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

“Primary Care for Sweaty People”

Dr. Carl Stanitski with wife & equestrian athlete, Debbie

I am fortunate to be spending my weekend in Ft. Lauderdale, Florida, where I am attending the 5th Annual Meeting of the Pediatric Research in Sports Medicine (PRiSM) Society Meeting.  This meeting is becoming a major fixture on the pediatric sports medicine calendar, and I have gained so much by joining this organization and attending the proceedings over the last few years.  If you specialize in pediatric sports medicine, the dates January 24 – 26 2019 (next PRISM meeting in Atlanta, Georgia) should be circled on your calendar.

Among the highlights of the meeting was a keynote talk by Dr. Carl Stanitski, Emeritus Professor of Orthopaedic Surgery and Pediatrics at the Medical University of South Carolina.  He, along with other legends like Dr. Lyle Micheli and Dr. Jim Andrews, was a pioneer in pediatric sports medicine in the 1970’s when, as he described it, the initial work being done in this field was derided as ‘primary care for sweaty people.’

My, how this field has grown.  In the USA, the advanced, fellowship training in this discipline has exploded in both the primary care and orthopaedic surgery worlds.In the primary care world alone, there are > 200 programs in operation

Twenty-five years ago, when the field was a lot smaller, Dr. Stanitski and others were already sending up the alarms over increasing sports injury rates seen in young athletes — check out this vintage New York Times article from 1992. The article notes:  “They attribute the rise in such so-called overuse injuries to intensive sports training programs for young children, longer playing seasons and specialty sports camps in which children may spend hours lobbing balls on a tennis court or throwing hundreds of pitches each day.”

Plus ça change….the more things change, they more they stay the same.  These are precisely the issues we still face, 25+ years down the road.  That same sentence in the NY Times could be written today.

CJSM and other journals (JATA, BJSM, AJSM, Sports Health) play major roles in publishing and disseminating the research on the diagnosis, management, treatment and prevention of pediatric sports injuries.  A cursory review of the pages of CJSM over the last few years reveals publications related to pediatric concussions , overuse injuries, and training.

What I walk away from this meeting with, more than ever, is the awareness of how much more we need to go in terms of knowledge translation.  If 25 years ago the leaders in this field were already noting a skyrocketing injury rate, and if there has been a wealth of increasing research in this area, why has the problem only seemed to worsen?

The issue of knowledge translation — of taking the information we researchers produce and we journals publish — is near and dear to the collective hearts of the CJSM editorial board.  As professionals we have to start getting the rubber to meet the road.  One of the reasons why we are so passionate at CJSM about using social media is our goal to spread knowledge widely, to get it in front of the people who can put this into practice.

Join us in this quest by following us on Twitter and Facebook and subscribing to our iTunes podcast feed.

Concussions around the globe

img_3327

Brandenburg Gate, Berlin

How do you get from Bethesda, MD to San Francisco to Berlin all in a month, during the busiest time of your year?

I don’t know — but my good friend Christina Master does.

Dr. Chistina Master is an esteemed colleague from Children’s Hospital, Philadelphia (CHOP), whom I am privileged to see at some medical conferences we both frequent, including the American Medical Society for Sports Medicine (AMSSM) and Pediatric Research in Sports Medicine (PRISM) meetings.   She is an associate professor of clinical pediatrics at the Perelman School of Medicine at the University of Pennsylvania, a prolific researcher, and a busy clinician with a focus on pediatric sports medicine.

She is also an avid runner and, it seems, world traveler.  A definite ‘must follow’ on Twitter if you want to stay up to date on pediatric sports medicine (or just enjoy her many photos of the beautiful trails on which she runs, or the great dining spots she hits on her travels). #OnTheMove may be the hashtag that best describes her!

Not being able to attend any one of the three fantastic meetings she hit this October, I asked her to share with the CJSM readership her reflections on the current state of concussion understanding from around the globe.  What follows are her first hand reports from the proceedings of the National Institutes of Health (NIH) Pediatric Concussion Workshop (Bethesda), the American Academy of Pediatrics (AAP) Council on Sports Medicine & Fitness meeting (San Francisco), and the “Concussion in Sports Group” (Berlin)

_______________________________________________________

img_2814-1

Dr. Christina Master (2nd from left) with some friends from CHOP

October is usually a busy month for concussions with all the fall sports in full swing. This October was also busy for concussions in a different way, with three important meetings focusing on the topic.  In mid October, the NIH convened a Pediatric Concussion Workshop, gathering an interdisciplinary group of researchers, clinicians and stakeholders together in Bethesda, MD to discuss the current state of the evidence in our understanding of pediatric concussion, particularly in those younger than high school.  It was an honor to present along with Bill Meehan and Kevin Guskiewicz among other experts at this workshop.  Topics addressed included Read more of this post

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