All Publications

  • Higher Adherence to Anterior Cruciate Ligament Injury Prevention Programs Is Associated With Lower Injury Rates: A Meta-Analysis and Meta-Regression. HSS journal : the musculoskeletal journal of Hospital for Special Surgery Halvorsen, K. C., Marx, R. G., Wolfe, I., Taber, C., Jivanelli, B., Pearle, A. D., Ling, D. I. 2023; 19 (2): 154-162


    Background: Athletes who participate in sports that involve cutting and pivoting movements are particularly susceptible to anterior cruciate ligament (ACL) injury. Preventing this injury is the best way to combat its health consequences and costs. There may be a dose-response relationship between adherence and injury reduction. Purpose: We sought to examine whether athletes' adherence to injury prevention programs (IPPs) is associated with reductions in ACL and lower extremity (LE) injuries. Methods: We conducted a systematic review of the PubMed, EMBASE, and Cochrane Library databases, searching for studies published between 2011 and 2021. Studies were included if they reported on the use of an ACL IPP compared with a control group and recorded the rate of injuries to calculate a rate ratio, as well as adherence to the program as a percentage of sessions performed. For the meta-analysis, the rate ratios were pooled using the DerSimonian-Laird random-effects model. Results: For the 15 studies included (11 randomized controlled trials and 4 cohort studies), the random-effects model grouped athletes' adherence to an IPP as high (76% or more of the sessions), moderate (51%-75% of the sessions), and low (50% or fewer of the sessions). We found that athletes with the highest level of IPP adherence had a significantly lower incidence of ACL injury. The rate ratios for moderate and low adherence did not demonstrate a reduced incidence of ACL injury. Injury prevention program participation was also associated with a decrease in LE injury rates. Conclusion: This systematic review and meta-analysis found that athletes with high adherence to IPPs had reduced rates of ACL and LE injuries. Our findings suggest that educating coaches and athletes on the dose-dependent benefits of IPPs may promote the routine incorporation of these programs into warm-up sessions to decrease the risk of ACL and LE injuries.

    View details for DOI 10.1177/15563316221140860

    View details for PubMedID 37065096

    View details for PubMedCentralID PMC10090850

  • Opioid Represcriptions After ACL Reconstruction in Adolescents are Associated With Subsequent Opioid Use Disorder. Journal of pediatric orthopedics Cahan, E. M., Halvorsen, K. C., Pham, N. S., Kaur, J., Bryson, X. M., Chan, C. M., Vorhies, J. S. 2023


    INTRODUCTION: Postoperative opioid prescriptions may confer a risk for subsequent opioid use disorders (OUDs). For many children, postoperative analgesia is often the first opioid exposure. The rates of anterior cruciate ligament (ACL) reconstruction in pediatric populations are rising. Here, we use an administrative claims database to describe opioid prescription patterns after ACL reconstruction and their effect on subsequent risk of OUD.METHODS: Using International Classification of Diseases (ICD)-9, ICD-10, and CPT codes, we identified patients, with ages 10 to 18, undergoing primary ACL reconstruction between 2014 and 2016 with minimum 1 year follow-up in the Optum Clinformatics Data Mart, which is a nationally representative administrative claims database. Demographic variables and prescription patterns (in morphine milligram equivalents [MMEs]) were analyzed using univariate tests and multivariable logistic regression to determine any potential association with the appearance of anew an ICD-9 or ICD-10 code for OUD within 1 year of the initial procedure.RESULTS: A total of 4459 cases were included and 29 (0.7%) of these patients were diagnosed with an OUD within 1 year of surgery. Upon univariate analysis, opioid represcriptions within 6 weeks were significantly more common among patients with OUD; 27.6% vs. 9.7% of patients that did not develop a new diagnosis of OUD (P=0.005). Multivariable logistic regression indicated an independent significant relationship between total MMEs initially prescribed and the odds of a subsequent OUD diagnosis: for each additional 100 MMEs prescribed in total, the odds of OUD increased by 13% (P=0.002). Patients with a represcription within 6 weeks of surgery had an average increase in the odds of OUD by 161% (P=0.027).CONCLUSIONS: In this cohort of patient ages 10 to 18 undergoing primary isolated ACL reconstruction, we found substantial variability in opiate prescribing patterns and higher initial opioid prescription volume, as well as opioid represcription within 6 weeks were predictive of the subsequent development of OUD.LEVEL OF EVIDENCE: Level III.

    View details for DOI 10.1097/BPO.0000000000002340

    View details for PubMedID 36652547

  • Factors Associated With an Intra-articular Infection After Anterior Cruciate Ligament Reconstruction: A Large Single-Institution Cohort Study AMERICAN JOURNAL OF SPORTS MEDICINE Marom, N., Kapadia, M., Nguyen, J. T., Ammerman, B., Boyle, C., Wolfe, I., Halvorsen, K. C., Miller, A. O., Henry, M. W., Brause, B. D., Hannafin, J. A., Marx, R. G., Ranawat, A. S. 2022: 3635465221078311


    An intra-articular infection after anterior cruciate ligament (ACL) reconstruction (ACLR) is a rare complication but one with potentially devastating consequences. The rare nature of this complication raises difficulties in detecting risk factors associated with it and with worse outcomes after one has occurred.To (1) evaluate the association between an infection after ACLR and potential risk factors in a large single-center cohort of patients who had undergone ACLR and (2) assess the factors associated with ACL graft retention versus removal.Case-control study; Level of evidence, 3.All ACLR procedures performed at our institution between January 2010 and December 2018 were reviewed; a total of 11,451 procedures were identified. A retrospective medical record review was performed to determine the incidence of infections, patient and procedure characteristics associated with an infection, infection characteristics, incidence of ACL graft retention, and factors associated with the retention versus removal of an ACL graft. Multivariable logistic regression analysis was used to identify potential risk factors for an infection after ACLR.Of the 11,451 ACLR procedures, 48 infections were identified (0.42%). Multivariable logistic regression analysis revealed revision ACLR (odds ratio [OR], 3.13 [95% CI, 1.55-6.32]; P = .001) and younger age (OR, 1.06 [95% CI, 1.02-1.10]; P = .001) as risk factors for an infection. Compared with bone-patellar tendon-bone autografts, both hamstring tendon autografts (OR, 4.39 [95% CI, 2.15-8.96]; P < .001) and allografts (OR, 5.27 [95% CI, 1.81-15.35]; P = .002) were independently associated with an increased risk of infections. Overall, 15 ACL grafts were removed (31.3%). No statistically significant differences besides the number of irrigation and debridement procedures were found for retained versus removed grafts, although some trends were identified (P = .054).In a large single-center cohort of patients who had undergone ACLR and those with an infection after ACLR, patients with revision cases and younger patients were found to have a higher incidence of infection. The use of bone-patellar tendon-bone autografts was found to be associated with the lowest risk of infection after ACLR compared with both hamstring tendon autografts and allografts. Larger cohorts with a larger number of infection cases are needed to determine the factors associated with graft retention versus removal.

    View details for DOI 10.1177/03635465221078311

    View details for Web of Science ID 000772386900001

    View details for PubMedID 35286225

  • Resting State Functional Connectivity is Directly Related to Clinical Presentation of Mild Traumatic Brain Injury Shetty, T., Nguyen, J. T., Kim, E., Garvey, M., Cogsil, T., Tsiouris, A., Niogi, S., Dalal, A., Halvorsen, K., Zhang, T., Masdeu, J., Mukherjee, P., Marinelli, L. LIPPINCOTT WILLIAMS & WILKINS. 2019