Today’s Top Story
Study: Intra-articular triamcinolone may be less effective than placebo for certain patients with knee OA.
Findings from a study published in the May 16 issue of The Journal of the American Medical Association suggest that triamcinolone injection may be less effective than placebo for treatment of symptomatic knee osteoarthritis (OA). The authors conducted a randomized, placebo-controlled, double-blind trial of 119 patients with symptomatic knee OA with ultrasonic features of synovitis, who were treated with intra-articular triamcinolone or saline every 12 weeks for 2 years. At 2-year follow-up, they found no significant difference across cohorts in the Western Ontario and McMaster Universities Osteoarthritis index Likert pain subscale. However, the authors noted that intra-articular triamcinolone was associated with significantly greater cartilage volume loss compared to saline. Read more…
Read the abstract…

Other News

Study: What factors are associated with progression of fatty muscle degeneration in rotator cuff tear?Data from a study published in the May 17 issue of The Journal of Bone & Joint Surgery suggest that progression of fatty muscle degeneration may be more likely in rotator cuff tears that are larger at baseline, enlarge over time, and undergo a larger magnitude of enlargement. The research team conducted a prospective study of 156 shoulders with full-thickness rotator cuff tear, 70 of which had measurable fatty muscle degeneration of at least one rotator cuff muscle at some time point. They found that overall, patients with fatty muscle degeneration in the shoulder were older than those without degeneration, and the median size of the tears at baseline was larger in shoulders with degeneration than in shoulders that did not develop degeneration. In addition, tears with fatty muscle degeneration were more likely to have enlarged during follow-up compared to tears that never developed muscle degeneration. The median time from tear enlargement to progression of fatty muscle degeneration was 1 year for the supraspinatus and 1.1 years for the infraspinatus muscle. Read the abstract…

Study: Medial clamp tine position may affect reduction accuracy during syndesmotic reduction.
According to a study published online in the Journal of Orthopaedic Trauma, the position of the medial clamp tine during syndesmotic reduction may impact reduction accuracy. The researchers conducted a prospective cohort study of 72 patients who underwent operative fixation of ankle syndesmotic injuries using reduction forceps. They assessed malreduction rates with bilateral ankle computerized tomography. The researchers found a significant association between medial clamp position and sagittal plane syndesmosis malreduction, with a 0 percent malreduction rate in the 18 patients where the clamp tine was placed in the anterior third, a 19.4 percent malreduction rate in the middle third, and a 60 percent malreduction rate in the posterior third. In reference to posterior fibular translation, they found an 11.1 percent malreduction when clamp placement was in the anterior third, a 16.1 percent malreduction rate in the middle third, and a 60 percent malreduction rate in the posterior third. They noted no significant association between medial clamp position and coronal plane malreduction. Read the abstract…

Study: Why do medical practices “fire” patients?
A study published online in the journal JAMA Internal Medicine examines reasons for patient dismissal by medical practices. The researchers surveyed 794 primary care practices, including 443 participants in the Comprehensive Primary Care (CPC) initiative and 351 comparison practices. They found that 708 respondents (90.5 percent) said that they had dismissed patients during the previous 2 years. Reasons given for dismissing patients included the following:

  • Disruptive or inappropriate behavior (567 practices [81.2 percent])
  • Violating chronic pain/controlled substance policies (552 practices [784 percent])
  • Repeatedly missing appointments (504 practices [74.4 percent])
  • Not following healthcare recommendations (313 practices [ 44.7 percent])
  • Repeatedly violating bill payment policies (263 practices [39.5 percent])
  • Not following lifestyle change recommendations (38 practices [6.8 percent])

Read more…
Read the abstract…

5th International Consensus Conference on Concussion in Sport issues statement on evaluation and treatment of SRC.
The British Journal of Sports Medicine has published a consensus statement from the 5th International Consensus Conference on Concussion in Sport. The statement is based on screening of approximately 60,000 published studies, and among other things, offers recommendations for sideline evaluation, noting that a key concept in sideline assessment is the rapid screening for a suspected sport-related concussion (SRC), rather than the definitive diagnosis of head injury. “It is important to note that SRC is an evolving injury in the acute phase,” the authors write, “with rapidly changing clinical signs and symptoms, which may reflect the underlying physiological injury in the brain. SRC is considered to be among the most complex injuries in sports medicine to diagnose, assess and manage. The majority of SRCs occur without loss of consciousness or frank neurological signs. At present, there is no perfect diagnostic test or marker that clinicians can rely on for an immediate diagnosis of SRC in the sporting environment.” Read the complete statement…

An article in Lexology describes updates to the 2013 Arkansas Peer Review Fairness Act (PRFA), which imposed limits on the process through which healthcare providers review the performance of their peers to identify potential problems, improve patient care, and, in some instances, remove staffers. Among other things, a law recently enacted by the governor of Arkansas does the following:

  • Refines the definition of the term “investigation” as used in PRFA
  • Outlines changes to hearing structure
  • Defines what information can be used by the court when a provider contests an adverse professional review action

Read more…

Last call: Sports Medicine Content Committee.
May 19 is the last day to submit your application for chair of the Sports Medicine Content Committee. Members of Content Committees analyze information to identify member knowledge gaps, and recommend development of new education programs to the Council on Education. Applicants for this position must be active members with a practice emphasis on sports medicine. Learn more and submit your application…(member login required)