Aims. The evidence base within trauma and orthopaedics has traditionally favoured quantitative research methodologies. Qualitative research can provide unique insights which illuminate patient experiences and perceptions of care. Qualitative methods reveal the subjective narratives of patients that are not captured by quantitative data, providing a more comprehensive understanding of patient-centred care. The aim of this study is to quantify the level of qualitative research within the orthopaedic literature. Methods. A bibliometric search of journals’ online archives and multiple databases was undertaken in March 2024, to identify articles using qualitative research methods in the top 12 trauma and orthopaedic journals based on the 2023 impact factor and SCImago rating. The bibliometric search was conducted and reported in accordance with the preliminary guideline for reporting bibliometric reviews of the biomedical literature (BIBLIO). Results. Of the 7,201 papers reviewed, 136 included qualitative methods (0.1%). There was no significant difference between the journals, apart from Bone & Joint Open, which included 21 studies using qualitative methods, equalling 4% of its published articles. Conclusion. This study demonstrates that there is a very low number of qualitative research papers published within trauma and orthopaedic journals. Given the increasing focus on patient outcomes and improving the patient experience, it may be argued that there is a requirement to support both quantitative and qualitative approaches to orthopaedic research. Combining qualitative and quantitative methods may effectively address the complex and personal aspects of patients’ care, ensuring that outcomes align with patient values and enhance overall care quality

Introduction. Patient reported outcome measures (PROMs) are used to understand the impact of lower limb reconstruction on patient's quality of life (QOL). Existing measures have not been developed to specifically capture patient experiences amongst adults with lower limb conditions that require reconstruction surgery. This systematic review of qualitative studies (qualitative evidence synthesis) aimed to identify what is important to these patients. Materials and Methods. MEDLINE, Embase, PsychINFO and Cinahl were searched from inception until November 2020. Studies were included if they employed qualitative research methods, involved patients requiring, undergoing or following lower limb reconstruction and explored patients' experiences of care, treatment, recovery and QOL. Mixed methods/population studies that did not separate the findings from each group and studies not in English were excluded. Included studies were analysed using thematic synthesis. The review followed the methodological framework published by the Cochrane Qualitative and Implementation Methods Group for qualitative evidence syntheses. Results. Nine studies met the inclusion criteria. Thematic synthesis identified two overarching themes:(1) areas of living key to QOL for lower limb reconstruction patients, with sub-themes: pain, daily functioning and lifestyle, identity, income and emotional wellbeing and (2) moving towards a new normal, with sub-themes: support, the ability to adapt and adjust and the ability to move forwards. The impact of lower limb reconstruction on QOL and recovery is complex and is influenced by a range of inter-related factors, which will affect patients to varying degrees depending on individual circumstances. Conclusions. The impact of lower limb reconstruction on patients' QOL is complex, may change over time and is strongly linked to their recovery. This review was conducted as part of the wider ‘PROLLIT' study, which will develop a conceptual framework to identify what outcomes are important to patients and should be included in a PROM. We will then map our conceptual framework onto existing PROMS to establish whether our identified factors are captured by current PROMS. Depending on the outcome of this work, a new PROM for patients following lower limb reconstruction may be developed

INTRODUCTION. Important surgical requirements for optimal function are accurate bone cut alignments and soft tissue balancing. From an unbalanced state, balancing can be achieved by Surgical Corrections including soft tissue releases, bone cut modifications, and changing tibial insert thickness. Surgical balancing can now be quantified using an instrumented tibial trial, but the procedures and results need further investigation. Our major purpose was to determine the initial balancing after making the bone cuts, and the final accuracy of balancing after Surgical Corrections. A related purpose was to determine the number and effectiveness of different Corrections in achieving balancing. METHODS. During 101 surgeries of a PCL-retaining TKA, screen capture software recorded the video feed of surgery, angular data from the navigation system, and lateral and medial contact forces from the instrumented tibial trial. Initial bone cuts were made using navigation based on measured resection. The instrumented tibial trial measured the magnitudes and locations of the contact forces on the lateral and medial sides throughout flexion. The Heel Push Test (Walker 2014) determined the initial balancing, defined as a ratio of the medial/total force at 0, 30, 60 and 90 degrees flexion. A balanced knee with equal lateral and medial forces would show a value of 0.5. Surgical Corrections were then performed with the goal of achieving balancing. The most common Corrections were soft tissue releases (total 63 incidences), including MCL, postero-lateral corner, postero-medial corner; and increasing/decreasing tibial insert thicknesses (34 incidences). RESULTS. After the bone cuts and inserting the trials, the average medial/total force ratio was 0.49 +/− 0.27. After final balancing, the ratio was 0.52 +/− 0.14 (Figure 1). The initial data was scattered between 0.0 (lateral force only) and 1.0 (medial force only). The final data showed a clear narrowing of the range of imbalance. The different Surgical Corrections achieved an improvement of the medial/total ratio between 0.11–0.18. A 2mm insert increase increased the total force by 106 Newtons. A final medial/total ratio between 0.35–0.65 was achieved in 80% of cases from 0–30 degrees; 77% from 0–90 degrees. In 84% of the cases, 0–2 Corrections were required. The average total force on the condyles from 0–90 degrees was 290.5+/−166.8 Newtons initially and 215.3+/−86.3 Newtons after balancing, the large range due to patient variations in ligament stiffness. DISCUSSION. Acceptable balancing was achieved in the majority of cases with only 0–2 Surgical Corrections. The sensitivity of the balancing values to the Surgical Corrections was consistent with a previous study showing that changes of 2mm or 2 degrees could correct most imbalanced states (Walker 2014), related to collateral stiffness being in the region of 50N/mm (Wilson 2012, Robinson 2005). With only 2 Surgical Corrections needed in the majority of cases, no additional time was needed compared with qualitative methods. The acceptable level in our study from 0.35–0.65 medial/total force ratio was based on what could readily be achieved, consistent with a previous study (Gustke 2014). An IRB study is now underway to determine the ideal balancing ratio and the effect on functional outcome

Introduction. The anterior cruciate ligament (ACL) is one of the most common ligament injuries. Several ACL reconstructions exist and are consequently performed. An accurate and comprehensive description of knee motion is essential for an adequate assessment of these surgeries, in terms of restoring knee motion. Methods. We propose to compare these reconstructions thanks to an index of articular coherence. This index measures the instantaneous state surface configurations during a motion. More specifically, this refers to the position between two articular surfaces facing each other. First of all, the index has to refer to a position known to be physiological. This initial position of the bones, named reference, directly results from the segmentation of CT scans. First we compute all distances between the two surfaces and then we compute the Cumulative Distribution Function (CDF). We process this way for each iteration of the motion. Then we obtain a batch of CDF curves which provide us qualitative information relative to the motion such as potential collisions or dislocations. The graph of all CDF curves is called Figure of Articular Coherence (FoAC). A good articular coherence is characterised by CDF which are close to the reference. This qualitative method is coupled to a quantitative one named Index of Articular Coherence (IoAC) which computes the Haussdorff distance between the temporal distributions and the reference. This distance has to be as low as possible. The tools were tested on cadaveric experiments of ACL reconstruction provided by Hagemeister et al, (1999). They recorded the knee flexion/extension motion in following situations: the intact knee, after ACL resection, after three methods of ACL reconstruction on the same knee (‘over-the-top’ method (OTT), two different two tunnel reconstructions (2 tunnel). Our method was used, for the time being, for one specimen. We compare different post-surgery kinematics thanks to the FoAC and IoAC. Results and discussion. Functions were well correlated to the reference, when considering flexion motion of the intact knee. Regarding the results of the FoAC after ACL resection, we observed that the functions evolve in the direction of decreasing distances more rapidly, compared to the intact knee. This means that both articular surfaces are close to collision when ACL is resected. Regarding the results of the IoAC for the different experimental situations, we observe that the highest index is obtained for the ACL resected knee. The OTT method has equivalent results to the intact knee and for both 2 tunnels reconstructions, the index values are higher than those obtained with the intact knee. This higher index can be explained by an over-constraint on the knee movement, the knee appears to be more stable but it can possibly rigidify the joint as well. Through the use of the FoAC and IoAC, we reached the same conclusions of Hagemeister's work in a way that is more intuitive than by using kinematic curves and angle values. Our tools can describe the instantaneous state of the joint and are able to compare kinematics corresponding to different types ACL reconstructions

Aims

COVID-19 has compounded a growing waiting list problem, with over 4.5 million patients now waiting for planned elective care in the UK. Views of patients on waiting lists are rarely considered in prioritization. Our primary aim was to understand how to support patients on waiting lists by hearing their experiences, concerns, and expectations. The secondary aim was to capture objective change in disability and coping mechanisms.