Background: The coronavirus 2019 (COVID-19) pandemic resulted in the cancellation of the 2020 National Football League (NFL) preseason and a decreased preseason roster size. The effect of this disruption on athlete injury rates is unknown. Purpose/Hypothesis: The purpose was to quantify the rates of anterior cruciate ligament (ACL), Achilles tendon, and hamstring tendon injuries in NFL players before and after the COVID-19 pandemic. We hypothesized that injury rates in the 2020 season would be higher than those seen prepandemic. Study Design: Descriptive epidemiology study. Level of evidence, 4. Methods: An online search using publicly available data was carried out to identify all NFL players who sustained an ACL, Achilles tendon, or hamstring tendon injury between April 1, 2017, and March 31, 2021. Data collected included player characteristics as well as career and season of injury workloads. Results: The number of Achilles tendon (27 vs 20; P = .024) and hamstring tendon (186 vs 149; P < .001) injuries, respectively, in the 2020 NFL season were significantly higher than the average of the 2017 to 2019 seasons. However, the number of ACL injuries sustained remained constant (43 vs 46; P = .175). More than half (52.9%) of ACL injuries in the 2017 to 2019 seasons occurred in the preseason, while most of the injuries (34.9%) in the 2020 season occurred in weeks 1 to 4. There was no player characteristic or career workload variable collected that was significantly different for players who sustained an ACL, Achilles tendon, or hamstring tendon injury in the 2020 NFL season compared with the 2017 to 2019 seasons. Conclusion: In the 2020 NFL season, the number of Achilles tendon and hamstring tendon injuries rose while the number of ACL injuries remained constant compared with the 2017 to 2019 seasons. Injuries that occurred during the first 4 games of the 2020 NFL season were consistent, with higher rates of injuries seen in the preseason in previous years.
Aims The optimal management of an infrapopliteal deep venous thrombosis (IDVT) following total knee arthroplasty (TKA) remains unknown. The risk of DVT propagation and symptom progression must be balanced against potential haemorrhagic complications associated with administration of anticoagulation therapy. The current study reports on a cohort of patients diagnosed with IDVT following TKA who were treated with aspirin, followed closely for development of symptoms, and scanned with ultrasound to determine resolution of IDVT. Methods Among a cohort of 5,078 patients undergoing TKA, 532 patients (695 TKAs, 12.6%) developed an IDVT between 1 January 2014 to 31 December 2019 at a single institution, as diagnosed using Doppler ultrasound at the first postoperative visit. Of the entire cohort of 532 patients with IDVT, 91.4% (486/532) were treated with aspirin (325 mg twice daily) and followed closely. Repeat lower limb ultrasound was performed four weeks later to evaluate the status of IDVT. Results Follow-up Doppler ultrasound was performed on 459/486 (94.4%) patients and demonstrated resolution of IDVT in 445/459 cases (96.9%). Doppler diagnosed propagation of IDVT to the popliteal vein had occurred in 10/459 (2.2%) cases. One patient with an IDVT developed a pulmonary embolus six weeks postoperatively. Conclusion The results of this study demonstrate a low rate of IDVT propagation in patients managed with aspirin. Additionally, no significant bleeding episodes, wound-related complications, or other adverse events were noted from aspirin therapy. Cite this article: Bone Joint J 2021;103-B(6 Supple A):18–22.
Background: The coronavirus disease of 2019 (COVID-19) pandemic led to the suspension and shortening of the 2020 Major League Baseball (MLB) season from 162 to 60 regular season games. The effect of this disruption on injury rates, specifically injury to the ulnar collateral ligament (UCL), has not been quantified. Purpose/Hypothesis: The purpose of this study was to compare the rate of UCL reconstruction (UCLR), surgery timing, and pitching workload in MLB pitchers from before and after the COVID-19 pandemic lockdown. We hypothesized that UCLR rates relative to games played would be increased and pitching workload would be decreased in 2020 compared with previous seasons. Study Design: Cohort study; Level of evidence, 3. Methods: An extensive online search using publicly available data was conducted to identify all MLB pitchers who underwent UCLR between January 1, 2017, and December 31, 2020. Only pitchers who were competing at the MLB level when undergoing reconstruction were included. Player characteristics and surgery date, as well as career and season of surgery pitching workload, were collected for all included pitchers. All data were compared as a pooled sample (2017-2019 vs 2020). Results: A similar number of pitchers underwent UCLR during or after the 2020 regular season (n = 18) compared with the 2017-2019 seasons (n = 16, 20, and 16, respectively). However, after accounting for the decrease in games played during the 2020 regular season, an MLB pitcher was 2.9 times more likely to undergo surgery per game after the COVID-19 lockdown compared with the previous years ( P < .001). MLB pitchers who underwent surgery in 2020 threw fewer preseason innings than did pitchers who underwent surgery between 2017 and 2019 (5.98 vs 9.39; P = .001). Conclusion: MLB pitchers were almost 3 times more likely to undergo UCLR per game after the COVID-19 lockdown. A decreased preseason pitching workload because of the COVID-19 lockdown may have had an effect on per game UCLR rates.
Introduction: In response to the SARS-CoV-2 pandemic, physician attire has evolved to incorporate personal protective equipment (PPE). Although PPE is mandated for all healthcare workers, variability exists in choice and availability. The purpose of this study was to determine patient perception of physician attire during the COVID-19 pandemic in an outpatient setting. Methods: Three hundred sixty-eight patients who presented to our outpatient orthopaedic clinics completed an anonymous survey. In addition to demographic characteristics, patient preferences for attire, PPE, and social distancing were obtained. Results: Scrubs (81%, 298/368) were found to be the most acceptable physician attire. Eye protection (34.2%, 126/368) and gloves (32.6%, 120/368), however, were deemed much less acceptable; 93.5% (344/368) of patients reported that no mask was unacceptable, with 41.0% (151/368) preferring a surgical mask. Predilection for a surgical mask and N95 rose with increasing patient education level. Interestingly, 55.2% (203/368) responded that physicians should stop wearing PPE only when the Center for Disease Control recommends. Conclusion: During the COVID-19 pandemic, most of the patients found scrubs to be the most acceptable attire in an office-based outpatient setting. Patients also found physician mask-wearing to be important but are less accepting of providers wearing eye and hand protection.
BackgroundCompetition for patients among orthopaedic private practices, multi-specialty groups, and hospital systems continues to persist. An effective marketing campaign is essential for a practice to succeed in this competitive environment. The purpose of this study was to investigate the cost-effectiveness and efficacy of each marketing campaign and the influence of patient demographics on efficacy. MethodsThe first 300 consecutive, new patients were prospectively surveyed on how they initially discovered and then selected the orthopaedic practice. Demographics and marketing costs were tabulated and categorized to analyze the effectiveness of each marketing strategy. ResultsA substantial portion of the marketing budget was allocated for traditional (67.0%) and online advertising (25.0%). However, only 56/300 (18.7%) patients surveyed were brought to the practice by these methods combined. In contrast, expenditure on a marketing liaison (8.0%) delivered 128 patients (42.7%) through referrals: 80 (26.7%) from physicians, 28 (9.3%) from urgent cares, 17 (5.7%) from physical therapists, and 3 (1.0%) from attorneys. ConclusionMarketing strategies were not proportionally beneficial during the first six months of the orthopaedic practice start-up period. During this early ramping up period, the most cost-effective marketing strategy was utilization of a liaison for direct in-person visits to various healthcare facilities.
Midlevel constraint prostheses have provided increased varus/valgus and rotational stability for patients with severe deformity or ligamentous instability undergoing total knee arthroplasty (TKA). Here we present a series of 5 patients, 2 in detail, who underwent a primary TKA with a midlevel constraint articular surface and a primary femoral component without stem extension who all suffered isolated medial femoral condyle insufficiency fractures. All 5 TKAs were performed in females with both preoperative valgus deformity and flexion contractures. Patients had an average age of 74.4 years, height 62.4 in, and weight 156.2 lbs. Revision TKA was performed in 4 of 5 cases. As a result of these cases, we now routinely consider implanting a stemmed femoral component in this population with osteoporotic medial femoral condyles.
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