Matthew D. Ramey

Background: Knee injuries among older adults carry disproportionate clinical consequences, since diminished bone quality and comorbidities can transform a routine sprain into a sentinel event for functional decline. Physical activity is essential to healthy aging but may also contribute to musculoskeletal injury. National data describing recreational activities associated with geriatric knee injuries and injury characteristics remain limited.Methods: This retrospective cohort study queried the National Electronic Injury Surveillance System (NEISS) for patients aged 65+ years presenting to United States emergency departments with knee injuries related to recreational and exercise activities from 2016 to 2025. National estimates (NEs) were calculated using NEISS sample weights and stratified by sex, age, activity, diagnosis, and hospitalization status.Results: An estimated 193,590 geriatric knee injuries were identified. Males accounted for 51.54% of injuries and females for 48.46%. Most injuries occurred among patients aged 65-74 years (63.46%). Injuries increased significantly over the study period (p < 0.001) Strain or sprain was the most common diagnosis across nine of ten most common activities, while bicycling was characterized primarily by contusion or abrasion (24.3%). Skiing carried the highest hospitalization proportion and bowling the lowest. Exercise without equipment and bicycling accounted for the largest share of injuries across sex and age strata.Conclusion: Geriatric knee injuries related to recreational activity have increased significantly, concentrated in low and moderate impact activities such as walking based exercise and bicycling, with meaningful variation in hospitalization risk. These findings support activity specific counseling tailored to recreational behaviors prevalent among older adults.

Background: Degenerative meniscus tears are common in middle-aged and older adults, and current guidelines favor nonoperative care. As patients increasingly turn to portal systems to view imaging results and communicate with their physicians, patient-facing wording may shape downstream treatment preferences and expectations. Objective: This study aimed to determine whether subtle differences in physician message framing about an identical degenerative meniscus tear influence preferred management, expectations for improvement with conservative therapy, and satisfaction when a physician recommends a different plan. Methods: A cross-sectional 37-question survey was developed de novo and distributed in January 2026 to lay adults in the United States (≥18 years) recruited via Amazon Mechanical Turk. Respondents were presented with a standardized vignette of an adult aged 60 years with knee pain due to a degenerative meniscus tear. Participants were randomized in a 1:1:1 fashion into 3 physician portal message framing groups: neutral, degenerative, and damage. Outcomes were the preferred next step in treatment, expected improvement with physical therapy, and retained satisfaction under physician-respondent disagreement. Chi-square and Fisher exact tests were used to compare categorical variables. Multivariable logistic regression analyses were used to assess associations between framing groups. Results: Of the 266 completed responses, 195 (73.3%) were included for analysis (neutral: n=67, 34.4%; degenerative: n=63, 32.3%; damage: n=65, 33.3%). Treatment preferences differed significantly across groups (χ22=6.1; P=.047), and the damage group was significantly more likely to prefer aggressive interventions (odds ratio 2.43, 95% CI 1.17-5.06; P=.02). Expectations for physical therapy success differed significantly (χ24=12.3; P=.02), with the damage group being most pessimistic about conservative care. Retained satisfaction under physician-respondent disagreement did not differ by framing group (χ26=6.7; P=.35) but did differ significantly by initial treatment preference (P=.03) and was the lowest among respondents preferring steroid injection. Conclusions: In this exploratory investigation, subtle differences in physician portal message framing regarding a magnetic resonance imaging impression of a degenerative meniscus tear were associated with shifts in treatment preferences and confidence in conservative care. These findings suggest that brief physician portal communications may be associated with shifts in hypothetical patient expectations and treatment preferences before clinical counseling occurs.

BACKGROUND Degenerative meniscus tears are common in middle-aged and older adults, and current guidelines favor nonoperative care. As patients increasingly turn to portal systems to view imaging results and communicate with their physicians, patient-facing wording may shape downstream treatment preferences and expectations. OBJECTIVE This study aimed to determine whether subtle differences in physician message framing about an identical degenerative meniscus tear influence preferred management, expectations for improvement with conservative therapy, and satisfaction when a physician recommends a different plan. METHODS A cross-sectional 37-question survey was developed de novo and distributed in January 2026 to lay adults in the United States (≥18 years) recruited via Amazon Mechanical Turk. Respondents were presented with a standardized vignette of an adult aged 60 years with knee pain due to a degenerative meniscus tear. Participants were randomized in a 1:1:1 fashion into 3 physician portal message framing groups: neutral, degenerative, and damage. Outcomes were the preferred next step in treatment, expected improvement with physical therapy, and retained satisfaction under physician-respondent disagreement. Chi-square and Fisher exact tests were used to compare categorical variables. Multivariable logistic regression analyses were used to assess associations between framing groups. RESULTS Of the 266 completed responses, 195 (73.3%) were included for analysis (neutral: n=67, 34.4%; degenerative: n=63, 32.3%; damage: n=65, 33.3%). Treatment preferences differed significantly across groups (χ22=6.1; P=.047), and the damage group was significantly more likely to prefer aggressive interventions (odds ratio 2.43, 95% CI 1.17-5.06; P=.02). Expectations for physical therapy success differed significantly (χ24=12.3; P=.02), with the damage group being most pessimistic about conservative care. Retained satisfaction under physician-respondent disagreement did not differ by framing group (χ26=6.7; P=.35) but did differ significantly by initial treatment preference (P=.03) and was the lowest among respondents preferring steroid injection. CONCLUSIONS In this exploratory investigation, subtle differences in physician portal message framing regarding a magnetic resonance imaging impression of a degenerative meniscus tear were associated with shifts in treatment preferences and confidence in conservative care. These findings suggest that brief physician portal communications may be associated with shifts in hypothetical patient expectations and treatment preferences before clinical counseling occurs. CLINICALTRIAL

Background: Across many sports, injuries to the upper extremity (UE) are prevalent due to falls on an outstretched hand (FOOSH) and overuse. This retrospective analysis aimed to characterize sports-related UE injuries in the United States (US) over the past decade, examining injury frequency, affected body part, diagnosis, and hospital disposition across age, sex, and sport. Methods: The National Electronic Injury Surveillance System (NEISS) was queried for sports injuries presented to US emergency departments (EDs) from 1 January 2014 to 31 December 2023. Patient demographics, injury site, diagnosis, and disposition were recorded. Annual injury trends were evaluated by linear regression. All statistical analysis was conducted using SPSS (version 30.0) software. Results: There were 1,330,108 nationally estimated (NE) UE sports injuries (47,371 NEISS Cases) that were presented to US EDs from 2014 to 2023. Linear regression revealed a significant decrease in annual injuries across the study period (β = −0.63, R² = 0.40 p = 0.05). For many sports, including football, basketball, soccer, baseball, softball, wrestling, volleyball, hockey, and rugby, rates of UE injury decreased significantly during the study period. Fractures were the predominant diagnosis across all age groups, observed among 99.3% of patients. Football was the most common sport associated with UE injury in elementary to high school-age children, with basketball becoming more common in patients from 19 to 50 years old. Tennis-related injuries were the most common for patients above 50 years old. Across all sports, the most commonly injured body parts were fingers (33.5%), wrists (20.3%), and lower arms (17.3%). Notably, shoulder injuries accounted for 99.1% of all wrestling cases and 71.5% of all lacrosse injuries included in this study. Conclusions: Sports-related UE injuries decreased significantly from 2014 to 2023, with notable declines during the COVID-19 pandemic. The injuries included in this study varied depending on sport, age, and sex, allowing for the recommendation of specific interventions. While few injuries led to hospitalization, those that did typically involved lower arm injuries; further efforts to reduce these injuries will reduce the burden placed on US hospitals.