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.

Disparities in sports medicine care — the pediatric ACL

MRI Sagittal view of left knee in a pediatric patient with an ACL tear

As 2020 winds down I want to bring to the attention of the blog readers a particularly important study published in our last edition of the year.  In our November 2020 issue you will find:  How do race and insurance status affect the care of pediatric anterior cruciate ligament injuries?

The group of authors hails from Children’s Hospital of Philadelphia (CHOP), which routinely vies for the top spot as best pediatric hospital in the U.S. 

Physicians from my home institution of Nationwide Children’s Hospital take a knee to protest racism June 2020

In a year like no other, 2020 saw the news dominated not just by the novel COVID pandemic but a pandemic much much older and more persistent: structural racism.  Around the world, sparked by incidents in the US in late May 2020, there was a passionate outcry from all segments of society, including the medical community, about this insidious problem.

The issues that are being discussed with renewed vigor are old, but the energy and insight surrounding this current moment feel anything but. Read more of this post

What to do about heading?

Heading the ball — photo courtesy of Wikimedia

I have been meaning to write a blog post for over a week, since a bit of breaking sports medicine news occurred with the publication of some research in the New England Journal of Medicine (NEJM).

It took a Tweet this morning to rouse me to action.  I promise it hasn’t been sloth on my part that has slowed my hand, but pleading “I’m busy” to the group of folks who usually will be reading CJSM media is not going to gain much sympathy.

And yes, with fall sports, I sure have been busy.  But I am sure you have too.

I hope, however, not too busy to have missed this piece of research from NEJM: “Neurodegenerative Disease Mortality Among Former Professional Soccer Players.”  There was an accompanying editorial to this study, a piece that is most definitely worth a read too. “Soccer and Mortality — Good News and Bad News”

The published research was a large retrospective cohort study looking at former professional Scottish football (soccer) players: 7676 cases were identified from databases of Scottish football players and 23,028 controls (3:1) from the ‘general population’ were identified using a Scottish ‘Community Health Index.’ Controls were matched to players on the basis of sex, age, and degree of social deprivation.  Of note, all the participants in this study were male.The researchers looked at two dependent outcome variables:  i) cause of death as noted on death certificates and ii) dispensed medications, information for which was obtained from the Scottish national Prescribing Information System.  Follow up information for study participants was for a median of 18 years (for each individual, “Age was used as the time covariate, with follow-up from age 40 years to the date of data censoring, which was either the date of death or the end of the follow up (December 31, 2016), whichever occurred first).”

The researchers report several important findings in this study, to note just a few:

Read more of this post

Medicine Through Movement — The CJSM Podcast with Dr. Jane Thornton

Jane Thornton, MD, PhD, of CASEM and the University of Western Ontario, Fowler Kennedy Sports Clinic. Twitter: @JaneSThornton

One of CJSM’s closest relationships is with our partner society the Canadian Academy of Sport and Exercise Medicine (CASEM).  After all, CASEM was the founding society for the ‘Canadian Journal of Sport Medicine’ (now the Clinical Journal of Sport Medicine).  We keep close tabs on what CASEM is doing because it’s sure to be of importance to both us and the world of SEM.

And so we’re excited to announce that just a few days from now — April 6 — CASEM will be hosting in Ottawa a special conference.  “Medicine Through Movement:  How Physical Activity is Changing Health Care.”

April 6 is, not coincidentally, World Physical Activity Day. The World Health Organization (WHO) named April 6 World Physical Activity Day in 2002 as part of in initiative to address the world-wide pandemic of physical activity.  We in primary care SEM are the troops on the ‘front lines’ waging battle against this pandemic.  We are always looking for effective tools to stem the tide.

One of the organizers of the Ottawa conference, and an expert in the field of ‘medicine through movement,’ is Dr. Jane Thornton, a clinician and researcher who most recently published in the pages of CJSM as the lead author of the CASEM position statement on the ‘physical activity prescription.‘  Always game to see research translated into practical action in the clinic and community, Dr. Thornton was a gracious guest on these blog pages three years ago.

We’re delighted to have her as CJSM’s guest again, and on this occasion she was able to sit down with us for a podcast conversation.  No small feat in her very busy life, I can assure you!

In preparation for the conference, or in its aftermath, take a listen to our conversation. Dr. Thornton weighs in on the highlights of the event, her research into the area of physical activity interventions, and tells us all about one of her heroesShe also shares her thoughts on ‘movement hacks’ — interventions that work for patients, and can be integrated into the busy, time-challenged clinics in which, I am sure, we all work.

If you’re not able to get to Ottawa, have a listen and by all means follow Dr. Thornton and the hashtag #MTM2019 on Twitter for the breaking information from that conference.

And before we forget, make sure to highlight May 16 – 18 2019 and April 29 – May 2 2020 on your calendars; these are the dates of the 2019 CASEM (Vancouver) and 2020 CASEM (Banff, Alberta) annual symposia. You won’t want to miss these, perhaps especially the 2020 event, when CASEM celebrates its 50th anniversary!

In the meantime, what are you waiting for?  Take a listen on iTunes or on our journal webpage to Dr. Jane Thornton on the newest CJSM podcast!

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