) were done at the five highest-volume hospitals. Middle-volume hospitals has the least lengths of stay and hospital costs. Independent of age and comorbidities, patients at hospitals with greater volumes of total shoulder arthroplasties were at reduced risk of patients being readmitted within 60 days. No other outcomes were significantly associated with hospital volume. The finding that greater hospital volume decreases risk of readmission may have important public health implications, but additional research is needed before implementing policy changes.

Age Distribution↗
PubMed2005

Measurement of shoulder activity level.

There are many measurement tools for assessing patients' shoulder symptoms (pain) and function (what patients can do), but they do not measure activity (how often a patient engages in activity). This is relevant because activity level can have an important impact on a patient's outcome. Our goal was to develop a short, easy to administer measure of shoulder activity which could be used to predict outcome of shoulder disorders. The activity scale was developed using established principles: item generation, item reduction, pretesting, and reliability and validity testing. The activity rating is a numerical sum of scores for five activities rated on a five-point frequency scale from never performed (0 points) to daily (4 points). Patients were scored on the following criteria: carrying an object 8 lb or heavier by hand, handling objects overhead, weight training with arms, swinging motion (ie, hitting tennis or golf ball), and lifting objects 25 lb or heavier. Two additional multiple choice questions provide a score assessing participation in contact and overhead sports. The activity scale showed excellent reliability and construct validity. It can be completed quickly and used in conjunction with patient-based measures of shoulder outcome to define patient populations for cohort studies, and to assess activity level as a prognostic factor in patients with shoulder disorders.

Activities of Daily Living↗
PubMed2005

Advancements in the surgical and alternative treatment of arthritis.

PURPOSE OF REVIEW: Surgical and nonsurgical treatment of arthritis is a rapidly developing and evolving field. It is vital for clinicians to keep up on the latest advances. This review focuses on clinical trials or large prospective studies over the past year that evaluated orthopedic surgical techniques for the treatment of arthritis and new nonsurgical therapies that may prevent the need for surgical intervention. Increasing attention has also been focused on the relation between surgeon or hospital case load and the quality of outcomes after surgery. RECENT FINDINGS: No fewer than 10 studies have been published over the past year evaluating the use of hyaluronic acid (a visco-supplement) or corticosteroid injections as alternative treatments to knee arthroscopy for osteoarthritis of the knee. Joint replacement research has explored minimally invasive and computer-guided or robot-guided joint replacement surgery, the best operative choice for advanced shoulder arthritis (hemiarthroplasty compared with total shoulder replacement), the role of patellar resurfacing during total joint replacement, and the use of bisphosphonates for retention of bone density after joint replacement. SUMMARY: The increasing attention on high-quality surgical trials should continue to improve surgical options based on sound research for patients with arthritis. Future research should continue to improve the available high-quality research for treatment choices.

Arthroplasty, Replacement↗
PubMed2005

American collegiate men's ice hockey: an analysis of injuries.

BACKGROUND: Reported rates and types of ice hockey injuries have been variable. Ice hockey combines tremendous speeds with aggressive physical play and therefore has great inherent potential for injury. PURPOSE: To identify rates and determinants of injury in American men's collegiate ice hockey. STUDY DESIGN: Prospective cohort study. METHODS: Data were collected from 8 teams in a Division I athletic conference for 1 season using an injury reporting form specific for ice hockey. RESULTS: There were a total of 113 injuries in 23,096 athlete exposures. Sixty-five percent of injuries occurred during games, although games accounted for only 23% of all exposures. The overall injury rate was 4.9 per 1000 athlete exposures (13.8 per 1000 game athlete exposures and 2.2 per 1000 practice athlete exposures). Collision with an opponent (32.8%) or the boards (18.6%) caused more than half of all injuries. Concussion (18.6%) was the most common injury, followed by knee medial collateral ligament sprains, acromioclavicular joint injuries, and ankle sprains. CONCLUSIONS: The risk of injury in men's collegiate ice hockey is much greater during games than during practices. Concussions are a main cause for time lost and remain an area of major concern.

Adult↗