Background: As sports have increased in popularity, the incidence of tendinopathy has also grown dramatically. Nonoperative techniques and treatments used to address these pathologies continue to evolve and improve. One such treatment, prolotherapy (PrT), has become increasingly popular and may provide patients with an alternative nonoperative treatment option. Purpose: To review high-quality randomized controlled trials (RCTs) that analyzed PrT treatments for the most common tendinopathies. Specifically, this review aims to provide meaningful data regarding methods and outcomes for each condition treated and guide professionals who are considering PrT as a treatment option. Study Design: Systematic review; Level of evidence, 2. Methods: All RCTs published in English between January 1, 1980, and July 30, 2021, and reported in Embase, Medline, and Web of Science databases were reviewed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. After the initial search, a total of 3264 articles were identified. Studies analyzing sports medicine injuries and musculoskeletal pathologies using an RCT design were included, while case-reports, case-studies, reviews, and observational studies were excluded. Two independent researchers reviewed the search results, and conflicts were resolved by discussion of inclusion and exclusion criteria among all authors. The articles’ quality was evaluated using the Cochrane tool for assessing the risk of bias. Statistical analysis and graphical representations were performed using SPSS Version 28.00. Results: A total of 20 articles, including 1136 patients, met the inclusion criteria and were included in the study. Overall, in 85% of the studies, PrT was found to be effective in the treatment of tendinopathy. Specifically, PrT was superior to or as effective as the control in 83% (10/12) of the studies analyzing lateral epicondylitis (LE) and rotator cuff (RC) tendinopathies and in 88% (7/8) of the studies on plantar fasciitis (PF), Osgood-Schlatter disease (OSD), and Achilles tendinosis (AT). LE, RC, and PF tendinopathies were the most studied conditions (17/20 studies), while AT and OSD were the least studied (3/20 studies). Of the studies, 95% (19/20) used dextrose solutions, with only 1 using solutions of 2.5% phenol, 25% glycerin, and 25% dextrose in sterile water. Conclusion: Our systematic review suggests that PrT appears to be a promising alternative treatment for common tendinopathies. Most studies used a hypertonic dextrose solution. Even though further, larger randomized controlled trials comparing PrT with other orthobiologics would be beneficial, based on this review, sports medicine physiciansmay safely pursue PrT as an additional component of conservative treatment.

Lateral epicondylitis (LE), also known as “tennis elbow,” is a common orthopedic tendinosis of the elbow that affects between 1% and 3% of the overall population. LE occurs due to overuse of the extensor mechanism or muscles of supination in the forearm. The National Institute of Health and the Center for Disease Control suggest that patient education materials (PEMs) be written at a 6th or 8th grade reading level, respectively; however, PEMs are often written far beyond these recommended reading levels. The goal of this study was to assess the readability level of PEMs published by some of the top orthopedic institutions throughout the United States. A list of the top 25 ranking orthopedic hospitals in the country was compiled using the 2022 U.S. News and World Report Best Hospitals Specialty Ranking. PEMs related to LE were cataloged from each institution’s website, and readability levels for each PEM were measured using the http://www.readabilityformulas.com website. This software analyzes readability using the formulas listed in Table 1. While the Flesch-Kincaid (FK) Reading Ease Score formula outputs a number from 0 to 100, in which larger numbers indicate easier reading, the remaining formulas demonstrate a text’s readability through assigning a grade-appropriate reading level. A Spearman regression was used to evaluate correlation between institutional ranking and FK Reading Ease Scores. Of the 25 PEM texts analyzed during this study, none were written at or below the sixth grade reading level, as recommended by the National Institutes of Health. These results suggest that the most prestigious orthopedic hospitals provide online informational resources that are unable to be read or understood by a large portion of the institution’s intended audience. Additionally, there was no correlation found between institutional ranking and FK Reading Ease Score. Internet-based health information has conveniently allowed patients to educate themselves on their health care. In accordance with National Institutes of Health and Centers for Disease Control and Prevention guidelines, orthopedic institutions should strive to publish PEMs at or below an eighth grade reading level.

Several studies have investigated the impact of body mass index (BMI) on total shoulder arthroplasty (TSA) outcomes and reported contrasting results. Therefore, this study aims to better understand the impact of BMI on 30-day post-TSA outcomes by performing a comprehensive risk stratification based on BMI using a large national database. All patients undergoing TSA, both anatomic and reverse, between 2015 and 2019 were queried from the American College of Surgeons National Surgical Quality Improvement Program database. The study population was stratified into 6 cohorts: BMI < 18.5 kg/m² (underweight), BMI of 18.5-24.9 kg/m² (reference cohort), BMI of 25.0-29.9 kg/m² (overweight), BMI of 30.0-39.9 kg/m² (obese), BMI of 40.0-49.9 kg/m² (morbidly obese), and BMI ≥ 50.0 kg/m² (super-morbidly obese). Postoperative complications within 30 days of surgery were collected. Multivariate logistic regression was conducted to investigate the association between BMI values and postoperative complications. Additionally, to facilitate a direct comparison with existing literature, and further validate our study methodology, a subgroup analysis with multivariate logistic regression was made comparing 2 groups: BMIs > 30 kg/m² and BMIs < 30 kg/m². Odds ratios (ORs) were reported with a 95% confidence interval. The level of statistical significance was set at P < .05. The analyses were conducted using SPSS 26.0. A total of 22,542 patients undergoing TSA between 2015 and 2019 were reported in the database. Of these, 410 patients did not have reported BMIs, leaving 22,132 patients for the analysis (1.8% attrition bias). The underweight cohort had a greater likelihood of mortality (OR, 6.184; P = .008) and nonhome discharge (OR, 1.824; P = .008). The morbidly obese cohort had a greater likelihood of developing wound infections (OR, 5.254; P < .002). The super-morbidly obese cohort presented a greater likelihood of developing wound infections (OR, 13.431; P = .002) and nonhome discharge (OR, 1.525; P = .035). Patients with BMI less than 18 and more than 40 were associated with an increased incidence of 30-day postoperative TSA complications such as wound infection, nonhome discharge, and mortality. Based on these findings, preoperative risk stratification based on BMI remains an important part of elective surgery.

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.