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Female patients have greater improvement in pain symptoms and physical activity after fasciotomy for treatment of chronic exertional compartment syndrome of the lower leg
Shankar, Dhruv S; Vasavada, Kinjal D; Gillinov, Lauren A; Kirschner, Noah; Mojica, Edward S; Blaeser, Anna M; Borowski, Lauren E; Jazrawi, Laith M; Cardone, Dennis A
PURPOSE/OBJECTIVE:The purpose of this study was to identify sex differences in postoperative outcomes and return-to-sport rates after fasciotomy for treatment of chronic exertional compartment syndrome (CECS) of the lower leg. It was hypothesised that male CECS patients would have a higher rate of return to sport than female CECS patients. METHODS:A retrospective cohort study was conducted involving patients who underwent primary fasciotomy of one to four leg compartments for treatment of CECS at a single centre from 2010 to 2020. Each affected leg was treated as a separate subject. Postoperative outcomes included CECS pain frequency and severity, return to sport and Tegner activity level. Multivariable regression was used to determine if sex was an independent predictor of outcomes after adjusting for demographic and clinical covariates. p < 0.05 were considered significant. RESULTS:Eighty-one legs (44 M, 37 F) of 47 unique patients (34 of whom had bilateral symptoms) were included with a mean follow-up time of 51.5 ± 31.4 months. Male subjects were older (p < 0.001) and had higher body mass index (p < 0.001) compared to female subjects. Most subjects (84.0%) underwent two- or four-compartment fasciotomies. Female sex was found to be predictive of lower overall postoperative pain severity (p = 0.007), higher odds of return to sport (p = 0.04) and higher postoperative Tegner score (p = 0.005). However, female sex was not predictive of postoperative pain frequency, odds of reoperation or odds of return to sport to at least the presymptomatic level (all p < 0.05). CONCLUSION/CONCLUSIONS:Female sex is independently predictive of reduced overall pain severity, higher odds of return to sport and higher postoperative improvement in Tegner score following fasciotomy for treatment of lower-limb CECS. LEVEL OF EVIDENCE/METHODS:III.
PMID: 38690978
ISSN: 1433-7347
CID: 5734222
Paresthesia Is Predictive of Symptom Recurrence After Fasciotomy for Exertional Compartment Syndrome of the Leg
Shankar, Dhruv S; Blaeser, Anna M; Gillinov, Lauren A; Vasavada, Kinjal D; Fariyike, Babatunde B; Mojica, Edward S; Borowski, Lauren E; Jazrawi, Laith M; Cardone, Dennis A
BACKGROUND/UNASSIGNED:Exertional compartment syndrome (ECS) is an underdiagnosed cause of lower extremity pain among athletes. The condition can be managed operatively by fasciotomy to relieve excess compartment pressure. However, symptom recurrence rates after fasciotomy are considerable, ranging from 3% to 17%. HYPOTHESIS/UNASSIGNED:Leg paresthesia and its distribution during ECS episodes would be a significant predictor of outcomes after fasciotomy. STUDY DESIGN/UNASSIGNED:Retrospective cohort study. LEVEL OF EVIDENCE/UNASSIGNED:Level 4. METHODS/UNASSIGNED:values <0.05 were considered significant. RESULTS/UNASSIGNED:= 0.04). CONCLUSION/UNASSIGNED:ECS patients who present with paresthesia have worse pain and activity outcomes after first-time fasciotomy, but prognosis is worst among those with tibial nerve paresthesia. CLINICAL RELEVANCE/UNASSIGNED:Paresthesia among ECS patients is broadly predictive of more severe recurrent leg pain, reduced activity level, and decreased odds of return to sport after fasciotomy.
PMCID:11025501
PMID: 36951383
ISSN: 1941-0921
CID: 5726122
Clinical Presentation and Outcomes of Sacral Stress Fractures in Athletes: A Case Series of 13 Patients
Shankar, Dhruv S; Gillinov, Lauren A; Buldo-Licciardi, Michael; Vargas, Luilly; Cardone, Dennis A
BACKGROUND/UNASSIGNED:Sacral stress fractures are a rare cause of low back pain in athletes. Given the low incidence of these fractures, there is a scarcity of data on symptomatology, risk factors, and clinical outcomes. HYPOTHESIS/UNASSIGNED:Patients diagnosed with sacral stress fractures would be athletes presenting with low back pain. STUDY DESIGN/UNASSIGNED:Case series of 13 patients with sacral stress fractures. LEVEL OF EVIDENCE/UNASSIGNED:Level 4. METHODS/UNASSIGNED:We conducted a retrospective review of medical records to identify patients diagnosed with sacral stress fractures at a single academic institution. Fractures were diagnosed on noncontrast T2-weighted magnetic resonance imaging scans and categorized using the Bakker classification system. Subjects were administered an electronic survey that asked about (1) the onset, time course, and location of pain and other symptoms; (2) time to treatment and treatment modalities pursued; (3) sports performance and time to return to sport; and (4) risk factors for stress fractures. RESULTS/UNASSIGNED:Of 18 eligible patients, 13 (72.2%) completed the survey with mean follow-up of 49.6 months (range, 1-144 months). Mean age was 28.0 years (range, 18-52 years); 9 patients (69.2%) were female, of whom 7 (77.8%) were premenopausal. The most common fracture type was Bakker type B (8 patients; 61.5%). Most patients presented with acute lumbosacral back pain in the setting of running/jogging activities. All patients underwent nonoperative treatment for an average of 3.8 months (range, 0-8 months) and three-quarters reported pain resolution at last follow-up. Rate of return to sport was 83.3%, but most patients reported ongoing deficits in running performance. CONCLUSION/UNASSIGNED:Sacral stress fractures commonly present as acute lumbosacral back pain provoked by running sports. While the pain associated with these fractures prevents most athletes from participating in sports, nonoperative management appears to be an effective treatment modality with a high rate of return to sport.
PMCID:11346241
PMID: 37542387
ISSN: 1941-0921
CID: 5679872
Clinical Presentation and Outcomes of Sacral Stress Fractures in Athletes: A Case Series of 13 Patients
Shankar, Dhruv S; Gillinov, Lauren A; Buldo-Licciardi, Michael; Vargas, Luilly; Cardone, Dennis A
BACKGROUND/UNASSIGNED:Sacral stress fractures are a rare cause of low back pain in athletes. Given the low incidence of these fractures, there is a scarcity of data on symptomatology, risk factors, and clinical outcomes. HYPOTHESIS/UNASSIGNED:Patients diagnosed with sacral stress fractures would be athletes presenting with low back pain. STUDY DESIGN/UNASSIGNED:Case series of 13 patients with sacral stress fractures. LEVEL OF EVIDENCE/UNASSIGNED:Level 4. METHODS/UNASSIGNED:We conducted a retrospective review of medical records to identify patients diagnosed with sacral stress fractures at a single academic institution. Fractures were diagnosed on noncontrast T2-weighted magnetic resonance imaging scans and categorized using the Bakker classification system. Subjects were administered an electronic survey that asked about (1) the onset, time course, and location of pain and other symptoms; (2) time to treatment and treatment modalities pursued; (3) sports performance and time to return to sport; and (4) risk factors for stress fractures. RESULTS/UNASSIGNED:Of 18 eligible patients, 13 (72.2%) completed the survey with mean follow-up of 49.6 months (range, 1-144 months). Mean age was 28.0 years (range, 18-52 years); 9 patients (69.2%) were female, of whom 7 (77.8%) were premenopausal. The most common fracture type was Bakker type B (8 patients; 61.5%). Most patients presented with acute lumbosacral back pain in the setting of running/jogging activities. All patients underwent nonoperative treatment for an average of 3.8 months (range, 0-8 months) and three-quarters reported pain resolution at last follow-up. Rate of return to sport was 83.3%, but most patients reported ongoing deficits in running performance. CONCLUSION/UNASSIGNED:Sacral stress fractures commonly present as acute lumbosacral back pain provoked by running sports. While the pain associated with these fractures prevents most athletes from participating in sports, nonoperative management appears to be an effective treatment modality with a high rate of return to sport.
PMCID:11346241
PMID: 37542387
ISSN: 1941-0921
CID: 5679882
Psychiatric Disorders Are Predictive of Worse Pain Severity and Functional Outcomes After Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg
Bi, Andrew S; Shankar, Dhruv S; Avendano, John P; Borowski, Lauren E; Jazrawi, Laith M; Cardone, Dennis A
OBJECTIVE:To determine whether concomitant psychiatric diagnoses and medication use were associated with postfasciotomy outcomes in patients with chronic exertional compartment syndrome (CECS). DESIGN/METHODS:Retrospective comparative cohort study. SETTING/METHODS:Single academic medical center from 2010 to 2020. PATIENTS/METHODS:All patients above 18 years old who underwent fasciotomy for CECS. ASSESSMENT OF RISK FACTORS/INDEPENDENT VARIABLES/UNASSIGNED:Psychiatric history was recorded from electronic health records including disease diagnosis and medications. MAIN OUTCOME MEASURES/METHODS:The 3 main outcome measures were postoperative pain using the Visual Analog Scale, functional outcomes using the Tegner Activity Scale, and return to sport. RESULTS:Eighty one subjects (legs), 54% male, with an average age of 30 years and follow-up of 52 months were included. 24 subjects (30%) had at least one psychiatric diagnosis at the time of surgery. Regression analysis found psychiatric history to be an independent predictor of worse postoperative pain severity and postoperative Tegner scores (P < 0.05). Furthermore, subjects with psychiatric disorders not on medication had worse pain severity (P < 0.001) and Tegner scores (P < 0.01) versus controls, whereas subjects with a psychiatric disorder on medication had better pain severity (P < 0.05) versus controls. CONCLUSIONS:History of psychiatric disorder was predictive of worse postoperative pain and activity outcomes after fasciotomy for CECS. Use of psychiatric medication was associated with improvement in pain severity in some domains.
PMID: 36808120
ISSN: 1536-3724
CID: 5433852
Patient and Physician Satisfaction with Telehealth During the COVID-19 Pandemic: Sports Medicine Perspective
Kirby, David J; Fried, Jordan W; Buchalter, Daniel B; Moses, Michael J; Hurly, Eoghan T; Cardone, Dennis A; Yang, S Steven; Virk, Mandeep S; Rokito, Andrew S; Jazrawi, Laith M; Campbell, Kirk A
PMID: 33512302
ISSN: 1556-3669
CID: 4767672
Decreased Injury Rate Following Mandated Headgear Use in Women's Lacrosse
Baron, Samuel L.; Veasley, Shayla J.; Kingery, Matthew T.; Nguyen, Michael V.; Alaia, Michael J.; Cardone, Dennis A.
INTRODUCTION:There has been controversy regarding whether headgear use in women's lacrosse will affect the rate of head and musculoskeletal injuries. The purpose of this study was to investigate the effect of mandated headgear use on the rate of head and musculoskeletal injuries in high school women's lacrosse. METHODS:This was a prospective cohort study of eight high school women's lacrosse teams and their game op-ponents who were mandated to wear F3137 headgear for the 2017 and 2018 seasons. Athletic trainers documented all injuries that occurred as a result of participation on the lacrosse teams. Injury rates in the headgear cohort were compared to a retrospective (control) cohort from the High School Reporting Information Online injury data reports. RESULTS:Over the study period, 17 total injuries were reported in the headgear cohort during 22,397 exposures for an injury rate of 0.76 injuries per 1,000 athlete-exposures. The headgear cohort demonstrated significant decreases in rates of in-game head and face injury (RR 0.141, 95% CI [0.004, 0.798]), in-game concussion (RR 0.152, 95% CI [0.004, 0.860]), and practice trunk and extremity injury (RR 0.239, 95% CI [0.049, 0.703]) when compared to the control cohort. CONCLUSION:Mandated use of headgear was shown to be effective at lowering the rate of head or face injury and concussions in women's lacrosse. Additionally, mandated headgear use was also shown to lower the rate of injury to body locations other than the head or face during practice. To our knowledge, this is the first study to demonstrate a decrease in injury rates associated with ASTM approved headgear in women's lacrosse.
PMID: 33207148
ISSN: 2328-5273
CID: 4708212
Nonoperative Treatment of Meniscus Tears
Chapter by: Cardone, Dennis; Borowski, Lauren; Essilfie, Anthony A
in: The management of meniscal pathology : from meniscectomy to repair and transplantation by Strauss, Eric J; Jazrawi, Laith M [Eds]
Cham, Switzerland : Springer, [2020]
pp. 53-60
ISBN: 9783030494872
CID: 5301122
Unexpected Hurdle in the Race: Hypophosphatasia Unmasked by the Female Athlete Triad
Fink, Dorothy A; Pasculli, Rosa M; Wright, Alana; Katz, Karin; Agrawal, Nidhi; Turner, Ryan; Cardone, Dennis A
Hypophosphatasia should be considered for any patient who presents with multiple metatarsal stress fractures and a low alkaline phosphatase.
PMID: 31834173
ISSN: 1537-8918
CID: 4235012
The effectiveness of mandated headgear use in high school women's lacrosse at reducing the rate of head and face injuries [Meeting Abstract]
Baron, S L; Veasley, S J; Kingery, M T; Alaia, M J; Cardone, D A
Objectives: There has been continued controversy regarding whether or not headgear use in women's lacrosse will increase or decrease the rate of head injuries. In 2017, the Public Schools Athletic of New York City became the first high school organization in the country to mandate ASTM standard F3137 headgear for all women's lacrosse players. The purpose of this study is to investigate the effect of mandated headgear use on the rate of head and face injuries in high school women's lacrosse.
Method(s): This was a prospective cohort study. The study group included eight varsity and junior varsity women's lacrosse teams, as well as their game opponents, who were mandated to wear F3137 headgear for all practice and game events over the course of the 2017 and 2018 seasons. Certified athletic trainers assessed and documented all injuries that occurred as a result of participation on the lacrosse teams and athlete exposures were estimated based on the number of team practice and game events. Injury rates were compared with those from the High School RIO (Reporting Information Online) injury data reports from the 2009 to 2016 seasons.
Result(s): Over the study period, 17 total injuries were reported during 22,397 exposures for an injury rate of 0.76 injuries per 1,000 athlete-exposures. Two head/face injuries, both of which were classified as concussions, were reported during the study for a head/face injury rate and concussion rate of 0.09 per 1,000 athlete-exposures. The headgear cohort demonstrated significant decreases in rates of in-game head/face injury (RR 0.141, 95% CI [0.004, 0.798]), in-game concussion (RR 0.152, 95% CI [0.004, 0.860) and practice non-head/face injury (RR 0.239, 95% CI [0.049, 0.703]) when compared to the control cohort.
Conclusion(s): Mandated use of F3137 headgear was shown to be effective at lowering the rate of head or face injury and concussions in women's lacrosse. Additionally, mandated headgear use was also shown to lower the rate of injury to body locations other than the head or face during practice
EMBASE:629239498
ISSN: 2325-9671
CID: 4080582