Background: Tibial eminence fractures are bony avulsions of the anterior cruciate ligament from its insertion on the intercondylar eminence. Numerous anatomic factors have been associated with anterior cruciate ligament injuries, such as posterior tibial slope, but there are few studies evaluating the association with tibial eminence fracture. Purpose: To compare posterior tibial slope of pediatric patients with and without tibial eminence fractures. We hypothesized that a steeper posterior tibial slope would be associated with tibial eminence fracture. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent surgical treatment of tibial eminence fracture were retrospectively identified between January 2000 and July 2021. Adults aged >20 years and those without adequate imaging were excluded. Controls without gross ligamentous or osseous pathology were identified. Descriptive information and Meyers and McKeever classification were recorded. Posterior tibial slope measurements were obtained by 2 independent orthopaedic surgeons twice, with measurements separated by 3 weeks. Chi-square tests and independent-samples t tests were used to compare posterior tibial slope and patient characteristics. Inter- and intrareviewer variability was determined via the intraclass correlation coefficient. Results: A total of 51 patients with tibial eminence fractures and 57 controls were included. By sex, tibial eminence fractures occurred among 34 male and 17 female patients with a mean age of 10.9 years. The posterior tibial slope among those with tibial eminence fractures (9.7°) was not significantly greater than that of controls (8.8°; P = .07). Male patients with a tibial eminence fracture had significantly steeper slopes compared with controls (10.0° vs 8.4°; P = .006); this difference was not observed between female patients and female controls. Patients with a slope ≥1 SD above the mean (12.0°) had 3.8 times greater odds (95% CI, 1.3-11.6; P = .017) of having a tibial eminence fracture. Male patients with a posterior tibial slope >12° had 5.8 times greater odds (95% CI, 1.1-29.1; P = .034) of having a tibial eminence fracture compared with male controls. Conclusion: Male patients undergoing surgical fixation of a tibial eminence fracture had an increased posterior tibial slope as compared with case-controls. Increased posterior tibial slope may be a risk factor for sustaining a tibial eminence fracture, although the clinical significance of this deserves further investigation.

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Background: There has been an established relationship between increased loading on the Achilles tendon and tension on the plantar fascia. This supports the idea that either tight gastrocnemius and soleus muscles or contractures of the Achilles tendon are risk factors for plantar fasciitis. Gastrocnemius recession has gained popularity as a viable surgical intervention for cases of chronic plantar fasciitis due to isolated gastrocnemius contracture. To our knowledge, this is the first study to investigate Patient-Reported Outcome Measurement Information Systems (PROMIS) scores in patients with plantar fasciitis before and after gastrocnemius recession. Methods: The Electronic Medical Record was queried for medical record numbers associated with Current Procedural Terminology code 27687 (gastrocnemius recession). Our study included all patients with a preoperative diagnosis of chronic plantar fasciitis with treatment via isolated gastrocnemius recession with 1-year minimum follow-up. Forty-one patients were included in our study. Patient variables were collected via chart review. Preoperative and postoperative PROMIS scores were collected in the clinic. Results: We followed up 41 patients with a median age of 48 years (interquartile range [IQR] 38-55) and median body mass index of 29.02 (IQR 29.02-38.74) for 1 year post surgery. Preoperative and postoperative PROMIS scores improved for physical function from 39.3 to 44.5 ( P = .0005) and for pain interference from 62.8 to 56.5 ( P = .0001). PROMIS depression scores were not significantly different ( P = .6727). Visual analog scale (VAS) scores significantly decreased from 7.05 to 1.71 ( P < .0001). Conclusion: In this case series, we found the gastrocnemius recession to be an effective option for patients with refractory pain in plantar fasciitis. Our PROMIS and VAS data confirm this procedure’s utility and highlight its ability to significantly decrease pain and improve physical function in patients with chronic plantar fasciitis, although final median scores did not reach normative standards for the population, suggesting some residual pain and/or dysfunction was, on average, present. Based on the results of this study, the authors conclude that gastrocnemius recession is a reasonable treatment option for chronic plantar fasciitis patients who fail nonoperative management. Level of Evidence: Level III, retrospective cohort study.

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The volume of academic paper submissions and publications is growing at an ever increasing rate. While this flood of research promises progress in various fields, the sheer volume of output inherently increases the amount of noise. We present a system to automatically separate papers with a high from those with a low likelihood of gaining citations as a means to quickly find high impact, high quality research. Our system uses both a visual classifier, useful for surmising a document's overall appearance, and a text classifier, for making content-informed decisions. Current work in the field focuses on small datasets composed of papers from individual conferences. Attempts to use similar techniques on larger datasets generally only considers excerpts of the documents such as the abstract, potentially throwing away valuable data. We rectify these issues by providing a dataset composed of PDF documents and citation counts spanning a decade of output within two separate academic domains: computer science and medicine. This new dataset allows us to expand on current work in the field by generalizing across time and academic domain. Moreover, we explore inter-domain prediction models -evaluating a classifier's performance on a domain it was not trained on -to shed further insight on this important problem.

Private insurance is designed to provide more timely and cost-effective medical care. With the increase in healthcare deductibles, however, patients are delaying operative management of a variety of pathologies toward the end of the fiscal year with the hopes of having met their deductible. In this retrospective review, the authors assess the operative timing of common orthopedic upper extremity surgeries between publicly and privately insured patients at both university and physician-owned medical institutions.

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