Esha Reddy

Rotator cuff tears are common, and although surgical repair is frequently performed, re-tear and complication rates remain substantial. The impact of selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) on postoperative outcomes after rotator cuff repair is not well understood. Using the TriNetX Research Network, adult patients undergoing arthroscopic rotator cuff repair were identified and stratified into SSRI/SNRI users (at least one prescription within 3 months preoperatively and continued use within 2 years postoperatively) and non-users. Propensity score matching was performed for demographic and medical comorbidities, yielding 2457 patients in each cohort. At 1-year follow-up, SSRI/SNRI users demonstrated lower rates of adhesive capsulitis compared with controls (3.1% vs. 5.8%; RR 0.53; 95% CI 0.41–0.70; p < 0.001), with similar revision rotator cuff repair rates. This pattern persisted at 2 years (3.6% vs. 6.1%; RR 0.58; 95% CI 0.45–0.75; p < 0.001), with comparable revision rates between groups. There were no differences in 30-day emergency department visits, readmissions, or 90-day postoperative infections. SSRI/SNRI users had lower early opioid use (21.0% vs. 29.5%; RR 0.71; p < 0.001) but higher prolonged (17.2% vs. 14.1%; RR 1.22; p = 0.003) and chronic opioid use (16.7% vs. 9.1%; RR 1.84; p < 0.001). In this large national cohort, SSRI/SNRI use was associated with lower rates of adhesive capsulitis and differences in postoperative opioid utilization, without differences in revision rotator cuff repair or short-term complications. These findings reflect associations rather than causation and highlight the need for further studies to clarify underlying mechanisms and clinical implications.

Objective: To characterize the epidemiology, diagnosis, and mechanisms of soccer-related injuries among goalkeepers and compare them with those sustained by field players, stratified by age and sex. Design: Descriptive epidemiological study. Setting: United States emergency departments reporting to the National Electronic Injury Surveillance System between January 2019 and December 2023. Patients (or Participants): All individuals who presented to US emergency departments with a soccer-related injury during the study period (n = 29 309 cases; national estimate 806 446). A subset of 562 cases were confirmed to have occurred while playing goalkeeper. Interventions (or Assessment of Risk Factors): Goalkeeper cases were identified through narrative key-term searches (“goalkeeper,” “keeper,” or “goalie”). Data were analyzed by age group, sex, diagnosis, body part injured, and mechanism of injury (MOI). Main Outcome Measures: National weighted injury estimates were used to assess differences in injury characteristics, diagnosis, and MOI between goalkeepers and field players, and across age groups and sex. Results: Goalkeepers were twice as likely as field players to be diagnosed with concussion (12.8% vs 6.4%). They sustained higher proportions of upper extremity injuries, particularly wrist and finger injuries. The mean goalkeeper age was 15.1 years, with most cases in adolescents aged 12 to 17 years (55%). School-aged children (6-11 years) were more likely to present after being struck by a soccer ball [odds ratios (OR) = 3.03] and to sustain fractures (OR = 2.21). Adolescents had increased odds of player-to-player collision injuries (OR = 2.26) and concussions (OR = 2.61). Young adults had greater odds of ground-related injuries (OR = 1.96) and joint dislocations (OR = 4.75). Men were more likely than women to be injured through collision with another player ( P = 0.015). Conclusions: There are distinct position- and age-specific patterns in soccer-related injuries presenting to US emergency departments. Goalkeepers face a disproportionate risk of upper extremity injuries and concussions, underscoring the importance of tailored injury-prevention strategies and greater awareness among coaches, trainers, and players.

Background: The purpose of this study was to identify demographic, clinical, and socioeconomic factors associated with follow-up adherence among hand trauma patients at an urban level I trauma center. Methods: A retrospective cohort study was conducted using electronic health records of adult patients presenting with hand trauma between June 2022 and March 2024. A 1:1 age- and sex-matched case-control sample of 1000 patients was created, divided by follow-up status. Variables included race, insurance type, injury category, likelihood of surgery, surgical treatment, multi-system injury, and Area Deprivation Index (ADI). Logistic regression was used to identify predictors of follow-up. Results: Insurance status and injury type were independently associated with follow-up. Patients with Medicaid (odds ratio [OR] 0.61, P = .024) or self-pay (OR 0.44, P = .014) were less likely to return than those with commercial insurance. Patients with soft-tissue injuries were significantly less likely to follow up than those with closed fractures or dislocations (OR 0.09, P < .001). Race and ADI were not independently predictive. The model demonstrated strong performance with an area under the curve (AUC) of 0.863. Conclusions: Insurance type and injury severity were significant predictors of follow-up adherence. Broader demographic and neighborhood-level socioeconomic measures were not independently associated. These findings may inform targeted strategies to reduce disparities in postinjury care.

Background/Objectives: Tranexamic acid (TXA) is widely used to reduce bleeding in orthopedic surgery, but its safety and impact on outcomes in arthroscopic rotator cuff repair (ARCR) remain unclear. The purpose of this study was to evaluate the safety and effects of injectable TXA on short- and long-term postoperative outcomes and opioid use following ARCR. Methods: The TriNetX Research Network, an insurance claims-based database, was utilized to conduct this retrospective, propensity-matched cohort study. Patients aged ≥18 years undergoing ARCR were identified and divided into TXA (n = 5855) and non-TXA (n = 5855) groups after propensity score matching. Outcomes assessed included 30-day hospital utilization, complications (infection, thromboembolism, hemarthrosis, blood transfusion), one-year revision and shoulder surgery rates, and early, prolonged, and chronic postoperative opioid use. Results: No significant differences were observed between groups in 30-day emergency department visits (2.0% vs. 1.8%, p = 0.502), readmissions, infections, wound dehiscence, blood transfusions, hemarthrosis, or one-year revision and shoulder surgery rates. TXA use was associated with significantly lower rates of early (24.8% vs. 26.8%, p = 0.011), prolonged (9.5% vs. 12.8%, p < 0.001), and chronic opioid use (6.6% vs. 9.6%, p < 0.001). Conclusions: Injectable TXA is safe in ARCR, with no increase in postoperative complications or hospital utilization. Furthermore, TXA use is linked to reduced postoperative opioid consumption, suggesting benefits in pain management and recovery. Prospective studies are warranted to further explore these findings.

Background: The popularity of pickleball as a recreational and competitive sport has increased dramatically over the last decade in the United States. Hypothesis: To evaluate trends in pickleball injury rates and specific injury characteristics. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Methods: The National Electronic Injury Surveillance System database was queried from 2014 to 2023 for national weighted injury estimates and injury characteristics from recreational pickleball players presenting to US emergency departments. Results: Annual national estimates of pickleball-related injuries increased significantly ( P < .001) from 2014 (1313; CI, 550-2078) to 2023 (24,461; CI, 3837-45,086). A transient 19.3% reduction in injury rates occurred in 2020, coinciding with the COVID-19 pandemic. Most injuries affected people aged 60 to 79 years, with nearly equal sex distribution (51.2% men vs 48.8% women). Most patients were discharged, although 5 deaths due to cardiac arrest were reported. Women had higher odds of upper extremity injuries (odds ratio [OR], 1.66), hand/wrist injuries (OR, 3.22), and fractures (OR 3.03). Men experienced more lower extremity injuries (OR, 1.71), trunk injuries (OR, 1.28), lacerations (OR, 1.71) and strains/sprains (OR, 1.87). Women were more likely to fall (OR, 2.08), while men were more often hit (OR, 1.92) or overexerted themselves (OR, 1.89). Older adults, aged 60 to 79 years, had increased odds of wrist/hand injuries (OR, 1.47) and fractures (OR, 1.75), with falls being 2.10 times more likely in this cohort. People aged 40 to 59 years had higher odds of lower extremity injuries (OR, 2.09), whereas those <19 years had higher odds of dislocation (OR, 5.25), head injury (OR, 1.95), and laceration (OR, 2.83). Conclusion: Pickleball injuries affect predominantly older adults, with distinct sex and age-related patterns. Clinical Relevance: There is a need for age and sex-specific injury prevention strategies to enhance safety in pickleball participation.