Today’s Top Story

Study: Return-to-play Outcomes after Pain-free versus Pain-threshold Rehab for Hamstring Injury

A randomized, controlled trial published in the February issue of the Journal of Orthopaedic & Sports Physical Therapy compared return-to-play (RTP) clearance outcomes in patients with acute hamstring strain injury (HSI) following a standardized rehabilitation protocol performed within either pain-free or pain-threshold limits. Acute HSI patients (all were male) were randomized to either a pain-free (n = 22) or pain-threshold (n = 21) rehabilitation group. Outcomes included days from HSI to RTP clearance, isometric knee flexor strength, biceps femoris long head (BFLH) fascicle length, fear of movement, and reinjury occurrence at six-month follow-up. Median time from HSI to RTP clearance did not largely differ between the pain-free and pain-threshold groups (15 days versus 17 days). The pain-threshold group had a 15 percent greater isometric knee flexor strength recovery at both 90 degrees of hip and 90 degrees of knee flexion. At two-month follow-up, BFLH fascicle length improvement from baseline was 0.91 cm greater in the pain-threshold group. In each group, two reinjuries occurred between RTP clearance and six-month follow-up.

Read the abstract…

In Other News

Study Explores Influential Factors of Subspecialty Choice for Females in Orthopaedics

According to a study published in the January issue of the Journal of the AAOS: Global Research & Reviews, mentorship was the most significant modifiable factor that affected subspecialty choice among female orthopaedic surgeons. A survey highlighting the area of subspecialty practice, motivations, and demographic data was emailed to the Ruth Jackson Orthopaedic Society, the Texas Orthopaedic Association, and a private internet page for women in orthopaedics. Respondents were practicing female orthopaedic surgeons, fellows, or fellowship-matched residents. Surveys from 288 respondents were included for analysis. The top three subspecialties were hand (24.0 percent), pediatrics (22.6 percent), and sports medicine (16.3 percent). Younger surgeons were more likely to subspecialize in sports medicine and less likely to pursue general orthopaedics. When asked why they selected their subspecialty, respondents’ top answers were personal satisfaction (50.8 percent), intellectual stimulation (42.1 percent), and strong mentorship (37.4 percent).

Read the study…

Study Evaluates Use of Low Risk Ankle Rule in Pediatric Emergency Department Visits

According to a study published online in Injury, the Low Risk Ankle Rule (LRAR) safely reduced radiography rates in pediatric ankle injuries without sacrificing important clinical features. Radiography and length of stay (LOS) data on ankle injuries presenting to an emergency department (ED) in 2016 were collected; education sessions were then implemented, and X-ray ordering prompts were designed so clinicians were more inclined to use the LRAR. In 2016, 969 ED patients presented with an ankle injury, of whom 90.7 percent received an X-ray; median LOS was 109 minutes. During the LRAR implementation period, 79 ankle injury patients who presented to the ED were eligible for study inclusion, of whom 49 had a positive LRAR exam. One LRAR patient received an X-ray that was normal. The 30 negative LRAR exam patients also received X-ray. The X-ray rate during the LRAR implementation period was 43.4 percent, representing a 47.3 percent reduction; average LOS was 101 minutes; and no clinically significant fractures were missed during the study period.

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Study Evaluates Technique to Predict Operative Failure following Bankart Repair

A retrospective, case-control study published online in Arthroscopy assessed the value of a method to measure capsule and labral volume on preoperative MRI to forecast primary Bankart repair failure. The study included arthroscopic Bankart repair patients treated between 2006 and 2015; patients with a postoperative dislocation (n = 33) were matched 1:2 to control patients without postoperative dislocation (n = 62). Labral and capsular volume were measured with a three-dimensional model using preoperative MRI arthrograms. The failure group had a significantly higher average number of preoperative dislocations than the nonfailure group (3.2 versus 2.0). Patients with normal labrum morphology had a 26 percent increased chance of surgical failure for every one-unit increase in the number of prior dislocations. Labral and capsular volume measurements did not largely differ between the groups. The rate of patients with a diffusely small labral morphology was significantly greater in the failure group than the nonfailure group (47 percent versus 17 percent). When controlling for the number of preoperative dislocations, the case group was 3.2 times more likely than the control group of having a diffusely small labral morphology.

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CMS Proposes Medicare Advantage Changes that Target Drug Pricing

The Centers for Medicare & Medicaid Services (CMS) proposed a rule for its Medicare Advantage program that would reduce cost-sharing on prescription drugs and promote greater transparency and comparability of out-of-pocket healthcare spending for different drugs. The proposal also extends eligibility to end-stage renal disease patients, promotes generics and biosimilars, and requires Part D Drug Management Programs to be implemented in line with the Substance Use-disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. AAOS is reviewing the rule and will continue to update members on the result of these proposals.

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Read the CMS press release…


February AAOS Now Is Now Available Online

AAOS members will soon receive the print edition of the February issue of AAOS Now, but the electronic edition is already available on the AAOS Now website and on iOS and Android devices through the AAOS Access app. This month’s issue highlights include factors to consider when assessing robotic technology, the importance of perioperative positioning to avoid patient harm, the story of an orthopaedist turned patient, and more.

Read more…


Last Chance: Annual Meeting Advance Registration Deadline—Register by Feb. 14 and Save

Time is running out to save on your registration and course tickets for the AAOS 2020 Annual Meeting in Orlando, Fla., March 24–28. Don’t miss your opportunity to learn and engage with colleagues and experts in stimulating, interactive education events, including:

  • Instructional Course Lectures (ICLs): Master in-depth experience-based orthopaedic techniques.
  • Case Presentation Courses: Engage in collaborative discussions with experts and peers.
  • Technical Skills Courses: Refine your positioning and approach.

ICL savings are just one click away but won’t last long.

Register for the Annual Meeting…