Editorial Commentary: Hip Capsular Preservation When Treating Femoroacetabular Impingement Syndrome Should Remain Universal, and Some Hip Phenotypes Necessitate Maximum Surgical Stability.

Hip capsular preservation remains most common in the United States despite literature to-date showing varying outcomes. Different surgeons prefer, and different patients require, periportal capsulotomies versus wider exposure with T-type capsulotomy and traction stitches. In addition to revision cases, some hip phenotypes may require more aggressive capsular management. Patients with borderline hip dysplasia, acetabular retroversion, increased femoral anteversion, and greater Beighton scores necessitate more hip stability; thus, capsular preservation and closure is essential. However, patients with "tight" hips, thicker capsules, and larger cam deformities may require less-stringent capsular care. Regardless, adequate bony decompression is paramount in patients with femoroacetabular impingment syndrome.

Musculoskeletal injuries during trail sports: Sex- and age-specific analyses over 20 years from a national injury database.

INTRODUCTION: Musculoskeletal (MSK) injuries in US trail sports are understudied as trail sport popularity grows. This study describes MSK injury patterns among hikers, trail runners, and mountain bikers from 2002 through 2021 and investigates MSK injury trends acquired during mountain sports. METHODS: The National Electronic Injury Surveillance System (NEISS) was used to identify US emergency department (ED) patients from 2002-2021 (inclusive) who endured MSK injuries during hiking, trail running, or mountain biking. Injury rates and national estimates were calculated across demographics. RESULTS: 9835 injuries were included (48.4% male, 51.6% female). Injuries increased over time, with 1213 from 2002-2005 versus 2417 from 2018-2021. No sex differences existed before 2010, after which female injury rates exceeded those of males. The following findings were statistically significant, with P<0.05: females endured more fractures and strains/sprains; males endured more lacerations; concussions and head injuries were higher among those <18 y; dislocations and strains/sprains were higher for 18 to 65 y; fractures were higher for >65 y; <18 y had high mountain-biking and low running rates; 18 to 65 y had high running rates; and >65 y had low biking and running rates. Although all diagnoses increased in number over time, no significant differences existed in the proportion of any given diagnosis relative to total injuries. CONCLUSIONS: MSK injuries during trail sports have increased since 2002. Males endured more injuries until 2009, after which females endured more. Significant sex and age differences were found regarding injury diagnosis and body parts. Further studies are needed to confirm these trends and their causes.

Editorial Commentary: Arthroscopic Irrigation and Debridement is an Effective Treatment for Acute Septic Arthritis of Native Joints.

Arthroscopic irrigation and debridement has long been known to be an effective treatment for acute septic arthritis of native joints. Systematic review shows that when compared to open irrigation and debridement, arthroscopy yields comparable hospital length of stay complication, reoperation, and readmission rates, as well as better patient-reported outcomes compared to open arthrotomy. However, reoperation rates are heterogeneously defined in the literature, not to mention that unplanned return to surgery likely suggests inadequate prior irrigation and debridement of an infection, whereas a planned repeat washout may be a surgeon's intention and practice for septic arthritis. Most of all, this condition should be managed urgently.

Attitudes and Practices Surrounding Opioid Prescriptions following Open Reduction Internal Fixation of Distal Radius and Ankle Fractures: A Survey of the Canadian Orthopaedic Association Membership.

Background: The past two decades have seen a significant increase in consequences associated with nonmedical misuse of prescription opioids, such as addiction and unintentional overdose deaths. This study aimed to use an electronic survey to assess attitudes and opioid-prescribing practices of Canadian orthopaedic surgeons and trainees following open reduction internal fixation (ORIF) of distal radius and ankle fractures. This study was the first to assess these factors following ORIF of distal radius and ankle fractures using a survey design. Methods: A 40-item survey was developed focusing on four themes: respondent demographics, opioid-prescribing practice, patients with substance use disorders, and drug diversion. The survey was distributed among members of the Canadian Orthopaedic Association. Descriptive statistics were used to summarize respondent demographics and outcomes of interest. A Chi-square test was used to determine if proportion of opioid prescriptions between attending surgeons and surgeons in training was equal. Results: 191 surveys were completed. Most respondents prescribed 10-40 tabs of immediate-release opioids, though this number varied considerably. While most respondents believed patients consumed only 40-80% of the prescribed opioids (73.6%), only 28.7% of respondents counselled patients on safe storage/disposal of leftover opioids. 30.5% of respondents felt confident in their knowledge of opioid use and mechanisms of addiction. Most respondents desired further education on topics such as procedure-based opioid-prescribing protocols (74.2%), alternative pain management strategies (69.7%), and mechanisms of opioid addiction (49.0%). Conclusions: The principle finding of this study is the lack of a standardized approach to postoperative prescribing in distal radius and ankle fractures, illustrated by the wide range in number of opioids prescribed by Canadian orthopaedic surgeons. Our data suggest a trend towards overprescription among respondents following distal radius and ankle ORIF. Future studies should aim to rationalize interventions targeted at reducing postoperative opioid prescribing for common orthopaedic trauma procedures.

Injury Rates at an NCAA Division I Institution After the COVID-19 Lockdown: A Descriptive Epidemiological Study.

Background: The coronavirus 2019 (COVID-19) pandemic led to frequent schedule changes, abbreviated seasons, and disrupted training at all levels of organized sports. Purpose/Hypothesis: The purpose of this study was to investigate the epidemiology of sports-related injuries at a single National Collegiate Athletic Association (NCAA) Division I institution during the 2020 COVID lockdown season when compared with pre-COVID seasons. It was hypothesized that there would be an increase in the overall injury rate and an increase in the number of days missed because of injury during the 2020 season when compared with the previous seasons. Study Design: Descriptive epidemiology study. Methods: The injury surveillance database at a single NCAA Division I institution was queried for injuries that resulted in time loss (missed game or practice) for a student-athlete or for injuries that persisted >3 days. Injuries were categorized by anatomic area. Days unavailable because of injury were recorded as total days that a student-athlete was listed as "out of activity." Injury incidence and days unavailable, per 1000 athlete-exposures (AEs), were calculated for 3 pre-COVID seasons (2017-2019) and the 2020 season. The authors calculated the injury rate ratio (IRR) and its associated 95% CI of the 2020 season in comparison with those for the pre-COVID seasons. Results: Compared with the pre-COVID seasons, the total injury incidence increased by 10.5% in the 2020 season (68.45 vs 75.65 injuries/1000 AEs; IRR, 1.11 [95% CI, 1.08-1.13]). Total days unavailable decreased by 20.7% in the 2020 season (1374 vs 1089 days/1000 AEs; IRR, 0.79 [95% CI, 0.77-2.26]). Compared with women's teams, men's teams had a larger increase in total injury incidence (16.4% vs 6.5%) and larger decrease in days unavailable (23.7% vs 10.75%). There were no clear trends to changes in anatomic distribution of injuries, either by sport or between the sexes. Conclusion: Compared with the pre-COVID seasons, the injury incidence was higher and the number of days missed because of injury lower among collegiate student-athletes at a single NCAA Division I school in the season immediately after the COVID-19 lockdown.

Association of Injury Rates Among Players in the National Football League With Playoff Qualification, Travel Distance, Game Timing, and the Addition of Another Game: Data From the 2017 to 2022 Seasons.

Background: Injury incidence is higher in the National Football League (NFL) than in other collision sports. Although previous research has identified that scheduling variations, including overseas games and bye week timing, does not affect concussion risk, data are currently lacking regarding the effects of scheduling variation on season-long musculoskeletal injury incidence. Purpose: To determine whether higher cumulative travel distance, overseas play, an early season bye week, and an expansion of the regular season is associated with higher injury rates in the NFL. Study Design: Descriptive epidemiology study. Methods: All 1275 injuries across 5 NFL seasons from 2017 to 2018 through 2021 to 2022 were reviewed retrospectively. Injury data and travel distances were extracted from publicly available sources, which were cross-referenced for validation. Injury rates were calculated per 1000 athletic-exposures (AEs). Cumulative team travel distances were compared statistically using a linear regression. Single factor analysis of variance was used to compare categorical variables. Results: Travel distance did not significantly predict injury rates (P = .47), and there was no difference in injury rates between teams that played a game overseas versus teams that did not (19.3 injuries per 1000 AEs for both; P = .96). In addition, no difference was found in injury rates (F[109,2100[ = 0.704; P = .73) or players placed on the injured reserve list (F[99,778] = 1.70; P = .077) between various bye weeks (P = .73). Injury rates did not differ between the new 17-game regular season (18.4 per 1000 AEs) versus the previous four 16-game regular seasons (19.7 per 1000 AEs; P = .12). However, teams that did not qualify for the playoffs had a significantly higher injury rate (19.9 per 1000 AEs) as well as players on injured reserve (8.0 per 1000 AEs) than playoff-qualifying teams (18.4 and 6.8 per 1000 AEs, respectively; P < .05 for both). Conclusion: Over 5 NFL seasons, cumulative travel distance, overseas play, bye week timing, and adding 1 regular season game were not associated with increased injury rates in NFL players. However, a lack of regular season success was associated with higher injury rates and more players on injured reserve.

Sex-Based Differences in Prevalence, Outcomes, and Complications of Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review and Meta-analysis.

Background: Trends between the sexes have been reported regarding prevalence, patient-reported outcomes (PROs), and complications of hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS), yet current results lack consensus. Purpose: To evaluate sex-based differences after HA for FAIS in (1) prevalence of cam and pincer morphology in FAIS and (2) PROs, pain scores, and postoperative complication rates. Study Design: Systematic review; Level of evidence, 4. Methods: The EMBASE, PubMed, and Ovid (MEDLINE) databases were searched from establishment to February 28, 2022, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies had sex-based data on prevalence, outcomes, and complications of HA for FAIS. Reviews and commentaries were excluded. Data were combined, and between-sex differences were analyzed. Meta-analyses using random-effects models were performed when possible. Pooled risk ratios (RRs) and standardized mean differences were calculated. Results: A total of 74 studies were included (213,059 patients; 132,973 female hips [62.4%] and 80,086 male hips [37.6%]). The mean age was 30.7 ± 7.7 years among male patients and 31.1 ± 7.8 years among female patients. Male patients experienced mixed-type impingement significantly more often (39.4% vs 27.2% for female patients; RR = 0.69 [95% confidence interval [CI], 0.58-0.81]; P < .001), whereas female patients experienced pincer-type impingement more often (50.6% vs 30.8% for male patients; RR = 2.35 [95% CI, 1.14-4.86]; P = .02). Male patients had higher likelihoods of undergoing femoroplasty (89.8% vs 77.4% for female patients; RR = 0.90 [95% CI, 0.83-0.97]; P = .006), acetabuloplasty (67.1% vs 59.3% for female patients; RR = 0.87 [95% CI, 0.79-0.97]; P = .01), or combined femoroplasty/acetabuloplasty (29.2% vs 14.5% for female patients; RR = 0.63 [95% CI, 0.44-0.90]; P = .01). Although female patients showed greater improvements in Hip Outcome Score-Sport-Specific subscale (P = .005), modified Harris Hip Score (P = .006), and visual analog scale pain (P < .001), both sexes surpassed the minimal clinically important difference at 1, 2, and 5 years postoperatively. Female patients had higher complication rates (P = .003), although no sex-based differences were found in total hip arthroplasty conversion rates (P = .21). Conclusion: Male patients undergoing HA for FAIS had a higher prevalence of mixed-type FAIS while female patients had more pincer-type FAIS. Female patients gained greater improvements in PROs, although both sexes exceeded the minimal clinically important difference, suggesting that both male and female patients can benefit from HA.

Does Running Increase the Risk of Hip and Knee Arthritis? A Survey of 3804 Marathon Runners.

BACKGROUND: Long-distance running is a popular form of cardiovascular exercise with many well-described health benefits, from improving heart health to the management of obesity, diabetes, and mental illness. The impact of long-distance running on joint health in recreational runners, however, remains inconclusive. HYPOTHESIS: The prevalence of osteoarthritis in runners is not associated with an athlete's running-related history, including the number of marathons completed, cumulative years of running, average weekly mileage, and average running pace. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A survey was distributed to all participants registered for the 2019 or 2021 Chicago marathon (n = 37,917). Surveys collected runner demographics and assessed for hip/knee pain, osteoarthritis, family history, surgical history, and running-related history. Running history included the number of marathons run, number of years running, average running pace, and average weekly mileage. The overall prevalence of osteoarthritis was identified, and a multivariable logistic regression model was used to identify variables associated with the presence of hip and/or knee osteoarthritis. RESULTS: Surveys were completed by 3804 participants (response rate of 10.0%). The mean age was 43.9 years (range, 18-83 years) and participants had completed on average 9.5 marathons (median, 5 marathons; range, 1-664 marathons). The prevalence of hip and/or knee arthritis was 7.3%. A history of hip/knee injuries or surgery, advancing age, family history, and body mass index (BMI) were risk factors for arthritis. Cumulative number of years running, number of marathons completed, weekly mileage, and mean running pace were not significant predictors for arthritis. The majority (94.2%) of runners planned to run another marathon, despite 24.2% of all participants being told by a physician to do otherwise. CONCLUSION: From this largest surveyed group of marathon runners, the most significant risk factors for developing hip or knee arthritis were age, BMI, previous injury or surgery, and family history. There was no identified association between cumulative running history and the risk for arthritis.

Characteristics of Team Physicians in the National Football League: The Road to Success and a Call for Diversity.

Background: The role of team physician (TP) in professional sports is a highly coveted position within sports medicine. There is currently limited research on the demographic characteristics of TPs within the National Football League (NFL). Purpose: To identify demographic characteristics and educational backgrounds of NFL head TPs (HTPs) and assistant TPs (ATPs). Study Design: Cross-sectional study. Methods: A list of TPs was identified through the National Football League Physicians Society (NFLPS). Variables investigated include age, gender, race, medical specialty, location and year of residency and fellowship training, leadership among medical societies and editorial boards, academic rank, and personal Scopus Hirsch index (h-index). Linear regression was performed to determine correlation, and t tests were used to assess differences in the h-index. Results: Of the 170 TPs, 21.2% were HTPs and 78.8% were ATPs. TPs were 97.6% male, 91.2% were non-Hispanic White, and 60% had attained an academic rank. The mean ages of the HTPs and ATPs were a 56.2 ± 9.6 and 52.6 ± 9.6 years, respectively (P = .047). Among orthopaedic surgeons, the most common subspecialties were sports medicine (70.5%), foot and ankle (7.6%), and spine (5.7%). Of the TPs, 48.2% and 32.9% worked for a team in the same state in which they graduated residency and fellowship, respectively. HTPs and ATPs had been in the NFLPS for a mean of 16.9 ± 10.8 and 8.8 ± 8.3 years, respectively (P < .001). Further, TPs holding an academic rank had a mean h-index of 14.0 ± 19.3, while those without an academic rank had a mean h-index of 6.2 ± 8.8 (P < .01). HTPs and ATPs had mean h-indices of 15.7 ± 15.9 and 9.6 ± 16.3 (P = .0503), respectively. Conclusion: TPs in the NFL are typically White men in their mid-50s who have trained at specific high-ranking institutions and obtained a fellowship in sports medicine. HTPs were likely to be older with longer tenures within the NFLPS and with more impactful research than their ATP counterparts.

COVID-19 Pandemic Impact on Confidence to Return to Sport: Perspectives From National Collegiate Athletic Association (NCAA) Athletes.

BACKGROUND: One of the unforeseen impacts of the COVID-19 pandemic has been a decrease in athletes' confidence to return to their sport after mandates were lifted. Both physical and psychological effects have been implicated. This study aimed to measure the severity of these changes among a group of National Collegiate Athletic Association (NCAA) athletes. METHODS: A novel Readiness to Return to Sport Survey, based on the validated ACL-RSI survey, was distributed to Division 1 collegiate athletes. The survey evaluated the psychological readiness of each player to return to sport in the context of the COVID-19 pandemic, utilizing a 1-10 scale (1 = least confident and 10 = most confident). Numerical responses to each survey were summed to create a primary outcome score-an athlete's Return to Sport Readiness Score. Higher scores indicate higher levels of readiness to return to sport in the nearest coming season. RESULTS: Responses came from 68 athletes representing a variety of sports. Of those with an injury, 14 (82.35%) attributed their injury to changes in their training schedule due to COVID-19 restrictions, and the remaining three (17.65%) did not. Among all athletes, the mean return to sport readiness (RTS) score was 44 (SD 24.76). Those playing a winter sport had the lowest mean RTS score, 35 ± 23, and those playing a fall season sport had the highest mean score, 48 ± 25.97. Overall, competitive athletes on leave from the sport due to collegiate and Division 1 COVID-19 guidelines had lower reported mean RTS scores as compared to athletes outlined in many other anterior cruciate ligament return to sport after injury survey (ACL-RSI) studies. CONCLUSIONS: Overall, the athletes surveyed in our study reported much lower levels of readiness to return to sport in the context of COVID-19 than athletes surveyed in other studies, exhibiting COVID-19's unique impact on their confidence to return to their scheduled sport season. These differences may highlight the COVID-19 pandemic as a more severe detriment to returning to sport readiness among division-one athletes than recovering from injury alone. Given such an impact, more research is needed to elucidate the percentage of these athletes that returned to or abstained from their sport, as well as any motivating, facilitating, or detrimental factors in their choice.

Qualitative Research in Return to Sport: a Current Review of the Literature.

PURPOSE OF REVIEW: Return to sport (RTS) is an important metric tied to patient satisfaction after receiving treatment for a sports-related injury. Recently, there has been an explosion of literature on RTS; yet a comprehensive review encompassing multiple injuries does not exist. Furthermore, RTS has historically been defined by quantitative measures that assess strength, function, and pain but little consideration has been given to psychologic factors nor has there been an open-ended forum for athletes to share with health care providers which factors they feel are most influential for RTS. This review also serves to heighten surgeons' awareness of underlying psychologic/psychosocial factors affecting RTS. RECENT FINDINGS: Qualitative studies which employ open-ended questioning of athletes who have undergone surgical management of superior labral anterior-posterior (SLAP) tears, shoulder instability, ulnar collateral ligament (UCL) rupture, femoral acetabular impingement (FAI), and anterior cruciate ligament (ACL) tear demonstrate that fear of reinjury, lack of social support, and unrealistic expectations are all barriers to RTS. Qualitative studies give health care providers unique insight into the perspectives of their patients so that unmet postoperative needs can be addressed to facilitate RTS. Sports psychologists, coaches, athletic trainers, and physical therapists should create a positive environment to address these needs and provide optimal, holistic care to return athletes to the field safely. Though time consuming, further qualitative research is necessary to understand the unique factors affecting RTS in athletes.

Injury Risk in Collegiate Football Players With Generalized Joint Hypermobility: A Prospective Cohort Study Over 2 Years.

Background: Generalized joint hypermobility (GJH) has been identified as a risk factor for injury in various athletic patient populations. Purpose: To evaluate GJH as a predisposing risk factor for injury in a population of National Collegiate Athletic Association (NCAA) Division I football players. Study Design: Cohort study; Level of evidence, 2. Methods: The Beighton score was collected for 73 athletes during their preseason physical examinations in 2019. GJH was defined as a Beighton score ≥4. Athlete descriptive characteristics, including age, height, weight, and playing position, were recorded. The cohort was evaluated prospectively for 2 years, and the number of musculoskeletal issues, injuries, treatment episodes, days unavailable, and surgical procedures for each athlete during this period were recorded. These measures were compared between the GJH and no-GJH groups. Results: The mean Beighton score was 1.4 ± 1.5 for the 73 players; 7 players (9.6%) had a Beighton score indicating GJH. During the 2-year evaluation, there were 438 musculoskeletal issues, including 289 injuries. The mean number of treatment episodes per athlete was 77 ± 71 (range, 0-340), and the mean number of days unavailable was 67 ± 92 days (range, 0-432 days). There were 23 athletes who required 25 operations, the most common procedure being arthroscopic shoulder stabilization (n = 6). The number of injuries per athlete was not significantly different between the GJH and no-GJH groups (3.0 ± 2.1 vs 4.1 ± 3.0; P = .13), nor were there any between-group differences in the number of treatments received (74.6 ± 81.9 vs 77.2 ± 71.5; P = .47), days unavailable (79.6 ± 124.5 vs 65.3 ± 89.3; P = .61), or rates of surgery (43% vs 30%; P = .67). Conclusion: A preseason diagnosis of GJH did not place NCAA football players at a greater risk for injury during the 2-year study period. Based on the findings of this study, no specific preparticipation risk counseling or intervention is warranted for football players who are diagnosed with GJH as defined by the Beighton score.

Chronic calcific tendonitis of the rotator cuff: a systematic review and meta-analysis of randomized controlled trials comparing operative and nonoperative interventions.

BACKGROUND: Calcific tendinitis is a relatively common shoulder disorder, with 7%-17% of individuals with shoulder pain having rotator cuff calcium deposits. Several nonoperative interventions, extracorporeal shockwave therapy (ESWT) and ultrasonography-guided needling (UGN), and surgical techniques have been described to treat calcific tendonitis with satisfactory outcomes. Clinical guidelines are lacking for surgical excision in cases refractory to nonoperative treatment. Several arthroscopic and open operative techniques have been described to treat calcific tendonitis with satisfactory clinical outcomes. The purpose of this systematic review of randomized controlled trials is to compare outcomes and complications of nonoperative vs. operative management of chronic calcific tendinitis of the rotator cuff, to provide evidence-based treatment guidelines for practitioners. METHODS: EMBASE, PubMed, and OVID [MEDLINE] were searched from database inception until February 20, 2022, for randomized controlled trials reporting outcomes related to operative or nonoperative management for calcific tendonitis of the shoulder. Clinical outcomes including pain on visual analog scale (VAS), Constant-Murley Shoulder Outcome Score (CMS), and resolution of calcific deposits were evaluated. Continuous data at last follow-up was pooled into mean differences using a random effects model for meta-analysis. RESULTS: A total of 27 studies (2212 nonoperative patients and 140 operative patients) met the final inclusion criteria. Pooled mean difference in VAS for ESWT was -3.83 (95% confidence interval [CI] -5.38, -2.27); P < .001), compared to -4.83 (95% CI -5.44, -4.22; P < .001) for UGN, and -4.65 (95% CI -5.47, -3.82; P < .001) for the operative interventions. Pooled mean difference in CMS score after ESWT was 18.30 (95% CI 10.95, 25.66; P < .001) compared to 22.01 (95% CI 8.17, 35.84; P = .002) for UGN, and 38.35 (95% CI 31.68, 45.02; P < .001) for the operative interventions. Eighty-five percent of patients receiving operative and 67% of patients receiving UGN management had complete radiographic resolution of calcific deposit. CONCLUSIONS: Surgical treatment of chronic calcific tendonitis of the rotator cuff results in larger improvement in functional outcome scores and comparable pain reduction to nonoperative interventions, particularly UGN. Both operative and nonoperative treatment modalities are likely to have clinically significant improvements in function and pain, and thus it is reasonable to trial UGN and ESWT as first-line treatment. Cost-effectiveness analyses will be needed to support one treatment over the other. High-quality randomized controlled trials directly comparing nonoperative interventions to operative interventions in patients prior to failing conservative treatment are needed to establish high-quality evidence-based guidelines.

Risk Factors for Athletic Pubalgia in Collegiate Football Student-Athletes: A Retrospective Cohort Study.

BACKGROUND: Athletic pubalgia (AP) is an increasingly recognized injury among young athletes. This study aimed to evaluate the characteristics associated with AP in college football players. HYPOTHESIS: Repetitive explosive movements that require aggressive core muscle activation results in AP in collegiate football players. STUDY DESIGN: Retrospective cohort design. LEVEL OF EVIDENCE: Level 3. METHODS: Football student-athletes at a single Division I collegiate institution from January 2010 to December 2019 were included in the study. The primary outcome measure was surgery for AP. The odds of AP were determined using logistic regression, with the dependent variable being whether or not the student-athlete received AP surgery. Independent variables included Olympic weightlifting (OWL) exposure, primary playing position (skill position vs nonskill position), and body mass index (BMI). RESULTS: A total of 1154 total student-athlete exposures met the inclusion criteria. Of the 576 student-athletes exposed to OWL (OWL occurred throughout entire calendar year), 20 developed AP, whereas 7 student-athletes not exposed to OWL (OWL was not performed at any point during calendar year) developed AP. Student-athletes exposed to OWL had a 2.86 (95% CI, 1.25-7.35; P = 0.02) times higher odds of AP than players not exposed after controlling for primary playing position and BMI. Skill position players had a 9.32 (95% CI, 1.71-63.96; P = 0.01) times higher odds of AP than nonskill position players when controlling for BMI and OWL training. CONCLUSION: Modifiable factors that increase exposure to repetitive explosive activities, such as OWL and playing a skill position, may be important considerations in developing AP. CLINICAL RELEVANCE: The cause of AP is multifactorial and poorly understood. Identifying factors associated with AP informs athletes, athletic trainers, physicians, and coaches.

Outcomes in Pediatric Hip FAI Surgery: a Scoping Review.

PURPOSE OF REVIEW: Femoracetabular impingement (FAI) is a common source of hip pain in children and adolescents. While nonoperative therapies and open surgical procedures can be effective, hip arthroscopy is a minimally invasive treatment option with substantial benefit. The purpose of this paper is to evaluate the current role of hip arthroscopy in treating FAI within the pediatric population. This article examines its efficacy through a review of hip arthroscopy outcomes in the contemporary orthopaedic literature. RECENT FINDINGS: Morphologic changes in the acetabulum and proximal femur seen in FAI can be attributed to a multitude of etiologies-including idiopathic FAI, Legg-Calve-Perthes, and slipped capital femoral epiphysis. In general, arthroscopic treatment of FAI secondary to these conditions leads to statistically significant improvements in pain and patient-reported outcomes in the short and long term. In the pediatric athlete, repetitive stress on the hip perpetuates FAI and can drastically hinder performance. Hip arthroscopy allows for a high rate of return to sport with minimal morbidity in this population. Overall, pediatric hip arthroscopy is effective in treating FAI secondary to a wide variety of conditions. Despite its clinical benefits, patients and their families should be counseled regarding alternative treatments, potential complications, and return to play.

A qualitative assessment of perceptions and attitudes toward postoperative pain and opioid use in patients undergoing elective knee arthroscopy.

BACKGROUND: Orthopedic surgeons routinely prescribe opioids to manage post-operative pain. In the face of an opioid epidemic, a one-size-fits-all approach to pain management is no longer appropriate. Patient-centred prescribing practices should be used by surgeons; however, little is known about what influences patient attitudes toward postoperative pain and its management to inform such practices. We sought to explore patient attitudes toward postsurgical pain management, including opioids. METHODS: We conducted qualitative, semistructured interviews of 11 opioid-naive patients (age 16-46 yr) who were scheduled to undergo arthroscopic knee surgery. Transcripts were analyzed thematically using a framework analysis that involved familiarization, developing a thematic framework, indexing, charting and mapping, and interpretation. RESULTS: Participant attitudes toward postoperative pain and opioids were influenced by perceived tolerance to pain based on personal experience, perceived predisposition to addiction based on personal assumptions regarding addictive personality traits and risk factors, and perceptions of opioid use shaped by external influences, including family, friends and the media's depiction of the opioid epidemic. Every patient expressed that preoperative counselling and education regarding postoperative pain management would be beneficial in improving their knowledge base, easing anxieties and clarifying misunderstandings. CONCLUSION: Surgeons can address the patient-reported factors identified in this study to help optimize a patient's perioperative experience without relying solely on prescribed analgesia. By improving accessibility to education and promoting safe, patient-centred prescribing practices, we may reduce reliance on opioids in orthopedic surgery.

Increased 30-Day Postoperative Readmission and Medical Complication Rates Among Patients 65 Years and Older Following Arthroscopic Rotator Cuff Repair.

Purpose: The purpose of this study is to use a large national database to assess short-term adverse events following arthroscopic rotator cuff repair in patients 65 years and older. Methods: The ACS NSQIP database was queried to identify patients that underwent arthroscopic rotator cuff repair between December 31, 2015, and January 1, 2017. Patients were split into two groups: 1) between 40-65 years old and 2) 65+ years old. Cases involving open rotator cuff repair, total shoulder arthroplasty, hemiarthroplasty, and emergency surgery were excluded. Exact matching was used to control for confounding variables, including sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, operative time, and several medical comorbidities. After matching, the incidence of several 30-day patient complication measures was compared between the groups. Binary logistic regression was used to identify covariates associated with various 30-day complications. Results: A total of 17,880 patients were included in the study. 69.4% (n = 12,404) patients were between 40 and 65 years old and 30.6% (n = 5,476) patients were 65+ years old. After matching, 9,210 patients were included in the final analysis. After matching, patients 65 years and older were more likely to experience 30-day unplanned readmission (P = .035) and overall medical complications (P = .036). There were no significant differences in most 30-day complication measures, including mortality (P = .250), reoperation (P = .449), non-home discharge (P = .255), surgical complications (P = .146), and several medical complications, including myocardial infarction (P = .165), deep venous thromboembolism (P = .206), pulmonary embolism (P = .196), and cerebrovascular accident (P > .999) between the two age groups. Conclusions: In this matched cohort study, patients 65 years and older experienced a higher rate of 30-day unplanned readmission and overall medical complications following elective arthroscopic rotator cuff repair relative to patients under 65. However, these older patients did not have significantly worse rates of other 30-day complication measures, including mortality, reoperation, return to the OR, and non-home discharge.

Determining the incidence and risk factors for short-term complications following distal biceps tendon repair.

BACKGROUND: Distal biceps rupture is a relatively uncommon injury that can significantly affect quality of life. Early complications following biceps tendon repair are not well described in the literature. This study utilizes a national surgical database to determine the incidence of and predictors for short-term complications following distal biceps tendon repair. METHODS: The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify patients undergoing distal biceps repair between January 1, 2011, and December 31, 2017. Patient demographic variables of sex, age, body mass index, American Society of Anesthesiologists class, functional status, and several comorbidities were collected for each patient, along with 30-day postoperative complications. Binary logistic regression was used to calculate risk ratios for these complications using patient predictor variables. RESULTS: Early postoperative surgical complications (0.5%)-which were mostly infections (0.4%)-and medical complications (0.3%) were rare. A readmission risk factor was diabetes (risk ratio [RR], 4.238; 95% confidence interval [CI], 1.180-15.218). Non-home discharge risk factors were smoking (RR, 3.006; 95% CI, 1.123-8.044) and ≥60 years of age (RR, 4.150; 95% CI, 1.611- 10.686). Maleness was protective for medical complications (RR, 0.024; 95% CI, 0.005-0.126). Surgical complication risk factors were obese class II (RR, 4.120; 95% CI, 1.123-15.120), chronic obstructive pulmonary disease (COPD; RR, 21.981; 95% CI, 3.719-129.924), and inpatient surgery (RR, 8.606; 95% CI, 2.266-32.689). CONCLUSIONS: Complication rates after distal biceps repair are low. Various patient demographics, medical comorbidities, and surgical factors were all predictive of short-term complications.

Revision ACL reconstruction has higher incidence of 30-day hospital readmission, reoperation, and surgical complications relative to primary procedures.

PURPOSE: Although there has been substantial improvement in ACL reconstructive surgery, graft failure remains a devastating complication for some patients. Revision procedures are inherently more complex and technically challenging. The purpose of this study is to determine the incidence of short-term complications after these procedures and to compare trends in operative length, relative valuation, and reimbursement after primary versus revision ACL reconstruction. METHODS: Primary and revision arthroscopic ACL reconstruction cases were identified on the American College of Surgeons' NSQIP database using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes between January 1, 2012 and December 31, 2017. Demographics, patient variables, and surgical variables were compared between primary and revision groups using Chi-squared tests. Logistic regression was used to identify independent risk factors for revision ACL reconstruction. Various 30-day outcome measures were compared between the primary and revision ACL reconstruction groups. Various measures of valuation-including total relative value units (RVU) and reimbursement per minute-were calculated and compared between the two groups. RESULTS: A total of 8292 patients-8135 primary and 157 revision procedures-were included in the final cohort. Higher ASA scores were associated with revision ACL reconstructions. Patients undergoing revision procedures were less likely to have an ASA score of 1 (p < 0.001) and more likely to have an ASA score of 2 (p = 0.004) or 3 (p = 0.020). Revision ACL reconstruction was associated with higher rates of poor 30-day outcome measures, including unplanned readmission (p = 0.029), reoperation (p = 0.012), return to the OR (p = 0.012), and surgical complications (p = 0.021). The total RVUs and reimbursement for revision procedures were significantly greater than those for primary procedures (p < 0.001). However, when accounting for operative time, the RVU/minute and reimbursement/minute were similar between the two groups (n.s.). CONCLUSIONS: Relative to primary ACL reconstruction, revision ACL procedures are associated with worse short-term outcomes-including unplanned readmission, reoperation, return to the OR, and surgical complications. A greater ASA score was independently predictive of revision ACL surgery. The current RVU system undervalues revision ACL procedures, considering the increased operative time and complexity of such procedures. LEVEL OF EVIDENCE: Level III.