Risk Factors Associated With Poor Outcomes After Quadriceps Tendon Repair.

Background: Ruptures of the quadriceps tendon present most frequently in older adults and individuals with underlying medical conditions. Purpose: To examine the relationship between patient-specific factors and tear characteristics with outcomes after quadriceps tendon repair. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review was conducted on all patients who underwent quadriceps tendon repair between January 1, 2016, and January 1, 2021, at a single institution. Patients <18 years and those with chronic quadriceps tendon tears (>6 weeks to surgery) were excluded. Information was collected regarding patient characteristics, presenting symptoms, tear characteristics, physical examination findings, and postoperative outcomes. Poor outcome was defined as a need for revision surgery, complications, postoperative range of motion of (ROM) <110° of knee flexion, and extensor lag of >5°. Results: A total of 191 patients met the inclusion criteria. Patients were aged 58.5 ± 13.2 years at the time of surgery, were predominantly men (90.6%), and had a mean body mass index (BMI) of 32.2 ± 6.3 kg/m2. Patients underwent repair with either suture anchors (15.2%) or transosseous tunnels (84.8%). Postoperatively, 18.5% of patients experienced knee flexion ROM of <110°, 11.3% experienced extensor lag of >5°, 8.5% had complications, and 3.2% underwent revision. Increasing age (odds ratio [OR], 1.03 [95% CI, 1.004-1.07]) and female sex (OR, 3.82 [95% CI, 1.25-11.28]) were significantly associated with postoperative knee flexion of <110°, and increasing age (OR, 1.08 [95% CI, 1.04-1.14]) and greater BMI (OR, 1.14 [95% CI, 1.05-1.23]) were significantly associated with postoperative extensor lag of >5°. Current smoking status (OR, 15.44 [95% CI, 3.97-65.90]) and concomitant retinacular tears (OR, 9.62 (95% CI, 1.67-184.14]) were associated with postoperative complications, and increasing age (OR, 1.05 [95% CI, 1.02-1.08]) and greater BMI (OR, 1.08 [95% CI, 1.02-1.14]) were associated with risk of acquiring any poor outcome criteria. Conclusion: Patient-specific characteristics-such as increasing age, greater BMI, female sex, retinacular involvement, and current smoking status-were found to be risk factors for poor outcomes after quadriceps tendon repair. Further studies are needed to identify potentially modifiable risk factors that can be used to set patient expectations and improve outcomes.

Return to recreational sports participation following rotator cuff repair in adults over 40 Years of age: outcomes and return to play analysis.

Background: Despite the high prevalence of rotator cuff (RTC) tears in older adults, there is limited literature evaluating the return to recreational sport after repair. The purpose of this study was (1) to assess the patient-reported outcomes and return to sport rates following rotator cuff repair in patients aged more than 40 years with minimum 2-year follow-up; (2) to compare baseline, preoperative and postoperative outcomes, and level of play following repair of self-reported athletes with nonathletes; and (3) to compare return to sport rates in overhead athletes compared to nonoverhead athletes. Methods: Patients undergoing arthroscopic rotator cuff repair between January 2016 and January 2019 were screened for inclusion. Inclusion criteria included (1) age more than 40 years at the time of surgery, (2) arthroscopic repair of a full thickness RTC tear, and (3) preoperative American Shoulder and Elbow Surgeons score (ASES) available. Eligible patients were contacted and invited to fill out a custom return to sport and patient-reported outcome survey. Results: Overall, 375 of the 1141 eligible patients completed the survey instrument. There were 210 self-reported athletes (mean age 59.2 ± 9.55 years) and 165 nonathletes (mean age 62.0 ± 8.27 years) (P = .003). Of the athletes, 193 (91.9%) returned to sport. The average age of athletes was 59.4 ± 9.33 years for those who returned to sport and 57.9 ± 12.0 years for those who did not (P = .631). Athletes reported higher ASES scores than nonathletes both preoperatively (49.8 ± 20.3 vs. 44.8 ± 18.9, P = .015) and postoperatively (87.6 ± 16.7 vs. 84.9 ± 17.5, P = .036), but there was no difference in mean ASES improvement between groups (37.7 ± 23.0 vs. 40.3 ± 24.5, P = .307). There was no difference in postoperative Single Assessment Numeric Evaluation scores when comparing self-reported athletes to nonathletes (85.4 ± 17.5 vs. 85.0 ± 18.7, P = .836). After controlling for age, sex, body mass index, and smoking status using a multivariate analysis, there was no difference in mean ASES improvement when comparing athletes to nonathletes. Conclusion: There is a high rate of return to sport activities (> 90%) in older adult recreational athletes following arthroscopic repair of full thickness RTC tears and rates of return to sport did not significantly differ for overhead and nonoverhead athletes. Self-reported athletes were noted to have higher baseline, preoperative, and postoperative ASES scores than nonathletes, but the mean ASES improvement following repair did not significantly differ between groups.

Rates of Reporting and Analyzing Patient Sex in Sports Medicine Research: A Systematic Review.

BACKGROUND: Sex differences in sports medicine are well documented. However, no studies to date have reviewed the rate at which sex is reported and analyzed in the athlete-specific orthopaedic sports medicine literature. PURPOSE: To determine the rates of reporting and analyzing patient sex in athlete-specific sports medicine literature. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: Articles published by the 3 journals of the AOSSM (American Journal of Sports Medicine [AJSM], Orthopaedic Journal of Sports Medicine, and Sports Health: A Multidisciplinary Approach) between 2017 and 2021 were considered for inclusion. Original sports medicine research studies that isolated athletes were included. Studies that isolated sports that are predominantly single sex at the college and/or professional levels (football, baseball, softball, and wrestling) were excluded. RESULTS: Of the 5140 publications screened, 559 met the inclusion criteria. In total, 93.9% of all studies reported patient sex, and 34.7% of all studies analyzed patient sex. However, 143 studies only included males and 50 studies only included females (n = 193). When excluding these single-sex studies, analysis of the remaining 366 studies found that the rate of sex-specific analysis increased to 53.0%. Rates of reporting patient sex did not significantly differ by journal or by year. Similarly, rates of analyzing patient sex did not differ by year, but Sports Health analyzed sex the most frequently, and AJSM analyzed sex the least frequently (P = .002). Studies that isolated college (84.1%), youth (66.7%), or recreational (52.6%) athletes analyzed sex at or above the overall rate of 53.0%, but studies of elite athletes (35.7%) tended to analyze sex less frequently. CONCLUSION: Patient sex is well reported in the athlete-specific sports medicine literature (93.9% of included studies reported sex), demonstrating that most studies include sex as a demographic variable. However, patient sex was analyzed only in 53.0% of studies that included both male and female patients. Given that athlete-specific sex differences are known to exist within the field of sports medicine, many studies that could benefit from using patient sex as a variable for analysis likely fail to do so.

Inequalities in the Evaluation of Male Versus Female Athletes in Sports Medicine Research: A Systematic Review.

BACKGROUND: Female sports participation continues to rise; however, inequalities between male and female athletes still exist in many areas and may extend into medical research. PURPOSE: The purpose of this study was to (1) compare the number of published studies evaluating male versus female athletes in various sports and (2) identify which co-ed sports currently underrepresent female athletes in the sports medicine literature. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: All nonreview research studies published from 2017 to 2021 in 6 top sports medicine journals were considered for inclusion. Sports medicine studies were included that isolated athletes, reported study outcomes specific to male and/or female patients, provided study outcomes for specific sports, and evaluated ≤3 different sports. The total number of studies reporting on male and/or female athletes were compared for all sports, and odds ratios (ORs) were calculated. Comparisons of study design, level of sports participation, outcomes assessed, and study quality were also made according to participant sex. RESULTS: Overall, 669 studies were included the systematic review. Most studies isolated male athletes (70.7%), while 8.8% isolated female athletes and 20.5% included male and female athletes. Female athletes were more frequently studied in softball and volleyball, while male athletes were more commonly researched in baseball, soccer, American football, basketball, rugby, hockey, and Australian football. Notably, male athletes were largely favored in baseball/softball (91% vs 5%; OR = 18.2), rugby (72% vs 5%; OR = 14.4), soccer (65% vs 15%; OR = 4.3), and basketball (58% vs 18%; OR = 3.2). CONCLUSION: Sports medicine research has favored the evaluation of male athletes in most sports, including the majority of co-ed sports. Potential reasons for this inequality of research evaluation include availability of public data and database data, financial and promotional incentives, a high percentage of male sports medicine clinicians and researchers, and sex biases in sport. While the causes of these differences are multifaceted, researchers should consider both sexes for study inclusion whenever possible, and journals should support a more balanced representation of research publications regarding male and female athletes.

The predictive value of 18 and 22 week uterine artery Doppler in patients with low first trimester maternal serum PAPP-A.

OBJECTIVE: To determine if the addition of uterine artery (UA) Doppler pulsatility index (PI) at 18 and 22 weeks of gestation improves the predictive accuracy of low first trimester pregnancy associated plasma protein A (PAPP-A) in the detection of adverse obstetrical outcomes. METHODS: This was a prospective interventional study. All women undergoing first trimester combined screening (FTS) at a single center, with a low maternal serum PAPP-A level (<0.4 MoM), were included. Patients underwent bilateral UA Doppler assessments at 18 and 22 weeks of gestation. A positive test was defined as a mean PI > 1.45. Primary outcomes were obtained from chart review, and logistic regression analysis was used to compare outcomes with positive and negative tests. Positive and negative predictive value, specificity and sensitivity were calculated. RESULTS: Between January and October 2007, 5359 women completed FTS. Among the low PAPP-A group (n = 289), 18 week UA Doppler was a significant predictor of low birth weight (OR = 2.28, p = 0.04) while 22 week UA Doppler significantly predicted preterm birth (OR = 12.6, p = 0.001), small for gestational age (OR = 8.24, p = 0.001) and low birth weight (OR = 2.28, p = 0.04). Test characteristics suggested improved positive and negative predictive value for Doppler at 22 versus 18 weeks for these outcomes. CONCLUSIONS: UA Doppler at 22 weeks is a useful adjunct in patients with low PAPP-A. However, a negative Doppler does not rule out all adverse outcomes and clinical judgment is advised in the management of these patients.