Analysis of surgery rates among 25 national collegiate athletic association sports.

OBJECTIVES: While injuries among collegiate athletes are common and well-studied, there have been no studies comparing which sports and injury types have the highest operation rates. This information would be valuable for athlete governing bodies and providers to improve player safety. Our hypothesis was the surgery incidence rates vary substantially between sports and injury types, with football and knee injuries representing the sport and injury type with the highest respective surgery rates. METHODS: This was a descriptive epidemiology study of all injuries requiring surgery as recorded in the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) for academic years 2004-2005 to 2013-2014. Surgery incidence rates (and 95% confidence intervals, CI) were calculated for each sport (per 10,000 athletic exposures [AE]) and for the most common injury types, by academic year. In addition, absolute numbers of performed surgeries were calculated as well as rates of return to sport. RESULTS: Sports with the highest surgery incidence rate (per 10,000 AEs) were women's gymnastics (8.9; 95% CI 7.2-10.9), men's football (6.1; 95% CI 5.8-6.4), and men's wrestling (5.3; 95% CI 4.5-6.3). Absolute numbers of injury-related surgeries performed were greatest for men's football (n = 31,043), women's basketball (6,625), and men's basketball (5,717). Anterior cruciate ligament tears had the greatest surgery incidence rate per 100,000 AEs for all sports combined (7.95; 95% CI = 7.5 to 8.5), and also represented the injuries with the lowest rate of return to sport. CONCLUSION: Women's gymnastics, men's football, and men's and women's basketball are NCAA sports with an elevated risk of injury requiring of surgery. The results from this study can guide the NCAA and providers regarding which sports should be the focus of future research, new injury prevention strategies, and healthcare personnel allocation during events.

Analysis of common shoulder injuries in collegiate baseball players.

OBJECTIVES: Baseball players are highly susceptible to shoulder injuries due to repetitive overhead throwing. The purpose of this study was to investigate men's collegiate baseball shoulder injury rates and associated risk factors. METHODS: Using the NCAA Injury Surveillance Program (ISP) database, shoulder injury data for men's baseball players was analyzed from 2009-2010 through 2013-2014. Only the most common shoulder injuries were examined, including acromioclavicular (AC) sprain, anterior dislocation, biceps tear, biceps tendinitis, SLAP (superior labrum from anterior to posterior) tear, non-SLAP labral tear, rotator cuff tear, rotator cuff tendinitis, and shoulder impingement. Statistical analysis was performed using proportion ratios (PR). Statistical significance was initially defined as p < 0.05; a post-hoc Bonferroni adjustment was applied using a p < 0.005 threshold balancing the likelihood of false positive and false negative findings. RESULTS: Overall, 138 shoulder injuries were identified of which 51.4% occurred during practice. Rotator cuff pathology represented 45.6% of all injuries, with rotator cuff tears significantly more likely to be season-ending injuries (PR 2.5, 95% CI 1.2-5.6, p = 0.019). Pitching or throwing was the mechanism of injury in 100% of players with rotator cuff tendonitis, 87.5% of SLAP tears, 70% of players with biceps tendinitis, and 67% of players with rotator cuff tears. Biceps tendinitis (PR 3.9, 95% CI 1.2-12.5, p = 0.024) and SLAP tears (PR 6.4, 95% CI 1.6-25.0, p = 0.008) were significantly more likely to be chronic. SLAP tears were significantly more likely to be recurrent (PR 5.5, 95% CI = 1.5-20.4, p = 0.010). Being a freshman or sophomore was significantly associated with a lower proportion of biceps tendinitis (PR = 0.2, 95% CI = 0.04-0.8, p = 0.028). All anterior shoulder dislocations occurred while running the bases or sliding, and AC sprains were significantly associated with contact (PR 20.6, 95% CI = 2.5-168.7, p = 0.0048). CONCLUSIONS: Repetitive overhead throwing in college baseball is a common cause of overuse shoulder injuries. These athletes are especially susceptible to rotator cuff pathology, which is significantly more likely to cause season-ending injuries. While we have to interpret these results in light of both adjusted and unadjusted p-values, this information signifies the importance of shoulder injury prevention strategies by physicians and trainers taking care of collegiate baseball players.

Addition of a Distal Femur Locking Plate to Augment Total Hip Arthroplasty in Osteogenesis Imperfecta: A Case Report.

CASE: We present a 55-year-old woman with osteogenesis imperfecta (OI) who underwent total hip arthroplasty (THA). She developed aseptic loosening of the femoral stem and was revised to a longer stem necessitating 2 osteotomies because of the proximal femur varus deformity. This was complicated by implant subsidence. She ultimately required another revision adding a distal femur locking plate to augment construct stability. CONCLUSION: The abnormal anatomy and suboptimal bone properties in patients with OI present unique challenges when performing THA. More aggressive prophylactic fixation to improve construct stability and prevent fracture may be necessary in this patient population.

Examining the Association of Knee Pain With Modifiable Cardiometabolic Risk Factors.

OBJECTIVE: A well-established link exists between obesity and knee osteoarthritis, and recent research has implicated diabetes mellitus as a potential cause of cartilage degeneration. The objective of this study was to use the National Health and Nutrition Examination Survey (NHANES) database to examine the association between knee pain and various metabolic factors. METHODS: A retrospective cross-sectional study of the NHANES database from 1999 to 2004 was performed. The main outcome was any knee pain and bilateral knee pain. The main effects of interest were body mass index (BMI) and glycohemoglobin A1c . We additionally assessed various patient factors, including age, race, poverty, sex, and smoking status. Multivariable logistic regression models and interaction terms were analyzed. RESULTS: Data on 12,900 patients were included. In the main adjusted analysis, the modifiable risk factors associated with any knee pain were overweight (odds ratio [OR] 0.91 [95% confidence interval (95% CI) 0.85-0.97), obesity (OR 1.54 [95% CI 1.42-1.66]), glycemic control (OR 1.20 [95% CI 1.03-1.38]), and current smoking (OR 1.15 [95% CI 1.05-1.27]) (all P < 0.05). These same factors remain significant for bilateral knee pain. Subgroup analysis showed that patients age <65 years have a 5% increase in the risk of any knee pain as their BMI increases, but patients age ≥65 years have a 10% increase in risk. CONCLUSION: This study confirms the association of knee pain with increased weight, glycemic control, current smoking, and age. Most of these risk factors can be modified in patients with knee pain and should be discussed when providing conservative treatment options.

Males and females exhibit distinct relationships between intervertebral disc degeneration and pain in a rat model.

Back pain is linked to intervertebral disc (IVD) degeneration, but clinical studies show the relationship is complex. This study assessed whether males and females have distinct relationships between IVD degeneration and pain using an in vivo rat model. Forty-eight male and female Sprague-Dawley rats had lumbar IVD puncture or sham surgery. Six weeks after surgery, IVDs were evaluated by radiologic IVD height, histological grading, and biomechanical testing. Pain was assessed by von Frey assay and dorsal root ganglia (DRG) expression of Calca and Tac1 genes. Network analysis visualized which measures of IVD degeneration most related to pain by sex. In both females and males, annular puncture induced structural IVD degeneration, but functional biomechanical properties were similar to sham. Females and males had distinct differences in mechanical allodynia and DRG gene expression, even though sex differences in IVD measurements were limited. Network analysis also differed by sex, with more associations between annular puncture injury and pain in the male network. Sex differences exist in the interactions between IVD degeneration and pain. Limited correlation between measures of pain and IVD degeneration highlights the need to evaluate pain or nociception in IVD degeneration models to better understand nervous system involvement in discogenic pain.

Retrospective review of open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement: a single surgeon's experience.

BACKGROUND: There have been conflicting results when comparing outcomes of open vs. arthroscopic anterosuperior rotator cuff repairs with subscapularis involvement. The purpose of this study was to evaluate midterm outcome differences and complications following open vs. arthroscopic repair of rotator cuff tears involving the subscapularis by a single surgeon. METHODS: This was a retrospective review of 57 rotator cuff repairs involving the subscapularis performed by a single surgeon over a 10-year period. During this time, the surgeon transitioned from open to arthroscopic repair. Preoperative and postoperative range of motion, lift-off test, belly press test, and American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment form scores were measured. RESULTS: Eighteen patients had open procedures and 39 had arthroscopic repair. The mean preoperative ASES score for the open group was 39 and postoperatively was 79. The mean preoperative ASES score for the arthroscopic group was 44 and improved to 80 postoperatively. There was no significant difference in score or change in score between the 2 groups (P > .05). There was only 1 complication. It occurred in the open group and was a superficial wound dehiscence. CONCLUSIONS: This study demonstrated no outcome differences between open and arthroscopic rotator cuff repair involving the subscapularis, even with large subscapularis tears. Both techniques significantly improved shoulder function. Arthroscopic and open rotator cuff repairs including the subscapularis are relatively safe procedures, and either technique is an acceptable option.

Overview of Metatarsalgia.

Metatarsalgia can be viewed as more of a symptom rather than a distinct diagnosis. Timing of forefoot pain during the gait cycle and evaluation of whether the pain is from anatomic abnormalities, indirect overloading, or iatrogenic causes can suggest a specific metatarsalgia etiology. A thorough physical examination of the lower extremity, especially evaluation of the plantar foot, and weight-bearing radiographs are critical for diagnosis and treatment. Nonoperative treatment consists of physical therapy, orthotics, shoe wear modification, and injections. If conservative treatment fails, surgical options may be considered. [Orthopedics. 2019; 42(1):e138-e143.].

Risk Factors for Postoperative Venous Thromboembolism in Orthopaedic Spine Surgery, Hip Arthroplasty, and Knee Arthroplasty Patients.

BACKGROUND: Orthopaedic surgery is a major risk factor for venous thromboembolism (VTE) manifesting as deep vein thrombosis (DVT) or pulmonary embolism (PE). Various patient characteristics alter the likelihood of a postoperative VTE, and there is substantial ambiguity in current VTE prophylaxis guidelines. PURPOSE: To determine if particular patient characteristics are risk factors for VTE following major orthopaedic surgery. METHODS: Data was reviewed from 201 patients presenting with either a PE or DVT following spine surgery or joint replacement from October 2009 through June 2013. The following characteristics were reviewed for each patient: VTE event date, surgery date and type, comorbidities and pre-existing conditions, calculated comorbidity level, body mass index, prophylaxis type, time to initiation of chemoprophylaxis, time to epidural removal, and VTE event type. The control patients were randomly selected from a group of 13,782 patients during the same period. RESULTS: A history of VTE (p < 0.0001), Factor V Leiden disorder (p = 0.04) and the use of general anesthesia (p =0.05) were significant risk factors for postoperative VTE. The frequency of VTE decreased following hip and knee arthroplasty during the study period and remained constant for spine surgery. DVTs occurred 14.2 days later than PEs (p < 0.0001). Over 90% of PEs and 33.3% to 75% of DVTs were diagnosed in the first week following surgery. CONCLUSIONS: A prior history of VTE, Factor V Leiden disorder and general anesthesia increases the risk of VTE postoperatively. The probability of PE beyond the second postoperative week is low.

Evaluation of anxiety-like behaviour in a rat model of acute postoperative pain.

BACKGROUND: Unrelieved acute postoperative pain can lead to a wide range of adverse effects, such as anxiety, depression, restlessness and sleep deprivation. OBJECTIVE: To investigate anxiety-like behaviour in a postoperative pain model. INTERVENTIONS AND MAIN OUTCOME MEASURES: Mechanical hypersensitivity was assessed with an electronic von Frey device, whereas anxiety-like behaviour was measured with light/dark testing and elevated plus maze testing. RESULTS: Rats developed significant mechanical hyperalgesia on 1, 3 and 8 days postsurgery compared with sham-operated rats. There was no reduction in motility between preincision and postincision when animals were allowed to move freely in an open field locomotion test. In light-dark tests, incised animals spent significantly less time than sham rats in the light compartment on the 1st and 3rd postoperative days. However, in an elevated plus maze test, differences between sham and incised rats were only observed on the 8th postoperative day as they spent significantly more time in the open arms. Pretreatment with morphine significantly increased withdrawal thresholds compared with treatment with saline (0.9% NaCl), but had no effect on light or open arm avoidance behaviour. CONCLUSION: We report that a rat model of acute postoperative pain is associated with anxiety-like increased light and open arm avoidance behaviour.