Purpose To evaluate how major United States commercial insurers justify medical‐necessity criteria for knee osteochondral allograft (OCA) transplantation, characterize the level of evidence (LOE) cited within their policies, and assess whether coverage criteria are supported by the cited literature. Methods Four major national commercial insurers with publicly available knee OCA policies were identified, and the most recent policy versions were retrieved. Medical‐necessity criteria were extracted, and all cited references applicable to knee OCA were screened, assigned an LOE and publication date, and coded for whether they supported each policy criterion. Coverage stance by lesion site was summarized. Publicly available revision histories were reviewed to compare administrative revision and evidence‐refresh cadence. A deidentified institutional dataset of current procedural terminology 27415 authorization requests was reviewed to contextualize findings in real‐world coverage outcomes. Results Across the 4 insurers, 40 applicable references were cited: Level V n = 7 (17.5%), Level IV n = 30 (75.0%), and Level III n = 3 (7.5%); Level I and II were 0. One insurer provided no OCA‐specific coverage criteria and instead deferred determinations to proprietary criteria not publicly available. Among the remaining 3 insurers, coverage was most permissive for unipolar femoral condyle lesions. Patellar lesions were explicitly excluded by 1 insurer, whereas bipolar and tibial plateau lesions were each excluded by 2 insurers. Among payers with assessable revision histories, administrative revisions occurred more frequently than documented evidence‐refresh events. In an institutional dataset of 34 current procedural terminology 27415 requests, 7 (20.6%) were initially denied; all cases with documented outcomes were ultimately approved after escalation. Conclusions Commercial payer knee OCA policies are largely based on older, low‐level evidence, and cited literature seldom supports key medical‐necessity criteria. Clinical Relevance Identifying discrepancies between insurance coverage and clinical evidence may help clinicians advocate more effectively during preauthorization and appeal processes, reduce delays in care, and inform payers’ efforts to align coverage criteria with modern outcome data.
Purpose To quantify the impact of femoral head height discrepancies on pelvic‐based versus ground‐based measurements for lateral center‐edge angle (LCEA) and Tönnis angle and to determine whether these discrepancies affected the clinical presentation of patients who presented to a hip preservation clinic. Methods Consecutive patients who underwent a primary hip arthroscopy between May 2021 and August 2021 and consecutive patients who underwent a primary periacetabular osteotomy between January 2020 and December 2023 with available preoperative standing anteroposterior radiographs were included. Patients were excluded if they (1) had undergone a previous surgery in either hip prior to the primary operation or (2) were less than 18 years of age at the time of surgery. The LCEA to the sourcil edge, LCEA to the bone edge, and Tönnis angle were calculated, referencing off (1) the pelvis and (2) the horizontal to the ground. Differences between measurements were calculated in degrees, and differences in femoral head heights to approximate pelvic obliquity were calculated in millimeters. Comparisons were made via regression analysis. Results Fifty hip arthroscopy patients and 75 periacetabular osteotomy patients were included. Regression analysis showed that LCEA to the sourcil edge was impacted by the difference in femoral head height when comparing the pelvic‐based measurement with the ground‐based measurement ( B = 0.298; R 2 = 0.775; 95% confidence interval = 0.274‐0.322; P < .001). Furthermore, in patients with a femoral head height difference of 10 mm or more, 100% (8/8) of patients who underwent a periacetabular osteotomy and 75% (6/8) of patients who underwent a hip arthroscopy reported more symptoms on the more elevated hip. Conclusions Differences in femoral head height on standing anteroposterior radiographs impact ground‐ versus pelvic‐based radiographic measurements of acetabular coverage by approximately 0.3° per millimeter of femoral head height difference and may result in functional undercoverage of the elevated hip. Level of Evidence Level IV, retrospective case series.
Purpose To conduct a systematic review of return‐to‐sport (RTS) definitions in the orthopaedic literature, addressing common operative athletic foot and ankle pathologies including ankle instability, Achilles tendon ruptures or tendinopathy, and fifth metatarsal fractures. Methods A systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Cochrane, Embase, Medline, and CINAHL databases were searched for studies published through March 2024. Inclusion criteria were studies in which subjects were involved in some level of sports and received surgery for 1 of 3 common sports‐related injuries: ankle instability, Achilles tendinopathy, and fifth metatarsal fracture. The primary outcome was each study's definition of RTS. Results There were 145 articles that met all inclusion criteria. Of these, 73 articles investigated ankle instability, 56 investigated Achilles tendinopathy, and 16 investigated fifth metatarsal fracture. Seventy‐nine articles (54.5%) had an unclear definition of RTS with 66 articles (45.5%) reporting a precise definition. Sixty‐four articles (44.1%) provided an isolated binary metric reporting whether a patient returned to sport or failed to provide a method for determining the timepoint for RTS. Thirty‐eight (26.2%) of the articles used an objective start criterion (e.g., resumption of competition), followed by custom (n = 27, 18.6%) and standardized patient‐reported questionnaire use (n = 21, 14.5%). Conclusions Most articles included in this systematic review did not provide an explicit definition of RTS or a clearly defined assessment methodology. When specified, RTS was assessed using objective events, custom questionnaires, or standardized patient‐reported outcome measures, highlighting substantial heterogeneity in both RTS definitions and assessment approaches across foot and ankle literature. Level of Evidence Level IV, systematic review of Level I to IV studies.
Purpose To assess the quality, reliability, and engagement of TikTok videos addressing the material about medial patellofemoral ligament (MPFL). Methods Between November 2 and 24, 2024, a comprehensive search of the TikTok platform was performed using both keyword‐based search (“MPFL,” “medial patellofemoral ligament”) and hashtag‐based search (#MPFL) to maximize content capture. Videos were included if they addressed the MPFL with respect to anatomy, injury mechanism, clinical evaluation, surgical management, or rehabilitation. Each video was independently assessed using the DISCERN instrument, Journal of the American Medical Association benchmark criteria, Global Quality Scale, and Patient Education and Decision Support Score. Video characteristics, including duration, number of views, likes, shares, and shares, were recorded, and correlations between engagement metrics and quality scores were analyzed. Results Of 100 videos analyzed, 9% were posted by medical doctors, 3% by physiotherapists, and 88% by private users. Most videos focused on personal experience, representing 74% of the information type and 80% of the content type. The mean scores of DISCERN, Journal of the American Medical Association , Global Quality Scale, and Patient Education and Decision Support Score were 16.25 ± 4.07, 0.1 ± 0.4, 1.1 ± 0.5, and 0.6 ± 1.88, respectively. Videos uploaded by medical professionals achieved significantly higher quality scores across all metrics ( P < .001). No significant differences were observed between physicians and physiotherapists ( P = .173). Engagement metrics (views, likes, shares) showed moderate positive correlations with DISCERN ( r = 0.31) and Patient Education and Decision Support Score ( r = 0.39), whereas video duration showed no correlation with any quality index. Conclusions TikTok videos related to the MPFL show low educational quality and limited reliability, with the most content produced by nonmedical users. Videos uploaded by health care professionals achieved significantly higher quality scores across all evaluated assessment tools. Clinical Relevance Patients with MPFL pathology frequently seek medical information on social media platforms. Awareness of the limited educational quality and reliability of MPFL‐related content on TikTok may help clinicians better counsel patients regarding online health information.
Purpose To estimate the financial impact of injury and illness among Team USA athletes who participated in the Paris 2024 Olympic Games and evaluate the cost‐effectiveness of a feasible illness prevention program. Methods All Team USA athlete‐events at the Paris 2024 Olympic Games were analyzed. Precompetition betting markets were used to derive the expected performance. Counterfactual finish distributions were generated using a Markov ranking model. Injury‐ and illness‐associated performance decrements were estimated relative to expected medal placement outcomes and translated into expected financial losses across 3 domains: Operation Gold performance incentives, athlete stipends, and estimated commercial value. Losses were summarized at the athlete‐event, athlete, and Team USA levels. A cohort Markov cost‐effectiveness model evaluated a potential illness prevention program using probabilistic sensitivity analysis. Results Across 808 Team USA athlete‐events, 186 injuries and 108 illnesses were recorded. Total injury‐ and illness‐attributable financial losses were estimated at $1,014,210 under conservative commercial value assumptions ( B = $10,000), including $462,409 attributable to injuries and $551,802 attributable to illnesses. Median athlete‐event‐level financial loss was $3000 (75th percentile: $5094; 90th percentile: $7758), whereas median athlete‐level loss was $4710 (90th percentile: $15,617; maximum: $62,915), indicating substantial right skewness and concentration of losses. Illness events were associated with higher mean financial losses per event than injuries ($5109 vs $2486). An illness prevention program costing $200 per athlete and reducing illness risk by 40% was cost‐saving, averting $220,721 in expected losses at a total cost of $117,000, yielding net savings of $103,721, and remaining cost‐saving in 95.2% of probabilistic simulations. Conclusions Injury and illness at the Olympic Games are associated with substantial and highly concentrated financial losses, with illnesses accounting for a disproportionate share of the total impact on Team USA athletes. Level of Evidence Level IV, retrospective cohort study with counterfactual performance modeling.
