The American journal of sports medicine
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The time between an anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) may influence baseline knee-related and general health-related patient-reported outcome measures (PROMs). Despite the common use of PROMs as main outcomes in clinical studies, this variable has never been evaluated. ⋯ After controlling for age, sex, competition level, smoking, and BMI, patients in the chronic ACLR group participated in less pivoting and cutting sports but reported better pain/function. Whether decreased activity is deliberate after an ACL injury or patients who undergo chronic ACLR are simply less active and may be treated successfully without surgery warrants further investigation. Nonrandomized studies that utilize PROMs should consider time from injury in study design and data interpretation.
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Observational Study
Unused Opioid Pills After Outpatient Shoulder Surgeries Given Current Perioperative Prescribing Habits.
In the past 16 years, the number of prescription opioids sold in the United States, as well as deaths from prescription opioids, has nearly quadrupled. However, the overall amount of pain reported by patients has not changed significantly. Specific information about opioid prescriptions in the perioperative period is lacking. Of the studies that have been published, investigators have shown that the majority of patients have unused postoperative opioid pills. Moreover, patients appear to lack information about disposal of unused opioid pills. ⋯ Most outpatient shoulder surgery patients who underwent certain operations were prescribed more opioid analgesics than they consumed. Patient education regarding the disposal of opioids was lacking.
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Osteochondral allograft transplantation (OAT) is being performed with increasing frequency, and the need for reoperations is not uncommon. ⋯ In this series, there was a 37% reoperation rate and an 87% allograft survival rate at a mean of 5 years after OAT. The number of previous ipsilateral knee surgical procedures was predictive of reoperations and failure. Of the patients who underwent arthroscopic debridement with an intact graft at the time of arthroscopic surgery, 82% experienced significantly improved outcomes, while 18% ultimately progressed to failure. This information can be used to counsel patients on the implications of a reoperation after OAT.
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Research on the acute effects of a concussion among lacrosse players is limited, and postconcussion patterns between male and female athletes have yet to be clearly established. Differences in the style of play and protective gear worn among male and female lacrosse players potentially confound a direct comparison of sex-based differences in this population. ⋯ Athletes performed more poorly on computerized cognitive screening tools and reported greater symptoms after an acute concussion relative to their baseline performance. Female sex may be a modifier of an acute concussion outcome, given that female athletes in this study performed significantly worse than male athletes across all neurocognitive measures and reported greater symptoms relative to their baseline testing compared with male athletes, regardless of the sport played. Female athletes were also more likely than male athletes to demonstrate scores on neurocognitive testing that exceeded reliable change cutoffs and were predictive of a protracted recovery. The practical significance of these findings should be further verified by prospective longitudinal research given the medium- to large-sized effect demonstrated for the overall relationship between sex and concussions.
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Observational Study
Descriptive Characteristics of Concussions in National Football League Games, 2010-2011 to 2013-2014.
Despite a high reported incidence rate of concussion, little is known about the on-field characteristics of injurious head impacts in National Football League (NFL) games. ⋯ In-game concussions in the NFL occurred through a diverse variety of mechanisms, surprisingly tended to be well-anticipated, and, also surprisingly, occurred with <10 yards of closing distance. The impacts causing concussion were broadly distributed over the helmet. More concussions occurred during the second half of game play, but we do not have evidence to explain this finding.