Davies, Callie M.

Purpose To compare lower extremity soft tissue injury and revision surgery rates for patients with anorexia nervosa (AN) and bulimia nervosa (BN) compared with matched controls. Methods This retrospective cohort study used a deidentified claims database. Patients were included if they carried an International Classification of Diseases code for AN or BN. Respective matched cohorts for AN and BN were created using propensity score matching. Primary and revision surgeries for anterior cruciate ligament (ACL) reconstruction, posterior cruciate ligament reconstruction, knee collateral ligament reconstruction, meniscus repair or meniscectomy, and any ankle ligament reconstruction were identified by their CPT codes. Patients over the age of 40 and without a minimum 2‐year follow‐up after primary surgery were excluded. Differences in prevalence and revision rates were analyzed. Results A total of 56,146 patients with AN and 42,630 patients with BN were included in this study with equal numbers in respective matched cohorts. Patients with BN showed an increased risk of ACL injury (relative risk = 1.32, P = .019), medial collateral ligament injury (1.17, 0.04), calcaneofibular sprain (1.92, <0.001), deltoid sprain (1.41, 0.004), and unspecified ankle sprain (1.44, <0.001). Patients with AN showed an increased risk for calcaneofibular sprain (1.25, 0.007), deltoid sprain (1.28, 0.015), and unspecified ankle sprain (1.17, <0.001). Patients with BN were more likely to have revision ACL repair (1.89, 0.02), partial meniscus revision (3.44, <0.001) and any meniscus revision (4.74, <0.001) while patients with AN were more likely to have an ACL revision (2.81, <0.001), partial meniscus (4.37, <0.001), and any meniscus (4.52, <0.001). Conclusions In this study, patients with AN and BN had a significantly increased risk for various knee and ankle injuries and revision surgeries compared with matched controls. Additionally, patients with AN and BN who sustained these injuries were more likely to undergo a revision surgical procedure within the first 5 years of the primary procedure. Level of Evidence Level III, retrospective comparative study.

Sacral stress fractures are rare in athletes, present as nonspecific gluteal and/or back pain, and are often missed on radiographs. Standard treatment includes activity modification, physical therapy, and pain medications. However, prolonged recovery and recurrence remain concerns in athletes. There is evidence for the use of extracorporeal shockwave therapy (ESWT) in the treatment of stress fractures, and platelet-rich plasma (PRP) has also shown promise in accelerating bony healing. This case report describes a 48-year-old male triathlete with a recurrent sacral stress fracture unresponsive to conservative management. Following MRI diagnosis, he underwent sequential ESWT and PRP injection, resulting in successful return to competitive training levels at 8-weeks post-treatment. Although an MRI at 3-months post-treatment showed persistent bony edema, his PROMIS-Pain Interference (PI) and Global Pain Scale (GPS) scores improved from 54 to 40 and 62/100 to 4/100, respectively. There is currently no published literature on the sequential use of ESWT and PRP for the treatment of sacral stress fractures. To our knowledge, this is the first documented case of this novel treatment, suggesting a potential role for combination therapy in such injuries. Further research is warranted to validate the efficacy and long-term outcomes of this emerging therapeutic approach in athletic populations.