Orthopaedic Sports Medicine Randomized Controlled Trials Infrequently Report on the Social Determinants of Health Factors of Their Patient Cohorts.

PURPOSE: To describe the prevalence of randomized controlled trials (RCTs) in orthopaedic sports medicine-related journals reporting on the social determinants of health (SDOH) of their patient cohorts, including factors receiving less attention, such as education level, employment status, insurance status, and socioeconomic status. METHODS: The PubMed/MEDLINE database was used to search for RCTs between 2020 and 2022 from 3 high-impact orthopaedic sports medicine-related journals: American Journal of Sports Medicine, Arthroscopy, and Journal of Shoulder and Elbow Surgery. The following information was extracted from each article: age, sex/gender, body mass index, year published, corresponding author country, and self-reported SDOH factors (race, ethnicity, education level, employment status, insurance status, and socioeconomic status). RESULTS: A total of 189 articles were analyzed. Articles originated from 34 different countries, with the United States (n = 66) producing the greatest number of articles. Overall, age (n = 186; 98.4%) and sex/gender (n = 184; 97.4%) were the factors most commonly reported, followed by body mass index (n = 112; 59.3%), race (n = 17; 9.0%), ethnicity (n = 10; 5.3%), employment status (n = 9; 4.8%), insurance status (n = 7; 3.7%), and education level (n = 5; 2.6%). Socioeconomic status was not reported in any of the articles analyzed. Articles from the United States report on SDOH factors more frequently than international articles, most notably race (24.2% vs 0.8%, respectively) and ethnicity (15.2% and 0%, respectively). CONCLUSIONS: RCTs from 3 high-impact orthopaedic sports medicine journals infrequently report on SDOH. CLINICAL RELEVANCE: Better understanding patient SDOH factors in RCTs is important to help orthopaedic surgeons and other practitioners best apply study results to their patients, as well as help researchers and our field ensure that research is being done transparently with relevance to as many patients as possible.

Assessment of Video Quality and Reliability of YouTube Videos Regarding Meniscus Tear Rehabilitation.

INTRODUCTION: YouTube is an open-source platform where creators can record and upload videos for others to see. As the popularity of YouTube increases, it is being increasingly used for healthcare-related information. However, with the relative ease of uploading videos, the content quality of individual videos is not regulated. This study aimed to assess and analyze the content quality of YouTube videos concerning meniscus tear rehabilitation. We hypothesized that most videos would be of low quality. METHODS: The keywords "meniscus tear treatment," "meniscus tear recovery," "meniscus tear physical therapy," and "meniscus tear rehabilitation" were used for searching videos on YouTube. A total of 50 videos was analyzed in this study that related to meniscal rehabilitation, grouped into one of four categories: non-physician professionals (physical therapists and chiropractors) (n=28), physicians (with or without academic affiliation) (n=5), non-academic healthcare-related websites (n=10), and non-professional individuals (n=7). Videos were then assessed by two independent authors using three scoring systems, which included the Global Quality Scale (GQS), modified DISCERN, and Journal of the American Medical Association (JAMA) scores. The number of likes, comments, video length, and views were collected for each video. Kruskal-Wallis tests were used to compare quality scores and video analytics. RESULTS: The overall median GQS, modified DISCERN, and JAMA scores were 3 (interquartile range (IQR): 2-3), 2 (IQR: 2-2), and 2 (IQR: 2-2), respectively. Sorted by GQS scores, 20 videos were of low quality (40%), 21 were intermediate (42%), and nine were of high quality (18%). Non-physician professionals produced 56% (28 of 50) of the videos assessed, with physical therapists constituting 86% (24 of 28) of this category. The median duration of each video was 6:54 (IQR: 3:59-10:50) minutes, views was 42,262 (IQR: 12,373-306,491), and likes was 877 (IQR: 239-4,850). Kruskal-Wallis testing showed a significant difference between JAMA scores, likes, and video length duration between video categories (p<0.028). CONCLUSION: The overall median reliability of YouTube videos on meniscus tear rehabilitation measured by JAMA and modified DISCERN scores was low. The overall median video quality, as assessed by GQS scores, was intermediate. Video quality was highly variable, with fewer than 20% meeting high-quality standards. As a result, patients are often viewing lower quality videos when researching their condition online.

Return to Play, Performance, and Economic Analysis of National Football League Players After Lisfranc Injury.

Background: A Lisfranc injury can occur to either the ligament or bone, which causes instability when attempting to perform strength and balance maneuvers. Purpose/Hypothesis: The study's aims were to (1) analyze the return-to-play (RTP) rate and performance level of players in the National Football League (NFL) after Lisfranc injury and (2) determine the economic and financial impact of Lisfranc injuries to the NFL. We hypothesized that there would be a low RTP rate following Lisfranc injury in the NFL. Study Design: Case series; Level of evidence, 4. Methods: Multiple online public records were used to identify NFL players with Lisfranc injuries between the 2009 and 2020 seasons. Players were assessed according to their RTP statistics: snap count, approximate value (AV), games played, and games started. Nonparametric methods were used to compare player statistics before and after injury. Also, player salaries while injured were calculated (in 2022 US dollars after adjusting for inflation) to approximate economic loss for those players who returned to play. Results: A total of 33 NFL athletes sustained a Lisfranc injury during the study period. Most Lisfranc injuries were experienced by offensive linemen (n = 8; 24.2%), followed by running backs (n = 7; 21.2%). Overall 27 players (81.8%) returned to play after injury at a median of 11.0 months (IQR, 10.2-11.8 months). There were no significant differences between pre- and postinjury snap counts or number of games played and started. In terms of player performance, there was a statistically significant decrease in AV at 1 year postinjury (median [IQR], 6.0 [4.0-10.0] preinjury vs 5.0 [2.5-7.5] postinjury; P = .022). The overall cost of recovery amounted to $104.7 million, with quarterbacks (n = 4) accounting for the greatest cost at $32.6 million. The next 2 most expensive positions were offensive and defensive linemen (n = 5 each) at $19.4 million each. Conclusion: Our results did not support the hypothesis, as the RTP rate for NFL athletes sustaining Lisfranc injuries was 81.8%. This injury was associated with a significant decrease in AV 1 year postinjury. In terms of economic impact, quarterbacks accounted for almost one-third of expenses while constituting only 14.8% of injuries.

Mood Disorders Are Associated with Increased Perioperative Opioid Usage and Health Care Costs in Patients Undergoing Knee Cartilage Restoration Procedure.

OBJECTIVE: To identify the prevalence of mood disorder diagnoses in patients undergoing cartilage transplantation procedures and determine the relationship between mood disorders, opioid usage, and postoperative health care costs. DESIGN: Patients with current procedural terminology (CPT) codes for osteochondral autograft transplantation (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI) were identified in the Truven Health Marketscan database (January 2009-September 2014). Patients were grouped based on having a preoperative mood disorder diagnosis (preMDD). Preoperative opioids, postoperative opioids ≥90 days, and health care costs within the year postoperative were compared for those with and without mood disorders. Costs were analyzed, adjusting for preoperative cost, sex, age, and opioid usage, for those with and without mood disorders. RESULTS: A total of 3,682 patients were analyzed (ACI: 690, OAT: 1,294, OCA: 1,698). A quarter of patients had preMDD (ACI: 25.4%, OAT: 20.6%, OCA: 22.7%). Postoperative opioid use was more prevalent in preMDD patients (OAT: 37.1% vs. 24.1%, P < 0.001; OCA: 30.4% vs. 24.8%, P = 0.032; ACI: 33.7% vs. 26.2%, P = 0.070) (odds ratio [OR] ranged from 1.29 to 1.86). First-year postoperative log-transformed costs were significantly greater for preMDD patients (ACI: $7,733 vs. $5,689*, P = 0.012; OAT: $5,221 vs. $3,823*, P < 0.001; OCA: $6,973 vs. $3,992*, P < 0.001; *medians reported). The estimated adjusted first postoperative year cost increase for preMDD OCA patients was 41.7% (P < 0.001) and 28.0% for OAT patients (P = 0.034). There was no statistical difference for ACI patients (P = 0.654). CONCLUSION: Cartilage transplantation patients have a high prevalence of preoperative mood disorders. Opioid use and health care costs were significantly greater for patients with preoperative mood disorder diagnoses. LEVEL OF EVIDENCE: Level III, retrospective therapeutic study.