Sailesh Vardhan Tummala

All Publications

• How Are We Matching in ACL Reconstruction Research? A Systematic Review of Methods, Reporting, and Covariate Selection ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Patel, J. R., Holle, A. M., Halpin, B. S., Tummala, S. V., Patel, K. A., Chhabra, A. 2026; 14 (7): 23259671261444318

  Abstract

  Matching techniques such as direct covariate matching and propensity score matching (PSM) are increasingly used in anterior cruciate ligament reconstruction (ACLR) research to reduce bias in observational study designs. However, the rationale for covariate selection, consistency in methodological reporting, and patterns of matching practices remain unclear.To systematically evaluate covariate matching practices in ACLR literature, including the types and number of covariates used, methodological transparency, and trends in matching strategies.Systematic review.A systematic literature search of the PubMed, EMBASE, and Cochrane databases was conducted to evaluate covariate matching practices in the ACLR literature. A comprehensive search identified 798 unique studies, of which 97 met eligibility criteria. Data were extracted on study design, matching technique, covariate inclusion, reporting practices, and matching ratios. Descriptive and comparative statistics were used to summarize trends.The 97 included studies encompassed 91,165 ACLRs. Most studies were retrospective (90.7%) and cohort in design (92.8%). PSM was used in 41 studies (42.3%), while 56 (57.7%) used direct matching. A total of 60 unique covariates were used across 76 different combinations. PSM studies used significantly more covariates than direct matching studies (6.17 ± 2.79 vs 3.75 ± 1.63; P < .0001), and database studies used more covariates than single-center studies (6.33 ± 2.89 vs 4.08 ± 1.96; P < .0001). The most commonly used covariates were age (96.9%), sex (84.5%), and body mass index (41.2%). Only 6 studies (6.2%) provided justification for covariate selection. The most frequent matching ratio was 1:1 (73.2%). While most studies reported descriptive statistics after matching (95.9%), only 10.3% did so before matching, and 13.4% failed to report prematching sample size.Matching practices in ACLR studies remain highly variable, with limited justification provided for covariate selection. PSM and database-based studies tend to incorporate a greater number of covariates, yet reporting of matching methodology is often inconsistent. To enhance the quality, reproducibility, and comparability of ACLR research, future studies should adopt standardized reporting practices for matching, including explicit descriptions of covariate selection, matching algorithms, balance diagnostics, and match ratios. These steps can serve as a foundation for a more unified research framework, enabling future studies to collectively generate higher quality, generalizable evidence for ACLR outcomes.

  View details for DOI 10.1177/23259671261444318

  View details for Web of Science ID 001813145000001

  View details for PubMedID 42416047

  View details for PubMedCentralID PMC13338535

• Adding a Lateral Extra-articular Tenodesis to Quadriceps Autograft Anterior Cruciate Ligament Reconstruction Reduces Risk of Graft Failure ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Renfree, S. P., Brinkman, J. C., Tummala, S. V., Hoffer, A. J., Economopoulos, K. J. 2026

  Abstract

  The purpose of this study was to compare graft failure and clinical outcomes following primary anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon autograft (QA), with or without a modified Lemaire lateral extra-articular tenodesis (LET).Patients with ACL deficiency who underwent primary QA ACLR with or without LET and completed at least 2-year follow-up were included. Patients with a Beighton score ≥4, a preoperative pivot shift grade ≥2, or an intention to return to cutting and pivoting sports were offered LET. The primary outcome variable assessed was graft failure as defined by graft rupture or grade ≥2 pivot shift at any point postoperatively. Secondary outcomes included return to sport clearance rates, the International Knee Documentation Committee and Lysholm scores and postoperative complications.There were 122 undergoing QA ACLR with LET (QA + LET group) and 152 undergoing isolated QA ACLR (QA group). The QA + LET group had a significantly lower failure rate of 14.8% versus 29.6% in the QA group (P = .02). In addition, the QA + LET group had a lower residual pivot shift rate compared with the QA group (11.3% vs. 26.3% respectively; P = .01). There was no difference in graft retear rates between the 2 groups (P = .37). The QA + LET returned to sport significantly faster at 8.8 months compared with 9.7 months in the QA group (P = .038).The addition of LET to QA ACLR was associated with a significantly lower overall graft failure rate and lower percentage of patients with residual pivot shifts after ACLR compared with QA alone at 2-year follow up. However, there was no difference between the 2 groups with regard to graft retear rates. The addition of an LET to QA ACLR also allowed athletes to return to sports faster compared with QA alone.Level III, retrospective comparative study.

  View details for DOI 10.1002/arj.70398

  View details for Web of Science ID 001808321600001

  View details for PubMedID 42385032

• Rotator Cuff Repair Augmentation With an Autograft Biceps Patch, the "Biceps Smash," Results in Low Retear Rates at 6 Months and Promising Clinical Outcomes at 12 Months ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Brinkman, J. C., Moore, M., Smith, C., Tummala, S. V., Tokish, J. M. 2026: 1347-1354

  Abstract

  To evaluate retear rates, clinical outcomes, and complications of a consecutive series of full-thickness rotator cuff repair cases augmented with an autograft biceps patch.A retrospective review was performed of patients undergoing rotator cuff repair with autograft biceps patch augmentation. Patients underwent either magnetic resonance imaging or ultrasound to evaluate rotator cuff repair integrity at a minimum of 6 months postoperatively. Patient-reported outcomes including the American Shoulder and Elbow Surgeons Score and Single Assessment Numeric Evaluation score were also collected and evaluated for clinical significance at a minimum of 12 months postoperatively. Analysis of retear rates was performed by comparing observed retear rates to expected retear rates using the modified Rotator Cuff Healing Index score.The final cohort included 25 rotator cuff repair cases. Postoperative imaging was obtained by magnetic resonance imaging in 22 patients at a mean of 9 months postoperatively (range, 6.0-15.3 months) and ultrasound in 3 patients at a mean of 30.4 months (range, 28.8-32.2 months). The expected retear rate using the modified Rotator Cuff Healing Index score was 21.5% for the entire cohort. There was 1 retear, resulting in an actual retear rate of 4% at an average of 23.5-month follow-up (P = .0196). The average Single Assessment Numeric Evaluation score was 93 (standard deviation 9), and the average American Shoulder and Elbow Surgeons Score was 96 (standard deviation 6.3) at an average of 23.5-month follow-up (range 14-32). Patient acceptable symptomatic state was achieved by 96% of the cohort for the American Shoulder and Elbow Surgeons Score and 88% of the cohort for the Single Assessment Numeric Evaluation score. There were no cases of reoperation or complications.In this consecutive series, the biceps autograft "smash" patch for rotator cuff augmentation resulted in a low rate of retears, favorable patient-reported outcomes, and no complications. This augmentation option has the potential to be safe and effective for improving rotator cuff repair healing rates.Level IV, retrospective case series.

  View details for DOI 10.1002/arj.70379

  View details for Web of Science ID 001793081600001

  View details for PubMedID 42295852

• Editorial Commentary: Periportal Capsulotomy Is the Mountain Worth Climbing in Hip Arthroscopy. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Tummala, S. V., Safran, M. R. 2026

  Abstract

  Optimal management of the capsule in hip arthroscopy continues to evolve. Historically, periportal capsulotomy has been considered the more difficult and time-consuming approach because of its limited visualization and the perceived learning curve. However, as our understanding of the importance of capsular integrity has grown, so has our prioritization of preserving its stabilizing function to prevent iatrogenic instability. Periportal capsulotomy techniques embody this shift by limiting capsular disruption while still allowing adequate visualization. Recent literature challenges long-held assumptions and demonstrates that periportal capsulotomy can lead to shorter operative times and faster recovery. When performed thoughtfully, the efficiency of periportal capsulotomy may be driven by avoiding the need for an extensive closure often required after larger capsulotomies. Periportal capsulotomy may not be the easiest technique to learn, but in the right hands it can be the more efficient and biologically respectful approach. It may be the mountain worth climbing in hip arthroscopy.

  View details for DOI 10.1002/arj.70100

  View details for PubMedID 41914663

• Preoperative Knee Bone Marrow Edema Is Associated With Poor Clinical Outcomes Following Posterior Medial Meniscal Root Repair ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Hiredesai, A. N., Tummala, S. V., Brinkman, J. C., Koschmeder, K. T., Economopoulos, K. J. 2026; 42 (3): 639-646

  Abstract

  To determine if preoperative femoral or tibial bone marrow edema (BME) is indicative of higher rates of re-tear and conversion to total knee arthroplasty (TKA) after posterior medial meniscal root tear repair, and, secondarily, whether preoperative BME impacted patient-reported outcome measures and rates of infection and arthrofibrosis.Patients that underwent posterior medial meniscal root tear repair between 2013 and 2021 with a 2-year minimum follow-up were retrospectively analyzed. Primary outcome measures included re-tears and TKA conversion. Secondary outcomes included International Knee Documentation Committee (IKDC) score and Lysholm score, infection, and arthrofibrosis. Cohort-specific minimally clinically important difference and Patient Acceptable Symptomatic Scale rates were calculated. Two-tailed t-tests, Wilcoxon rank-sum tests, and Fisher's exact tests were used where appropriate.The study population consisted of 97 knees (74 without BME [NBME], 23 with BME) with average follow-up of 38.9 months (24-68). Preoperatively, the NBME group had higher IKDC scores (P = .008). Postoperatively, the NBME group had higher IKDC scores at 6 months, 1 year, and 2 years (84.5 [6.0] vs 68.5 [11.0]) (P = .041, <.001, <.001). IKDC minimally clinically important difference rates were not significantly different between groups at all follow-ups. Patient Acceptable Symptomatic Scale rates were higher for the NBME group at 1-year and final follow-up (100.0% vs 60.9%) (P < .001 for both). Lysholm scores were higher for the NBME group at 1-year and final follow-up (84.0 [5.6] vs 74.6 [12.8]) (P = .019 and .008, respectively). Re-tear occurred in 17.4% of the BME group and 0% of the NBME group (P = .003). TKA conversion rates were 21.7% in the BME group and 2.7% in the NBME group (P = .008). There was no difference in arthrofibrosis or infection rates.Preoperative BME in patients undergoing posterior medial meniscal root tear repair is associated with higher rates of recurrent meniscal root tearing and conversion to TKA in addition to lower subjective IKDC and Lysholm scores compared to patients without preoperative BME.Level III, retrospective prognostic case control series.

  View details for DOI 10.1002/arj.70081

  View details for Web of Science ID 001714123800001

  View details for PubMedID 41838458

• Characterization of quadriceps muscle injuries in National Basketball Association athletes and effects on player performance following injury BMC SPORTS SCIENCE MEDICINE AND REHABILITATION Parmar, R. P., Tummala, S. V., Morikawa, L., Buckner-Petty, S., Chhabra, A. 2026; 18 (1)

  Abstract

  BACKGROUND: In basketball, quadriceps strains and contusions are common due to the muscle’s role in knee extension and hip flexion, with the rectus femoris most prone to injury because it crosses both joints, making it vulnerable to eccentric loading. The purpose of this study was to describe the epidemiology of quadriceps injuries in National Basketball Association (NBA) players, assess changes in player performance statistics after injury, and to determine factors that were associated with a greater or equal player efficiency rating (PER) and usage percentage (USG%) 1 year and 2 years after a quadriceps injury. METHODS: Quadriceps muscle injury data from the 2015 to 2020 NBA seasons were extracted using a publicly available database. Injury characteristics and player demographics were evaluated with descriptive statistics. PER, USG%, points per game (PPG), and minutes per game (MPG) were calculated for the season prior, 1 season after, and 2 seasons after injury. A Poisson logistic regression analysis was performed to identify risk factors associated with greater or equal PER and USG% at 1 year and 2 years after injury. RESULTS: A total of 116 quadriceps muscle injuries were sustained among 89 NBA players. Contusion was the most common injury type, and the majority of injuries resulted in less than ten games missed. PER at 1 year after injury (15.8; P = 0.015) was significantly lower than baseline PER (16.5), but recovered at 2 years post-injury (16.8; P = 0.166). Older age was associated with a relative risk of having a decreased USG% (relative risk [RR] 0.83; 95% confidence interval [CI] 0.76–0.90) and a decreased PER (RR 0.75; 95% CI 0.64–0.88) at 1 year after injury, but these associations were not significant at 2 years after injury (P = 0.084 and P = 0.431, respectively). CONCLUSION: Contusions are the most common quadriceps muscle injury sustained by NBA players. Older age may be associated with decreased usage and efficiency one year after injury. NBA players are likely to return to baseline PER and USG% statistics at two years post injury.

  View details for DOI 10.1186/s13102-026-01595-y

  View details for Web of Science ID 001754695700001

  View details for PubMedID 41709337

  View details for PubMedCentralID PMC13134158

• Age, Workload, and Usage Rate: Risk Factors Associated With Knee Injuries in Women's National Basketball Association Athletes ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Menon, S., Sai, S., Traversone, J., Lin, E., Tummala, S. V., Chhabra, A. 2026; 14 (1): 23259671251405404

  Abstract

  Knee injuries are among the most common injuries in female basketball players. Despite the growing popularity of professional women's basketball, particularly the Women's National Basketball Association (WNBA), there are limited recent data evaluating the incidence of and risk factors for knee injuries in WNBA athletes.Older age, minutes played per game, number of games played, and player usage rate would be significantly associated with having a knee injury in WNBA players from the 2017 to 2022 seasons.Descriptive epidemiology study.Publicly available data on the injury history and player records of active WNBA players between the 2017 and 2022 seasons were reviewed to identify players with a knee injury resulting in ≥1 games missed. The primary outcome was the incidence of knee injuries reported per 1000 minutes-exposures (MEs). Player demographics, statistics, and injury characteristics were recorded. Secondary analysis was conducted using bivariate and multivariable logistic regression to investigate risk factors associated with having a knee injury.A total of 87 players (10.8% of all players) sustained a combined 104 knee injuries between the 2017 and 2022 seasons, indicating a rate of 6.03 knee injuries per 1000 MEs. Accounting for potential confounders, having a knee injury was significantly associated with older age (OR, 1.11; 95% CI, 1.05-1.18; P = .0002) and higher usage rate (OR, 1.06; 95% CI, 1.02-1.11; P = .02).This study showed that knee injuries occurred in 10.8% of players, with an overall rate of 6.03 injuries per 1000 MEs. The most significant risk factors associated with having a knee injury in WNBA athletes were older age and higher player usage rate. Implementing targeted load management strategies for players with higher usage rates or advanced age may help reduce the incidence of knee injuries among female basketball athletes.

  View details for DOI 10.1177/23259671251405404

  View details for Web of Science ID 001662363500001

  View details for PubMedID 41552620

  View details for PubMedCentralID PMC12811573

• Diagnostic Arthroscopy for Identifying Patellofemoral Chondral Lesions Missed by MRI in Pediatric Patients Undergoing MPFLR ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Parmar, R. P., Keane, A., Tummala, S. V., Lin, E., Vij, N., Menzer, H., Vaughn, J. 2025; 13 (11): 23259671251389130

  Abstract

  Patellofemoral dislocations are often associated with chondral injuries. In adults, diagnostic arthroscopy (DA) has identified chondral injuries in up to one-third of cases where magnetic resonance imaging (MRI) was negative. However, the value of DA in detecting cartilage injuries in pediatric patients undergoing medial patellofemoral ligament reconstruction (MPFLR) has not been well studied.To evaluate the utility of DA in diagnosing cartilaginous injuries in pediatric patients undergoing MPFLR with negative preoperative MRI findings and to compare postoperative outcomes between patients with and without chondral injury findings on DA.Cohort study (diagnosis); Level of evidence, 3.A retrospective review was conducted on patients aged 0 to 18 years who underwent combined MPFLR and DA procedures from 2015 to 2023 at a single institution. The exclusion criteria were as follows: revision MPFLR; tibial tubercle osteotomy; multiligament reconstructions; and previous meniscal injury. MRI and DA reports were reviewed for chondral findings. Patients were classified into 3 groups: +MRI/+DA, -MRI/+DA, and -MRI/-DA. Subgroup analysis was performed within the -MRI/+DA group to compare outcomes in the immediate postoperative recovery period between those who underwent a chondroplasty versus those who did not.Of the 155 patients included, follow-up averaged 7.8 months (median, 5 months [range, 0-41 months]). Among 89 patients with negative MRI findings, 39 (43.8%) had chondral injuries detected on DA. Targeted treatment was performed in 22 (56.4%) of these patients, a lower rate than in those with positive MRI findings (80.3%; P = .02). No significant differences were observed in knee flexion at 2 weeks postoperatively: +MRI/+DA (77.9°± 23°), -MRI/+DA (66.5°± 30.2°), and -MRI/-DA (73.3°± 30°) (P = .14). Similarly, no significant differences were found at 12 weeks: +MRI/+DA (135.3°± 13°), -MRI/+DA (127.8°± 21°), and -MRI/-DA (134.1°± 13.4°) (P = .10). Range of motion and complication rates were comparable across all groups (P > .05). A subgroup analysis in the -MRI/+DA cohort comparing patients who underwent an arthroscopic procedure (n = 22) with those who did not (n = 17) showed no significant differences in range of motion or complication rates (P > .05).Diagnostic arthroscopy detected cartilaginous injuries in 43.8% of pediatric patients with negative preoperative MRI undergoing MPFLR. This highlights the diagnostic value of DA in identifying injuries that would otherwise remain undetected.

  View details for DOI 10.1177/23259671251389130

  View details for Web of Science ID 001616356800001

  View details for PubMedID 41244228

  View details for PubMedCentralID PMC12618834

• Editorial Commentary: Are we checking our bias in patients with fibromyalgia that need hip arthroscopy? Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Tummala, S. V., Economopolous, K. J. 2025

  Abstract

  Like all diagnoses and co-morbidities, patients with hip pain should be managed with individualized treatment plans. Patients with fibromyalgia undergoing hip arthroscopy are no different. Even if their absolute scores remain lower than those without fibromyalgia, these patients can achieve clinically meaningful improvements in patient-reported outcomes after treatment of femoroacetabular impingement. As orthopedic providers we should be aware of potential bias against patients with chronic musculoskeletal pain and critically evaluate the literature that supports clinically relevant improvement after surgical intervention. Fibromyalgia should not be viewed as a condition that excludes or increases the threshold for hip arthroscopy, but rather as a factor requiring nuanced, multidisciplinary perioperative care and realistic goal-setting.

  View details for DOI 10.1016/j.arthro.2025.06.034

  View details for PubMedID 40617454

• Prescription Testosterone Is Associated With an Increased Risk of Anterior Cruciate Ligament Injury ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Brinkman, J. C., Holle, A. M., Paul, B. R., Payne, C. S., V. Tummala, S., Haglin, J. M., Chhabra, A. 2025; 41 (7): 2440-2445.e1

  Abstract

  To characterize the relationship between testosterone replacement therapy (TRT) and anterior cruciate ligament (ACL) injuries.A retrospective cohort study using a large insurance database was conducted. Patients who were prescribed TRT for at least 3 months were matched with controls who were not prescribed TRT. Rates of ACL tears were compared between the cohorts. Multiple subgroups were created based on age (<25, 25-35, 36-45, 46-55, 56-65, and 65+ years). Multivariable logistic regressions were performed to determine the association of TRT with ACL tears while accounting for demographic variables and comorbidities.After matching, there were 160,839 patients in both the TRT cohort and the control cohort. The incidence of ACL injuries was 17.8 per 10,000 person-years (95% confidence interval [CI]: 16.4-19.2) for patients who were prescribed TRT and 4.9 per 10,000 person-years (95% CI: 4.1-5.7) for controls (P < .001). Within 2 years of filling a testosterone prescription for at least 3 months, 572 (0.35%) patients experienced an ACL injury compared to only 157 (0.10%) controls during the same follow-up period (odds ratio: 2.77; 95% CI: 2.26-3.42, P < .001). When stratified by age, all groups except the <25 years of age group demonstrated a significantly higher rate of ACL tears (odds ratio 3.91-12.3, P < .001-.009). When separated by sex, males on TRT were 3.13 (95% CI: 2.50-3.93, P < .001) times more likely while females on TRT were 1.94 (95% CI: 1.13-3.41, P = .018) times more likely to experience an ACL injury compared to controls.This study found that patients prescribed at least 3 months of TRT had a significantly higher incidence of ACL injuries compared to controls within a 2-year follow-up period.Level III, retrospective comparative study.

  View details for DOI 10.1016/j.arthro.2024.10.032

  View details for Web of Science ID 001519123300010

  View details for PubMedID 39510204

• Unequal Access and Evolving Priorities in US Uveitis Clinical Trials: A 23-year Analysis of Regional, Institutional, and Anatomic trends EYE Shah, J., Pathuri, S., Wilkins, C. S., Parsons, A. D., Acar, I., Safaei, E., Tummala, S. V. 2025; 39 (10): 2104-2105

  View details for DOI 10.1038/s41433-025-03854-7

  View details for Web of Science ID 001489757100001

  View details for PubMedID 40379811

  View details for PubMedCentralID PMC12209447

• Long-term nonsteroidal anti-inflammatory drug use is associated with rotator cuff tears in adult patients JSES INTERNATIONAL Tummala, S., Parmar, R. P., Holle, A., Brinkman, J. C., Hassebrock, J. D., Tokish, J. M. 2025; 9 (3): 666-671

  Abstract

  To determine if long-term nonsteroidal anti-inflammatory drug (NSAID) is associated with rotator cuff tears (RCTs) in an adult population.A retrospective study using a national database was performed. All patients with a diagnosis of long-term NSAID use with active records for at least 1 year or 2 years were identified. These patients were matched 1:1 to controls without NSAID use based on age, gender, and Charlson comorbidity index. Rates of new rotator cuff tendon tears were compared. Subgroup analyses in the following age ranges for each sex were done: 35-45, 46-55, 56-65, and 66-75.Out of 499,240 patients with chronic NSAID use, 10,180 patients sustained a RCT compared to 7471 of the control patients (2.04% vs. 1.50%, respectively; odds ratio [OR]: 1.18; 95% confidence interval [CI]: 1.14-1.21; P < .001). Male NSAID users in the 46-55 age range had higher rates of RCTs compared to matched control patients (OR: 1.41; 95% CI: 1.30-1.52; P < .001). Female NSAID users in the 46 to 55 age range had higher rates of RCTs compared to matched control patients (OR: 1.40; 95% CI: 1.31-1.49; P < .001). Comparable results were seen in the 56-65 age range for both males and females. Furthermore, chronic NSAID users (n = 1888; 18.5%) underwent rotator cuff repair at higher rates compared to controls (n = 1223; 16.4%; P = .01).Long-term NSAID use is associated with an increased incidence of rotator cuff tendon tears at the 1- and 2-year follow-up periods in adult patients, particularly those in the 46-55 age range.

  View details for DOI 10.1016/j.jseint.2024.11.021

  View details for Web of Science ID 001634915300011

  View details for PubMedID 40486780

  View details for PubMedCentralID PMC12145042

• Outcomes of Multiply Revised ACL Reconstruction with Quadriceps Tendon Autograft plus Lateral Extra-articular Tenodesis in Competitive Athletes ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Tummala, S. V., Brinkman, J. C., Parmar, R., Haglin, J. M., Hoffer, A. J., Economopoulos, K. J. 2025; 13 (5): 23259671251337478

  Abstract

  The number of multiply revised anterior cruciate ligament reconstructions (rrACLRs) performed each year continues to increase. The most reliable graft type and surgical technique in the young, active patient remains to be determined.To determine the outcomes of rrACLR using quadriceps tendon (QT) autograft with lateral extra-articular tenodesis (LET).Case series; Level of evidence, 4.A retrospective review was performed of all competitive athletes undergoing rrACLR with QT autograft and LET at a single institution with a minimum follow-up of 2 years. Patient demographics, physical examination, and radiological findings, and previous surgical details were documented. Patient outcomes were noted, including the International Knee Documentation Committee (IKDC) and Lysholm scores, ability to return to sport and return at the same level of play, retear rate, and other complications.A total of 19 rrACLRs were performed and met inclusion criteria in the 10-year study period. All participants were high school, collegiate, or professional athletes with a mean age of 22 years, and 63.2% were female. The mean follow-up was 42.3 months, and IKDC scores increased from 51.6 preoperatively to 74.7 at the final follow-up (P < .001). Likewise, the Lysholm score increased significantly from a preoperative value of 53.6 to 76.8 at the final follow-up (P < .001). Return to play was possible in 52.6% of the patients at a mean of 11.5 months, with 31.6% returning to the same or higher level of play. One (5.3%) patient experienced a recurrent ACL tear, and 2 (10.5%) experienced a contralateral tear. Arthrofibrosis requiring surgical intervention occurred in 26.3% of the athletes.Short- to midterm results demonstrated that competitive athletes who received an rrACLR using a QT autograft with LET had statistically significant improvements in both IKDC and Lysholm scores, with more than half of patients being able to return to sport and nearly a third returning at the same or higher level of play. In the setting of a third ACL reconstruction, quadriceps tendon autograft with LET is a reasonable option even in high-risk patients.

  View details for DOI 10.1177/23259671251337478

  View details for Web of Science ID 001489845400001

  View details for PubMedID 40386643

  View details for PubMedCentralID PMC12084710

• Low Income, Younger Age, Female Sex, and Poor Mental Health Are Risk Factors for Diminished Access to Care Among Patients With Meniscus Tears. Arthroscopy, sports medicine, and rehabilitation Barron, D. W., Gill, V. S., Boddu, S. P., Beckett, N. C., Tummala, S. V., Chhabra, A. 2025; 7 (2): 101064

  Abstract

  Purpose: To use the All of Us database to investigate barriers to health care access for patients with meniscus tears and to examine how specific demographic, socioeconomic, and health-related factors independently influence their health care utilization.Methods: The National Institutes of Health All of Us database was queried for patient data between March 2017 and March 2023 to form a cohort of patients with meniscal tears. Patients with meniscal tears were identified using Systematized Nomenclature of Medicine clinical terms. All patients with self-reported meniscus tears were included, with no exclusion criteria to ensure a diverse representation of underrepresented individuals. Patient responses to the "Healthcare Access and Utilization Survey" were analyzed across 4 domains: "delayed care," "could not afford care," "skipped medication," and "have not seen a provider in over one year."Results: In total, 5,671 survey respondents with meniscal tears were included for analysis from a population of 436,000 eligible records. Among them, 27.7% reported delayed care, 23.9% were unable to afford care, 11.8% skipped medication, and 2.0% had not seen a provider in over a year. Patients with annual incomes under $50,000 were more likely to delay care (odds ratio [OR], 1.41; P < .001), be unable to afford care (OR, 1.73; P < .001), or skip medications (OR, 1.79; P < .001). Younger age than the cohort mean of 65.4 years, female sex, and poor physical and mental health were associated with impaired access in at least 1 care domain.Conclusions: Over one-fourth of patients with a diagnosis of meniscus tear who responded to the All of Us "Healthcare Access and Utilization Survey" reported difficulties with access to care across 4 domains, with those of low income, younger age, female sex, and poor mental or physical health experiencing significant barriers to care.ClinicalRelevance: This research can inform strategies for equitable treatment of meniscal injuries by highlighting disparities in orthopaedic care access and utilization.

  View details for DOI 10.1016/j.asmr.2024.101064

  View details for PubMedID 40297065

• Long-Term Preoperative Nonsteroidal Anti-inflammatory Drug Use Does Not Impact Revision Rate After Repair of Rotator Cuff, Achilles, Distal Biceps, or Quadriceps Tendon. Arthroscopy, sports medicine, and rehabilitation Parmar, R., Tummala, S. V., Holle, A., Iturregui, J., Hoffer, A. J., Tokish, J. M. 2025; 7 (2): 101034

  Abstract

  Purpose: To determine whether long-term preoperative nonsteroidal anti-inflammatory drug (NSAID) use affected the revision rates after primary tendon repair for the following common sports medicine surgical procedures: rotator cuff repair (RCR), Achilles tendon repair (ATR), distal biceps repair (DBR), or quadriceps tendon repair (QTR).Methods: A retrospective comparative study using a national insurance database was performed. Patients who underwent major tendon repair, including RCR, ATR, DBR, or QTR, with at least 2-year follow-up were identified. Those who had a diagnosis of long-term NSAID use prior to the index operation were identified and matched 1:4 to controls without NSAID use based on age, sex, specific tendon repaired, and Elixhauser Comorbidity Index. The revision repair rates of the 2 groups were compared.Results: A total of 36,068 patients underwent major tendon repair. Of these, 7,246 (20%) met the long-term NSAID use criteria prior to tendon repair (NSAID users). After RCR, 3.2% of NSAID users (n= 190) and 2.6% of controls (n= 617) underwent revision surgery within 2 years (odds ratio [OR], 1.15; 95% confidence interval [CI], 0.97-1.36; P= .10). After ATR, NSAID users had a revision rate of 3.9% (n= 24) versus 2.5% (n= 62) in the control cohort (OR, 1.47; 95% CI, 0.89-2.38; P= .12). After DBR, both NSAID users and controls had fewer than 11 revision cases (OR, 1.54; 95% CI, 0.49-4.16; P= .42). After QTR, the revision rate was 5.9% (n= 30) for NSAID users compared with 4.8% (n= 95) for the control group (OR, 1.22; 95% CI, 0.77-1.86; P= .38). None of the observed differences in revision rates between NSAID users and controls were significant.Conclusions: Patients with a diagnosis of and coding for long-term preoperative NSAID use do not have greater revision rates within 2 years of primary tendon repair than patients without this diagnosis.Level of Evidence: Level III, retrospective case-control study.

  View details for DOI 10.1016/j.asmr.2024.101034

  View details for PubMedID 40297086

• Increased Musculoskeletal Injury Risk Without Impact on Statistical In-Game Performance Within 90 Days From Concussion Among Professional Basketball Athletes ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Parmar, R., Tummala, S. V., Morikawa, L., Haglin, J., Patel, K., Chhabra, A. 2025; 13 (3): 23259671251319507

  Abstract

  Concussions have previously been shown to have persistent neurological changes represented by altered reaction time and postural stability in high-level athletes. The effects of concussions on professional basketball players' performance and subsequent injuries during the 90 days after return to play (RTP) have not been investigated.the purpose of this study was to evaluate player statistical performance and risk of musculoskeletal (MSK) injury within 90 days of RTP from a diagnosed concussion. It was hypothesized that within the 90 days after RTP from a concussion, players would be at a greater risk for MSK injury with an associated decrease in player statistical performance.Descriptive epidemiology study.Concussions sustained by National Basketball Association (NBA) players between the 2015-2016 and 2021-2022 seasons, excluding the 2019-2020 season, were evaluated using a publicly available database. The database was queried to identify any MSK injury in the 90-day post-RTP period after a concussion, along with time loss after subsequent injury. Performance statistics were obtained from each player's preindex season and postindex season, as well as defined time points within the 90-day post-RTP period. Each concussed player was matched 1 to 1 with a nonconcussed control using position, win shares, player efficiency rating, and points per game. MSK injury incidence and player statistics in the concussion group were compared with controls using unpaired Student t tests.A total of 70 concussions were identified in 70 professional basketball players and included in this analysis. A total of 49 players sustained an MSK injury in the 90-day post-RTP period (70%). Compared with controls, the odds of sustaining an MSK injury in the concussed cohort were 11.3 times greater (95% CI, 5.04-25.2; P < .001). Games missed after subsequent MSK injury were similar between the concussed and control groups (P = .687). Comparisons over the 90-day post-RTP period did not reveal any significant changes in points per game, minutes per game, or true shooting percentage (P > .05). When compared with controls, no changes in performance statistics were significantly different (P > .05).Our analysis demonstrates that basketball players who sustain concussions are at a significantly increased risk for subsequent MSK injury within the 90-day post-RTP period but not player performance. Knowledge of this increased risk of MSK injury in concussed athletes can help guide concussion management for proper RTP and targeted rehabilitation in professional basketball players.

  View details for DOI 10.1177/23259671251319507

  View details for Web of Science ID 001437003200001

  View details for PubMedID 40052175

  View details for PubMedCentralID PMC11881116

• Association of Smokeless Tobacco Use With Perioperative Complications and Revision Surgery After Anterior Cruciate Ligament Reconstruction AMERICAN JOURNAL OF SPORTS MEDICINE Holle, A. M., Tummala, S. V., Pejic, J., Van Schuyver, P. R., Chhabra, A., Economopoulos, K. J. 2025; 53 (2): 308-314

  Abstract

  Tobacco use is a known modifiable risk factor for postoperative complications and revision surgery after anterior cruciate ligament reconstruction (ACLR). Previous studies focus on tobacco as a broad categorization of traditional smoking, smokeless tobacco, and other forms of nicotine use. It is unclear if differences in the type of nicotine used lead to similar adverse outcomes after ACLR.To (1) assess the incidence of postoperative complications among ACLR patients who use smokeless tobacco and (2) compare these outcomes with those of patients who do not use tobacco and those who smoke tobacco.Cohort study; Level of evidence, 3.A retrospective cohort study utilizing the PearlDiver database was conducted. Patients undergoing primary ACLR with a minimum 2-year follow-up were included. Smokeless tobacco users (n = 898), cigarette smokers (n= 22,062), and non-tobacco users (n= 207,462) were matched based on patient variables and comorbidities. Postoperative complications within 90 days of surgery and subsequent knee surgery within 2 years were compared among groups. Multivariable logistic regressions were used to control for confounding variables.Compared with nonusers, smokeless tobacco users demonstrated an increased risk of pneumonia (odds ratio [OR], 3.36; 95% CI, 1.41-7.90), acute kidney injury (OR, 12.7; 95% CI, 3.77-52.8), and emergency department (ED) utilization (OR, 6.29; 95% CI, 3.70-10.9) within 90 days of the ACLR. Additionally, smokeless tobacco users had an increased risk of ACLR (OR, 4.75; 95% CI, 3.60-6.26) and meniscal surgery (OR, 2.89; 95% CI, 2.23-3.73) within 2 years. When compared with cigarette smokers, smokeless tobacco users showed an increased risk of pneumonia (OR, 3.25; 95% CI, 1.33-7.78), acute kidney injury (OR, 7.63; 95% CI, 2.72-22.5), and ED visits (OR, 1.55; 95% CI, 1.26-1.90) within 90 days and subsequent ACLR (OR, 4.81; 95% CI, 3.58-6.47) and meniscal surgery (OR, 3.23; 95% CI, 2.45-4.26) within 2 years.Smokeless tobacco use was associated with an increased risk of medical complications, ED utilization, and subsequent procedures compared with nonuser controls and traditional smokers. These findings highlight the importance of considering specific forms of tobacco use in preoperative screening for patients undergoing ACLR.

  View details for DOI 10.1177/03635465241303487

  View details for Web of Science ID 001389267300001

  View details for PubMedID 39754412

• Association Between Autograft Choice and Psychological Readiness to Return to Sport After ACL Reconstruction ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Brinkman, J. C., Hassebrock, J. D., Tummala, S. V., Richman, E. H., Haglin, J. M., Makovicka, J. L., Poon, S. K., Economopoulos, K. J. 2025; 13 (1): 23259671241291926

  Abstract

  It has been demonstrated that an athlete's psychological readiness contributes to one's ability to successfully return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction. However, the effect of graft choice on psychological readiness is not yet understood.The purpose of this study was to evaluate the association between graft choice and an athlete's psychological readiness to RTS. It was hypothesized that similar ACL-Return to Sport after Injury (ACL-RSI) scores would be achieved among patients who underwent ACL reconstruction with quadriceps autograft (QA), hamstring tendon autograft (HA), and bone-patellar tendon-bone (BTB) autograft.Cohort study; Level of evidence, 3.Patients who underwent primary ACL reconstruction at a single institution between January 2017 and December 2018 were placed into separate cohorts depending on graft type (HA, BTB, or QA; n = 30 patients in each group), and the ACL-RSI, International Knee Documentation Committee subjective form, and Lysholm scores were compared between the different graft cohorts at 6 months postoperatively, at RTS, and at 2 years postoperatively. Also, the rate of patients who achieved an ACL-RSI score of ≥65 (predictive of return to preinjury sport at 2 years postoperatively) was calculated, as was the RTS rate and time.The QA group demonstrated significantly higher ACL-RSI scores than both the HA and BTB groups at 6 months postoperatively (P < .0001) and RTS (P = .011). The QA group also had a higher rate of achieving ≥65 on ACL-RSI than the other groups at 6 months postoperatively (P = .002) and RTS (P = .024). There was no significant difference in the RTS rate between the 3 groups, although the QA group demonstrated a significantly quicker return (QA, 8.1 months; BTB, 9.6 months; HA, 10.5 months; P < .001).Athletes undergoing primary ACL reconstruction with QA achieved a higher mean ACL-RSI score and more often achieved a score of ≥65 at the 6-month and RTS time points compared with the HA and BTB groups. QA may afford an advantage over other grafts in terms of improved psychological readiness to RTS.

  View details for DOI 10.1177/23259671241291926

  View details for Web of Science ID 001408362100001

  View details for PubMedID 39877422

  View details for PubMedCentralID PMC11773525

• Regional differences in reimbursement, volume, and patient characteristics exist for rotator cuff repairs: a temporal analysis from 2013 to 2021 JOURNAL OF SHOULDER AND ELBOW SURGERY Gill, V. S., Tummala, S., Haglin, J. M., Boddu, S. P., Cancio-Bello, A. M., Tokish, J. M. 2025; 34 (1): 76-87

  Abstract

  Prior studies have demonstrated declining reimbursement and changing procedural utilization across multiple orthopedic subspecialties, yet a comprehensive examination of this has not been performed for rotator cuff repair (RCR), particularly at a geographic level. The purpose of this study was to evaluate changes in reimbursement, utilization, and patient populations for open and arthroscopic RCRs from 2013 to 2021 at a national and regional level.The Medicare Physician and Other Practitioners database from years 2013 to 2021 were queried to extract all episodes of open chronic RCR, open acute RCR, and arthroscopic RCR. Utilization was measured as procedural volume per 10,000 Medicare beneficiaries. Inflation-adjusted reimbursement, utilization, surgeon information, and patient characteristics were extracted for each procedure for each year. Data was stratified geographically based on US Census regions and rural-urban commuting codes. Kruskal-Wallis tests and linear regressions were performed to compare geographical areas.Between 2013 and 2021, arthroscopic RCR utilization increased by 9.4% (11.0/10,000-12.0/10,000), while open chronic RCR utilization decreased by 58.8% (2.0/10,000-0.8/10,000). During that time, average inflation-adjusted reimbursement declined by 10.0% and 11.3% for arthroscopic and open chronic RCR, respectively. The increase in utilization and decrease in reimbursement was greatest in the Midwest. In 2021, arthroscopic RCR utilization was 12.0/10,000, while average reimbursement was $846.87, nationally. Utilization was highest in the South (14.5/10,000) and lowest in the Northeast (8.1/10,000) (P < .001). Alternatively, reimbursement was highest in the Northeast ($904.60) and lowest in the South ($830.80) (P < .001). The proportion of patients who were male, Medicaid eligible, or non-White was highest in the West (P < .001). Patients in the West also had the fewest comorbidities. Increased patient comorbidities, when controlling patient demographics, were associated with lower reimbursement nationally and within the Northeast (P < .001).Geographical discrepancies in RCR utilization and reimbursement exist. The South consistently demonstrates the highest utilization of RCR, while also having the lowest reimbursement. Alternatively, the Northeast has the lowest utilization but the highest reimbursement. Increased patient population comorbidities were associated with reduced RCR reimbursement for surgeons in the Northeast, but not in other regions.

  View details for DOI 10.1016/j.jse.2024.03.034

  View details for Web of Science ID 001376610500001

  View details for PubMedID 38710363

• Meniscectomy Reimbursement and Utilization Are Declining at Different Rates Across the United States ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Gill, V. S., Haglin, J. M., Tummala, S., Iturregui, J., Economopoulos, K. J., Chhabra, A. 2024; 40 (11): 2717-2726

  Abstract

  To evaluate how arthroscopic meniscectomy utilization, reimbursement, physician billing practices, and patient populations have changed within the Medicare population from 2013 to 2021 at a national level and regional level.The Medicare Physician & Other Practitioners database was queried for all episodes of 2-compartment and single-compartment arthroscopic meniscectomy between 2013 and 2021. Utilization per 10,000 beneficiaries and average inflation-adjusted reimbursement were assessed. Physician practice styles, measured through changes in the services billed, and Medicare beneficiary demographic characteristics were extracted each year. The Kruskal-Wallis test was performed to compare regions.Between 2013 and 2021, two-compartment meniscectomy utilization per 10,000 Medicare beneficiaries declined by 54.9% and single-compartment meniscectomy utilization declined by 54.2%. Average reimbursement declined by 9.3% and 12.5% for 2-compartment meniscectomy and single-compartment meniscectomy, respectively. In 2021, the South had the highest utilization of both 2-compartment (3.8/10,000) and single-compartment (4.7/10,000) meniscectomies while having the lowest average reimbursement for 2-compartment meniscectomy ($383.02, P < .001). Nationally, the average number of beneficiaries per surgeon performing single-compartment meniscectomy declined by 3.8% whereas the average number of billable services performed per beneficiary increased by 46.6%. The comorbidity risk score of these patients decreased by 8.7%, with the West having the healthiest patients in 2021.Meniscectomy utilization and reimbursement have been declining nationally within the Medicare population. Surgeons in the South performed the most meniscectomies while having among the lowest reimbursement. The practice patterns of surgeons performing meniscectomies have been changing, with surgeons performing nearly 50% more total billable services per beneficiary while performing fewer unique billable services. Additionally, the patient population of surgeons who perform meniscectomy was healthier in 2021 than in 2013.This study highlights changes in meniscectomy utilization and reimbursement over time in the face of changing evidence of meniscectomy use in elderly patients and new Medicare legislature regarding reimbursement.

  View details for DOI 10.1016/j.arthro.2024.01.039

  View details for Web of Science ID 001347000800001

  View details for PubMedID 38336106

• The Primary Risk Factors for Season-Ending Injuries in Professional Basketball Are Minutes Played Per Game and Later Season Games ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Menon, S., Morikawa, L., Tummala, S., Buckner-Petty, S., Chhabra, A. 2024; 40 (9): 2468-2473

  Abstract

  To determine the incidence rates and associated risk factors of season-ending injuries (SEIs) in the National Basketball Association (NBA) from the 2015-20 seasons.Publicly available records of active NBA players between the 2015-16 and 2020-21 seasons were reviewed to identify players with an SEI. In this study, SEI was classified as any injury that resulted in failure to return at least 5 games before the end of the team's game schedule. Injury data from the 2019-20 NBA season, shortened because of the coronavirus disease 2019 pandemic, were omitted. The primary outcome was the incidence of SEIs reported per 1,000 game exposures (GEs). Player demographics, basketball statistics, injury characteristics, and timing of injury were recorded. Secondary analysis, including bivariate analysis and multivariate logistic regression, was performed to investigate factors associated with having an SEI.In total, 196 players (15.6% of all players) sustained a combined 238 SEIs between the 2015-16 and 2020-21 seasons, indicating a rate of 1.74 SEIs per 1,000 GEs. When characterized by body part, knee injuries were found to be the most frequent SEI, at a rate of 0.47 injuries per 1,000 GEs. Accounting for potential confounders, having an SEI was significantly associated with more minutes per game played (odds ratio, 1.06, 95% confidence interval, 0.99-1.01, P < .001).SEIs occurred in 15.6% of players in this study, with an overall rate of 1.74 SEIs per 1,000 GEs. The most significant risk factor associated with injury was minutes per game. SEI was more likely to occur in the third and fourth quartiles of the NBA season than in the first or second quartile.Level III, retrospective comparative prognostic investigation.

  View details for DOI 10.1016/j.arthro.2024.01.018

  View details for Web of Science ID 001340558400001

  View details for PubMedID 38311270

• Geographical Differences in Surgeon Reimbursement, Volume, and Patient Characteristics in Primary Total Hip Arthroplasty JOURNAL OF ARTHROPLASTY Gill, V. S., Tummala, S. V., Haglin, J. M., Sullivan, G., Spangehl, M. J., Bingham, J. S. 2024; 39 (9): 2179-2187

  Abstract

  The purpose of this study was to evaluate changes in regional and national variations in reimbursement to arthroplasty surgeons, procedural volumes, and patient populations for total hip arthroplasty (THA) from 2013 to 2021.The Medicare Physician and Other Practitioners database was queried for all billing episodes of primary THA for each year between 2013 and 2021. Inflation-adjusted surgeon reimbursement, procedural volume, physician address, and patient characteristics were extracted for each year. Data were stratified geographically based on the United States Census regions and rural-urban commuting codes. Kruskal-Wallis and multivariable regressions were utilized.Between 2013 and 2021, the overall THA volume and THAs per surgeon increased at the highest rate in the West (+48.2%, +20.2%). A decline in surgeon reimbursement was seen in all regions, most notably in the Midwest (-20.3%). Between 2013 and 2021, the average number of Medicare beneficiaries per surgeon declined by 12.6%, while the average number of services performed per beneficiary increased by 18.2%. In 2021, average surgeon reimbursement was the highest in the Northeast ($1,081.15) and the lowest in the Midwest ($988.03) (P < .001). Metropolitan and rural areas had greater reimbursement than micropolitan and small towns (P < .001). Patient age, race, sex, Medicaid eligibility, and comorbidity profiles differ between regions. Increased patient comorbidities, when controlling for patient characteristics, were associated with lower reimbursement in the Northeast and West (P < .01).Total hip arthroplasty (THA) volume and reimbursement differ between US regions, with the Midwest exhibiting the lowest increase in volume and greatest decline in reimbursement throughout the study period. Alternatively, the West had the greatest increase in THAs per surgeon. Patient comorbidity profiles differ between regions, and increased patient comorbidity is associated with decreased reimbursement in the Northeast and the West. This information is important for surgeons and policymakers as payment models regarding reimbursement for arthroplasty continue to evolve.

  View details for DOI 10.1016/j.arth.2024.03.041

  View details for Web of Science ID 001294913600001

  View details for PubMedID 38522798

• Arthroscopic Technique for Headless Compression Screw Fixation of Large Bony Bankart Fractures in Anterior Shoulder Instability ARTHROSCOPY TECHNIQUES Hoffer, A. J., V. Tummala, S., Tokish, J. M. 2024; 13 (8): 103029

  Abstract

  A bony Bankart fracture is a common injury pattern in anterior shoulder instability. The fracture fragment size varies and the larger the fragment the more likely recurrent instability will occur. When a large bony Bankart fracture is present, surgical fixation is preferred. Both open and arthroscopic approaches exist with multiple fixation techniques including anterior-to-posterior screw fixation, suture anchor bridge fixation, and suture button fixation. Arthroscopic screw fixation is difficult, as the angle necessary to be parallel to the glenoid surface requires a far medial start point and places the nerve at risk. The use of a variable-pitch, headless compression screw placed from posterior to anterior avoids these risks. We describe an arthroscopic technique for glenoid fixation using a posterior-to-anterior, cannulated, variable-pitch headless compression screw for the treatment of an anterior BBF.

  View details for DOI 10.1016/j.eats.2024.103029

  View details for Web of Science ID 001293403700001

  View details for PubMedID 39233807

  View details for PubMedCentralID PMC11369937

• Arthroscopy Patients in Medicare Population Became Sicker While Reimbursement Decreased From 2013 to 2020. Arthroscopy, sports medicine, and rehabilitation Haglin, J. M., Brinkman, J. C., Lin, E., Tummala, S. V., McQuivey, K. S., Patel, K. A., Chhabra, A. 2024; 6 (4): 100950

  Abstract

  Purpose: To assess surgeon reimbursement for common arthroscopic procedures, including arthroscopic meniscal debridement and arthroscopic rotator cuff repair, in patients with differing risk profiles within the Medicare population.Methods: A publicly available Medicare database was used to identify all cases of arthroscopic meniscal debridement and arthroscopic rotator cuff repair procedures billed to Medicare from 2013 to 2020. The surgeon reimbursement from Medicare was collected and adjusted for inflation. All procedure episodes were split into 2 cohorts; those with a hierarchical condition category (HCC) risk score ≥1.5, and those with patient HCC risk scores <1.5. Reimbursement rates were compared between groups.Results: From 2013 to 2020, a total of 624,077 meniscal debridement procedures and 567,794 arthroscopic rotator cuff repairs were billed to Medicare Part B. During this time, the mean adjusted surgeon reimbursement for arthroscopic rotator cuff repair decreased by 9.2% from 2013 to 2020. During the same time period, the adjusted mean surgeon reimbursement for arthroscopic both compartment meniscal debridement and single compartment meniscal debridement decreased by 7.9% and 9.9%, respectively. Throughout the study period, the mean HCC risk score increased from 1.19 in 2013 to 1.31 in 2020 (P < .001). Across all years in the study, the sicker cohort had a significantly greater rate of all comorbidities and a greater mean body mass index (P < .001 for all variables). The mean reimbursement across this cohort was lower for both rotator cuff repair (P= .037) and meniscal debridement procedures (P < .001) compared with the healthier cohort.Conclusions: This study demonstrates that from 2013 to 2020, inflation-adjusted surgeon reimbursement for arthroscopic rotator cuff repair and meniscal debridement decreased while patient complexity increased. Further, mean surgeon reimbursement was lower among patients with more complexity in comparison with their healthier counterparts for such procedures.Level of Evidence: Level III, retrospective cohort study.

  View details for DOI 10.1016/j.asmr.2024.100950

  View details for PubMedID 39421342

• Functional Return-to-Sport Testing Demonstrates Inconsistency in Predicting Short-Term Outcomes Following Anterior Cruciate Ligament Reconstruction: A Systematic Review ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Gill, V. S., Tummala, S. V., Sullivan, G., Han, W., Haglin, J. M., Marks, L., Tokish, J. M. 2024; 40 (7): 2135-2151.e2

  Abstract

  To systematically review the relationship between functional testing at the time of return to sport (RTS) and short-term outcomes, such as second anterior cruciate ligament (ACL) tear and return to a preinjury level of sport, among athletes who underwent anterior cruciate ligament reconstruction (ACLR).A systematic literature search was performed in MEDLINE, EMBASE, Scopus, and Web of Science to identify studies examining athletes who underwent functional RTS testing and were followed for at least 12 months following ACLR. Studies were screened by 2 reviewers. A standardized template was used to extract information regarding study characteristics, ACLR information, functional test results, and risk factors associated with retear or reduced RTS.Of the 937 studies identified, 22 met the inclusion criteria. The average time between ACLR and RTS testing was 8.5 months. Single leg hop for distance performance had no association with retear risk in any study and no association with RTS rates in most studies. Quadriceps strength had conflicting results in relation to retear risk, whereas it had no relationship with RTS rates. Rates of reinjury and RTS were similar between patients who passed and did not pass combined hop and strength batteries. Asymmetric knee extension and hip moments, along with increased knee valgus and knee flexion angles, demonstrated increased risk of retear.Individual hop and strength tests that are often used in RTS protocols following ACLR may have limited and inconsistent value in predicting ACL reinjury and reduced RTS when used in isolation. Combined hop and strength test batteries also demonstrate low sensitivity and negative predictive value, highlighting conflicting evidence to suggest RTS testing algorithm superiority.Level IV, systematic review of Level I-IV studies.

  View details for DOI 10.1016/j.arthro.2023.12.032

  View details for Web of Science ID 001264239000001

  View details for PubMedID 38216071

• Preoperative Postvoid Residual Is Not Predictive of Postoperative Urinary Retention in Primary Total Joint Arthroplasty Patients ARTHROPLASTY TODAY V. Tummala, S., Verhey, E. M., Spangehl, M. J., Hassebrock, J. D., Swanson, J., Probst, N., Joseph, A. M., Kosiorek, H., Bingham, J. S. 2024; 26: 101341

  Abstract

  Postoperative urinary retention is a common complication after total hip and knee arthroplasty. Postvoid residual (PVR) scanning is a noninvasive method commonly used to evaluate this complication. Preoperatively increased PVR (PrePVR) has been suggested as a risk factor for postoperative catheterization. The aim of this study was to prospectively assess the importance of PrePVR and its relationship with urinary catheter placement, urology consult, and length of stay postoperatively.Data was prospectively and consecutively collected at a single institution. All patients were bladder scanned preoperatively to collect PrePVR and subsequently scanned on postoperative days zero and one to collect Postoperative PVR. Chart review was performed to determine the number of straight catheterizations, Foley placement, urology consult and length of stay as well as patient demographics.Ninety-four consecutive patients were included in this study. There was a significantly increased postoperative PVR as compared to PrePVR (48.0 mL vs 21.0 mL; P < .0001). A PrePVR >50 mL was not associated with a significant difference in PVR between before and after surgery (P = .13); length of stay (P = .08); need for straight catheterization (P = .11); postoperative Foley placement (P = 1.0); or urology consult (P = 1.0). The only significant risk factor identified for postoperative Foley catheter placement was age (77.7 vs 64.2; P = .02).PrePVR >50 mL was not an accurate predictor of postoperative urinary retention after total joint arthroplasty. PVR significantly increased in all patients. Male sex and increasing age were associated with large increases in PVR postoperatively and an increased risk of catheterization.

  View details for DOI 10.1016/j.artd.2024.101341

  View details for Web of Science ID 001221397600001

  View details for PubMedID 38450395

  View details for PubMedCentralID PMC10915509

• Medial Collateral Ligament Pie-Crusting for Isolated Medial Meniscal Root Repair Is Associated With Improved Clinical Outcomes with Minimum 2-Year Follow-Up ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Herber, A. P., Brinkman, J. C., Tummala, S., Economopoulos, K. J. 2024; 40 (3): 869-875

  Abstract

  To determine clinical and radiographic outcomes of medial collateral ligament (MCL) pie-crusting during isolated medial meniscal root repair.A retrospective review was conducted between August 2013 and December 2019 in patients undergoing isolated medial meniscal root repair. Outcomes, including International Knee Documentation Committee (IKDC) score, Lysholm score, re-tears, MCL laxity, and conversion to total knee arthroplasty (TKA), were compared between pie crust (PC) and non-pie crust (NPC) cohorts. Other assessments included subjective instability or stiffness, infection, and intra-operative chondromalacia. Additionally, radiographic outcomes were compared to determine progression of medial compartment arthrosis.Final analysis included 97 knees, 45 in the PC, and 52 in the NPC group. IKDC and Lysholm scores were similar between both groups preoperatively and 3 months postoperatively. However, at the 6,12, and 24-month follow up, the PC group had a significantly higher measured IKDC and Lysholm scores than the NPC group. PASS percentages for the IKDC score were significantly higher in the PC group at 6 months, 1 year, and 2 years (96.2%; P = .02) follow-up compared to the NPC group. MCID percentages for the IKDC score were also significantly higher at the 1- and 2-year (100%; P = .05) follow-up in the PC group compared to the NPC group. There was also a significantly higher rate of recurrent medial meniscal root tears in the NPC group (4 [8.9%]) compared to the PC group (0 [P = .03]). No MCL laxity was observed at 6 months follow-up.MCL pie-crusting during isolated medial meniscal root repair can be used as an alternative surgical technique, as it leads to improved clinical and patient outcomes compared to patients who do not undergo MCL pie-crusting in the short term. Additionally, those that underwent MCL pie-crusting had a lower incidence of recurrent tears, and no patients experienced MCL laxity at 6 months.Level III, retrospective cohort/comparative study.

  View details for DOI 10.1016/j.arthro.2023.07.029

  View details for Web of Science ID 001190911200001

  View details for PubMedID 37532161

• Regional variation from 2013 to 2021 in primary total shoulder arthroplasty utilization, reimbursement, and patient populations JOURNAL OF SHOULDER AND ELBOW SURGERY Gill, V. S., Haglin, J. M., Tummala, S. V., Lin, E., Cancio-Bello, A., Hattrup, S. J., Tokish, J. M. 2025; 34 (1): e35-e46

  Abstract

  Total shoulder arthroplasty (TSA), encompassing both anatomical and reverse TSA, has increased in popularity worldwide. The purpose of this study was to assess how TSA utilization, reimbursement, surgeon practices, and patient populations have evolved within the Medicare population from 2013 to 2021 at a national and regional level.The Medicare Physician and Other Practitioners dataset was queried for all episodes of primary TSA (CPT-23472), both anatomic and reverse, between years 2013 and 2021. TSA utilization was assessed as volume per 10,000 Medicare beneficiaries. Average inflation-adjusted reimbursement, physician practice styles, and patient demographics of each TSA surgeon were extracted each year. Data were stratified geographically based on US census classifications and rural-urban commuting codes. Kruskal-Wallis and multivariate regressions were utilized to determine differences between regions.Between 2013 and 2021 TSA utilization increased by 121.8%, nationally. The increase was greatest in the Northeast (+147.2%) and least in the Midwest (+115.5%). Average TSA reimbursement declined by 8.8% nationally, with the least decline in the Northeast (6.4%) and the greatest decline in the Midwest (-11.9%). In 2021, the Midwest had the highest TSA utilization (18.1/10,000), while having the lowest average reimbursement ($1108.59; P < .001). The Northeast had the lowest utilization (11.5/10,000) and highest reimbursement ($1223.44; P < .001) in 2021. Nationally, the number of Medicare beneficiaries per surgeon performing shoulder arthroplasty declined by 5.9%, while the average number of TSAs per surgeon (+8.5%) and average number of billable services per beneficiary (+16.6%) both increased. Surgeons in the South performed the most services per beneficiary in 2021 (9.0; P < .001). The average comorbidity burden of patients was decreased by 4.8% between 2013 and 2021, with the West having the healthiest patients in 2021. Higher patient comorbidities were associated with lower physician reimbursement nationally (P < .001).This study demonstrates that TSA utilization in the Medicare population has more than doubled between 2013 and 2021, while average inflation-adjusted reimbursement has declined by nearly 10%. The Midwest has the highest per-capita TSA utilization, while simultaneously having the lowest average reimbursement per TSA. Over time, TSA surgeons are seeing fewer and healthier beneficiaries but performing more services per beneficiary. Additionally, increased patient complexity may be associated with lower reimbursement. Together, these findings are concerning for long-term equitable access to care within shoulder surgery.

  View details for DOI 10.1016/j.jse.2024.03.054

  View details for Web of Science ID 001376616500001

  View details for PubMedID 38754542

• Residents and Fellows of US Medical Residencies and Fellowships Strongly Prefer In-Person to Virtual Conference Format A Cross-sectional Survey JBJS OPEN ACCESS Glattke, K., Tummala, S. V., Weldon, E., Bingham, J. 2024; 9 (2)

  Abstract

  Medical conferences are an integral aspect of medical education as they allow attendees to stay up to date with recent advancements in medicine, to develop presentation and communication skills, and to network and establish connections with professionals in their field of interest. But, when the coronavirus disease 2019 (COVID-19) pandemic was declared in March 2020, face-to-face medical conferences were suspended, and conference organizers began shifting their meetings to virtual platforms. These new virtual conferences afforded medical residents and fellows the unique opportunity to attend conferences from the comfort of their own home or workplace; however, the virtual meeting platforms did not provide attendees with the same networking experiences as in-person conferences. Since the end of the COVID-19 public health emergency, medical conferences are now faced with the question of whether they should remain virtual, shift back to in-person meetings, or develop a hybrid model of both options. Thus, the purpose of this study was to analyze medical resident and fellow sentiments and preferences by comparing virtual and in-person conference formats.A voluntary electronic survey was distributed to medical residents and fellows across the United States through their program coordinators and directors.The main findings of this study suggest that medical residents and fellows largely prefer in-person conferences (85%) as compared to a virtual format because of the networking opportunities afforded to them along with the development of camaraderie with their peers. The findings in this study suggest that the largest benefit in attending a virtual conference is the flexibility to attend from any location (79% important or very important), which offered convenience, flexibility, and comfort to participants (n = 100).These results support our hypothesis that despite the convenience and portability afforded by attending conferences virtually, medical residents and fellows still ultimately prefer to attend conferences in person. Overall, the findings in this study are of relevance to conference organizers in understanding the driving forces behind attendance and should be considered in determining meeting format.

  View details for DOI 10.2106/JBJS.OA.23.00116

  View details for Web of Science ID 001199831000001

  View details for PubMedID 38616848

  View details for PubMedCentralID PMC11008663

• Strains/Sprains and Fractures Are the Most Common Hand and Wrist Injuries in National Basketball Association Athletes Who Return to Preinjury Player Efficiency and Equal or Greater True Shooting Percentage Within Two Years of Injury. Arthroscopy, sports medicine, and rehabilitation Lin, E., Tummala, S. V., Morikawa, L., Vij, N., Petty, S. B., McQuivey, K. S., Chhabra, A. 2023; 5 (6): 100829

  Abstract

  Purpose: To characterize the prevalence and incidence of in-game hand and wrist injuries in the National Basketball Association (NBA), to determine the factors associated with an equal or greater player efficiency rating (PER), and to determine the factors associated with an equal or greater true shooting percentage (TS%) 2 years after a hand and wrist injury using a large-scale national database of NBA players.Methods: Injury data from seasons 2015-2016 to 2020-2021, with exclusion of the 2019-2020 because of abbreviated play due to the coronavirus disease 2019, were extracted from a public online database, Pro Sports Transactions. Injury characteristics and NBA player demographic information were assessed using descriptive statistics. Poisson logistic regression analyses were performed to identify risk factors associated with equal or increased PER and TS% 2years after injury.Results: There were 214 reported hand and wrist injuries, and of these injuries, 173 (81%) were classified as structural. The most common injury types were a strain or sprain (0.63 per 1,000 game exposures), followed by fractures (0.37 per 1,000 game exposures). Older age (relative risk [RR] 0.89; 95% confidence interval [CI] 0.84-0.95) and more years played in the NBA were modestly associated with relative risk of having a decreased PER at 2 years after injury. Increased weight (RR 1.02; 95% CI 1-1.05) and increased body mass index (RR 1.14; 95% CI 1.01-1.29) were also modestly associated with having a decreased PER and TS%, respectively at 2 years after injury.Conclusions: Strains/sprains and fractures are the most common hand and wrist injuries sustained by NBA players. Regardless of dominant or nondominant hand and wrist injuries, NBA players are likely to return to baseline overall player efficiency based on PER and TS% within 2 years of injury.Clinical Relevance: Our study characterizes hand and wrist injuries of NBA players and provides an understanding for these injuries on player performance at 2 years.

  View details for DOI 10.1016/j.asmr.2023.100829

  View details for PubMedID 38107373

• Mid-Term Outcomes of the All-Soft Quadriceps Tendon Autograft Are Noninferior to Hamstring Autograft in Primary Anterior Cruciate Ligament Reconstruction: Comparison With Minimum 5-Year Follow-Up ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Brinkman, J. C., Tummala, S., Hassebrock, J. D., McQuivey, K. S., Makovicka, J. L., Economopoulos, K. J. 2023; 39 (4): 1008-1013

  Abstract

  To compare the 5-year clinical and functional outcomes of the soft-tissue quadriceps tendon (QT) with those of the hamstring tendon (HT) autograft.A retrospective review of patients undergoing anterior cruciate ligament reconstruction using either soft-tissue QT or double-tendon HT autograft with at least 5 years of follow-up was conducted. Surgical technique included anteromedial portal creation for the femoral tunnel and transtibial technique for the tibia. Graft fixation was achieved with interference composite screws for the QT and combination of interference composite screw and suture button for the HT cohort. The 2 groups were compared for differences in outcomes, including International Knee Documentation Committee (IKDC) score, Lysholm score, return to sport, and complications.A total of 37 patients with QT autograft and 46 HT autografts were included in the study, with a mean follow up of 69.9 months and 70.9 months, respectively. The QT group demonstrated a larger graft size on average (9.64 mm vs 7.90 mm, P < .001). The IKDC and Lysholm scores were similar between the 2 groups at 2-years' postoperatively. At 5 years' postoperatively, the QT group demonstrated significantly greater IKDC (P = .018) and Lysholm (P = .007) scores. The cohorts demonstrated similar rates of achieving minimal clinically important difference thresholds at both 2 and 5 years' postoperatively. The 2 groups also demonstrated comparable rates of return to sport, time to return, and postoperative complications.Although the QT autograft demonstrated increased patient-reported outcome scores when compared with the HT at 5 years' postoperatively, there was no clinically significant difference between the cohorts at 2 or 5 years' postoperatively. The QT autograft is an effective alternative to HT autograft with noninferior results to the HT autograft at mid-term follow-up.III, retrospective comparison study.

  View details for DOI 10.1016/j.arthro.2022.10.035

  View details for Web of Science ID 000994355100001

  View details for PubMedID 36343766

• There Is Substantial Variation in Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction: A Survey of 46 American Orthopaedic Surgeons ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Glattke, K. E., Tummala, S., Goldberg, B., Menzer, H., Chhabra, A. 2023; 39 (3): 578-589.e20

  Abstract

  To identify the clinical practice preferences of orthopaedic surgeons regarding anterior cruciate ligament reconstruction (ACLR) rehabilitation through a survey of members of the Arthroscopy Association of North American (AANA) and the American Orthopaedic Society for Sports Medicine (AOSSM).An online survey was distributed to members of AANA and AOSSM between November 2020 and September 2021. Participants reported on their clinical preferences for ACLR protocol development and patient selection, use of technology in ACLR recovery and rehabilitation, and preferences for advancing through multiple phases of the rehabilitative process.Responses from 46 orthopaedic surgeons were analyzed. Patient-reported outcome measures were not found to be utilized often at various phases of the perioperative period. Thirty-eight (82.6%) participants reported utilization of postoperative bracing. There was no consensus on when participants allow their patients to advance through rehabilitation, but most report waiting 3 to 4 months for advancement to jogging/lateral movement, 6 to 8 months for return to noncontact sport, and 9 months of more for return to unrestricted sport. Many participants utilize functional and strength testing with associated limb symmetry indices to determine patient readiness to return to sport, with 18, 26, and 25 participants reporting use of functional testing and 28, 26, and 27 participants reporting use of strength testing at the return to jogging/lateral movements, noncontact return to sport, and unrestricted return-to-sport phases, respectively.This study provides an insight into the rehabilitative protocols and modalities utilized for ACLR by orthopaedic surgeons in practice across the United States. There is notably substantial variation in rehabilitative patterns and preferences, particularly with regards to what constitutes criteria for progressing patients through the phases of returning to unrestricted sport. Additionally, our findings show that while many surgeons believe that quantitative assessment technology could be beneficial in decision-making for returning patients to sport, there are still many barriers that stand in the way of its implementation into clinical practice.Postoperative rehabilitative protocols after ACLR vary by surgeon.

  View details for DOI 10.1016/j.arthro.2022.07.024

  View details for Web of Science ID 000992565900001

  View details for PubMedID 35988795

• Performance Is Regained Within 2 Seasons After Quadriceps Tendon Tears in National Basketball Association Players. Arthroscopy, sports medicine, and rehabilitation Morikawa, L., Tummala, S. V., Brinkman, J. C., Chhabra, A. 2022; 4 (6): e2073-e2078

  Abstract

  Purpose: To characterize quadriceps tendon injuries over 30 National Basketball Association (NBA) seasons and assess the effects on player performance upon return to play.Methods: Partial and complete quadriceps tendon tears in NBA players between the 1990-1991 and 2021-2022 seasons were queried from a publicly available database. The primary outcomes were changes in player performance statistics obtained from each player's preindex season and first 2 postindex seasons. These interseason changes were compared with the changes of a healthy control cohort. Each injured player was matched with 2 controls using position, career length and win shares by season. The secondary measure of this study was the rate of return to play.Results: Nine quadriceps tendon tears (6 partial, 3 complete) were identified in NBA players. Seven (78%) of the players returned to play in NBA games, missing 50 ± 30 games and 214 ± 112 calendar days on average. Comparisons between these player's preindex and first postindex seasons revealed significant declines in games played (73.2 ± 6.6 vs 41.8 ± 10.8, P= .009) and minutes per game (27.2 ± 2.9 vs 23.0 ± 3.7, P= .042). When compared with controls, only the decrease in games played was significant (-31.3 ± 7.6 vs 1.4 ± 8.2, P= .004). These findings were consistent when comparing preindex and second postindex seasons (games played: 79.6 ± 1.9 vs -28.4 ± 5.4, P= .006; minutes per game: 29.3 ± 2.6 vs 51.2 ± 4.6, P= .003). All other player performance metrics including player efficiency rating returned to near-baseline levels in the first 2 seasons after injury.Conclusion: NBA players with quadriceps tendon tears return to play in 78% of cases. These athletes achieved preinjury levels of performance within 1 to 2 seasons, but with reduced games played per season.Level of Evidence: IV, therapeutic case series.

  View details for DOI 10.1016/j.asmr.2022.09.009

  View details for PubMedID 36579031

• General Surgery Residency Applicants' Perspective on Social Media as a Recruiting Tool JOURNAL OF SURGICAL EDUCATION Fuller, C. C., Deckey, D. G., Brinkman, J. C., V. Tummala, S., Lu, P. G., Mishra, N., Bingham, J. S. 2022; 79 (6): 1334-1341

  Abstract

  General surgery residency programs have increased their social media presence to educate and recruit prospective residents. This study aims to understand the impact of general surgery residency program social media on the 2020-2021 applicants' evaluation of prospective programs, particularly during the COVID-19 pandemic.An optional 20-item online survey regarding specialty choice, sub-internship rotation completion, social media resource use, social media impact, and general demographic information.Large academic medical center, United States.A total of 1191 Participants to our general surgery residency program were sent a survey. Six hundred thirteen completed the survey.Surveys were sent to all general surgery residency applicants of a single program (1,191) and 613 (51.4%) responded. Overall, social media resources use included official residency program website (92.4%), Doximity (36.5%), and Twitter (35.6%). The most frequently relied upon resources by applicants were the official residency program website (64.9%) Twitter (10.9%) and Instagram (10.8%). Most respondents agreed that social media was an effective means to inform applicants (70.9%) and that it positively impacted their perception of the program (62.6%). The most commonly cited benefits were helping the program exhibit its culture and comradery among residents, faculty, and staff (79.2%), with posts of social events and camaraderie as being the most helpful in learning about residency programs. Of all applicants, 71.3% noted that social media had a significant impact on perceptions of programs during the application cycles that were limited by COVID-19 safety and travel restrictions. However, most applicants disagree with (35.3%) or are neutral toward (32.1%) the statement that social media will have less of an impact on future cycles not limited by COVID-19.During the 2020-2021 application cycle, the majority of applicants utilized social media to inform and educate themselves about the general surgery programs they applied to. Residency-based social media had a positive impact on the majority of applicants, especially in terms of allowing a program to demonstrate its culture and camaraderie. Investing time and resources into residency social media accounts appears to be a meaningful pursuit for general surgery programs and is an important aspect in today's recruitment effort.

  View details for DOI 10.1016/j.jsurg.2022.06.003

  View details for Web of Science ID 000922743300005

  View details for PubMedID 35739022

• Arthroscopic Remplissage Using Knotless, All-Suture Anchors ARTHROSCOPY TECHNIQUES McQuivey, K. S., Brinkman, J. C., Tummala, S., Shaha, J. S., Tokish, J. M. 2022; 11 (4): E615-E621

  Abstract

  Glenohumeral bone loss is a significant risk factor for recurrent instability after shoulder dislocation. The Hill-Sachs lesion is an osseous defect of the posterior humeral head that is commonly recognized after anterior shoulder dislocation. Several procedures exist to address humeral-sided bone loss, including soft tissue filling procedures, osteoarticular allografts, bone plugs, rotation osteotomies, and humeral head replacements. However, among the most common of these procedures is the arthroscopic remplissage. This technique involves capsulotenodesis of the posterior shoulder capsule and infraspinatus tendon into a Hill-Sachs lesion. Previously described techniques use knotted suture anchors. In this report, we describe a modified technique for remplissage using knotless, all-suture anchors to perform capsulotenodesis of a Hill-Sachs lesion. Benefits of this technique include a single skin incision, improved bone preservation, and easier facilitation of revision surgery if required.

  View details for DOI 10.1016/j.eats.2021.12.015

  View details for Web of Science ID 000821514900020

  View details for PubMedID 35493050

  View details for PubMedCentralID PMC9051975

• Anterior Cruciate Ligament Reconstruction Recovery and Rehabilitation A Systematic Review JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Glattke, K. E., Tummala, S., Chhabra, A. 2022; 104 (8): 739-754

  Abstract

  The success of anterior cruciate ligament (ACL) reconstruction is influenced by effective rehabilitation. Previously published, comprehensive systematic reviews evaluating rehabilitation after ACL reconstruction have studied Level-I and II evidence published through 2012. Interval studies continue to evaluate the efficacy of various rehabilitative modalities.A total of 824 articles from 2012 to 2020 were identified using multiple search engines. Fifty Level-I or II studies met inclusion criteria and were evaluated using the Consolidated Standards of Reporting Trials (CONSORT) criteria and National Institutes of Health (NIH) Study Quality Assessment Tools.Accelerated rehabilitation can be effective for patients with semitendinosus-gracilis grafts. Blood flow restriction (BFR) training with high-intensity exercise is not effective for ACL reconstruction recovery. Postoperative bracing does not offer any advantages or improve limb asymmetry. Cryotherapy is an effective analgesic when used perioperatively. The early introduction of open kinetic chain exercises may improve ACL reconstruction outcomes, and high-intensity plyometric exercise is not effective. Estimated pre-injury capacity (EPIC) levels may be more accurate than the Limb Symmetry Index (LSI) when using functional test results to predict reinjury rates, and hip external rotation strength may be the most accurate predictor of the hop test performance. Nerve blocks can provide postoperative analgesia with minimal complication risk. Neuromuscular electrical stimulation is effective when used independently and in combination with rehabilitative exercises. Psychological readiness should be evaluated both objectively and subjectively before allowing patients to safely return to sport. Electromyography biofeedback may help to regain muscular function, and whole-body vibration therapy can improve postural control. Supervised rehabilitation is more effective than unsupervised rehabilitation.Various rehabilitative modalities following ACL reconstruction are effective in improving surgical outcomes and return-to-sport rates. Further evidence and improved study design are needed to further validate modalities including accelerated rehabilitation, BFR training, functional testing, and return-to-sport criteria.Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

  View details for DOI 10.2106/JBJS.21.00688

  View details for Web of Science ID 000783891900016

  View details for PubMedID 34932514

• In National Collegiate Athletic Association Men's and Women's Soccer Athletes There Is a Low Rate of Lumbar Spine Injury, Women Suffer More Recurrent Injuries than Men, and Most Injuries Occur in the Preseason. Arthroscopy, sports medicine, and rehabilitation Kuttner, N. P., Llanes, A. C., Tummala, S. V., Brinkman, J. C., McQuivey, K. S., Hassebrock, J. D., Makovicka, J. L., Chhabra, A. 2022; 4 (2): e705-e711

  Abstract

  Purpose: To use the National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) from the 2009-2010 through the 2014-2015 seasons to report lumbar spine injury rates, characteristics, and time lost from sport in soccer players.Methods: Characteristics of lumbar spine injuries by season, competition/practice, and time lost from sport were determined using the NCAA-ISP database. Rates of injury were calculated as the number of injuries divided by the number of athlete exposures (AEs). AEs are any athlete participation in a competition or practice. Incidence rate ratios (IRRs) were calculated to compare rates between event types and time of season. Injury proportion ratios (IPRs) were used to evaluate differences in injury rates between men and women.Results: The NCAA-ISP estimated 4,464 LSIs over 5 years. The rate of LSI in men was 2.1/10,000 AEs and 3.0/10,000 AEs in women. Women were 1.43 times more likely to suffer an LSI compared to men. Women were 2.15 times as likely to suffer an LSI in competition compared to in practice while men were 1.10 times as likely. Women were 2.15 times as likely to be injured in the preseason compared to the regular season, while men were 3.76 times as likely. Non-contact injuries were the most common cause of lumbar spine injuries (LSIs) in men (35%); however, contact injuries were more common in women (33%). Most athletes both male (57%) and female (59%) returned to play within 24 hours.Conclusion: This study provides information on the characteristics of LSIs in NCAA soccer. The overall injury rate to the lumbar spine is relatively low. Injury rates are highest in the preseason and in competition. Women suffer from more recurrent LSI's than men, and men acquired more injuries through non-contact mechanisms. More than one-half of athletes returned to sport within 24 hours.

  View details for DOI 10.1016/j.asmr.2021.12.015

  View details for PubMedID 35494295

• Orthopaedic Surgery Away Rotations JBJS OPEN ACCESS Rosenow, C. S., Brinkman, J. C., Deckey, D. G., Tummala, S. V., Pollock, J. R., Spangehl, M. J., Bingham, J. S. 2022; 7 (2)

  View details for DOI 10.2106/JBJS.OA.21.00119

  View details for Web of Science ID 001111227700018

• Orthopaedic Residency Applicants' Perspective on Program-Based Social Media JBJS OPEN ACCESS Brinkman, J. C., Deckey, D. G., Tummala, S. V., Hassebrock, J. D., Spangehl, M. J., Bingham, J. S. 2022; 7 (2)

  Abstract

  Social media and online resources have been used in graduate medical education for years. In addition to an official residency program website, many orthopaedic surgery programs have an established social media presence to interact, educate, and engage with prospective applicants. The role of social media in orthopaedic surgery has significantly expanded in recent years. Despite its increasing use, the specific impact of social media on orthopaedic surgery residency applicants remains unknown.Applicants to the home institution's orthopaedic surgery residency program were sent an optional online survey during the 2020 to 2021 application cycle. No incentive was provided in exchange for participation.Of 812 orthopaedic surgery applicants, 650 (80%) completed the survey. Program-based social media is widely accessed by applicants. Instagram is used by most applicants (61.9%), and nearly a third (28.7%) rely on it as their main resource when researching prospective residency programs. The majority (66.9%) agreed that social media can be successfully used to inform and interact with applicants. Most of the applicants (60.6%) also reported that social media had a positive impact on their perception of the associated program. Only 5.7% of respondents indicated that social media had a negative influence. The most effective uses of social media seem to be in allowing a program to display its culture and transparency.Social media plays a substantial role in the orthopaedic surgery residency application process, and its use continues to grow. Programs can use it to effectively engage with and inform prospective applicants. The impact of social media is positive on most of the applicants. Instagram is the preferred social media platform used by applicants, and nearly one-third rely on it as their main resource when researching programs. Investing time and resources into a social media presence seems to be a worthwhile pursuit for orthopaedic surgery programs as an important piece to a well-rounded recruitment effort of modern orthopaedic surgery applicants.

  View details for DOI 10.2106/JBJS.OA.22.00001

  View details for Web of Science ID 001111227700006

  View details for PubMedID 35620527

  View details for PubMedCentralID PMC9116946

• Prevalence, Biomechanics, and Pathologies of the Meniscofemoral Ligaments: A Systematic Review. Arthroscopy, sports medicine, and rehabilitation Deckey, D. G., Tummala, S., Verhey, J. T., Hassebrock, J. D., Dulle, D., Miller, M. D., Chhabra, A. 2021; 3 (6): e2093-e2101

  Abstract

  PURPOSE: To systematically review the literature to examine current understanding of the meniscofemoral ligaments (MFLs), their function, their importance in clinical management, and known anatomical variants.METHODS: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, EMBASE, and Cochrane databases. Studies were included if they reported on the biomechanical, radiographic, or arthroscopic evaluation of human MFLs, or if they reported on an anatomical variant. These were then categorized as cadaveric, radiographic, or clinical. Biomechanical, radiographic, patient-reported, and functional outcomes data were recorded.RESULTS: Forty-seven studies were included in the qualitative analysis, and 26 of them were included in the quantitative analysis. Of these, there were 15 cadaveric, 3 arthroscopic, and 9 radiographic studies that reported on the prevalence of MFLs. Overall, when looking at all modalities, the presence of either the anterior or posterior MFL (aMFL, pMFL) has been noted to be 70.8%, with it being the aMFL 17.4% and the pMFL 40.6%. The presence of both ligaments occurs in approximately 17.6% of individuals. Eleven reported on mean MFL length and thickness. When evaluating mean length in both men and women, the aMFL has been reported between 21.6 and 28.3 mm and the pMFL length in this population is between 23.4 and 31.2 mm. Five reported on cross-sectional area. Nine additional papers report anatomical variants.CONCLUSIONS: This review shows that there continues to be a variable incidence of MFLs reported in the literature, but our understanding of their function continues to broaden. A growing number of anatomic and biomechanical studies have demonstrated the importance of the MFLs in supporting knee stability. Specifically, the MFLs serve an important role in protecting the lateral meniscus and augmenting the function of the posterior cruciate ligament.CLINICAL RELEVANCE: Our findings will aid the clinician in both identifying and treating pathologies of the meniscofemoral ligaments.

  View details for DOI 10.1016/j.asmr.2021.09.006

  View details for PubMedID 34977667