Variability in Patient-Incurred Costs and Protocols of Regenerative Medicine Procedures for Musculoskeletal Conditions in the United States.

Background: The use of regenerative medicine as an "off label" treatment for musculoskeletal conditions has increased in recent years. However, the literature is sparse regarding the costs of these treatments to patients. Purposes: We sought to determine the patient-incurred costs for regenerative medicine treatments performed by physicians for musculoskeletal conditions in the United States, according to primary specialty, geographic region, practice setting, and years in practice. We also sought to characterize pre- and posttreatment protocols and image guidance use. Methods: We performed a cross-sectional study with data collection occurring between April 2020 and April 2021. It began with the distribution of an online survey through an email campaign by the American College of Sports Medicine to its members. Approximately 90 emails were sent by our research team as well. Throughout the year, various participant recruitment methods were used (through Twitter, for example). Survey data included physician demographics, practice/training information, types/costs of regenerative medicine treatments performed, and pre-/postprocedure protocols. Results: One hundred physicians who self-reported performing standalone regenerative medicine procedures participated in this online survey. According to the responses, the most common treatments performed were platelet-rich plasma (PRP; 100%), bone marrow concentrate (BMC; 41%), microfragmented adipose grafting (36%), prolotherapy (33%), and bone marrow aspirate (BMA; 21%) administered to the peripheral joints, tendons/muscles, ligaments, and/or spine. Overall, the respondents reported large variations in treatment costs to patients; BMA and BMC were the most expensive and had the largest ranges in costs for all anatomical locations. Costs for PRP were lower than those for BMA and BMC, with less variation. Physicians in private practice reported higher PRP, BMC, and BMA costs in the peripheral joints than those in academic settings. Most physicians recommended avoiding non-steroidal anti-inflammatory drugs pre- and postprocedure, and 74% recommended physical therapy postprocedure. Conclusions: Findings from a survey of physicians who provide regenerative medicine procedures as off-label treatment for musculoskeletal conditions suggest that there is variation in related patient-incurred costs. Future studies should explore associations between treatment costs and outcomes.

The Epidemiology, Risk Factors, and Nonsurgical Treatment of Injuries Related to Endurance Running.

ABSTRACT: Running is a popular form of exercise that is easily accessible to various populations; endurance running, defined as distances beyond 5 km, continues to grow within the sport. Endurance running-related injuries are common in the lower extremities and are primarily overuse related. A multitude of risk factors for injury exist, including extrinsic factors, such as running distance and frequency, and intrinsic factors, such as biomechanics and nutrition status. Training and rehabilitation techniques vary with a general focus on strengthening and gradual increase in activity, but evidence is mixed, and it is difficult to generalize programs across different running populations. Management of specific running groups, including youth runners, is an area in which additional research is needed. New treatments, such as orthobiologics and wearable technology, have promising potential to optimize performance and recovery and minimize injury. However, they need to be further evaluated with high-quality studies.

Injury rate and pattern among Brazilian jiu-jitsu practitioners: A survey study.

OBJECTIVE: To determine the 6-month incidence rate and pattern of Brazilian jiu-jitsu (BJJ)-related injuries and characterize associations between injuries and experience level, demographic factors, and training variables. DESIGN: Descriptive epidemiology study. SETTING: Online survey. PARTICIPANTS: 1287 adult BJJ practitioners. OUTCOME MEASURES: 6-month BJJ-related injury incidence, anatomical pattern of injuries, and injury-associated demographic and training variable identification. RESULTS: 59.2% of practitioners reported at least one injury over 6 months. The knee was the most common site. Logistic regression analysis demonstrated 6-month injury incidence was negatively associated with years of training and body weight, and positively associated with training days per week and instructor status. More experienced athletes were more likely to report low back injury, while less experienced athletes more frequently reported head, upper extremity, and elbow injuries. None of the following variables were predictive of injury risk: gi preference, instruction on break-falling, and participation in a structured beginner's program. CONCLUSIONS: The risk factor analysis is applicable to BJJ instructors interested in reducing student injury risk. The widespread pattern of injuries and the distinction between types of injuries sustained at different levels of experience are notable findings that sports medicine practitioners should keep in mind when working with BJJ athletes.

Resident Education of Ultrasound-Guided Procedures: A Homemade Practice Model Pilot Study.

The aim of this study was to evaluate an agar model that could be used to train physicians to perform ultrasound-guided procedures. Eleven (N = 11) physical medicine and rehabilitation residents volunteered to be subjects. All subjects completed a questionnaire about their experience and comfort with ultrasound-guided procedures. In phase 1, subjects were instructed to identify specific structures and perform specific procedures on the agar models; these tasks were timed. All subjects were then given a short lecture on fundamentals of ultrasound-guided procedures and percutaneous needle tenotomy. In phase 2, subjects then performed the same tasks again on the agar model and completed the questionnaire again. Analysis was performed using paired t tests. The number of structures successfully identified significantly increased from phase 1 (mean = 1.45) to phase 2 (mean = 2.54) (P = 0.003). Time to complete the needle access task in phase 2 (mean = 258 secs) significantly decreased compared with phase 1 (mean = 394 secs) (P = 0.04). Subjectively, our participants reported that they felt more comfortable performing ultrasound-guided procedures (P = 0.005) and felt more familiar with percutaneous needle tenotomy (P = 0.00004) after using the model. In conclusion, residents demonstrated improvement in ultrasound-guided procedural skills and reported increased comfort performing these procedures after training on the agar model.