Browsing by Author "Ekdahl, Max"

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    Substantial influence of psychological factors on return to sports after anterior shoulder instability surgery: a systematic review and meta-analysis
    (2023) Velásquez García, Ausberto; Iida, Naoya; Kuroiwa, Tomoyuki; Hsu, Kai-Lan; Marinis Acle, Rodrigo Ignacio de; Abdo, Glen; Ekdahl, Max
    Purpose: This systematic review and meta-analysis aimed to (1) determine the proportion of patients who underwent anterior shoulder instability surgery and did not return to sports for psychological reasons and (2) estimate differences in psychological readiness scores between patients who did and did not return to sports. Methods: The EBSCOhost/SPORTDiscus, PubMed/Medline, Scopus, EMBASE and Cochrane Library databases were searched for relevant studies. The data synthesis included the proportion of patients who did not return to sports for psychological reasons and the mean differences in the psychological readiness of athletes who returned and those who did not return to sports. Non-binomial data were analysed using the inverse-variance approach and expressed as the mean difference with 95% confidence intervals. Results: The search yielded 700 records, of which 13 (1093 patients) were included. Fourteen psychological factors were identified as potential causes for not returning to sports. The rates of return to sports at any level or to the preinjury level were 79.3% and 61.9%, respectively. A total of 55.9% of the patients cited psychological factors as the primary reason for not returning to sports. The pooled estimate showed that patients who returned to sports had a significantly higher Shoulder Instability-Return to Sport After Injury score (P < 0.00001) than those who did not, with a mean difference of 30.24 (95% CI 24.95–35.53; I2 = 0%; n.s.).Conclusions: Psychological factors have a substantial impact on the rate of return to sports after anterior shoulder instability surgery. Patients who returned to sports had significantly higher psychological readiness than those who did not return to sports. Based on these results, healthcare professionals should include psychological and functional measurements when assessing athletes’ readiness to return to sports.
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    The Reliability of Acromioclavicular Joint Dislocation Classification Systems: A Comparison Between the Rockwood and Kraus Classifications
    (2023) Velasquez Garcia, Ausberto; Liendo, Rodrigo; Ekdahl, Max; Calvo, Cristobal; Vidal, Catalina
    Background:The Rockwood system for the classification of acute acromioclavicular (AC) joint dislocations has been associated with a lack of reliability. A novel system has been proposed (Kraus classification) that is based on dynamic posterior translation of these injuries. Purpose:To assess the interobserver and intraobserver reliability of the Rockwood and Kraus classification systems and also to examine the impact of surgeon experience on the assessments. Study Design:Cohort study (diagnosis); Level of evidence, 3. Methods:Included were 45 patients with acute AC joint injuries who underwent a radiographic examination using standard bilateral AP and modified Alexander views. For interobserver reliability, 6 shoulder surgeons (expert group) and 6 orthopaedic residents (novice group) reviewed the radiographs to classify injuries according to the Rockwood and Kraus classifications; for each categorization, the participants chose between nonoperative management and surgical treatment. The evaluation was repeated 6 weeks later to determine intraobserver reliability. Kappa (kappa) coefficients and their 95% CIs were used to compare interobserver and intraobserver reliability for each classification system according to assessor experience. Statistical differences were considered significant when the upper and lower boundaries of the 95% CI did not overlap. Results:The overall interobserver agreement for diagnosis (both novice and expert groups) was moderate (kappa = 0.52 [95% CI, 0.51-0.54]) for the Rockwood classification and substantial (kappa = 0.62 [95% CI, 0.53-0.65]) for the Kraus classification; however, no significant differences were observed between the kappa values. The overall interobserver agreement for treatment selection was substantial when using both the Rockwood (kappa = 0.78 [95% CI, 0.72-0.81]) and Kraus (kappa = 0.77 [95% CI, 0.66-0.87]) classifications. The overall intraobserver agreement for diagnosis was substantial using both the Rockwood (kappa = 0.65 [95% CI, 0.61-0.67]) and Kraus (kappa = 0.73 [95% CI, 0.69-0.75]) classifications. There were no significant differences between the novice and expert groups on any of the evaluations. Conclusion:The Kraus system was slightly more reliable than the Rockwood system for classifying AC joint injuries both between assessor groups and overall. The level of surgeon experience had no impact on the evaluations.