Does Insurance Provide Adequate Coverage for Physical Therapy Visits for Common Orthopedic Diagnoses? A Survey Study.

OBJECTIVES: This study aimed to analyze the association between physical therapists' recommended number of visits for a full recovery from common orthopedic injuries/surgeries and the extent of insurance coverage for these visits. METHODS: A prospective observational study was conducted with board-certified physical therapists. A qualitative questionnaire was used to gather physical therapists' demographics and the recommended number of physical therapy visits to achieve a full recovery after 11 common orthopedic diagnoses. Physical therapists also were asked to report whether they believe that insurance provides an adequate number of visits overall. In addition to the qualitative survey, insurance coverage details of major Alabama companies were obtained for comparison. Descriptive statistics of the participating therapists were analyzed for sex, age, degree/training, and years of experience. Kruskal-Wallis statistics were used to analyze variance between the aforementioned groupings when compared with the reported average number of sessions. RESULTS: The survey (N = 251) collected data on the average number of physical therapy sessions that are necessary for a complete recovery as recommended by physical therapists for 11 common orthopedic diagnoses. From this survey, the average number of necessary visits ranged from 11.3 visits (ankle sprains) to 37.3 visits (anterior cruciate ligament reconstruction), with the overall average number of visits being 23.8. Only 24% of physical therapists believed that insurance companies provided enough coverage. Insurance coverage varied but often required additional procedures to allocate the adequate number of visits for the studied orthopedic pathologies. CONCLUSIONS: The majority of practicing physical therapists in Alabama perceive insufficient insurance coverage for physical therapy visits for most orthopedic diagnoses. This study has implications for healthcare decision making and patient-centered rehabilitation goals. Physicians and physical therapists can use this information to optimize treatment decisions and rehabilitation goals. Patients will benefit from improved physical and economic well-being. This study has the potential to drive further research and influence national insurance policies to better serve patients' needs.

Anterior Cruciate Ligament Reconstruction using Bone-Tendon-Bone Allograft: Surgical Technique Using Augmentation with Bio-Composite Scaffold.

Anterior cruciate ligament (ACL) rupture rates remain high; the incidence of isolated ACL ruptures is 68.6 per 100,000. This Technical Note introduces a technique for ACL reconstruction (ACLR) using a bone-tendon-bone (BTB) allograft augmented with BioBrace, a biocomposite scaffold. The BioBrace scaffold is sutured onto the BTB allograft to reinforce the ligament and accelerate healing. Graft preparation with BioBrace, ACLR, and graft passage is described. This technique aims to reduce re-rupture risk, enhance graft healing, and improve patient-reported outcomes. BioBrace offers advantages over other augmentation approaches and synthetic materials, providing improved remodeling, biologic integration, and increased mechanical strength. Feasibility and efficacy have been demonstrated in animal models and human applications. This technique presents a promising approach to enhance ACLR outcomes.

Anchor-Based Meniscal Ramp Repair.

Ramp lesions of the medial meniscus are underdiagnosed because of difficulty in visualizing via magnetic resonance imaging and during arthroscopy. They most often occur simultaneously with anterior cruciate ligament (ACL) injury but may also be associated with posterior plateau contusions, steeper medial tibial plateau slope, and excess varus alignment. Upwards of 24% of ACL reconstructions have concomitant ramp lesions. Failure to repair the ramp lesion is associated with increased rotational laxity, tibial translocation, persistent pivot shift, and poorer outcomes after ACL reconstruction. The purpose of this article is to describe an all-suture anchor-based repair of a meniscal ramp lesion, which confers several advantages over traditional repair techniques.

The Influence of Psychosocial Factors on Patients Undergoing Anterior Cruciate Ligament Reconstruction.

CONTEXT: Anterior cruciate ligament (ACL) injuries greatly impact patients in terms of future performance, reduced physical activity and athletic participation, and overall economic burden. Decades of research have investigated how to improve ACL reconstruction (ACLR) outcomes. Recently, there has been growing interest to understand the effects of psychosocial factors on patient outcomes. STUDY DESIGN: Clinical review. EVIDENCE ACQUISITION: A search of the PubMed database was performed in March 2023. Articles were reviewed by at least 2 authors to determine relevance. We highlighted publications of the past 5 years while incorporating previous pertinent studies. LEVEL OF EVIDENCE: Level 5. RESULTS: There is no standardization of psychosocial factors regarding ACLR. As such, there is a lack of consensus regarding which psychosocial measures to use and when. There is a need for clarification of the complex relationship between psychosocial factors and physical function. Despite this, psychosocial factors have the potential to help predict patients who are more likely to return to sport: (1) desire/motivation to return; (2) lower levels of kinesiophobia; (3) higher levels of self-efficacy, confidence, and subjective knee function; (4) risk acceptance; and (5) social support. However, there are no standardized interventions to improve psychosocial factors after ACLR. CONCLUSION: Psychosocial factors affect outcomes after ACLR. However, the interplay between psychosocial factors and physical function is complex. There is emerging evidence that testing and interventions may improve ACLR outcomes. There is a lack of standardized interventions to determine or improve psychosocial factors after ACLR. Further research is needed to identify psychosocial factors and to develop standardized interventions for clinicians to implement to improve clinical outcomes.

Repair of a Radial Tear of the Meniscus Augmented With a Biocomposite Scaffold.

Meniscal tears are a common musculoskeletal pathology in the United States, affecting 61 in every 100,000 people. Surgical repair is indicated for certain tear patterns to reduce the risk of joint degeneration, normalize contact forces in the knee, and help restore normal knee kinematics. However, radial meniscus tear repairs fail to completely heal 38% of the time due to tear characteristics, biology, surgical technique, and inadequate rehabilitation. Recent efforts have incorporated biological augmentation to enhance the healing potential of the meniscus. The BioBrace is a biocomposite scaffold designed to mechanically reinforce tissue and biologically enhance healing. The purpose of this article is to describe an all-inside, meniscal radial tear repair augmented with BioBrace.

Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft: Surgical Technique Using Augmentation With a Biocomposite Scaffold.

Anterior cruciate ligament (ACL) reconstruction augmentation continues to be widely studied. Both biologic and synthetic augments have been employed to enhance ACL healing and provide early protection. The BioBrace is a biocomposite scaffold that both mechanically reinforces the graft while biologically enhancing graft healing. The purpose of this article is to describe augmentation of an ACL reconstruction with BioBrace.

Change in craving and frequency of consuming palatable foods for non-homeostatic motives after a gut-cued eating intervention.

INTRODUCTION: Little is known regarding consumption of palatable foods (PFs) for non-homeostatic reasons after weight-loss interventions and if baseline or change in frequency of this kind of eating can predict weight-loss outcomes. Little is also known of the relationship between PF eating for non-homeostatic motives and PF craving. Addressing these gaps is important because cravings and habitual consumption of PFs in the absence of homeostatic need contribute to obesity. METHODS: N = 30 adults with a mean 34.8 BMI completed a seven-response choice version of the PEMS (PEMS-7) before and after Gut-Cued Eating (GCE), an intervention that did not ban PFs but instructed them to eat only when stomach-hungry and stop eating before feeling too full. Photos of PFs were also rated pre- and post-GCE. RESULTS: Frequency of eating PFs for social, reward enhancement, and coping, but not conformity motives, decreased after GCE. The decreases predicted amount of weight loss independent of initial weight and demographics. PF craving also decreased and, while correlated with decreasing PF intake, it did not predict weight loss. DISCUSSION: The study is preliminary because GCE was uncontrolled. However, results warrant a controlled investigation. That craving and frequency of consuming PFs for non-homeostatic motives declined with an intervention that did not ban PFs suggests a method that may voluntarily decrease one's intake of PFs. This should facilitate weight-loss and healthy-weight maintenance. Finally, decreased eating for non-homeostatic motives suggests that individuals were no longer using PFs to cope, socialize, and enhance reward, a change with benefits beyond weight loss.