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PURPOSE: To review patient outcomes in the literature following arthroscopic partial meniscectomy (APM) in order to identify when patients report reaching subjective maximal improvement postoperatively. METHODS: A systematic review of the literature from January 2004 to August 2019 was conducted using PRISMA guidelines to identify articles evaluating patient-reported outcome measures (PROMs) up to a minimum of 6 months after APM in patients >18 years old. Studies were excluded if additional interventions were performed such as repairs, ligamentous reconstruction or repair, cartilaginous manipulation, or revision surgery. PROMs were pooled between studies at preoperative, 3 months, 6 months, 1 year, and 2 year time points. Weighted averages were used within a mixed model method in order to account for the differences in sample size and variance among studies. Significant improvements in PROMs at various time intervals were statistically analyzed using minimal clinically important difference. RESULTS: A total of 12 studies including 1663 patients who underwent APM were selected for the review. The pooled cohort consisted of 1033 (62%) males and 630 (38%) females. Significant improvements were demonstrated from preoperative scores to 3 months postoperatively in Knee Injury and Osteoarthritis Outcome Score subcategories, Lysholm, and visual analog scale scores while no differences were found for Tegner and International Knee Documentation Committee scores. Although statistically significant improvement in PROMs remained at all postoperative time points compared to preoperative scores, no significant differences were observed after 3 months postoperatively. CONCLUSIONS: Patients undergoing APM had significant mean changes in legacy PROMs by 3 months postoperatively that exceeded given minimal clinically important difference values, without further clinically important improvement reported up to 2 years postoperatively. STUDY DESIGN: Level III, systematic review.

To investigate the impact of arthroscopic shoulder labral repair without shoulder instability on career longevity, game use, and performance in National Hockey League (NHL) athletes.A retrospective review of all NHL players who underwent arthroscopic shoulder labral repair from 2004 to 2020 was performed. A 2:1 matched control group was used for comparison. Controls were matched by age, body mass index, position, and experience prior to the index year. Demographic characteristics, game use, and performance metrics were collected for all athletes. Statistical analysis examined game use and performance both at 1-year and 3-year follow-up compared with one season before injury.Twenty-nine players who underwent arthroscopic shoulder labral surgery returned to play (100%) and were matched with 55 control players. The operative cohort experienced shorter careers compared with controls (4.4 ± 3.1 vs 6.0 ± 3.6 seasons,Following return to play after arthroscopic shoulder labral repair, NHL players demonstrated reduced career longevity compared with healthy controls. Players exhibited significant reductions in game use and performance at one season after injury but returned closer to baseline after 3 seasons.Level III; retrospective case control.

Purpose: To investigate which factors predispose patients for prolonged opioid use after medial patellofemoral ligament (MPFL) reconstruction. Methods: A retrospective review of all patients who underwent MPFL reconstruction at a single institution between January 2013 and June 2020 was conducted. Opioid consumption before and after surgery was recorded and confirmed using Michigan Automated Prescriptions System monitoring program. Patients were classified into preoperative opioid users and nonusers. Risk factors for continued opioid use were assessed by collecting patient demographic variables, psychiatric history, number of previous patellar dislocations, and operative factors. Results: A total of 102 patients were included during the time frame of interest. Patients were on average 21.6 ± 8.5 years old with a mean body mass index of 28.2 ± 7.9. Thirty patients (29.0%) sustained >10 dislocations preoperatively. Preoperative opioid use was present in 13 (12.7%) patients. Greater than 10 dislocations (odds ratio [OR] 5.00, 95% confidence interval [CI] 1.12-20.92) and psychiatric history (OR 3.33, 95% CI, 1.2-9.1; P = .016) significantly predicted opioid refills the first month after surgery. Risk factors for opioid refills at 2 to 12 months postoperatively included smoking (OR 4.50, 95% CI 1.13-17.96), preoperative opioid use (OR 7.32, 95% CI 1.88-28.47), psychiatric disorder (OR 3.77, 95% CI 2.3-6.2; P < .001), age >30 years (OR 7.03, 95% CI 3.63-13.61; P < .001), and obesity (OR 2.68, 95% CI 1.40-5.14; P = .002). Compared with Outerbridge 0, a greater percentage of patients with Outerbridge 1 or 2 and 3 or 4 continued using opioids 2 to 12 months after surgery (OR 3.06, 95% CI 1.33-7.02; P = .006 and OR 2.86, 95% CI 1.24-6.59; P = .010, respectively). Conclusions: For patients undergoing MPFL reconstruction, preoperative opioid use, cartilage damage, age >30 years, smoking history, body mass index >30, and history of psychiatric disorder were found to be significantly associated with prolonged opioid use after surgery. Postoperative opioid refills in this cohort declined after 1 month. Level of Evidence: Level III, retrospective cohort study.

Purpose To assess the effects of surgical treatment of athletic pubalgia (AP) on game use and performance metrics in National Basketball Association (NBA) players. Methods A retrospective review of all NBA players who underwent surgical management for AP from 1996 to 2018 was performed. A matched control group was created for comparison. The index period was defined as the entire NBA season in which surgery occurred, including the corresponding offseason. Player demographics, use (games played, games started, and minutes per game) and performance (player efficiency rating) metrics were collected for all players. Statistical analysis was performed to compare data before and after return to play. Results Thirty players with a history of surgical management for AP were included in the final analysis. Following surgery for AP, NBA players were found to have a return to play (RTP) rate of 90.91% (30/33). The average RTP following surgery was 4.73 ± 2.62 months. Compared with control athletes, athletes in the AP group played significantly fewer seasons postinjury (4.17 ± 2.70 vs 5.49 ± 3.04 seasons, respectively; P = .02). During the first year following RTP, NBA players experienced significant reductions in game use and performance, both when compared with the year prior and matched control athletes (P < .05). At 3-year follow-up, players continued to demonstrate significant reductions in game use (minutes per game, P < .05) but not performance. Conclusions Following surgical treatment of AP, NBA players demonstrated a high RTP rate, but shortened career. A short-term reduction in game use and performance metrics was found the year of return following surgery. However, 3-year follow-up performance metrics normalized when compared with healthy controls. Study Design Level III; retrospective case-control study.

General population utility valuation study.To develop a technique for calculating utilities from the Neck Disability Index (NDI) score.We recruited a sample of 1200 adults from a market research panel. Using an online discrete choice experiment (DCE), participants rated 10 choice sets based on NDI health states. A multi-attribute utility function was estimated using a mixed multinomial-logit regression model (MIXL). The sample was partitioned into a training set used for model fitting and validation set used for model evaluation.The regression model demonstrated good predictive performance on the validation set with an AUC of .77 (95% CI: .76-.78). The regression model was used to develop a utility scoring rubric for the NDI. Regression results also revealed that participants did not regard all NDI items as equally important. The rank order of importance was (in decreasing order): pain intensity = work; personal care = headache; concentration = sleeping; driving; recreation; lifting; and lastly reading.This study provides a simple technique for converting the NDI score to utilities and quantify the relative importance of individual NDI items. The ability to evaluate quality-adjusted life-years using these utilities for cervical spine pain and disability could facilitate economic analysis and aid in allocation of healthcare resources.

The aim of this systematic review is to summarize the incidence of injuries occurring in professional baseball and compare player outcomes reported in the literature METHODS: We conducted a systematic review utilizing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines across three databases (PubMed, MEDLINE, Embase). Inclusion criteria were studies of injury incidences and/or injury outcomes on active MLB athletes and studies published in the English language. Exclusion criteria was non-MLB players, case series and case report studies with a cohort of3 players, and/or review articles.A total of 477 articles were identified from the initial search of three databases with 105 studies meeting inclusion criteria. Amongst these articles, the most common injuries studied were elbow (38%), shoulder (14%), hip/groin (11%), hand/wrist (7%), head/face (7%), knee (7%), spine (5%), and foot/ankle (3%). Injuries with the highest incidence included hand/wrist (150.3 per year), hamstring (7.8-73.5 per year), ulnar collateral ligament tears (0.23-26.8 per year), gastrocnemius strains (24.2 per year), and concussions (3.6-20.5 per year). Lowest rates of return to play were seen following shoulder labral tears (40-72.5%), rotator cuff tears (33.3-87%), and UCL tears (51-87.9%). The injuries leading to most time away from sport included elbow UCL tears (average 90.3 days treated non-operatively to 622.8 days following revision reconstruction), shoulder labral tears (average 315-492 days) and ACL tears (average 156.2-417.5 days). Following ACL tears, rotator cuff tears, shoulder labral tears, and hip femoroacetabular impingement (FAI) requiring arthroscopy, athletes had a significantly lower workloads compared to prior to injury upon return to play.Most published investigations focus on elbow injuries of the UCL, with variable RTP and mixed performance following surgery. Ulnar collateral ligament tears, shoulder labral tears, and anterior cruciate ligament tears result in the most missed time. Upper extremity injury such as shoulder labral tears, rotator cuff tears, and UCL tears had the poorest RTP rates. Workload was most affected following ACL reconstruction, rotator cuff repair, shoulder labral repair, and hip arthroscopy for FAI.

To develop a predictive machine learning model to identify prognostic factors for continued opioid prescriptions after arthroscopic meniscus surgery.Patients undergoing arthroscopic meniscal surgery, such as meniscus debridement, repair, or revision at a single institution from 2013 to 2017 were retrospectively followed up to 1 year postoperatively. Procedural details were recorded, including concomitant procedures, primary versus revision, and whether a partial debridement or a repair was performed. Intraoperative arthritis severity was measured using the Outerbridge Classification. The number of opioid prescriptions in each month were recorded. Primary analysis used was multivariate Cox-Regression model. We then created a naïve Bayesian model, a machine learning classifier that utilizes Bayes' theorem with an assumption of independence between variables.A total of 581 patients were reviewed. Postoperative opioid refills occurred in 98 patients (16.9%). Using multivariate logistic modeling, independent risk factors for opioid refills included male sex, larger BMI, chronic preoperative opioid use while meniscus resection demonstrated decreased likelihood of refills. Concomitant procedures, revision procedures, and presence of arthritis graded by the Outerbridge classification were not significant predictors of postoperative opioid refills. The Naïve Bayesian model for extended postoperative opioid use demonstrated good fit with our cohort with an area under the curve of 0.79, sensitivity of 94.5%, positive predictive value (PPV) of 83%, and a detection rate of 78.2%. The two most important features in the model were preoperative opioid use and male sex.After arthroscopic meniscus surgery, preoperative opioid consumption and male sex were the most significant predictors for sustained opioid use beyond 1 month postoperatively. Intraoperative arthritis was not an independent risk factor for continued refills. A machine learning algorithm performed with high accuracy, although with a high false positive rate, to function as a screening tool to identify patients filling additional narcotic prescriptions after surgery.

Background: The term “social determinants of health” (SDOH) refers to social and economic factors that influence a patient’s health status. The effect of SDOH on the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive test (CAT) scores and postoperative resource utilization in patients with anterior cruciate ligament reconstruction (ACLR) have yet to be thoroughly studied. Purpose: To investigate the impact SDOH have on PROMIS CAT outcomes and postoperative resource utilization in patients with ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: The electronic medical record was used to identify the SDOH for patients who underwent ACLR by 1 of 3 sports medicine fellowship–trained orthopaedic surgeons between July 2017 and April 2020. PROMIS CAT measures of Physical Function (PROMIS-PF), Pain Interference (PROMIS-PI), and Depression (PROMIS-D) were completed at the preoperative, 6-month postoperative, and 12-month postoperative time points. Postoperative health care utilization was recorded as well. Independent 2-group t tests and Wilcoxon rank-sum tests were used to analyze mean differences between patient groups based on SDOH. Results: Two-hundred and thirty patients who underwent ACLR were included (mean age, 27 years; 59% male). Compared with White patients, Black patients were represented more frequently in the lowest median household income (MHI) quartile (63% vs 23%, respectively; P < .001). White patients were represented more frequently in the highest area deprivation index (ADI) quartile when compared with Black patients (67% vs 12%, respectively; P = .006). Significantly worse PROMIS-PF, PROMIS-PI, and PROMIS-D scores at all 3 time points were found among patients who were Black, female, smokers, and in the lower MHI quartiles, with higher ADI and public health care coverage. In terms of resource utilization, Black patients attended significantly fewer postoperative physical therapy visits when compared with their respective counterparts. Those in the lower MHI quartiles attended significantly fewer postoperative imaging encounters, and female patients attended significantly more postoperative virtual encounters than male patients. Conclusion: Specific SDOH variables, particularly those that reflect racial and socioeconomic disparities, were associated with differences in postoperative health care utilization and ACLR outcomes as measured by PROMIS CAT domains.

OBJECTIVES Hip and core injuries are common in National Football League (NFL) athletes; however, the impact following injury remains unclear. The goal of this manuscript was to determine the impact of nonoperative hip and core injuries on return to play and performance. METHODS NFL athletes who sustained a hip or core injury treated nonoperatively between 2010 and 2016 were identified. Offensive and defensive power ratings were calculated for each player's injury season and two seasons before and after to assess longitudinal impact. A matched control group without an identified hip and/or core injury was assembled for comparison. RESULTS A total of 41 offensive and 71 defensive players with nonoperative hip or core injury were analyzed. All athletes returned to play; offensive and defensive players missed 4.0 ± 5.2 and 3.1 ± 2.6 games after injury, respectively. Offensive players played fewer cumulative career games returning from core injury versus hip (23.5 ± 20.6 vs 41.0 ± 26.4). Defensive players played fewer games (58.1 ± 41.1 versus 37.4 ± 27.1, p

Study Design General population utility valuation study. Objective To develop a technique for calculating utilities from the Neck Disability Index (NDI) score. Methods We recruited a sample of 1200 adults from a market research panel. Using an online discrete choice experiment (DCE), participants rated 10 choice sets based on NDI health states. A multi-attribute utility function was estimated using a mixed multinomial-logit regression model (MIXL). The sample was partitioned into a training set used for model fitting and validation set used for model evaluation. Results The regression model demonstrated good predictive performance on the validation set with an AUC of .77 (95% CI: .76-.78). The regression model was used to develop a utility scoring rubric for the NDI. Regression results also revealed that participants did not regard all NDI items as equally important. The rank order of importance was (in decreasing order): pain intensity = work; personal care = headache; concentration = sleeping; driving; recreation; lifting; and lastly reading. Conclusions This study provides a simple technique for converting the NDI score to utilities and quantify the relative importance of individual NDI items. The ability to evaluate quality-adjusted life-years using these utilities for cervical spine pain and disability could facilitate economic analysis and aid in allocation of healthcare resources.

Purpose To investigate the demographic factors that influence time to respond (TTR), time to completion (TTC), and response rate when using a text messaging-based system and to determine the feasibility and applicability of mobile messaging-based services for collection of patient-reported outcomes among orthopaedic sports medicine patients. Methods On the day of surgery, patient mobile phone number was collected and the automated mobile messaging service (MOSIO, Seattle, WA) messaged patients for 10 ``days postoperatively. Patient visual analog scale (VAS) scores were collected 3 times daily, side effects were asked each evening, and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) Short Form was collected on postoperative day 3 and 7. Results A total of 177 patients were enrolled in the study. The overall response rate to the survey questions was 75.0%. For all patients, the average TTR of questions was 35.09 ± 12.57 minutes. The TTC was 2.75 ± 3.56 minutes for PROMIS-PI, 3.51 ± 1.26 minutes for VAS, and 3.80 ± 6.87 for side-effect questions. When patients were stratified into age groups, the youngest group, 16 to 32 years, had the greatest response rate of 85.2% and patients in the 49 to 59 years group had the lowest response rate of 68.4% and 69.1%, respectively (P < .001). There was no significant difference in the TTR or TTC for VAS, PROMIS-PI, or side-effect questions when patients were stratified by age or sex groups (P > .05). Conclusions Collectively, all age groups successfully achieved a mean response rate of 75%; however, significantly lower response rates were observed for patients >49 years old. Differences in age and sex did not impact the overall TTR or TTC for VAS, PROMIS-PI, or side-effect questions. Mobile-based applications present as an emerging opportunity to track postoperative outcome scores and reduce clinic survey load. Level of Evidence Case series, level of evidence IV.

Clinical research has boomed over the past decade, with the development of multiple clinical datasets that are available for retrospective review. However, data remain incomplete based on fragmented reporting, provider change, and loss of follow-up. New technologies are being developed to assist with this limitation, by joining health care systems' medical records, and tracking Medicare claims files. The future of health care will rely more heavily on these systems, and artificial intelligence to quickly pull relevant clinical and genomic data regarding particular diagnoses, as a means to personalize medicine. This article reviews current advances in management of Big Data.

The objective of this study was to perform a propensity matched analysis exploring smoking as a risk factor for readmission following hip, knee and shoulder arthroscopy. Patients undergoing knee, shoulder or hip arthroscopy between 2006-2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Patient's smoking was analyzed for its effect on 30-day readmission using multivariate regression adjusting for demographics and comorbidities. A propensity matched analysis control identified 19,732 non-smokers to serve as the control group. The readmission rate for the non-smoking cohort was 0.9% and 1.3% in the smoking group (p = 0.01). In a multivariate analysis adjusting for baseline characteristics and medical comorbidities, smoking status was associated with increased risk readmission (Odds Ratio: 1.37 [95% Confidence Interval: 1.133-1.657] p = 0.0012). This study suggests that smoking increases chances of readmission in all arthroscopic surgery. (Journal of Surgical Orthopaedic Advances 28(4):272-276, 2019).

OBJECTIVE The aim of this study was to identify if prolonged length of hospital stay was protective for certain post-discharge complications requiring readmission after pancreatectomy. METHODS Patients undergoing elective pancreatectomy from 2012 to 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Multivariate regression analyses were conducted to elucidate the association of length of hospital stay (LOS), in-hospital complications, and post-discharge complications with 30-day hospital readmission. RESULTS Mean LOS for the readmitted versus not readmitted cohort was 9.01 and 10.36, respectively (P

To determine whether elevated INR or PTT values predicted 30-day postoperative adverse events following elective pancreatectomy.The American college of surgeons national surgical quality improvement program (ACS-NSQIP) database was used to identify 14 747 patients undergoing elective pancreatectomy from 2005 to 2013. The association of elevated INR or PTT with 30-day postoperative outcomes of morbidity and mortality was examined using multivariate logistic regression analysis.The overall 30-day mortality rate increased from 1.8% to 3.3% from the control to the high INR or PTT group (P = 0.001). An elevated INR/PTT increased the odds for bleeding requiring transfusion, superficial SSI, sepsis, unplanned intubation or48 h on a ventilator, cardiac arrest or myocardial infarction, acute renal failure, return to the OR, and prolonged length of stay. With the exception of superficial SSI, multivariate logistic regression models revealed that these same events remained statistically significant after controlling for potential confounders.Prolonged bleeding times (high INR/PTT) is associated with increased mortality and adverse outcomes after pancreas surgery. A patient's coagulation profile may serve as a risk stratification tool to identify higher risk patients that require more resources.

Background Among breast cancers, the triple-negative breast cancer (TNBC) subtype has the worst prognosis with no approved targeted therapies and only standard chemotherapy as the backbone of systemic therapy. Unique metabolic changes in cancer progression provide innovative therapeutic opportunities. The receptor tyrosine kinases (RTKs) epidermal growth factor receptor (EGFR), and MET receptor are highly expressed in TNBC, making both promising therapeutic targets. RTK signaling profoundly alters cellular metabolism by increasing glucose consumption and subsequently diverting glucose carbon sources into metabolic pathways necessary to support the tumorigenesis. Therefore, detailed metabolic profiles of TNBC subtypes and their response to tyrosine kinase inhibitors may identify therapeutic sensitivities. Methods We quantified the metabolic profiles of TNBC cell lines representing multiple TNBC subtypes using gas chromatography mass spectrometry. In addition, we subjected MDA-MB-231, MDA-MB-468, Hs578T, and HCC70 cell lines to metabolic flux analysis of basal and maximal glycolytic and mitochondrial oxidative rates. Metabolic pool size and flux measurements were performed in the presence and absence of the MET inhibitor, INC280/capmatinib, and the EGFR inhibitor, erlotinib. Further, the sensitivities of these cells to modulators of core metabolic pathways were determined. In addition, we annotated a rate-limiting metabolic enzymes library and performed a siRNA screen in combination with MET or EGFR inhibitors to validate synergistic effects. Results TNBC cell line models displayed significant metabolic heterogeneity with respect to basal and maximal metabolic rates and responses to RTK and metabolic pathway inhibitors. Comprehensive systems biology analysis of metabolic perturbations, combined siRNA and tyrosine kinase inhibitor screens identified a core set of TCA cycle and fatty acid pathways whose perturbation sensitizes TNBC cells to small molecule targeting of receptor tyrosine kinases. Conclusions Similar to the genomic heterogeneity observed in TNBC, our results reveal metabolic heterogeneity among TNBC subtypes and demonstrate that understanding metabolic profiles and drug responses may prove valuable in targeting TNBC subtypes and identifying therapeutic susceptibilities in TNBC patients. Perturbation of metabolic pathways sensitizes TNBC to inhibition of receptor tyrosine kinases. Such metabolic vulnerabilities offer promise for effective therapeutic targeting for TNBC patients. Electronic supplementary material The online version of this article (doi:10.1186/s40170-017-0168-x) contains supplementary material, which is available to authorized users.