Today’s Top Story
Study: Concussed athletes may be at increased risk of acute lower extremity musculoskeletal injury after return to play.
Findings from a study published online in The American Journal of Sports Medicine suggest that athletes who experience concussion may be at increased risk of acute lower extremity musculoskeletal injury after return to play. The researchers conducted a cohort study of 75 collegiate athletes (87 cases of concussion) and 182 non-concussed matched control athletes. During the 90-day periods after return to play, the researchers found that incidence of acute lower extremity musculoskeletal injury was higher among recently concussed athletes (15/87; 17 percent) compared with matched controls (17/182; 9 percent). Overall, they found that the odds of sustaining an acute lower extremity musculoskeletal injury were 2.48 times higher in concussed athletes than controls during the same 90-day period. Read the abstract…

Other News

ASBMR report offers guidance on bisphosphonate use.
A report by a task force of the American Society for Bone and Mineral Research (ASBMR) offers guidance on the use of bisphosphonates. The authors base their recommendations on evidence from two trials that examined long-term use of bisphosphonates. Among the recommendations included in the report:

  • Patients should be reassessed for risk after 5 years of oral bisphosphonate or 3 years of intravenous bisphosphonate use.
  • In women considered to be at high fracture risk, continuation of bisphosphonate treatment for up to 10 years (oral) or 6 years (intravenous), with periodic evaluation, should be considered.
  • For women not at high fracture risk after 3 to 5 years of bisphosphonate treatment, a drug holiday of 2 to 3 years can be considered.

The authors note that their recommendations for long-term bisphosphonate use are based on limited evidence, only for vertebral fracture reduction, in mostly white postmenopausal women, and should not replace the need for clinical judgment. Read the complete report…

Study: Obesity linked to decreased long-term, but not mid-term, implant survivorship after TAA.
Obese patients who undergo total ankle arthroplasty (TAA) may be at long-term risk of implant failure, according to data published in the January issue of the journal Foot & Ankle International. The research team conducted a chart review of 97 primary TAA patients. At 5-year follow-up, they found no significant difference in implant survivorship between cohorts of obese patients (body mass index ≥30 kg/m2; n = 49) and non-obese patients (n = 48). However, the research team noted an increased long-term risk of implant failure among obese patients that was not seen in the intermediate term. In addition, they found that obese patients with primary osteoarthritis (OA) displayed significantly decreased 5-year implant survivorship after TAA compared with obese patients with inflammatory or posttraumatic arthritis. Read the abstract…

Study: Knee OA pain may be linked to genetic factors.
Data from a study published in the Scandinavian Journal of Pain suggest a genetic component may influence knee pain sensitivity. The authors examined day-to-day variability in knee OA pain for 120 patients with different variants of catechol-O-methyltransferase (COMT) and mu-opioid receptor (OPRM1) single nucleotide polymorphisms (SNPs). They found that, regarding OPRM1 rs1799971 (Asn40Asp), patients with two copies of the Asn40 allele displayed the greatest day-to-day pain variability. Regarding COMT rs4680 (Val158Met), patients with the Val/Val genotype showed the greatest pain variability and also experienced the greatest increase in pain as a result of physical activity. They found no significant between-person differences in daily pain when comparing patients according to COMT rs4680, or OPRM1 rs1799971. Read more…
Read the abstract…

Studies look at trends in use of imaging.
Findings published online in the Journal of Surgical Research suggest an increase in the use of computed tomography (CT) among minor trauma patients from 2005 through 2013. The researchers reviewed data on 8,535,831 adult patients from the California Office of Statewide Health Planning and Development Emergency Department and Ambulatory Surgery Data. They found that overall, 5.9 percent received at least one CT study during their emergency department visit. The proportion of patients with at least one CT scan increased from 3.51 percent in 2005 to 7.17 percent in 2013. After adjustment for clinical and demographic factors, the researchers noted a 1.97-fold increase in the use of CT for minor trauma over the study period. Read more…
Read the abstract…
     In a second study, published in the February issue of the journal Medical Care, the authors reviewed 2010 commercial insurance claims data of more than 21 million patients and compared the use of diagnostic imaging and standardized payments between enrollees in health plans with and without high deductibles. Compared with those in plans without high deductibles, the authors found that enrollment in a high deductible plan was associated with a 7.5 percent decrease in the number of imaging studies and a 10.2 percent decrease in standardized imaging payments. Read more…
Read the abstract…

HHS guidelines clarify patient access to medical records.
The U.S. Department of Health and Human Services (HHS) has issued guidelines to help clarify patients’ rights to access to their own medical records. According to The New York Times, federal official say they have received numerous complaints from consumers who have been denied access to their records. “While the Privacy Rule allows covered entities to require that individuals request access in writing and requires verification of the identity of the person requesting access, a covered entity may not impose unreasonable measures on an individual requesting access that serve as barriers to or unreasonably delay the individual from obtaining access,” the guidelines state. “For example, a doctor may not require an individual:

  • Who wants a copy of her medical record mailed to her home address to physically come to the doctor’s office to request access and provide proof of identity in person.
  • To use a web portal for requesting access, as not all individuals will have ready access to the portal.
  • To mail an access request, as this would unreasonably delay the covered entity’s receipt of the request and thus, the individual’s access.

While a covered entity may not require individuals to request access in these manners, a covered entity may permit an individual to do so, and covered entities are encouraged to offer individuals multiple options for requesting access.” Read more…
Read the guidelines…

Massachusetts.
MassLive.com reports that the Massachusetts House of Representatives has unanimously passed a bill that, if enacted, would limit first-time opioid prescriptions for adults and all opioid prescriptions for minors to 7 days. Exceptions could be made for some patients with chronic pain. The bill now moves to a joint House-Senate committee for negotiation. Read more…

Call for volunteers: Annual Meeting Committee.
Jan. 29 is the last day to submit your application for a position on the Annual Meeting Committee (chair designee and allied health representative openings). Applicants for the chair designee position must be active fellows with a strong interest in the AAOS Annual Meeting. Applicants for the allied health representative member position must be active fellows with an interest in and knowledge of allied health education. Learn more and submit your application…(member login required)