Duchman, Kyle R.

Syndesmotic injuries are complex and often require a longer return to play as compared with lateral ankle sprains. As common as they are, they can be difficult to diagnose owing to the complex biomechanics of the ankle joint as well as their varying degrees of stability. A careful physical examination and dedicated imaging can assist with the diagnosis. Weightbearing ankle X-rays should be obtained to assess for fractures or gross instability with anteroposterior, lateral, and mortise views. If these are inconclusive but there is high clinical suspicion, stress views can be added. Advanced imaging also plays a role. Classification systems attempt to distinguish a stable, dynamically unstable, and unstable injury, as this guides management. Stable injuries can be treated conservatively and unstable injuries warrant surgical intervention. It is the diagnosis and treatment of unstable injuries that can be particularly challenging.

Objectives: The purpose of this study was to characterize content posted by orthopaedic surgeons on social media (SM) while investigating patient perceptions of this content from various regions of the United States. Analysis was included regarding how this content may influence the respondents’ healthcare decisions. Methods: SM posts by orthopaedic surgeons were reviewed and categorized. A patient survey was written to assess respondent SM usage practices as well as respondent perceptions of these categories. The survey was administered in the clinic of 13 separate orthopaedic surgeons via QR code. Survey results were analyzed for differences in SM utilization. Patient responses were assessed to judge perception of social medial content types. Results: There were 674 completed patient surveys. The 18-24 (89.3%) and 25-34 (87.6%) age groups were more likely to report daily use (p=0.002), but SM utilization was high among all age groups. 23% of patients reported using SM to see information about their healthcare at least once per month, 38% of patients reported reviewing the SM account of a physician at least once per month, and 23% of patients reported that they were likely or very likely to view the SM account of their own physician. 26% of patients reported that SM content is likely or very likely to influence which physician they see. Patients held the most consistently positive view of posts educating patients regarding common injuries, discussing sports team coverage, providing patient testimonials, and posts illustrating examples of imaging used to diagnose and treat patients. Patients held consistently neutral views of posts educating colleagues, discussing research and presentations at national meetings, displaying aspects of surgeons’ personal lives, and supporting marginalized groups. Several post categories elicited negative or highly polarized responses including those discussing research publications, showing surgical techniques or pictures/videos taken during surgery, or political statements. Conclusions: SM is an increasingly useful tool to help physicians interact with patients or build a practice. Physicians who wish to interact with patients should consider posting content viewed most positively including posts educating patients, discussing sports team coverage, and patient testimonials. Content that is viewed less favorably should be posted sparingly or with a sensitive tag. The most effective way to reach large patient populations appears to be through Instagram, Facebook, Tik Tok, Snapchat, and LinkedIn, in that order. Further ongoing study is required to understand the differences between physician SM content focused on interacting with patients compared to content focused on interacting with other physicians.

Purpose To identify risk factors for opioid consumption after arthroscopic meniscectomy using a large national database. Methods Patients undergoing primary arthroscopic meniscectomy from 2007 to 2016 were retrospectively accessed from the Humana database. Patients were categorized as those who filled opioid prescriptions within 3 months (OU), within 1 month (A‐OU), between 1 and 3 months (C‐OU), and never filled opioid prescriptions (N‐OU) before surgery. Rates of opioid use were evaluated preoperatively and longitudinally tracked for each cohort. Prolonged opioid use was defined as continued opioid prescription filling at ≥3 months after surgery. Multiple logistic regression analysis was used to identify factors associated with opioid refills at 12 months after surgery. Results There were 88,120 patients (53.7% female) who underwent arthroscopic meniscectomy, of whom 46.1% (n = 39,078) were N‐OU. About a quarter (25.3%) of patients continued filling opioid prescriptions at 1 year postoperatively. In addition, opioid fill rate at 1 year was significantly greater in the OU group compared with the N‐OU group with a relative risk of 2.89 (40.7% vs 14.1%; 95% confidence interval 2.81‐2.98; P < .0001). Multiple logistic regression model identified C‐OU (odds ratio 3.67; 95% confidence interval 3.53‐3.82; P < .0001) as the strongest predictor of opioid use at 12 months postoperatively. Furthermore, male sex, A‐OU, knee osteoarthritis, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, fibromyalgia, anxiety or depression, alcohol use disorder, and tobacco use ( P < .02 for all) had significantly increased odds of opioid use at 12 months postoperatively. However, patients <40 years ( P < .0001) had significantly decreased odds of opioid use 12 months postoperatively. Conclusions Preoperative opioid filling is a significant risk factor for opioid use at 12 months postoperatively. Male sex, preexisting knee osteoarthritis, and diagnosis of anxiety or depression were independent risk factors for opioid use 12 months following arthroscopic meniscectomy. Level of Evidence Level‐III, Retrospective Cohort Study.