September 13, 2019
Today’s Top Story

Study Finds Psychological Factors Impact Return to Sport after ACL Reconstruction

A study published online in Knee Surgery, Sports Traumatology, Arthroscopy found that psychological factors were more significantly associated with return to sport and physical activity levels compared to functional outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction. Researchers assessed 40 patients who were at least one-year post-ACL reconstruction. Participants completed a series of patient-based and functional outcome assessments and were also instructed to wear a pedometer for one week to monitor daily steps. Twenty-five participants (62 percent) did not return to sport and 29 (72 percent) did not average 10,000 steps per day. Those with elevated levels of self-reported kinesiophobia were 17 percent less likely to return to sport. Self-reported knee self-efficacy and knee-related quality of life accounted for 27.1 percent of the variance of average daily step counts.

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In Other News

Study: Low- versus Standard-intensity Warfarin Prophylaxis During Hip or Knee Arthroplasty

Low-intensity warfarin prophylaxis did not meet the criterion for noninferiority for risk of the composite outcome of venous thromboembolism (VTE) or death among patients undergoing hip or knee arthroplasty, according to a randomized trial published in the Sept. 3 issue of JAMA. However, the authors noted that the trial may have been underpowered to meet this criterion. The Genetic Informatics Trial of Warfarin to Prevent Deep Vein Thrombosis enrolled 1,650 patients (mean age, 72.1 years; 63.6 percent were female) aged 65 years or older who initiated warfarin for elective hip or knee arthroplasty at six U.S. centers. Patients were randomized to a target international normalized ratio (INR) of 1.8 (n = 823; low-intensity) or 2.5 (n = 827; standard-intensity). The rate of VTE or death (primary outcome) was 5.1 percent (n = 41/804) in the low-intensity group and 3.8 percent (n = 30/793) in the standard-intensity group, for a difference of 1.3 percent. Major bleeding occurred in 0.4 percent and 0.9 percent, respectively, for a difference of −0.5 percent.

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Study Finds Early Exercise Improves Recovery after Sports-related Concussion

According to a preliminary study published in the September issue of the Clinical Journal of Sport Medicine, early subthreshold aerobic exercise for symptomatic adolescent males within one week of a sports-related concussion can accelerate recovery and may prevent delayed recovery. Patients were categorized into an exercise (n = 24; mean age, 15.13 years) or rest (n = 30; mean age, 15.33 years) group. The exercise group performed a progressive program of at least 20 minutes of daily subthreshold aerobic exercise, while the rest group did not receive structured exercise. Both groups completed daily online symptom reports via the Postconcussion Symptom Scale for 14 days. Recovery time from initial visit was a mean 8.29 days (standard deviation [SD], 3.9 days) in the exercise group compared to a mean 23.93 days (SD, 41.7 days) in the rest group. All symptom clusters decreased with time, and there was no significant interaction between treatment group and time. No exercise participants experienced delayed recovery (defined as > 30 days), whereas 13 percent (n = 4) of the rest group did.

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Study: Sarcopenia Predicts Mortality and Adverse Events in Those with Spinal Metastases

Sarcopenia is predictive of early postoperative mortality and adverse events (AEs) in patients undergoing urgent surgery for spinal metastases, according to a study published online in The Spine Journal. The single-institution, retrospective cohort study assessed incidence of AEs and one- and three-month mortality in 188 patients undergoing urgent surgery for spinal metastases from 2009 to 2015. Sarcopenia was defined using the L3 Total Psoas Area/Vertebral Body Area technique on CT. Most patients (85 percent) had at least one acute AE. Sarcopenia predicted the occurrence of at least one postoperative AE. Sarcopenia and the degree of neurological impairment were predictive of postoperative AE, but the Modified Frailty Index and Metastatic Frailty Index were not. Sarcopenia predicted three-month mortality, independent of primary tumor type.

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Physicians Call on Congress to Do Something About Prior Authorizations

This week, four doctors representing physician associations testified before the House Committee on Small Business about prior authorization hurdles, noting that these requirements delay necessary patient care, increase physician burnout, and lead to worse patient outcomes. Each health insurer has its own prior authorization policies and formularies that can change often, making it difficult to keep up, they said. The physicians also noted that doctors should be involved in fixing the prior authorization process.

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Sex-related Differences in Sports Medicine: Bone Health and Stress Fractures

During an Instructional Course Lecture presented at the American Orthopaedic Society for Sports Medicine Annual Meeting, panelists discussed the influence of sex-related factors on treatment outcomes and return to play in sports medicine. This article focuses on bone health and stress fractures, with particular attention given to female athletes.

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Action Alert: Push Congress to Consider Unintended Consequences of Government Benchmarking

Congress is back in session following the August recess, and first up on the agenda is legislation to fix surprise medical billing. Insurance companies are using this opportunity to prevent physicians from negotiating fair rates and to lock in a federally mandated benchmark for out-of-network care. In August, AAOS members wrote emails, made phone calls, and held meetings urging Congress to fix the issue the right way—without handing insurance companies all the leverage. With Congressional action imminent, it is vital that we push lawmakers to consider the unintended consequences of government rate-setting on access to care, particularly in rural and underserved communities.

Take action…

Download surprise billing infographic…

Check out AAOS’ Advocacy Resource Guide…


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