To systematically investigate the influence of pre-operative depression diagnosis and symptom severity on outcomes following anterior cruciate ligament reconstruction.
A literature search was performed using PubMed, Scopus, and EMBASE databases according to the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Studies evaluating the impact of depression on clinical outcomes following ACL reconstruction were included. Clinical outcomes, changes in depression, and complications were aggregated.
Nine studies comprising 308,531 patients (mean age of 28.1 years; range 14-50 years) were included. Depression incidence ranged from 3.8-42%. Seven studies showed postoperative improvement in depression scores, with five reporting statistical significance.
Assessment of depression exhibited substantial variability, with Patient-Reported Outcomes Measurement Information System (PROMIS) scores being the most common method.
Depressed patients, despite showing greater improvements in scores, experienced significantly higher PROMIS Pain Interference (PROMIS-PI) scores preoperatively (range, 59.1-65.7 vs 56.8-59.2) and postoperatively (range, 46.3-52.3 vs 46.3-47.4) compared to non-depressed patients. They also demonstrated significantly lower preoperative (range, 33-38.1 vs 39.7-41.5) and postoperative (range, 51.6-56.7 vs 56.7-57.6) PROMIS Physical Function (PROMIS-PF) scores, regardless of greater score improvement. Patients affected by depresssion had significantly higher rates of minimal clinically important difference (MCID) achievement for PROMIS-PF (71-100% vs 80%) and similar rates for PROMIS-PI (71-81% vs 68%) than non-depressed patients in three studies. Depression was associated with reduced adherence to rehabilitation protocols and increased postoperative complications, including infections, graft failures, arthrofibrosis, and readmission.
ACL reconstruction yields favorable outcomes for patients with and without preoperative depression. Individuals with preoperative depression may report inferior outcomes in terms of pain and functionality; nevertheless, despite these challenges, they exhibit significant improvements across all outcome measures following surgery, including reductions in depression levels.
Systematic review of level II - IV studies; Level of evidence IV
To compare injury profiles of meniscal and/or chondral injury in skeletally mature (SM) versus immature (SI) patients undergoing primary anterior cruciate ligament reconstruction (ACLR).
CPT code 29888 was queried from January 2012 to April 2020. Subjects aged under 22 who underwent primary ACLR within 6 months of injury were included. Exclusion criteria included age greater than 22, treatment after 6 months, revision ACLR, concurrent osteotomy, or multi-ligamentous injury. All subjects required a minimum of one year follow-up. Demographics and intra-operative pathology was recorded. Data was analyzed for factors affecting intra-articular injury and stratified by sport.
Of 927 patients (739 SM,188 SI), the average age was 16.63 and 14.00 for the SM and SI cohorts, respectively(p<.001). There were more SM males (51.4%) compared to SI males (81.9%)(p<.001); however in univariate analysis gender did not significantly affect the rates of meniscal(p=.519) or chondral injury(p=.961). 887 meniscal injuries were recorded (344 medial, 543 lateral) in 659 patients. SM sustained greater rates of medial meniscal tear (MMT) (p<.001), and underwent higher rates of partial meniscectomy(p=.022). Male sex conferred meniscal injury (95%CI[0.43,0.81],p=.001). BMI prognosticated medial meniscal (95%CI[1.01,1.06],p=.002) and medial chondral injuries (95%CI[1.02,1.09],p<.001). Skeletal maturity was a superior predictor of intra-articular pathology than age for all outcomes: MMT (95%CI[0.00,0.06],p=.002), LMT (95%CI[0.00,0.75],p=.034), and chondral injury (95%CI[0.00,0.49],p=.049). In sport sub-analysis, soccer ACL injuries were most common (32.6%). Soccer and basketball athletes were more likely SM (p=.016,p=.003 respectively) with increased medial compartment pathology. Football ACL injuries occurred significantly in SI athletes(p=.001) via contact mechanisms(p=.025).
Skeletal maturity affects the meniscal and chondral injury profile in ACL-injured patients. SM patients have greater risk of sustaining concomitant meniscal injury, while chondral injury profile depends more on the mechanism of injury. Mechanism of injury and skeletal maturity status impact risk of sports related ACL rupture and ACL-concurrent pathology in young patients. Patient-specific variables influence injury profiles within each sport. Skeletal maturity rather than age predicts concomitant intra-articular injury risk.
III – Retrospective Cohort Study
The purpose of this study was to determine the incidence rates and associated risk factors of season-ending injuries (SEIs) in the National Basketball Association from the 2015-2020 seasons.
Publicly available player records of active NBA players between the 2015-16 and 2020-21 seasons were reviewed to identify players with a season-ending injury. In this study, SEI was classified as any injury that resulted in failure to return at least five games before the end of their team’s game schedule. Injury data from the 2019-20 NBA season, shortened due to the COVID-19 pandemic, was omitted. The primary outcome was the incidence of season-ending injuries, reported per 1,000 game exposures (GEs). Player demographics, basketball statistics, injury characteristics, and timing of injury were recorded. Secondary analysis, including bivariate analysis and multivariable logistic regression, was performed to investigate factors associated with having a season-ending injury.
In total, one hundred ninety-six players (15.6% of all players) sustained a combined two hundred thirty-eight season-ending injuries between the 2015-16 and 2020-21 seasons, indicating a rate of 1.74 season-ending injuries per 1,000 GEs. When characterized by body part, knee injuries were found to be the most frequent SEI at a rate of 0.47 injuries per 1,000 GEs. Accounting for potential confounders, having a season-ending injury was significantly associated with more minutes per game played (odds ratio [OR] 1.06; 95% confidence interval [CI] 0.99-1.01; P = <0.001).
Season-ending injuries occurred in 15.6% of players in this study with an overall rate of 1.74 season-ending injuries per 1,000 game exposures. The most significant risk factor associated with injury was minutes per game. Season-ending injury was more likely to occur in the third and fourth quartile of the NBA season than in the first or second quartile.
The purpose of this study was to evaluate the association between the timing of intra-articular hip corticosteroid injections and the risk of postoperative infection in patients undergoing hip arthroscopy.
The 2010-2021 PearlDiver M157 administrative claims database was queried for patients who underwent hip arthroscopy. Patients who received intra-articular corticosteroid injections within 12 weeks prior to arthroscopy were matched to those who did not 1:1 based on age, sex, and Elixhauser-Comorbidity Index, and the presence of diabetes mellitus, hypertension, obesity, and tobacco use. Those with injection prior to arthroscopy were subdivided based on having had the injection within 12 weeks prior to surgery. To verify that the corticosteroid injection and surgery were conducted in the hip joint, Current Procedural Terminology (CPT) codes were utilized. Using CPT coding and the International Classification of Diseases (ICD) 9th or 10th Revision, postoperative surgical site infection following corticosteroid injection was evaluated. The impact of the timing of preoperative corticosteroid injections on the incidence of postoperative infection was evaluated using multivariable logistic regression analysis.
A total of 12,390 hip arthroscopy cases were identified, including 3,579 patients who received a corticosteroid injection 0-4 weeks prior to the surgery, 4,759 within 4-8 weeks prior to the surgery, and 4,052 within 8-12 weeks prior to the surgery. Compared to controls, patients who received a corticosteroid injection within 0-4 weeks preoperatively had a significantly higher rate of surgical site infection (OR 2.43; P=0.0001). No significant differences were observed in infection rates at the later time intervals (4-8 weeks or 8-12 weeks). Furthermore, in comparison to controls, patients who received a corticosteroid injection had a significantly higher rate of wound dehiscence (OR 1.84, P=0.0007).
Intra-articular corticosteroid injections within 4 weeks prior to hip arthroscopy were significantly associated with increased surgical site infection rates following hip arthroscopy surgery.
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