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Demographics and rates of surgical arthroscopy and postoperative rehabilitative preferences of arthroscopists from the Arthroscopy Association of North America (AANA)

Shah, Neil V; Solow, Maximilian; Kelly, John J; Aylyarov, Alexandr; Doran, James P; Bloom, Lee R; Akil, Samuel; Siddiqui, Bilal; Newman, Jared M; Chatterjee, Dipal; Pancholi, Neel; Dixit, Anant; Kavousi, Borna; Barbash, Scott E; Urban, William P; Neuman, David T
Survey of 869 arthroscopists regarding joint-specific arthroscopic procedures and postoperative rehabilitative preferences revealed comparable support for use of supervised physical therapy (SPT) and home exercise programs (HEPs) but stronger preference for joint-specific HEP applications (wrist, knee). Among respondents utilizing HEPs, modality of delivery (verbal/handout/web-based) didn't differ by joint, yet only 2.9% utilized web-based HEPs. This is the first known study to identify postoperative rehabilitation preferences. With 1.77 million estimated arthroscopic procedures annually (mean: 325.4 procedures/respondent), this study highlights under-utilization of web-based HEPs. Reliable, web-based HEPs can improve post-arthroscopic outcomes for patients, arthroscopic surgeons, and rehabilitative specialists while being cost efficient.
PMCID:5990328
PMID: 29881200
ISSN: 0972-978x
CID: 5018392

Trends and Epidemiology of Tennis-Related Sprains/Strains in the United States, 2010 to 2016

Chevinsky, Jonathan D; Newman, Jared M; Shah, Neil V; Pancholi, Neel; Holliman, John; Sodhi, Nipun; Eldib, Ahmed; Naziri, Qais; Zikria, Bashir A; Reilly, John P; Barbash, Scott E; Urban, William P
BACKGROUND:While tennis is one of the most popular sports in the world, it predisposes those who play it to a number of injuries. Several studies have shown sprains/strains to be the most common tennis-related injury. However, data is limited regarding trends in tennis-related sprains/strains. Therefore, this study evaluated: 1) trends in tennis-related sprains/strains; 2) trends in tennis-related sprains/strains by age; and 3) trends in the most common tennis-related sprained/strained body parts. MATERIALS AND METHODS/METHODS:This study utilized the National Electronic Injury Surveillance System (NEISS) database to collect all tennis-related sprains/strains that occurred between January 1, 2010 and December 31, 2016. The annual trends of overall tennis-related sprains/strains were evaluated. Then, the trends in tennis-related sprains/strains by age groups (less than 14 years, 14 to 29 years, 30 to 54 years, and 55 years and older) were compared, and the tennis-related sprains/strains injuries of different body parts were evaluated. RESULTS:A total of 48,638 tennis-related sprains/strains occurred during the study period. There was a decrease in the annual estimated weights of sprains/strains, from 8,433 in 2010 to 5,326 in 2016 (p=0.094). When stratified by age, tennis-related sprains/strains occurred in 3,295 (6.8%) patients younger than 14 years, 15,169 (31.2%) patients between the ages of 14 and 29 years, 16,814 (34.6%) patients between the ages of 30 and 54 years, and 13,360 (27.5%) in patients 55 years and older. Also, the trends tended to decrease for every age group, but this was not statistically significant. Furthermore, the most common tennis-related sprains/strains involved the ankle (30.2%), knee (13.7%), lower leg (11.3%), wrist (10.3%), lower trunk (8.5%), shoulder (8.1%), foot (4.9%), and elbow (2.5%). There was a significant decrease in the annual trends of ankle sprains/strains over the study's time-period (p=0.003). CONCLUSION/CONCLUSIONS:Sprains/strains were the most common tennis-related injuries, and the trends decreased over time, regardless of age. The lower extremity was more commonly injured than the upper extremity, with the ankle being the most common location. Understanding incidence and trends of tennis-related sprains/strains may help elucidate uncertainty pertaining to tennis injury statistics, ultimately improving the ability-of-care providers to work with players to develop preventive measures and better guide treatment.
PMID: 29315449
ISSN: 1090-3941
CID: 5018382

Clinical outcomes and structural healing after arthroscopic rotator cuff repair reinforced with a novel absorbable biologic scaffold: A prospective, multicenter trial [Note]

Barbash, S; Denny, C; Collin, P; Reish, T; Hart, J M; Brockmeier, S F
Objectives: Arthroscopic rotator cuff repair has been demonstrated to provide reliable clinical outcomes, but the rate of retear remains high (11% to 94%). Retears are associated with poorer outcomes and the majority of retears have been shown to occur within 6 months after surgical repair. Improving the mechanical and/or biological environment during index repair is a common strategy utilized to reduce retear rate. Biofiber© is a bi-layer, absorbable reinforced poly (4)-hydroxybutyrate scaffold that can be used to reinforce rotator cuff repair. Rotator cuff repairs augmented with Biofiber appear to have improved biomechanical properties as compared to standard repair constructs in cadaveric study. Therefore, BioFiber augmented rotator cuff repair may be a viable consideration for patients with larger tears, poorer tissue quality, or in revision repairs. The purpose of this prospective multi-center clinical trial is to evaluate the clinical outcomes and rates of successful healing by ultrasound evaluation in patients undergoing augmented arthroscopic rotator cuff repair using a BioFiber scaffold. Methods: A cohort of 50 patients were prospectively enrolled from three study sites in the US (2 sites) and France (1 site). Patients with an imaging demonstrated and arthroscopically confirmed full-thickness rotator cuff tear who underwent arthroscopic rotator cuff repair augmented with a BioFiber scaffold were included in the study. All patients were evaluated clinically at baseline prior to surgery, and subsequently at 6 months and 1 year post-operatively using functional outcomes evaluation (Constant Score and WORC Index), ROM, and strength testing. Ultrasound evaluation at 6 months and 1 year was also carried out to assess repair integrity. Results: The average patient age of the cohort was 61 +/- 9 years with an average BMI of 28.4. There were 27 female (54%) and 23 male (46%) patients; 10% of those enrolled were worker's compensation patients, 12% were undergoing revision rotator cuff repair. The average AP tear length was 25.2mm +/- 1.8mm with an average retraction of 17.1mm +/- 1.2mm from the greater tuberosity. Arthroscopic repairs were achieved in all 50 patients using either double-row (78%) or single-row (22%) constructs. The total surgical time for the procedure averaged 77 minutes, with a mean time required for placement of the Biofiber scaffold of 17 minutes. At 6 months post-operatively, the mean adjusted Constant Score was 94.0 (baseline 61.0) and the mean WORC Index was 82.1 (baseline 37.5). Ultrasound evaluation demonstrated intact repairs in 96% of the evaluated patients at the 6 month time point, with no additional evidence of repair failure at 1 year. Conclusion: This interim analysis suggests that reinforcement of rotator cuff repairs with Biofiber may result in a mechanically superior repair leading to a high rate of tendon healing. Tear size and quality of repair have been the best predictors for tendon healing in rotator cuff surgery, with recent studies demonstrating improved Constant scores when tendon healing is seen on ultrasound. This cohort had 96% rate of repair integrity on ultrasound evaluation. Furthermore, functional outcome scores after Biofiberaugmented repair were equal to or better than those recently reported for similar populations. Given this data, arthroscopic rotator cuff repair using a BioFiber augmented repair may provide a promising option in the treatment of patients with full-thickness rotator cuff tears
EMBASE:20160562645
ISSN: 2325-9671
CID: 2214142

Current Concepts in Sports-Related Concussion

Chatterjee, Dipal; Frumberg, David B; Mulchandani, Neil B; Eldib, Ahmed M; Xavier, Fred; Barbash, Scott E; Saha, Subrata; Urban, William P
Traumatic brain injury, specifically concussion, is prevalent in contact sports. In the United States (US) each year, 170 million adults participate in physical recreational activities, and 38 million children and adolescents participate in organized sports. The Centers for Disease Control estimate that in this group ~1.6 to 3.8 million concussions occur annually. Recent class-action lawsuits in the US filed by professional athletes against their respective leagues allege negligence in protecting them from concussions, and this has contributed to the attention received in the popular media. In response, concussion-related publications have increased exponentially during the past several years. Recent studies have challenged earlier assumptions that the effects of concussion are transient. Stronger links between concussion and neurodegenerative processes such as Alzheimer's disease-like conditions, depression, and heightened risk for suicide are being elucidated. In this article, we explore the current knowledge on concussion, including pathophysiology, management, and long-term effects. We conclude that more evidence-based results regarding guidelines for diagnosis, treatment, and return to play (RTP) are needed and should be the focus of future investigations. Attributing the etiology of certain neurodegenerative conditions to a history of concussion has been suggested in the current literature, but additional quantitative data regarding the pathophysiology and causality are needed as well. Bioengineers can have an important role in measuring the dynamic forces encountered during head impacts and their effects on the brain. These results can be effective in designing better helmets as well as improved playing surfaces to reduce the impact of such injuries. At this time, we believe that groups of people with heightened risk for concussion should be followed closely during longer periods of time and compared to matched controls. Such long-term studies are urgently needed to develop appropriate guidelines for safety and protect our young and adult athletes in the future.
PMID: 27480581
ISSN: 1943-619x
CID: 5018372

Olfactory dysfunction in leprosy

Mishra, Anupam; Saito, Kenji; Barbash, Scott E; Mishra, Nimisha; Doty, Richard L
Leprosy (Hansen's disease) is associated with a high incidence of nasal pathology. Despite this fact, the influence of this disorder on the sense of smell is poorly understood. In this study, we administered a standardized 12-item odor identification test to 77 patients with three types of leprosy: tuberculoid (n = 9), borderline (n = 42), and lepromatous (n = 26). All three types exhibited significantly lower test scores than their respective age-, sex-, and smoking-habit-matched controls. Patients with lepromatous leprosy exhibited significantly lower test scores than those with the other two types. Only patients with lepromatous leprosy exhibited meaningful improvement in smell function after treatment. No association between disease duration, per se, and the severity of the olfactory deficit was present. Overall, 100% of the patients exhibited olfactory dysfunction, suggesting that earlier prevalence estimates based on nonstandardized olfactory testing have underestimated the prevalence of this problem.
PMID: 16540900
ISSN: 0023-852x
CID: 5018362

Electrical taste thresholds established on the medial tongue using two sizes of electrodes

Nicolaescu, Serban A; Wertheimer, Jaclyn M; Barbash, Scott E; Doty, Richard L
OBJECTIVES/HYPOTHESIS/OBJECTIVE:The present study determined whether a 125 mm electrode would produce lower and more reliable electrical taste thresholds than a 25 mm electrode when measurement occurred in a medial tongue region relatively sparse in taste bud numbers. We hypothesized this would be the case and that the obtained threshold values would be higher than those previously reported for anterior and lateral tongue regions. STUDY DESIGN AND METHODS/METHODS:Sixteen college-age subjects were tested twice, once using the 25 mm electrode and once using the 125 mm electrode on each of two sessions separated by 2 to 16 days. The order of presentation of the sessions was counterbalanced across subjects. Measurement was confined to the medial tongue, 0.7 cm lateral to the median furrow. RESULTS:As hypothesized, the larger electrode resulted in lower and more reliable threshold values than the smaller electrode (respective median threshold values = 20.06 microA & 33.59 microA, P = .001; respective test-retest rs = 0.78 [P < .001] and 0.46 [P < .05]). Also as hypothesized, the threshold values were higher (i.e., sensitivity lower) than previously reported for anterior and lateral tongue regions. CONCLUSIONS:The magnitude and reliability of electrical taste thresholds depends on the tongue region examined and the size of the electrodes used. These results suggest that relatively large electrodes should be considered for electrogustometric threshold testing, particularly when lingual regions not highly populated with taste buds are evaluated.
PMID: 16094134
ISSN: 0023-852x
CID: 5018352