International Survey of the AANA and AOSSM Membership Regarding Medrol Dosepak Use for Sports Injuries

Abstract

PURPOSE: There is little authoritative data to support/refute the use of Medrol Dosepaks as a treatment adjunct for routine sports injuries. Medrol Dosepaks (MDP) contain twenty-one 4mg tablets of methylprednisolone administered in a tapered fashion over a six-day course. The entire Arthroscopy Association of North America (AANA) and the American Orthopedic Society for Sports Medicine (AOSSM) international membership was surveyed to determine the prevalence of MDP use, assess its perceived efficacy, and identify the approximate frequency of complications. METHODS: A survey was mailed to the entire AANA and AOSSM international membership directory. Surveys were collected and the data was analyzed. RESULTS: Total response rate: 41% (1290/3167). US response rate: 43%. International response rate: 20% (44/261). Members who do prescribe MDP: 47% (603/1290). There was a wide distribution of the estimated total number of prescriptions and equal representation of doctors from all years in practice. 49% have prescribed MDP for >10 years. 83% prescribe MDP <50 times/year. 41% have prescribed MDP multiple times for an individual patient over a one-year interval. Post-injury pathology was the most common indication. Perceived efficacy: 82% improved function, 92% decreased pain, 70% improved motion, 52% accelerated return (mean 7 days, SD 4.5 days, range 0.5–30 days). The most common complication was glucose intolerance (37%); 8% have seen 101 total cases of osteonecrosis, predominantly the hip. Other complications cited: facial flushing: insomnia/sleep disturbance; shingles; weight gain; GI disturbance; hypertension; behavior disturbance. 75% have an age limit below which they will not prescribe MDP (mean 17y/o, SD 3 yrs, range 10–40 y/o). Members who do not prescribe MDP: 52% (672/1290). There was approximately equal representation from all years in practice. 96% provided explanations for not using MDP. Most important reasons in decreasing order: 30% fear of osteonecrosis; 27% fear of complications in general; 27% lack of proven efficacy; 4% stated fear of malpractice. Least important reasons in decreasing order: 61% fear of malpractice; 25% lack of proven efficacy; 17% fear of complications in general; 14% fear of osteonecrosis. 25% have seen 500 cases of osteonecrosis - mostly the hip. CONCLUSIONS: This survey provides a reflection of the collective experience of the AANA and AOSSM membership. The considerably high international response reflects wide reaching concern with Medrol Dosepak use as a treatment modality. Prospective studies are underway to investigate the complications seen.