Sports Medicine Patients Research Articles

Athletic Identity Associations in Young Sports Medicine Patients.

Few studies have assessed athletic identity levels in young patients. This study examined athletic identity in adolescents and explored associations between athletic identity, patterns of sport participation, and coping skills. Patients aged 12 to 18 years who received sports medicine care completed a one-time, voluntary, anonymous survey. Surveys included demographics, sport participation information, Athletic Identity Measurement Scale (AIMS), and Athletic Coping Skills Inventory (ACSI). Statistical analysis included Fisher exact test, Student t test, Wilcoxon rank sum test, Kruskal-Wallis test, and Pearson correlation. Three hundred thirty-four patients (mean ± SD age 15.0 ± 1.8 years, 64.7% girls) completed questionnaires. The mean AIMS and ACSI scores were 45.2 ± 11.5 and 50.2 ± 10.9, respectively. No notable differences were observed in AIMS scores between age groups or sexes. An increase in mean AIMS scores (higher athletic identity) was seen with greater weekly hours of sport participation (P < 0.001) and months per year of primary sport participation (P < 0.001). Multisport per season athletes had higher AIMS scores than single-sport athletes (48.2 ± 10.1 vs. 43.0 ± 11.9, P < 0.001). Team sport athletes reported higher athletic identities than individual sport athletes (47.0 ± 10.7, 41.4 ± 11.4, P < 0.001). Athletic Identity Measurement Scale scores positively correlated with ACSI scores (r = 0.31, P < 0.0001). Athletes with the highest athletic identity had markedly higher scores on ACSI subscales of Coachability, Concentration, Confidence and Achievement Motivation, Goal Setting and Mental Preparation, and Peaking Under Pressure than athletes with the least athletic identity. However, those with the highest athletic identities reported significantly lower scores on the ACSI Freedom From Worry subscale (P < 0.001). Athletic identity did not differ among adolescents by age or sex. Athletic identity was higher in team sport athletes and those with increased sport participation volumes. While high athletic identity was associated with higher scores on favorable coping skill dimensions, these athletes may also worry more, potentially placing them at greater psychological risk after injury.

Analyzing Resilience in the Orthopedic Sports Medicine Patient Population.

Little research has been done to compare resilience, as measured by the Brief Resilience Scale (BRS), across common sports medicine patient populations. Our purpose was to investigate resilience levels across sports medicine patient populations. All patients who underwent reconstruction of the anterior cruciate ligament (ACLR), partial meniscectomy (PM), meniscal repair (MR), rotator cuff repair (RCR), or shoulder stabilization (SS) between January 1 and June 30, 2020, were screened for inclusion. At our institution, BRS scores are routinely collected during the preoperative period. Patients with preoperative BRS scores available were included for analysis. Patients who were eligible on the basis of ACLR who underwent concomitant PM or MR were included in the ACL group. A total of 655 patients with a median age of 49 years were included in analysis. The median preoperative resilience score across all patients was 3.83 (interquartile range, 3.50-4.17), and the highest scores were seen in the ACLR group (median, 4.00; interquartile range, 3.67-4.17). On multivariate regression, scores were significantly and independently lower in the PM and RCR groups. Male patients were found to have significantly higher scores than female patients overall (P=.028), but in subgroup analysis by pathology, this effect was only seen in the SS and PM groups. Psychological factors are important to consider when surgically treating patients, and resilience specifically may play a role in predicting treatment success. Patients undergoing PM and RCR tend to report lower resilience scores than patients undergoing ACLR at preoperative baseline. [Orthopedics. 2024;47(2):95-100.].

Poster 374: Patient knowledge of and willingness to pay for platelet-rich plasma injections: A prospective survey study on orthopedic sports medicine patients

Objectives: The efficacy of platelet-rich plasma (PRP) injections for sports-related injuries is a hotly- debated topic. PRP is a cash-pay procedure that is not covered by insurance, and it is actively advertised for a number of different indications, some without supporting evidence. Yet, an increasing number of patients are asking their physicians for PRP injections. The aim of this study is to better understand patients’ knowledge of PRP and willingness to pay out of pocket. Methods: This ongoing Institutional Review Board-approved prospective study included patients presenting with a new chief complaint at a sports medicine orthopedic office in a large urban academic health system. Patients completed an anonymous survey prior to evaluation by an orthopedic surgeon. The survey collected demographic information, clinical information, knowledge of PRP, willingness to pay for PRP based on expected percentage pain reduction, and motivators behind willingness to pay. Two cohorts included: 1) patients who had heard of PRP and 2) patients who had not. The latter group was given a short educational excerpt on PRP. Two-tailed Mann-Whitney U and Kruskal-Wallis tests evaluated pain scores and willingness to pay for PRP between the cohorts. Spearman rank correlation tests evaluated correlations between household income and willingness to pay. Results: To date, we have enrolled 32 patients of which 37.5% had previous orthopedic surgery, 43.75% had seen another medical provider for their current symptoms and 37.5% had previously heard of PRP. Patients who had heard of PRP (versus those that had not) reported lower median pain scores (median 4.75 versus 5.0 out of 10), the same hindrance of daily activities (median 3.0 out of 5), and longer duration of symptoms (median 5.0 months versus 1.0 month), although not statistically significant. Patients were willing to pay more for a greater anticipated reduction in pain: median of $50, $250, and $500 for 25%, 50% and 100% reduction in pain, respectively (Table 1) (p&lt;0.05). Patients who had heard of PRP were willing to pay more for PRP (median $500 versus $200; Table 1); this was not statistically significant. There was no correlation between patients’ income and willingness to pay. Finally, regarding willingness to pay for a given percent reduction in pain, patients reported their top three motivators to be symptoms affecting their day-to-day life, desire to try non-surgical interventions, and desire to return to normal activity (Table 1). For patients who had not heard of PRP, after being informed of PRP these patients reported physician trust as the greatest motivator behind their willingness to pay (Table 1). Conclusions: This ongoing study demonstrates the correlation between willingness to pay and perceived effectiveness of PRP while also noting motivators to pay. Moreover, we were also able to demonstrate some differences between patients who had heard of PRP versus those that had not. These data may be further refined with ongoing enrollment and will provide important insights into patients’ knowledge and how this impacts decision-making in the context of PRP injections. [Table: see text]

Comprehensive Physical Examination of the Hip

Background: Hip pain is a common chief complaint among sports medicine patients, and there is a wide variety of pathology that may cause pain around the hip joint. Indications: Any patient presenting to a clinic with a complaint of hip and groin pain should undergo a comprehensive physical examination to aid in diagnosis and treatment planning. Technique Description: All patients presenting with hip pain, regardless of the complaint, undergo a screening examination to further identify potential etiology of their pain. Based on the screening examination, as well as a comprehensive history and imaging findings, more specific examination maneuvers may be conducted to further establish an accurate diagnosis and treatment plan. Conclusion: Hip pain presents a diagnostic challenge for sports medicine providers, as there is a wide range of pathology that may manifest as pain around the hip joint. It is vital for all sports providers, regardless of the area of interest, to have the ability to perform a comprehensive physical examination of the hip to obtain an accurate diagnosis and to initiate appropriate treatment plans. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Patients Prefer Medical Facts and Educational Videos From Sports Medicine Surgeons on Social Media

To provide updated information on which sports medicine patients are most influenced by provider presence on social media, as well as their preferences in social media platforms and content. Between November 2021 and January 2022, an anonymous online, voluntary, self-administered questionnaire containing 13 questions was distributed to patients who had a clinic visit with 1 of 2 orthopaedic sports medicine surgeons at the same institution. Descriptive statistics were used to analyze the data. A total of 159 responses were received for a response rate of 29.5%. The most common platforms used by patients were Facebook (110; 84%), YouTube (69; 53%), and Instagram (61; 47%). Most participants indicated that it did not make a difference if their sports medicine surgeon was on social media (N= 99, 62%), and they indicated they would not travel further to see a physician who was active on social media (N= 85, 54%). Compared with other age groups, significantly more respondents over the age of 50 years used Facebook to follow their physicians (47 of 60, 78%, P= .012). Seventy-eight (50%) patients noted that they were interested in seeing medical facts, whereas 72 (46%) were interested in seeing educational videos on their physician's social media page. In this study, we found that sports medicine patients prefer to see educational videos and medical facts from their surgeons on social media, most predominantly on Facebook. Social media is a popular way to connect in our modern world. As the influence of sports medicine surgeons on social media grows, it is important to understand how this is perceived by patients.

Patient-Reported Outcomes Following Intra-articular Hyaluronic Acid for Knee Osteoarthritis

BackgroundIntra-articular hyaluronic acid (IAHA) has been commonly used in the management of knee osteoarthritis (OA). This study sought to assess patient-reported outcomes (PRO) following different formulations of hyaluronic acid injections for patients who have knee OA. MethodsA retrospective analysis was performed on patients who have knee OA and received IAHA knee injections from October 2018 to May 2022 in sports medicine (SM) and adult reconstructive (AR) clinics. Patients completed PRO measures including the Patient-Reported Outcome Measurement Information System (PROMIS) Mobility, Pain Interference, and Pain Intensity at baseline, 6-week, 6-month, and 12-month follow-up. Univariate and multivariate analyses were used to evaluate changes in PRO measures between baseline and follow-up periods and to evaluate differences between the SM and AR divisions. A total of 995 patients received IAHA for knee OA and completed PRO assessments. ResultsThere was no difference in the PROMIS measures based on molecular weight at 6 weeks, 6 months, and 12 months. Except for 6-month Mobility scores between the SM and AR patients (−0.52 ± 5.46 versus 2.03 ± 6.95; P = .02), all other PROMIS scores were similar. Mobility scores at 6 months were significantly different based on Kellgren and Lawrence grade (P = .005), but all other PROMIS scores were similar. ConclusionAverage change in PROMIS scores were significantly different only for 6-month Mobility scores based on divisions and Kellgren and Lawrence grade but did not achieve minimally clinical important difference at most timepoints. Further studies are needed to investigate whether improvement is observed in specific patient populations.

Survey of blood flow restriction therapy for rehabilitation in Sports Medicine patients

Blood flow restriction (BFR) therapy has demonstrated benefits across a spectrum of musculoskeletal injuries, including improved strength, endurance, function, and reduction in pain perception. There is, however, no standardized application of BFR therapy among orthopaedic surgeons within the United States (US). The indication and protocol for BFR therapy vary significantly across providers in the US. An online survey of 21 multiple-choice questions was sent to 3,281 surgeons listed on a large orthopaedic registry. A cross-sectional study was performed on all surgeons who successfully completed the questionnaire. Surgeons were queried on current or planned use of BFR, indications, contraindications, and peri-operative and non-operative management of sports-related injuries. Overall, 250 physicians completed the survey, with 149 (59.8%) reporting current BFR use and 75.2% initiating use in the last 1-5 years. Most protocols (78.8%) utilize the modality 2-3 times per week while 15.9% use it only once weekly. Anterior cruciate ligament reconstruction (ACLR) rehabilitation was the most reported indication for initiating BFR therapy (95.7%) along with medial patellofemoral ligament reconstruction (70.2%), multiligamentous knee reconstruction (68.8%), meniscus repair (62.4%), collateral ligament reconstruction (50.4%), Achilles tendon repairs (30.5%), and meniscectomy (27%). Only 36.5% reported using BFR after upper extremity procedures, such as distal biceps repair (19.7%), ulnar collateral ligament elbow reconstruction (17%), rotator cuff (16.8%), and shoulder labrum repair (15.3%). For non-operative injuries, 65.8% of surgeons utilized BFR. Of those not currently using BFR therapy, 33.3% intended to implement its use in the future. BFR therapy has increased in popularity with most physicians implementing its use in the last 5 years. BFR was commonly utilized after ACLR. BFR allows light-load resistance to simulate high-intensity resistance training. This study describes US orthopaedic surgeons' common practice patterns and patient populations that utilize BFR therapy.

Trends in Patient-Reported Outcomes Measurement Information System (PROMIS) Utilization in Orthopedic Sports Medicine: A Scoping Review.

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) developed by the National Institutes of Health provides a standardized method for collecting outcomes data from sports medicine patient populations. Methods: The objective of this scoping review is to report on PROMIS utilization in orthopedic sports medicine research and practice. We searched PubMed, ScienceDirect, and Cochrane Library using keywords and database-specific subject headings to identify studies that reported PROMIS utilization. Inclusion criteria were the use or mention of PROMIS in any population of patients commonly treated by orthopedic sports medicine physicians. Results: Following a screening process, we included 67 studies published from 2019 through 2022 in this review. A near-equal distribution of studies was published per year during this period. Twenty-four domains were assessed across the studies. Among studies with adult populations, the Pain Interference (45 studies, 67%) and Physical Function (37 studies, 55%) domains were the 2 most reported by researchers. Upper Extremity (4 studies, 6%) and Mobility (3 studies, 4%) were the 2 most used domains in studies involving pediatric populations. Conclusion: Our results demonstrate consistent utilization of PROMIS domains in the field of sports medicine. Researchers commonly used PROMIS with other legacy measures, comparing the scores to one another to assess responsiveness and validity. This review provides evidence that PROMIS domains are being used to collect data on a variety of factors related to sports medicine patient outcomes that may help physicians better understand the complexities of the recovery and rehabilitation process.

Impact of the COVID-19 Pandemic on Sports Medicine Patient Care

The COVID-19 pandemic has necessitated new practices in sports medicine patient care. Telehealth has been validated as a reliable tool for consultations and physical examinations and increases access to care in a cost-efficient manner. Social distancing and avoiding team members who have tested positive are the most effective ways to reduce spread. For screening, daily self-reported symptom checklists and fever monitoring help identify potentially infected athletes who should be instructed to isolate and seek care. Polymerase chain-reaction (PCR) testing for the virus via nasopharyngeal swab is not recommended for screening and should be reserved for symptomatic individuals with fever, cough, or shortness of breath. Face masks and personal protective equipment (PPE) may be beneficial in high-risk settings, but there is little evidence to support use in athletic populations. Median return to play after COVID-19 in elite athletes has been reported as 18 days (range, 12 to 30), with 27% not fully available at 28 days. Chest pain at diagnosis was the only symptom associated with time loss before 28 days. Finally, canceled competitions or time loss results in grief, stress, and frustration for athletes, as well as loss of a social support network and routine training regimens. Mental health support services may be indicated.

Poster 117: An Activity Scale for All Youth Athletes? An Analysis of The Hss Pedi-Fabs in 2274 Pediatric Sports Medicine Patients

Objectives:The HSS Pedi-FABS activity scale has become increasingly used in children age 10-18 since its development in 2013. Research reports on the utility of the measure in general youth athletes with knee injuries, however limited information is available regarding use in evaluating a variety of joint injuries, athletes who participate in sports with disparate biomechanics, or specialized competitive athletes. This study assessed the sensitivity and distribution of Pedi-FABS in an athletic youth population. Secondarily, this study evaluated Pedi-FABS association with PROMIS® Pediatric Global Health 7(PGH7) with Pain Interference(PGHPI) and Fatigue(PGHF) components.Methods:A retrospective review of youth athletes age 10-18 presenting for evaluation at a single pediatric sports medicine clinic between 4/2016-7/2020 was performed. Participants were included if they completed a pre-visit intake questionnaire and Pedi-FABS. Descriptive statistics were used to analyze Pedi-FABS for normal distribution and the presence of a floor or ceiling effect in subgroups determined by demographics, injury characteristics, and sports participation. A floor or ceiling effect was determined to be present if more than 15% of respondents scored the lowest or highest possible score. A Kruskal-Wallis test used to compare average scores in each subgroup. Spearman’s Correlations were calculated to assess the association of PGH with Pedi-FABS scores.Results:2274 sports medicine patients (14.6±2.1 years; 53.0% females) were included. Of these, 2010 youth athletes reported participating in sports for 9.6±7.9 hours per week during 32.3±15.7 weeks per year with 6.2±3.4 years of participation in 21 distinct primary sports. 80.3% of patients reported participation in only one sport. Pedi-FABS Score differences were found across demographic(Table 1) and sport participation(Table 2) subgroups. Broad distribution was seen in each subgroup with no floor or ceiling effects. Pedi-FABS score correlated with hours per week(r=0.20), days per week(r=0.28), weeks per year(r=0.12), and years of participation(r=0.16/p<0.01). An inverse correlation was observed between Pedi-FABS and Days from Injury to Presentation(r=-0.21/p<0.01). An association between general health and activity level was noted as all three PGH components correlated with Pedi-FABS(PGH7: r=0.28/PGHF: r=-0.16/PGHPI: r=-0.12, p<0.01).Conclusions:Correlations with multiple forms of self-reported activity without floor or ceiling effects demonstrates the validity and sensitivity of Pedi-FABS for use in athletes with a variety of primary sports and injury types. Additionally, mean differences between demographic and sport participation subgroups, as well as associations with days to presentation and a commonly used patient reported outcome measure, may demonstrate the utility of Pedi-FABS for sports medicine clinicians.Table 1.HSS Pedi-FABS Score Distributions by Study Cohort Demographics and Injury CharacteristicsTable 2.HSS Pedi-FABS Score Distributions by Sports Participation Characteristics Among Self-Reported Athletes in Study Cohort

COVID-Delayed Elective Surgery Has a Negative Effect on Young Sports Medicine Patients

PurposeThe purpose of this study was to evaluate the physical and psychological effects of COVID-related elective surgery delays on young sports medicine patients.MethodsWe conducted a cross-sectional study of patients (10-25 years old) who had elective sports medicine surgery delayed due to the COVID crisis. Electronic surveys were sent to patients and included the 12-item Short Form Health Survey (SF-12), which yields a physical component score (SF12-PCS) and a mental component score (SF12-MCS), the PROMIS Psychological Stress Experience survey (PROMIS-PSE), and self-designed questions about patient concerns regarding the COVID crisis and delayed surgery.ResultsOf the 194 eligible patients with delayed elective sports surgeries, 107 patients (55%) elected to participate (mean age 17.6 ± 3.09 years, 30% male). The mean surgical delay was 76 days (CI 57-98). Delayed surgery patients scored significantly lower than population norms on the SF12-PCS (mean 39.3, CI 37.0-41.7; P < .001). Males scored significantly higher than females on the SF12-MCS (52.8 vs 45.7; P = .002), but the overall SF12-MCS mean was not significantly different from the general population (47.4; P =.07). The mean PSE score was significantly higher than population norms (57.7, CI 56.1-59.3; P < .001), but they did not differ by age or gender. Patients who reported higher levels of concern about their surgical delay endorsed significantly lower scores on the SF-MCS (P = .006) and higher scores on the PROMIS-PSE (P < .001), indicating greater emotional symptoms. The biggest concern with COVID-related surgical delays was a concern about not being back in time for a sports season.ConclusionsYoung sports medicine patients reported significant physical and emotional symptoms associated with COVID-related surgical delays. Patients were most concerned about delays resulting in missed sport seasons. Those who reported greater levels of concern with surgical delays reported more emotional symptoms and higher levels of psychological stress. Clinical Relevance: It is important to understand the impact of delayed elective surgical treatment on young patients due to COVID. This study will allow us to make more informed choices for patients during the pandemic.

Assessment of Coping Skills in Pediatric Sports Medicine Patients

Background:Psychological variables play integral roles in an athlete’s response to injury recovery, and poor mental coping skills have been shown to have a negative impact. The Athletic Coping Skills Inventory-28 has been demonstrated to have predictive value in identifying pediatric patients who may be at risk for a prolonged recovery.Hypothesis/Purpose:The purpose of this study was to investigate variations in coping skills in pediatric sports medicine patients using the Athletic Coping Skills Inventory-28, and to examine correlations with the following variables: age, gender, individual vs. team sports, and time devoted to sport.Methods:This was a cross-sectional, single institution study, that assessed young sports medicine patients, ages 12-18. A one-time, voluntary, anonymous survey was utilized to assess demographics, primary sport, sport participation patterns, and the validated Athletic Coping Skills Inventory-28 (ACSI, range 0-84). Younger adolescents were considered to be ages 11-14 and older adolescents ages 15-18 for data analysis. Statistical analysis included Fischer’s exact tests, t-tests, Pearson correlations, linear regression analysis, and Wilcoxon rank sum tests.Results:Of 430 eligible patients, 334 (mean±sd age 15.0±1.8 years, 64.7% female, 35.3% male) completed questionnaires, for a 78% response rate. The mean ACSI score was 50.2±10.9. No significant differences were observed in overall ACSI scores between genders. ACSI scores were higher in younger adolescents compared to older adolescents (52.4±10.5 vs 48.9±10.9, p <0.010). Team sport athletes reported higher coping skill scores than individual sport athletes (51.2±10.9 vs 47.2±10.8, p<0.001). Multivariable linear regression revealed that younger team sport athletes demonstrated higher coping skill scores compared to older team sport athletes (55.9 vs 49.8, p<0.001). Younger team sport athletes also scored higher than the younger individual sport athletes (55.9 vs 47.6 p=0.002). In addition, playing >16 hours per week of sports adds 6.36 (95% CI: 3.14, 9.57) units to the total ACSI score compared to participants who play <11 hour per week.Conclusion:Athletic coping skills scores did not significantly differ among genders in adolescent athletes. ACSI scores were higher in younger adolescents and athletes playing team sports. Coping skill scores are also positively correlated with time devoted to playing sports.

An Activity Scale for all Youth Athletes? An Analysis of the Hss Pedi-Fabs in 2274 Pediatric Sports Medicine Patients

Background:The HSS Pedi-FABS activity scale has become increasingly used in children age 10-18 since its development in 2013. Research reports on the utility of the measure in general youth athletes with knee injuries, however limited information is available regarding use in evaluating a variety of joint injuries, athletes who participate in sports with disparate biomechanics, or specialized competitive athletes.Hypothesis/Purpose:This study assessed the sensitivity and distribution of Pedi-FABS in an athletic youth population. Secondarily, this study evaluated Pedi-FABS association with PROMIS® Pediatric Global Health 7(PGH7) with Pain Interference(PGHPI) and Fatigue(PGHF) components.Methods:A retrospective review of youth athletes age 10-18 presenting for evaluation at a single pediatric sports medicine clinic between 4/2016-7/2020 was performed. Participants were included if they completed a pre-visit intake questionnaire and Pedi-FABS. Descriptive statistics were used to analyze Pedi-FABS for normal distribution and the presence of a floor or ceiling effect in subgroups determined by demographics, injury characteristics, and sports participation. A floor or ceiling effect was determined to be present if more than 15% of respondents scored the lowest or highest possible score. A Kruskal-Wallis test used to compare average scores in each subgroup. Spearman’s Correlations were calculated to assess the association of PGH with Pedi-FABS scores.Results:2274 sports medicine patients(14.6±2.1 years; 53.0% females) were included. Of these, 2010 youth athletes reported participating in sports for 9.6±7.9 hours per week during 32.3±15.7 weeks per year with 6.2±3.4 years of participation in 21 distinct primary sports. 80.3% of patients reported participation in only one sport. Pedi-FABS Score differences were found across demographic(Table 1) and sport participation(Table 2) subgroups. Broad distribution was seen in each subgroup with no floor or ceiling effects. Pedi-FABS score correlated with hours per week(r=0.20), days per week(r=0.28), weeks per year(r=0.12), and years of participation(r=0.16/p<0.01). An inverse correlation was observed between Pedi-FABS and Days from Injury to Presentation(r=-0.21/p<0.01). An association between general health and activity level was noted as all three PGH components correlated with Pedi-FABS(PGH7: r=0.28/PGHF: r=-0.16/PGHPI: r=-0.12, p<0.01).Conclusion:Correlations with multiple forms of self-reported activity without floor or ceiling effects demonstrates the validity and sensitivity of Pedi-FABS for use in athletes with a variety of primary sports and injury types. Additionally, mean differences between demographic and sport participation subgroups, as well as associations with days to presentation and a commonly used patient reported outcome measure, may demonstrate the utility of Pedi-FABS for sports medicine clinicians.Table 1.HSS Pedi-FABS Score Distributions by Study Cohort Demographics and Injury CharacteristicsTable 2.HSS Pedi-FABS Score Distributions by Sports Participation Characteristics Among Self-Reported Athletes in Study Cohort

Readability of Patient Educational Materials in Sports Medicine.

Background:The internet has become an increasingly popular resource among sports medicine patients seeking injury-related information. Numerous organizations recommend that patient educational materials (PEMs) should not exceed sixth-grade reading level. Despite this, studies have consistently shown the reading grade level (RGL) of PEMs to be too demanding across a range of surgical specialties.Purpose:To determine the readability of online sports medicine PEMs.Study Design:Cross-sectional study.Methods:The readability of 363 articles pertaining to sports medicine from 5 leading North American websites was assessed using 8 readability formulas: Flesch-Kincaid Reading Grade Level, Flesch Reading Ease Score, Raygor Estimate, Fry Readability Formula, Simple Measure of Gobbledygook, Coleman-Liau Index, FORCAST Readability Formula, and Gunning Fog Index. The mean RGL of each article was compared with the sixth- and eighth-grade reading level in the United States. The cumulative mean website RGL was also compared among individual websites.Results:The overall cumulative mean RGL was 12.2 (range, 7.0-17.7). No article (0%) was written at a sixth-grade reading level, and only 3 articles (0.8%) were written at or below the eighth-grade reading level. The overall cumulative mean RGL was significantly higher than the sixth-grade [95% CI for the difference, 6.0-6.5; P < .001] and eighth-grade (95% CI, 4.0-4.5; P < .001) reading levels. There was a significant difference among the cumulative mean RGLs of the 5 websites assessed.Conclusion:Sports medicine PEMs produced by leading North American specialty websites have readability scores that are above the recommended levels. Given the increasing preference of patients for online health care materials, the imperative role of health literacy in patient outcomes, and the growing body of online resources, significant work needs to be undertaken to improve the readability of these materials.

The Effects of The Covid-19 Pandemic on Pediatric Orthopaedic Sports Medicine &amp; Arthroscopy: Practice Implications, and The Management and Triaging of Surgical Cases

Background:The COVID-19 pandemic has had a significant impact on pediatric sports medicine patients. Many surgeons found themselves simultaneously managing surgical pathology, concerns of exposure, and limited resources. This led to challenging decisions regarding relative patient and case urgency.Purpose:1. Define through expert opinion the relative urgency of prototypical pediatric arthroscopic surgical cases 2. Define current practices regarding pre-surgical testing and findings relevant to the recent, current, and potentially forthcoming challenges inherent to the COVID-19 pandemic. We further gathered information regarding variability of current practices and access to resources.Methods:A mixed-methods survey was performed of the POSNA membership, specific to surgeons identifying as sub-specialized in pediatric sports medicine. A clinical vignette style survey was developed by the POSNA QSVI: Sports Committee. Cases included patients with a: meniscal tear, a bucket handle meniscus tear, ACL tear, unstable osteochondritis dissecans (OCD) lesion of the knee, locked knee due to a loose body, OCD of the capitellum, recurrent and primary shoulder instability, traumatic patellar instability with a loose osteochondral fragment, and a patient with a symptomatic discoid meniscus. The survey further asked how resource limitations could impact surgical decision-making, and how pre-operative testing might impact surgical timing and decisions. Information regarding personal and institutional experiences and limitations during the first 6 months of the pandemic was also collected.Results:There were 119 survey respondents, of whom 54 met inclusion criteria. Seventy-five percent were primarily based at a university or academic hospital. Almost 56% of respondents had all scheduled cases cancelled for 4-7 weeks, 22% for 8-11 weeks, and 17% were shut down for more than 12 weeks. Forty-two percent followed guidance from an orthopaedic governing body, most commonly national orthopaedic organizations. There was significant variation in pre-operative testing protocols, ranging from screening questions to PCR testing and rapid testing. Triaging factors chosen by respondents for determining relative urgency, in order, were: Diagnosis, severity of symptoms/pathology, duration of symptoms, age, activity level, originally planned surgical date, and patient request. Each clinical vignette elicited variability in responses, but each had clear leaders in opinion regarding relative urgency. Most cases had more than 2/3 of respondents in relative agreement with respect to urgency.Conclusion:This study provides comparative details of the challenges and resource limitations experienced in pediatric sports medicine, and provides much-needed sub-specialty opinions on standards with respect to relative urgency and triaging for related cases. These experiences and opinions may be of benefit when advocating for patient access and care.

Prevalence of Cannabinoid (CBD) Use in Orthopaedic Sports Medicine Patients.

Background:Although there is some evidence that cannabinoid (CBD) products may provide a therapeutic effect for musculoskeletal pain, little is known about the usage patterns or their prevalence of use in orthopaedic sports medicine patients.Purpose:To report the prevalence and perceived self-efficacy of CBD products in patients evaluated in an orthopaedic sports medicine clinic.Study Design:Descriptive epidemiology study. Level of evidence, 2.Methods:The study population consisted of new patients who visited an orthopaedic surgery sports medicine clinic at a large academic center for consultation with a surgeon between August 2020 and March 2021. All patients were asked to complete a survey that assessed perceived pain and effectiveness of CBD products and other nonsurgical treatment modalities using the Single Assessment Numeric Evaluation score (range, 0-100) and the Numeric Pain Rating Scale (NRS). Descriptive factors were collected via chart review. Descriptive statistics were used to characterize the data.Results:Overall, 823 patients completed the survey (45.4% female; mean age, 51 years [range, 18-87 years]; mean body mass index, 28.9 [range, 17.2-58.4]). Body areas involved included 285 shoulders, 44 elbows, 76 hips, 276 knees, 58 ankles, and 77 other. Of these patients, 19% (152/823) endorsed the use of CBD products before their initial evaluation. The mean NRS for pain was significantly different between non-CBD users and CBD users (5.6 vs 6.1; P = .029). CBD users were significantly more likely to have tried other nonoperative modalities compared with nonusers, including nonsteroidal anti-inflammatory drugs (79.6% vs 69.8%; P = .032), bracing (44.7% vs 34.6%; P = .024), steroid injections (38.8% vs 21.6%; P < .001), and physical therapy (54% vs 36.1%; P < .001). In addition, 30.9% of CBD utilizers reported marijuana use compared with 2.8% of non-CBD users (P < .001) for management of their pain.Conclusion:In the current study, 19% of patients had used CBD products to manage joint-related issues. Sports medicine providers should be aware of this high incidence of usage and the potential interactions CBD products may have with other treatment modalities. Further studies are needed to assess the effectiveness of CBD as a therapeutic agent and the specific interactions it has with other drugs and other forms of treatment.

Clinical Utility and Validity of Exercise Vital Sign in Children.

We reviewed charts of 14,446 sports medicine patients, children aged 5 to 18 years, over a 3-year period to determine the discriminant validity of Exercise Vital Sign (EVS) questions. A logistic regression analyzed factors related to any moderate to vigorous physical activity (MVPA). A linear regression analyzed factors related to amount of MVPA for those who participated in any weekly MVPA. Overall, 48% of children reported meeting physical activity guidelines for 420 min·wk-1. Overall, children reported 400.36 ± 280.04 min·wk-1 of MVPA. Those with depression had significantly less MVPA than those without (95% confidence interval [CI], -96.65 to -26.31). Girls had significantly less MVPA than boys (95% CI, -59.15 to -40.31). Overweight and obese children reported less MVPA compared with normal weight children (95% CIs, -42.65 to -17.29 and -91.61 to -65.50, respectively). EVS demonstrates strong discriminant validity to detect differences between groups as a function of sex, body mass index, and depression.

Management of Outpatient Elective Surgery for Arthroplasty and Sports Medicine During the COVID-19 Pandemic: A Scoping Review.

Background:The onset of the coronavirus disease 2019 (COVID-19) pandemic has presented unforeseeable challenges to the orthopaedic community, especially arthroplasty and sports medicine subspecialities, as many surgeries were deemed nonessential and delayed. Although there is a glimpse of hope with the approval and distribution of vaccines, daily case numbers and death tolls continue to rise at the time of this review.Purpose:To summarize the available literature on the management of elective sports medicine and arthroplasty procedures in the outpatient setting to gather a consolidated source of information.Study Design:Scoping review; Level of evidence, 5.Methods:A scoping review of 3 databases (PubMed, Embase, and OVID Medline) was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. All retrospective and prospective analyses, systematic reviews and meta-analyses, expert opinions, and societal guidelines were included for review, with 29 articles meeting the inclusion criteria.Results:Guidance for resumption of elective arthroplasty and sports medicine surgery and patient selection during the COVID-19 pandemic focuses on resource availability, patient fitness, and time sensitivity of the procedure, with patient and surgical team safety as the highest priority. Telemedicine and other innovative technology can be used to continue patient care during periods of delayed surgery through monitoring disease progression and offering nonoperative management options.Conclusion:While the current societal recommendations provide guidance on safety protocols and patient prioritization, each orthopaedic practice must consider its unique situation and use evidence-based medicine when determining surgical timing and patient selection.

Reliability of Plain Radiographs Versus Magnetic Resonance Imaging to Measure Tibial Slope in Sports Medicine Patients: Can They Be Used Interchangeably?

Background:The slope of the tibial plateau has been proposed as a reason for failure of anterior cruciate ligament reconstruction.Purpose:To evaluate the interobserver reliability of measurements of tibial slope on radiographs versus magnetic resonance imaging (MRI) scans and to assess whether the modalities can be used interchangeably for this purpose.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:This retrospective study included 81 patients aged 18 to 30 years who were evaluated in a sports medicine setting for knee pain and who had lateral knee radiographs as well as knee MRI scans on file. Medial and lateral tibial plateau slope measurements were made by 3 blinded reviewers from the radiographs and MRI scans using graphic overlay software. The paired t test was used to compare measurements of the medial tibial plateau slope (MTPS) and lateral tibial plateau slope (LTPS) from radiographs and MRI scans. Intraclass correlation coefficients (ICCs) were calculated to determine intra- and interobserver reliability of measurements within each imaging modality, and Pearson correlation coefficients were calculated to determine the relationship between measurements on radiographs versus MRI scans.Results:Imaging from 81 patients were included. The average MTPS was significantly larger on radiographs compared with MRI scans (8.7° ± 3.6° vs 3.7° ± 3.4°; P < .001), and the average LTPS was also significantly larger on radiographs compared with MRI scans (7.9° ± 3.4° vs 5.7° ± 3.7°; P < .001). ICC values indicated good to excellent intraobserver agreement for all imaging modalities (ICC, 0.81-0.97; P ≤ .009). The ICCs for interobserver reliability of MTPS and LTPS measurements were 0.92 and 0.85 for radiographs, 0.87 and 0.83 for MRI based off the subchondral bone, and 0.86 and 0.71 for MRI based off the cartilage, respectively (P < .001). Medium correlation was noted between radiographic and MRI measurements; Pearson correlation coefficients for radiographic versus subchondral MRI measurements were 0.30 and 0.37 for MTPS and LTPS, respectively.Conclusion:The average MTPS and LTPS were significantly larger on radiographs compared with MRI scans. Although tibial slope measurements using radiography and those using MRI are reliable between individuals, the measurements from radiographs and MRI scans cannot be used interchangeably, and caution should be used when interpreting and comparing studies using measurements of the tibial slope.

Venous thromboembolism prophylaxis after ambulatory arthroscopic knee surgery: a systematic review and meta-analysis of incidence and risk factors (109)

Objectives:Over 100,000 anterior cruciate ligament (ACL) reconstructions are performed in the United States annually, yet the reported incidence of venous thromboembolism (VTE) and the use of VTE thromboprophylaxis after ACL reconstruction and other arthroscopic knee surgeries still varies widely. Current VTE risk assessment scores, for example the Caprini score, incorporate arthroscopic surgery as a known risk factor but were not developed for stratification of an outpatient ambulatory surgical patient population. There is no current consensus to guide the orthopedic surgeon in prescribing chemoprophylactic agents after arthroscopic knee surgery. The objectives of this study were to determine the incidence, efficacy, and risk factors for VTE specifically following knee arthroscopic procedures. The null hypotheses of this study was that previously defined risk factors for VTE after ambulatory knee arthroscopy (age over 60 years, BMI greater than 30 kg/m2, tobacco use, prior VTE, malignancy, coagulopathy, oral contraceptive use, family history of coagulopathy, and prolonged tourniquet time greater than 90 minutes) would not reach statistical significance when compared across multiple cohorts. Our hypothesis is that a systematic review and meta-analysis of these variables will reject the null hypotheses with a significance of level of p < .05.Methods:A systematic review and meta-analysis was performed using data collected from 30 cohort and therapeutic trials (721,005 patients) published between January 2000 and April 2020 to compare both the incidence of deep vein thrombosis (DVT) and/or pulmonary embolism (PE) and associated risk factors after knee arthroscopy with or without thromboprophylaxis in adults. Ultrasound, venography, and International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes were deemed acceptable detection methods for VTE. We also performed a meta-analysis of published patient characteristics and risk factors in developing VTE after arthroscopic knee procedures. Individual studies were not evaluated for symptomatic versus asymptomatic VTE detection criteria or methods.Results:Of 331 eligible articles, 6 therapeutic RCTs and 24 cohort studies met the inclusion criteria. Overall incidence of DVT and PE was found to be 0.97% and 0.03% respectively. Analysis of the RCTs was found to support the use of prophylactic anticoagulation in preventing DVTs (relative risk: 0.24, 95% confidence interval [CI]: 0.13-0.44). After analysis of the cohort studies, age greater than 60 years was found to be a statistically significant risk factor for VTE (OR: 1.84, 95% CI: 1.03 – 3.29; p=.04) while a history of malignancy (OR: 2.61, 95% CI: 0.97 – 7.00; p=.06), and history of previous VTE (OR: 4.14, 95% CI: 0.90 – 19.14, p=.07) trended toward significance. Other factors such as BMI greater than 30 kg/m2, tobacco use, tourniquet time, personal or family history of coagulopathy, and oral contraceptive use were not found to be statistically significant risk factors for VTE after knee arthroscopy, however there were limited studies (one to three studies per risk factor) available to distinguish of a majority of these variables.Conclusions:Our results show that the overall incidence of DVT in adults after arthroscopic knee surgery is approaching 1% and that of PE is exceedingly rare, however this may be underestimated if asymptomatic VTE is not identified. Despite a low incidence of VTE after knee arthroscopy, thromboprophylaxis is effective in preventing VTE and trends in risk factors exist in ambulatory sports medicine patients diagnosed with VTE post-operatively. The risk for adverse bleeding events while taking chemoprophylaxis and requires further research. Only rejection of the null hypothesis on age over 60 years was statistically significant, however other defined risk factors may be clinically significant. With these results, we conclude that a preoperative assessment may be warranted in identifying at-risk, high risk, or multi-risk patients for which prophylactic anticoagulation postoperatively after knee arthroscopic procedures may be beneficial. A modified version of the Caprini score specifically stratifying these risk factors in an ambulatory sports medicine population may be valuable to the practicing orthopedic arthroscopic surgeon. More research is warranted for identifying risk factors to better stratify this unique patient population.