Commercial Insurance Payer References Do Not Substantiate Coverage Denial of Stem Cell Therapy for Orthopedic Applications.

Background: Regenerative therapies are being studied for use in several orthopedic conditions, but as these approaches gain in popularity, insurance coverage denials have become a critical issue for patients, physicians, hospitals, and payers.

Purpose: We sought to analyze the references commercial payers use to support their policies denying coverage for orthopedic applications of mesenchymal stem cell (MSC) therapy.

Methods: We reviewed the policies regarding orthopedic applications of MSC therapy of the top 11 national commercial health insurance payers, 5 of which had publicly accessible policies.

Females Experience Higher Rates of Recurrent Dislocation Following Medial Patellofemoral Ligament Reconstruction: A Systematic Review.

Purpose: To perform a systematic review to investigate and summarize the literature regarding the influence of sex on postoperative outcomes following primary medial patellofemoral ligament (MPFL) reconstruction, with a primary focus on MPFL failure and recurrent dislocation, and a secondary analysis of postoperative patient-reported outcome measures (PROMs).

Methods: A literature review was performed using the PubMed, Scopus, and Web of Science databases. Included were randomized controlled trials or cohort studies that provided sex-stratified, quantitative analysis of MPFL reconstruction outcomes.

Insurance payer policies for subacromial balloon spacer coverage utilize poor quantity and quality of references.

Background: Prior studies of orthopedic procedures have shown poor quality of evidence supporting commercial payer coverage policies. This study aimed to analyze commercial payer policies for balloon spacer coverage to determine the quality and quantity of references cited in these policies.

Methods: Eleven major national health insurance payers (Aetna, Anthem, Centene Corp.

Commercial Insurance Payer Coverage Criteria for Meniscal Allograft Transplantation Poorly Reflect Modern Indications for the Procedure.

ObjectiveTo investigate whether insurance coverage criteria for meniscal allograft transplantation (MAT) are sufficiently supported in the policy documentation and whether these criteria represent current research and expert consensus on indications for the procedure.DesignThe top 11 United States (US)-based national commercial health insurance payers for MAT were identified. A Google search was performed to identify payer coverage policies.

Spin is Prevalent in Abstracts of Systematic Reviews and Meta-analyses of Anterolateral Ligament Reconstruction and Lateral Extra-Articular Tenodesis.

Purpose: To analyze the incidence of spin in the abstracts of systematic reviews and meta-analyses investigating anterolateral ligament augmentation or lateral extra-articular tenodesis as treatment for anterior cruciate ligament injuries.

Method: Studies were identified using the Preferred Reporting Items for Systematic Reviews and Meta Analysis guidelines searching PubMed, Web of Science, and Scopus in November 2023. The abstracts were graded for the incidence of the 15 most common types of spin, and full texts were reviewed for AMSTAR 2 classification.

Preference Signals and Away Rotations Greatly Influence Application Success in the Integrated Plastic Surgery Match.

Objective: Integrated plastic surgery implemented a preference signaling program (PSP) starting the 2022 to 2023 application cycle which allowed applicants to signal their top 5 preferred programs through the Plastic Surgery Central Application (PSCA). In this study, we aim to evaluate the effect on this new PSP at both the applicant and program level.

Design: This cross-sectional study relies on self-reported survey data from 2019 to 2024 from the Texas Seeking Transparency in Application to Residency (STAR) database.

Prevalence of Spin in Reviews on Intrawound Application of Vancomycin for Surgical Site Prophylaxis in Spine Surgery.

Study DesignSystematic Review.ObjectivesSystematic reviews and meta-analyses that aggregate data on the intrawound application of vancomycin for surgical site infection (SSI) prophylaxis in spine surgeries are at an increased risk of spin, the overstating of beneficial effects of an intervention. The purpose of this study was to identify studies that coalesce outcomes of intrawound vancomycin SSI prophylaxis in spine surgeries and define the prevalence and types of spin in the identified literature.

Rehabilitation and Long Term Outcomes Including Return to Work or Sport Following Reverse Total Shoulder Arthroplasty.

Purpose Of Review: Reverse total shoulder arthroplasty has become an excellent surgical option for patients suffering from various shoulder pathologies including rotator cuff arthropathy, inflammatory arthritis and proximal humerus fractures. The goals of this operation are to reduce pain, restore function, and allow patients to be able to return to both work and sport. This article provides insight into the return to work and sport of patients who have undergone reverse total shoulder arthroplasty.

Industry affiliation influence on randomized controlled trials for platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review.

Background: Explicit funding and industry affiliation are believed to potentially impact medical research. There have been an increasing number of studies that have evaluated this relationship. The purpose of this study is to determine whether industry affiliation influences the outcomes of randomized controlled trials that investigate the effectiveness of platelet-rich plasma (PRP) in the treatment of lateral epicondylitis.

Abstracts of systematic reviews and meta-analyses investigating meniscal root repair exhibit a high prevalence of reporting bias.

Background: To present rates of reporting bias in systematic reviews and meta-analyses investigating meniscal root repair.

Methods: In this systematic review, PubMed, Scopus and Web of Science databases were queried for studies that investigated meniscal root tears treated with root repair. Included studies were systematic reviews and/or meta-analyses published in peer-reviewed journals in the English language with available full-texts.

Randomized Controlled Trials for Platelet-Rich Plasma Use in Knee Osteoarthritis Rarely Report Key Sociodemographic Patient Variables: A Scoping Review.

Purpose: To investigate the characteristics and rate of sociodemographic variables reported in randomized controlled trials (RCTs) studying platelet-rich plasma (PRP) injections in the treatment of knee osteoarthritis (OA).

Methods: In January 2024, PubMed, Scopus, and Web of Science databases were queried for the phrase "Platelet-Rich Plasma Knee Osteoarthritis." Included studies were RCTs investigating PRP use in knee OA published in English between 2012 and 2023.

Perioperative opioid use in total shoulder arthroplasty is associated with dose-dependent risk of major surgical and medical complications.

Background: Higher perioperative opioid use has been associated with an increase in periprosthetic joint infection (PJI), thromboembolic complications, respiratory events, gastrointestinal complications, cost, and length of stay following hip and knee arthroplasty. Limited data exist regarding the relationship between the postoperative opioid dose and complication rates following primary total shoulder arthroplasty (TSA). The purpose of this study is to investigate the relationship between perioperative opioid consumption and postoperative complications following TSA.

Harms Reporting in the RCTs Underpinning the AAOS Clinical Practice Guidelines for Clavicle Fractures.

Background: The American Academy of Orthopaedic Surgeons (AAOS) publishes clinical practice guidelines (CPGs) for various pathologies. An extension to the Consolidated Standards for Reporting (CONSORT) checklist provides authors with a framework for reporting harms in randomized controlled trials (RCTs).

Objectives: The purpose of this study was to measure harms reporting among RCTs cited as supporting evidence for the AAOS CPG on the treatment of clavicle fractures.

Most Athletes Who Fail to Return to Sport After Latarjet Procedure Cite Psychological Factors: A Systematic Review.

Purpose: To identify the return-to-sport (RTS) rate in athletes undergoing a Latarjet procedure while outlining the specific reasons for failure to RTS.

Methods: An electronic literature search was conducted (PubMed/MEDLINE, Scopus, Web of Science). Studies in peer-reviewed journals with Latarjet procedures performed on athletes that reported rates and reasons for failure to RTS were included.

Tranexamic acid use in total shoulder arthroplasty continues to increase and is safe in high-risk patients.

Background: Tranexamic acid (TXA) is increasingly utilized in total shoulder arthroplasty (TSA) to minimize blood loss. Despite its benefits, concerns persist regarding its use in patients at elevated risk of postoperative venous thromboembolism (VTE). This study evaluates trends in TXA use and assesses its safety in both general and high-risk patient populations.

Evaluating the References of Insurance Policies for Computer-Assisted Navigation in Total Knee Arthroplasty Compared With the American Academy of Orthopaedic Surgeons Clinical Practice Guideline.

Background: This study aimed to investigate the quality and quantity of sources cited by insurance payers for computer-assisted navigation (CAN) in total knee arthroplasty (TKA) and to compare these sources with those cited by the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline (CPG).

Materials And Methods: References were included from insurance payer policies on CAN that discussed the use of CAN in TKA, while every reference from the AAOS CPG for surgical navigation in TKA was included.

Results: Fifty-four unique articles from insurance payers met criteria, with 68.

The Relationship Between Surgeon Volume and Major Surgical Complications After Total Shoulder Arthroplasty: An Evaluation of 3177 US Orthopedic Surgeons.

Background: Total shoulder arthroplasty (TSA), which includes anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA), is a technically demanding procedure and limited data exist on the relationship between case volume and complications. We sought to identify volume thresholds for TSA, aTSA, and rTSA at which risk of a major surgical complication decreased and to compare complications of patients treated by high-volume surgeons with those of patients treated by low-volume surgeons.

Materials And Methods: Primary, elective TSAs (aTSA and rTSA) from January 1, 2016, to December 31, 2019, were identified in the Premier Healthcare Database.

Commercial Insurance Coverage Criteria for Autologous Chondrocyte Implantation Poorly Reflect Current Research.

ObjectiveThe aim of this study is to both quantify and qualify the way insurance companies justify their coverage policies for autologous chondrocyte implantation (ACI) and determine whether these policies align with recent research on the subject.DesignThe top 11 national commercial health insurance payers for ACI were identified. Coverage policy documents were recovered for 8 payers.

Preoperative Mental Health Disorders Affect Opioid Consumption and Perioperative Complications After Total Shoulder Arthroplasty.

Background: Limited evidence exists regarding the influence of mental health disorders (MHDs) on opioid use and complications after total shoulder arthroplasty (TSA). We aimed to identify the prevalence of common MHDs among patients undergoing anatomic TSA (aTSA) and reverse TSA (rTSA).

Materials And Methods: The Premier Healthcare Database was queried for patients undergoing primary aTSA and rTSA from 2016 to 2020.

The Literature that Commercial Insurance Payers Use to Substantiate Knee Osteochondral Allograft Policies Are of a Low Level of Evidence.

ObjectiveThe purpose of this study is to analyze how the largest insurance companies support their medical necessity policies regarding osteochondral allograft transplantation (OCA) and to determine whether the literature they cite in their policies is of a high level of evidence (LOE).DesignThe 10 largest national health insurance companies were identified. Each payer was contacted via phone or email to obtain their coverage policy regarding OCA.

Studies With Direct Industry Affiliation Are More Likely to Report Positive Results in Randomized Controlled Trials for Platelet-Rich Plasma Use in Rotator Cuff Tears: A Systematic Review.

Purpose: To perform a systematic review to evaluate the effect of industry affiliation on the outcomes of randomized controlled trials for platelet-rich plasma (PRP) injections in rotator cuff tears METHODS: The PubMed, SPORTDiscus, and Scopus databases were searched from 2010 to the present for the terms "rotator cuff" and "platelet-rich plasma." The inclusion criteria were randomized controlled trials comparing PRP with controls for the treatment of rotator cuff tears, and the exclusion criteria were systematic reviews, meta-analyses, case reports, cohort studies, basic science studies, studies of Level III or below, and studies not in English. Degree of industry affiliation was categorized into 3 groups: directly, indirectly, and not affiliated.

Industry affiliation does not predict outcomes of randomized controlled trials for mesenchymal stem cells in knee osteoarthritis.

Background: This research aims to determine the influence of industry on the outcomes of randomized controlled trials (RCTs) for Mesenchymal Stem Cell (MSC) treatments in knee osteoarthritis (OA).

Methods: PubMed, Scopus, and Web of Science were searched from 2010 onwards using the terms "knee osteoarthritis" and "mesenchymal stem cells". After identifying relevant RCTs, studies were categorized as industry-affiliated or non-industry-affiliated.

Most Major Hospitals Fail to Comply With Federal Price Transparency Regulations.

Purpose: To present hospital compliance with federal price transparency regulations for sports medicine procedures.

Methods: Online price estimator and machine-readable files were recovered for U.S.

Effect of body mass index on complications following total shoulder arthroplasty: a population-wide analysis.

Background: Evidence regarding the effect of body mass index (BMI) on complications following anatomic shoulder arthroplasty (aTSA) and reverse shoulder arthroplasty (rTSA) remains controversial. This high-powered study examines the effect of BMI on surgical and medical complications following aTSA and rTSA.

Methods: This retrospective cohort study was conducted using the Premier Healthcare Database to query all adult patients who underwent primary, elective TSA (aTSA, rTSA) from 2016 to 2020.

Results of Randomized Controlled Trials of Platelet-Rich Plasma in Lower-Extremity Tendinopathy Are Not Influenced by Industry Sponsorship.

Purpose: To determine whether industry affiliation influences the results of randomized controlled trials (RCTs) studying the use of platelet-rich plasma (PRP) for the treatment of patellar or Achilles tendinopathy.

Methods: The PubMed, Scopus, Cochrane, and MEDLINE databases were searched in July 2023 for RCTs investigating PRP for the treatment of patellar or Achilles tendinopathy published between 2009 and July 2023. Industry affiliation was determined by analyzing each study's funding or conflict-of-interest section.