CJSM Podcast: The effect of race and insurance status on ACL injury outcomes in children and adolescents

ACL injuries are a common subject for sports medicine publications:  according to a 2019 study in the Orthopaedic Journal of Sports Medicine, there have been 18,696 ACL publications in PubMed during the past 40 years, trending upwards from 26 articles published in 1979 to 1380 articles published in the year 2018 alone.

The reasons for this are clear. ACL injuries are a common injury in the young and physically active, and the ligament itself is the most commonly operated ligament of the knee.  The injury is consequential, both in its impact on athletic performance as well as on long-term morbidity, with a well-known risk of early onset osteoarthritis which can cause long-term pain, functional limitations, and decreased quality of life.

Another phenomenon also all too common in American medicine is that of health care disparities.  You name the disease or injury in medicine and the therapy or intervention in question, and dollars to donuts you’ll find a study showing that race, ethnicity, and socioeconomic status can have negative consequences on outcomes.

A new study in the November 2020 CJSM looks at the intersection of these two common phenomena, and reports on the impact of race and insurance status (a proxy for socioeconomic status) on outcomes in the care of pediatric ACL injuries. As soon as I finished reading the study, I wrote a blog post.

I also knew whom I had to have on as the next guest for the CJSM podcast.

Neeraj Patel M.D., M.P.H. performing knee arthroscopy in the O.R.

Neeraj Patel M.D., M.P.H., corresponding author of the study — How do race and insurance status affect the care of pediatric anterior cruciate ligament injuries — is an attending physician at Lurie Children’s Hospital in Chicago, USA and an Assistant Professor of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine. He joined me one morning to do a deeper dive into the work he and his team from Children’s Hospital of Philadelphia (CHOP) did to bring this excellent study to the pages of CJSM.

Dr. Patel and the senior author, Dr. Ted Ganley, are both members of the Pediatric Research in Sports Medicine Society (PRiSM), which I have profiled in previous blog postsPRiSM is conducting its annual meeting January 28 – 30 and, not surprisingly in this COVID era, it is taking place virtually.  By all means attend if you can to hear from researchers like Dr. Patel.

Also, go now to the the study itself in CJSM.  And finally, as ever you can subscribe to our CJSM podcasts at iTunes or go to the journal website and find this podcast with Dr. Patel and all of our podcasts.

The AMSSM Position Statement on Conducting the PPE During the SARS-CoV-2 Pandemic

Dr. Alex B. Diamond, co-author of the recent AMSSM guidance statement on administering the PPE during the COVID pandemic

If you’re like us, we are ready to turn the page on 2020!

Literally and figuratively in CJSM’s case.

We’ve decided to push out the January 2021 issue early to get a start on the New Year!  And we’ve got our first podcast of the, ahem, ‘New Year’ to go along with it.

There are many submissions in this edition to highlight, but today I wanted to bring to the attention of the blog readers and podcast listeners one in particular.

CJSM’s partner society, the American Medical Society for Sports Medicine (AMSSM) convened a writing group early in 2020 to give guidance to clinicians in conducting the pre-participation examination (PPE) during the SARS-Cov-2 pandemic.  The result is a manuscript entitled, “Interim Guidance on the Preparticipation Physical Examination for Athletes During the SARS-CoV-2 Pandemic.”

The pandemic has touched all aspects of our field, and the PPE poses some new challenges that clinicians must address while the SARS virus holds sway.

Co-chair of the AMSSM committee and co-author of the AMSSM statement, Alex B. Diamond, D.O., M.P.H. is our guest on the first podcast of the new year.  The other co-chair was Dusty Narducci, M.D. Drs. Diamond and Narducci headed an illustrious team of authors, many whose names will be recognizable to those in the world of sports medicine (special shout out to two of our CJSM editors on the panel: Dr. William Roberts and Dr. Jason Zaremski).

Dr. Diamond is an Associate Professor in the Departments of Orthopaedics and Pediatrics at Vanderbilt University Medical Center, and among many other positions is also the team physician for several Nashville- area high schools, Vanderbilt University (NCAA D1) and the Nashville Predators of the NHL.

In our conversation we do a deep dive on conducting the PPE during the pandemic.  We cover issues such as venue (medical home vs. mass event), the risk of myocarditis in infected individuals, and the potential barriers to sport access created by the PPE.

Go to the statement, which is now freely available in our January 2021 issue. And go to iTunes to check out this episode and subscribe to all of our podcasts, or go to the journal’s main website to access the podcast and other CJSM media.

CJSM Podcast with Dr. William Meehan — long-term quality-of-life benefits for collegiate female athletes

Dr. William Meehan (R) and yours truly (L) in that oh so 2020 virtual space

CJSM’s November 2020 issue — the last of this unprecedented calendar year — contains many many interesting research studies.

One of the studies was the subject of our most recent blog post journal club.

I enjoyed that submission so much that I thought I would ‘ring’ the authors and see if they could join me on a podcast.

Corresponding author Dr. William (Bill) Meehan kindly set aside time from his busy schedule to share his thoughts on this study: Stracciolini A, et al. Female Sport Participation Effect on Long-Term Health-Related Quality of Life,

Dr. Meehan has been a regular at CJSM — here in the blog, on a previous CJSM podcast, and most especially in the journal itself.  He is a prolific author.

He is also a friend and trusted colleague, whom I met a long time ago when he and I both completed our sports medicine fellowship at Boston Children’s Hospital. God bless him, he always responds to that hook of friendship when I call him and need some collegial advice!

In this new study, he and the team of authors led by Dr. Andrea Stracciolini looked at a cohort of women in their 40’s to 70’s who have previously participated as athletes in college at NCAA DIII level institutions.

In our conversation Dr. Meehan covers a wide variety of subjects:  what are DIII institutions, what is Title IX, how does college sport participation associate with long-term QOL measures, and more. 

Check out and subscribe to our podcasts on iTunes or go to the media tab on our main CJSM web page. And check out the study itself in our November 2020 issue. Any way you engage with CJSM, we’re happy to have you.

Can you do a brief but comprehensive examination of a concussed patient in your clinic?

Well, can you?

If your exam is brief, can it be comprehensive? If it’s comprehensive, will you be able to get through all of the patients on your schedule?

These are some practical questions that most of us in the world of sports medicine struggle with.

I’m looking at my clinic schedule tomorrow, and I have 15 minutes for most patients; for new concussed patients I’m ‘given’ 30 minutes.

Most of us know these clinic slots are a Procrustean bed – there really is little chance we can fit the patient and their needs, as well as our obligation to diagnose and manage the injury, in these time frames.

M. Nadir Haider, M.D.

Good news, then – authors from the University of Buffalo Concussion Management Clinic have just produced a Practical Management article that promises to make your approach much more efficient when you next see a clinic patient with a sports related concussion (SRC).

The first and corresponding author of this manuscript, M Nadir Haider, M.D., is our guest on the newest CJSM blog post. Dr. Haider is affiliated with the Jacobs School of Medicine, State University of New York (SUNY), Buffalo where he is an Assistant Professor of Orthopedics and Sports Medicine and the Assistant Director of Research at the University Concussion Management Clinic. Many of the readers of CJSM and listeners of the podcast will be familiar with the voluminous research that comes out of the SUNY, Buffalo center.  This work has been transformative in the area of SRCs.

Listen in on our conversation, where Dr. Haider walks us through the evidence-based exam, and then go to the September 2020 CJSM where you will find the Practical Management article itself, currently free of charge.

As always you can find the podcast on our journal website, or you may go to iTunes to listen in and subscribe as well.

Any way you read, listen or engage with CJSM, we are happy you are part of our sports medicine community.

<span>%d</span> bloggers like this: