Masking Adherence in K-12 Schools and SARS-CoV-2 Secondary Transmission.

OBJECTIVES: Masking is an essential coronavirus 2019 mitigation tool assisting in the safe return of kindergarten through 12th grade children and staff to in-person instruction; however, masking adherence, compliance evaluation methods, and potential consequences of surveillance are currently unknown. We describe 2 school districts' approaches to promote in-school masking and the consequent impact on severe acute respiratory syndrome coronavirus 2 secondary transmission. METHODS: Two North Carolina school districts developed surveillance programs with daily versus weekly interventions to monitor in-school masking adherence. Safety teams recorded the proportion of students and staff appropriately wearing masks and provided real-time education after observation of improper masking. Primary infections, within-school transmission, and county-level severe acute respiratory syndrome coronavirus 2 infection rates were assessed. RESULTS: Proper mask use was high in both intervention groups and districts. There were variations by grade level, with lower rates in elementary schools, and proper adherence being higher in the weekly surveillance group. Rates of secondary transmission were low in both districts with surveillance programs, regardless of intervention frequency. CONCLUSIONS: Masking surveillance interventions are effective at ensuring appropriate masking at all school levels. Creating a culture of safety within schools led by local leadership is important and a feasible opportunity for school districts with return to in-person school. In our study of schools with high masking adherence, secondary transmission was low.

Clinical outcome at a minimum of five years after reconstruction of the anterior cruciate ligament.

BACKGROUND: We are not aware of any previous studies in which independent measurements of function with validated outcome questionnaires such as the Knee Injury and Osteoarthritis Outcome Score and the International Knee Documentation Committee score were evaluated five years after reconstruction of the anterior cruciate ligament. We hypothesized that patient demographics, mechanism of injury, and intra-articular injuries and their treatment are factors associated with function five years after reconstruction of the anterior cruciate ligament. METHODS: A consecutive series of unilateral, arthroscopically assisted primary reconstructions of the anterior cruciate ligament performed by one surgeon using a patellar tendon graft was evaluated. Data on patient demographics, injury variables, and intra-articular lesions noted at the time of surgery were collected prospectively. Multivariable regression analysis was used to identify independent predictors of outcomes as measured with five questionnaires. RESULTS: Sixty-nine percent (217) of 314 knees with a reconstruction of the anterior cruciate ligament were followed for an average of 5.4 years. The average age at the time of the operation was twenty-seven years. Independent predictors of a worse outcome, which was measured with the overall Knee Injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee score, the Lysholm score, and the Western Ontario and McMaster Universities Osteoarthritis Index score, included the patient's recollection of hearing or feeling a pop at the time of the injury, a weight gain of >15 lb (6.8 kg), and no change in educational level since the surgery. There was a lack of association between the outcome and either the occurrence or the form of treatment of a meniscal tear or chondromalacia of the articular cartilage. CONCLUSIONS: To our knowledge, we performed the first prospective cohort study to evaluate the prognosis following reconstruction of the anterior cruciate ligament by identifying significant associations between multiple variables and clinical outcomes as measured with validated questionnaires. The clinician can counsel patients about the intermediate-term functional outcomes of reconstructions of the anterior cruciate ligament on the basis of these findings. Suggestions regarding weight control and future education may improve intermediate-term outcomes.

Cryotherapy decreases intraarticular temperature after ACL reconstruction.

Cryotherapy has been shown to decrease intraarticular temperature in all regions of the knee after arthroscopy. The purpose of our study was to determine if similar declines in intraarticular temperature were seen with the use of cryotherapy after anterior cruciate ligament reconstruction, a procedure which, unlike simple arthroscopy, produces postoperative hemarthrosis. Sixteen patients had intraarticular temperatures measured for 2 hours after anterior cruciate ligament reconstruction with cryotherapy instituted for only 1 of the 2 hours (eight patients for the first hour and eight patients for the second hour). Significant declines were seen in the suprapatellar pouch after either hour (-2.7 degrees C in Group 1, -2.7 degrees C in Group 2) but not in the lateral gutter. The difference between cryotherapy versus no cryotherapy in the first hour in the suprapatellar pouch was 6.0 degrees C, a clinically meaningful temperature difference. We hypothesize the swelling and hemarthrosis was more pronounced in the lateral gutter because of its dependent position and therefore blunted the effect of cryotherapy seen in the lateral gutter. Cooling of the intraarticular temperature should be considered in the clinical benefits of cryotherapy.

Intra-articular knee temperature changes: ice versus cryotherapy device.

BACKGROUND: Cryotherapy is commonly applied without research documenting the intra-articular (IA) temperature changes or subject discomfort between ice and a cryotherapy device. HYPOTHESIS: The null hypothesis is that no difference would be observed in IA temperature decline or subject tolerance between ice and the cryotherapy device in normal knees. STUDY DESIGN: Prospective, within-subject controlled clinical trial. METHODS: Twelve subjects had IA temperature in suprapatellar pouch and skin recorded bilaterally after application of cryotherapy versus ice. Subject tolerance was recorded by 10-cm visual analog scale (VAS). Statistical evaluation was by Spearman's correlation analysis and paired, nonparametric Wilcoxon's signed rank test. RESULTS: Both significantly lowered (P < 0.001) skin and IA temperature with median decreases (ice/cryotherapy) at 30 (3.3 degrees C/2.2 degrees C), 60 (12.8 degrees C/7.1 degrees C), and 90 (15.2 degrees C/9.7 degrees C) minutes. However, ice lowered the IA temperature significantly more than the cryotherapy device (P < 0.001) and was more painful by VAS at 30 and 60 minutes (P < 0.01). CONCLUSIONS: Both methods produced large declines in skin and IA temperatures. However, ice was more effective yet resulted in higher pain scores. The authors hypothesize that IA temperatures below a threshold are associated with increased perceived pain.

Prospective comparison of arthroscopic medial meniscal repair technique: inside-out suture versus entirely arthroscopic arrows.

BACKGROUND: Medial meniscal repairs are commonly performed with inside-out sutures and entirely arthroscopic with arrows, but few comparative evaluations on failures have been performed. HYPOTHESIS: No differences in failure rates exist between medial meniscal repairs performed with inside-out suture or entirely arthroscopic at the time of anterior cruciate ligament reconstruction. STUDY DESIGN: Prospective cohort study. MATERIALS: A single surgeon performed 47 consecutive inside-out suture repairs from August 1991 to June 1996 and 98 consecutive entirely arthroscopic repairs with arrows from June 1996 to December 1999. All data were derived from a prospective database and rehabilitation was held constant (nonweightbearing 5 weeks). Clinical success was defined as no reoperation for failed medial meniscal repair. Statistical evaluation was by Kaplan-Meier curves and Cox proportional hazards model. RESULTS: The inside-out suture group had 85% follow-up (40 of 47) with a median 68 months and the entirely arthroscopic group had 87% follow-up (85 of 98) with a median 27 months. There were seven failures in each group. Both Kaplan-Meier curves and the Cox proportional hazards model showed no difference in time to reoperation between techniques (P = 0.85). Three-year success rates (proportions with no reoperations) were 88% for sutures versus 89% for arrows. CONCLUSIONS: Repairs of the longitudinal posterior horn of the medial meniscus during an anterior cruciate ligament reconstruction with nonweightbearing for 5 weeks can be performed with an equivalent high degree of clinical success for both repair techniques.

Intraarticular injuries associated with anterior cruciate ligament tear: findings at ligament reconstruction in high school and recreational athletes. An analysis of sex-based differences.

BACKGROUND: Despite research on the increased risk of anterior cruciate ligament tears in female athletes, few studies have addressed sex differences in the incidence of associated intraarticular injuries. HYPOTHESIS: When patients are stratified by sport and competition level, no sex differences exist in either the mechanism of injury or pattern of intraarticular injuries observed at anterior cruciate ligament reconstruction. STUDY DESIGN: Prospective cohort study. METHODS: Two hundred twenty-one athletes undergoing anterior cruciate ligament reconstruction met our inclusion criteria of anterior cruciate ligament tear as a singular event without reinjury or history of prior injury or surgery in either knee. Data were collected on competition level (high school, amateur), sport (basketball, soccer, skiing), mechanism of injury, articular cartilage injuries, and meniscal tears. Data were statistically analyzed by sex with the chi-square test and Student's t-test. RESULTS: High school athletes had no significant sex differences in mechanism of injury. Female soccer athletes had fewer medial meniscal tears than did male athletes, and female basketball players had fewer medial femoral condyle injuries. At the amateur level, female basketball players had more contact injuries, an earlier onset of swelling, and fewer lateral meniscal tears than did male players. CONCLUSION: At the high school level, male and female athletes shared a common mechanism of injury, and yet the female athletes had fewer intraarticular injuries in basketball and soccer. If such intraarticular injuries prove to be a significant risk factor for poor long-term outcome, women may enjoy a better prognosis after reconstruction.