Background: Pickleball is one of the fastest-growing sports in the United States. It is popular among seniors but has recently grown across all age groups. As pickleball has gained interest, its corresponding injury burden has also increased. Purpose/Hypothesis: The purpose of this study was to identify pickleball-related injury trends and underlying mechanisms across different age groups presenting to US emergency departments. It was hypothesized that (1) pickleball-related injuries would increase significantly between 2013 and 2022, (2) older age groups would have the greatest frequency of injury, and (3) falls would be the most common mechanism of injury. Study Design: Descriptive epidemiology study. Methods: The National Electronic Injury Surveillance System (NEISS) was queried for pickleball injuries between January 1, 2013, and December 31, 2022. The demographic information, injury site, and diagnosis were recorded, and case narratives were reviewed to identify the injury mechanism. The statistical sample weight assigned for NEISS cases by hospital was used to calculate national estimates (NEs). Injury trends over time were evaluated by linear regression. Results: A total of 1110 NEISS cases representing 66,350 nationally estimated pickleball-related injuries were included. The mean age was 64 ± 14.7 years (range, 4-93 years). Most injuries occurred in those aged 65 to 80 years (NEISS cases = 643; NE = 40,507 [61.1%]), followed by those aged 35 to 64 years (NEISS cases = 349; NE = 20,785 [31.3%]). Falls were the most common injury mechanism overall (NEISS cases = 699; NE = 43,434 [65.5%]). However, being hit with a paddle and a twist/inversion were the most common mechanisms for ages 0 to 17 and 18 to 34 years, respectively. Fractures were the most common diagnosis (NEISS cases = 363; NE = 21,703 [32.7%]), followed by strains/sprains (NEISS cases = 327; NE = 20,419 [30.8%]). Also, 69.1% of all fractures occurred in female players. The wrist was the most injured, accounting for 12.7% of all injuries. Significant increases in pickleball injuries were seen over time ( P < .001) and across all age groups ( P < .05). Conclusion: There was a significant increase in pickleball-related injuries presenting between 2013 and 2022, with most injuries arising from a fall. Notably, injuries decreased by 14% between 2019 and 2020 but rose again by 41% between 2020 and 2021 during the coronavirus 2019 pandemic. Older players disproportionately presented to the emergency department with pickleball-related injuries. Increased awareness and comprehensive injury prevention initiatives may be warranted to address the considerable prevalence of fractures and overuse/strain injuries.

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.

Background Nerve wrapping has been advocated to minimize scarring and adhesion following neurorrhaphy or neurolysis. A wrap should provide an enclosure that is snug enough to protect and support the affected nerve without strangulating the nerve. The degree to which resorbable wraps should be “tightened” around the nerve is largely subjective with scant literature on the subject. The purpose of this study was to evaluate the effects of tightly fitting resorbable nerve wraps around intact rat sciatic nerves. Methods Twenty-four Sprague-Dawley rats underwent exposure and circumferential measurement of the right sciatic nerve. Porcine-derived extracellular matrix (ECM) wraps were trimmed and sutured to enclose the nerve with a tight (same as that of the nerve, n = 8) or loose (2.5x that of the nerve, n = 8) circumference. Sham-surgery control animals (n = 8) had no wrap treatment. Functional outcome was recorded biweekly by sciatic functional index (SFI) with walking track analysis and electrical stimulation. Animals were sacrificed at 12 weeks for histologic analyses. Results No withdrawal response could be evoked in the tight-wrap group until week 9, while significant improvement in SFI first occurred between weeks 5 and 7. By week 12, the tight-wrap group required 60% more current compared with baseline stimulation to produce a withdrawal response. They recovered 81% of SFI baseline values but also demonstrated significantly greater intraneural collagen content (p < 0.001) and lower axon density (p < 0.05) than in the loose-wrap and sham groups. The loose-wrap group had comparable functional and histologic outcomes to the sham control group. Conclusion Resorbable ECM nerve wraps applied tightly around intact rat sciatic nerves caused significant functional impairment and histological changes characteristic of acute nerve compression. Significant but incomplete functional recovery was achieved by the tight-wrap group after 12 weeks, but such recovery may not apply in humans.

Numerous studies have investigated the outcomes of outpatient total shoulder arthroplasty (TSA). However, some patients originally planned for outpatient surgery may unexpectedly require inpatient hospital stay, which can obscure the distinction of “outpatient” and “inpatient” cases. Ultimately, this inconsistent classification of “outpatient” surgery may influence study results. The objectives of this study were (1) to characterize the differences in definition of “outpatient” surgery (hospital-defined outpatient [HDO] vs. same-day discharge [SDD]), and (2) to study the effect of different definitions on 30-day outcomes following TSA. The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TSA between 2011 and 2021. HDO cases were identified based on the National Surgical Quality Improvement Program inpatient or outpatient variable, and SDD cases were identified based on length of stay = 0. Demographic and clinical characteristics were compared between HDO and SDD cohorts. Propensity score was utilized to match each HDO and SDD case with one inpatient case without replacement. Two distinct sets of multivariate analyses, using Poisson regressions with robust error variance, were performed to calculate the risks of readmission, reoperation, morbidity, and complications for HDO and SDD. A total of 30,458 patients met the inclusion criteria, including 6711 HDO and 4490 SDD cases. 3501 out of the 6711 (52.2%) HDO patients required at least one night of inpatient hospital stay (length of stay >0). Between 2011 and 2021, the annual incidence of HDO TSA rose from 4.1% to 61.6% of all TSA cases, and the incidence of SDD TSA increased from 2.0% to 34.1% of all TSA cases. Compared to SDD, HDO was associated with female sex, higher body mass index, functional dependence, diabetes, chronic obstructive pulmonary disease, congestive heart failure, hypertension, American Society of Anesthesiologists ≥3, longer operation time, and nonhome discharge. After controlling for potential confounders, inpatient TSA was associated with increased risk of 30-day readmission and reoperation compared with HDO cases, while morbidity and individual complication rates were similar. However, compared with SDD patients, inpatient TSA was associated with higher rates of readmission, reoperation, morbidity, pneumonia, pulmonary embolism, myocardial infarction, and deep venous thrombosis. Definitional differences in “outpatient” surgery can lead to significantly different study outcomes related to TSA. Future investigations on this topic should maintain consistency in the definition of “outpatient” surgery. Accurate data on the risk factors for adverse events after TSA are critical for appropriate patient selection and improving surgical outcomes.

Background Extensive studies have been conducted using the rat model to understand the potential technical errors that lead to anastomotic failure. However, current literature indicates that the rat model has excellent tolerance to diverse errors committed by microsurgeons. The error-investigating rat model is often created by one or two experienced surgeons, and only one isolated technical error is examined. These biases may potentially cause limitations of the results from previous studies. Meanwhile, venous anastomoses have rarely been investigated in previous literature. Therefore, it is important to elucidate this topic with a more comprehensive study design. Methods Ninety-four arterial and 94 venous anastomoses on Sprague–Dawley rat femoral vessels that were performed by 47 microsurgeons who participated in the microsurgery course at the Columbia University and the University of Thessaloniki were evaluated. In total, 10 technical errors were examined: (1) disruption of suture line, (2) back-wall stitch, (3) oblique stitch, (4) wide bite, (5) partial thickness bite, (6) unequal suture distance, (7) tear in vessel wall, (8) excessively tight suture, (9) suture threads in lumen, and (10) large edge overlap. The frequency of each error committed, and the 30-minute postoperative patency was also recorded. The underlying causal relationship between these errors, potential interaction, and the short-term anastomosis patency was analyzed statistically. Results Only the back-wall stitch was found to have a significant causal effect on arterial anastomosis failure (p < 0.001). Back-wall stitch, wide bite, and partial thickness bite significantly impact venous anastomosis patency (p < 0.001). No other statistically significant result was found. Conclusion Overall, the rat model is highly resilient to various technical errors despite these mistakes being often considered clinically unacceptable. Therefore, researchers need to consider the resilience of the rat model when designing and analyzing future studies. In addition, microsurgery instructors should focus on individual stitch quality rather than the final patency.