Return to Play and Performance After Anterior Cruciate Ligament Reconstruction in the National Women's Soccer League

Background

The anterior cruciate ligament (ACL) is commonly injured in elite-level female athletes, which usually requires ACL reconstruction (ACLR).

Purpose

To analyze return to play (RTP) and changes in performance of players in the National Women's Soccer League (NWSL) after ACLR.

Study Design

Descriptive epidemiology study.

Methods

NWSL players who sustained an ACL tear and underwent surgery between the 2013 and 2020 seasons were identified by multiple online resources. Players were classified as forwards, defenders, midfielders, and goalkeepers. RTP was assessed according to games played, games started, percentage of minutes played, plus/minus net per 90 minutes (a measure of a player's contribution to their team's performance while on the field), goals scored, and assists. A subanalysis was performed based on the median age at the time of the injury (≤24 vs ≥25 years). Nonparametric testing methods were used throughout the analysis.

Results

A total of 30 NWSL athletes were included. Midfielders had the highest percentage of injuries (n = 11; 36.7%), followed by forwards (n = 10; 33.3%). Overall, 27 players returned to the NWSL at a median of 12.1 months (IQR, 10.9-14.3 months), constituting a 90.0% RTP rate. There was a significant decrease in the percentage of minutes played from 1 year before the injury to 1 year after the injury (median, 87.9% [IQR, 80.7%-90.6%] vs 25.1% [IQR, 16.3%-57.2%], respectively; P = .031). Forwards and midfielders had a significant decrease in the number of assists from 1 year before the injury to 1 year after the injury (median, 3.0 [IQR, 1.0-3.0] vs 0.0 [IQR, 0.0-1.0], respectively; P = .037) as well as the number of goals scored when averaging across 2 seasons before the injury to 2 seasons after the injury (median, 3.0 [IQR, 1.5-5.5] vs 1.0 [IQR, 0.5-3.5], respectively; P = .031). On subanalysis, older players started in significantly more games (median, 12.0 [IQR, 3.8-18.5] vs 3.0 [IQR, 0.5-6.0], respectively; P = .048) and had a higher percentage of minutes played (median, 63.0% [IQR, 18.8%-77.3%] vs 14.9% [IQR, 2.0%-21.2%], respectively; P = .046) at 1 year after the injury versus younger players.

Conclusion

There was a 90.0% RTP rate after ACLR in the NWSL. Players who returned to the NWSL had a lower percentage of minutes played in their first year after RTP, with older players starting in more games and having a greater percentage of minutes played. Compared with preinjury performance, forwards and midfielders had a significant decrease in the number of assists at 1 year after the injury as well as the number of goals scored at 2 years after the injury.

Interest in Serving the Underserved: Role of Race, Gender, and Medical Specialty Plans

Introduction

Medical students often express their plans to care for medically underserved populations, but little is known about how this interest remains during medical school (MS). This study examined how self-reported interest in working with medically underserved communities may change during MS training based on several student characteristics.

Methods

A secondary data analysis of all student records in the Electronic Residency Application Service (ERAS) from 2005 to 2010 is presented. Predictors included gender, under-represented in medicine (URiM) status, age, academic metrics, career interest, and medical specialty choice. Outcomes included interest in caring for medically underserved populations when entering MS, graduating MS, and graduating MS controlling for entering interest.

Results

The total population included 6890 student records (49.5% women and 18.2% URiM). Women had a higher likelihood of being interested in practicing in underserved communities when entering and graduating MS (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.37-1.77; OR 1.24, 95% CI 1.09-1.40). For all outcomes, URiM students had a higher likelihood of planning on a career with underserved populations compared with their non-URiM peers. Compared with Emergency Medicine, Internal Medicine/Pediatrics and Family Medicine had a higher likelihood of plans to work with underserved populations upon entering, graduating, and at graduation controlling for entering interest.

Discussion

Gender, race, and specialty choice all had meaningful associations with a student's plans on practice in an underserved community. This study's findings can help support efforts to improve MS diversity nationally and drive study on cultural effects embedded within medical specialty identity.

Assessing the Impact of Decision Aid Use on Post Prostatectomy Patient Reported Outcomes

OBJECTIVE

To evaluate whether completing a decision aid, Personal Patient Profile - Prostate (P3P), prior to prostatectomy, affects self-reported bother from post-prostatectomy urinary incontinence and erectile dysfunction.

MATERIALS AND METHODS

This retrospective analysis included data from men with newly diagnosed clinically localized, very low to intermediate risk prostate cancer who elected for prostatectomy within the Michigan Urological Surgery Improvement Collaborative between 2018-2021. Multivariable logistic regression models were used to estimate the association between P3P use and bother from post prostatectomy erectile dysfunction and urinary incontinence as measured by the Expanded Prostate Cancer Index Composite (EPIC-26).

RESULTS

Among the 3987 patients included, 7% used P3P (n = 266). Men who used P3P reported significantly less bother from erectile dysfunction at 6 months vs non-users (aOR 0.42 [95% CI 0.27-0.66]). At 12 months, the effect of P3P on bother from erectile dysfunction was not statistically significant (aOR 0.62 [95% CI 0.37-1.03]). Men who used P3P did not have a statistically significant difference in bother from urinary incontinence (3-month: aOR 0.56 [95% CI 0.30-1.06]; 6-month; aOR 0.79 [95% CI 0.31-1.97]).

CONCLUSION

Within the stated limitations of this study, we find that use of a decision aid for localized prostate cancer was associated with decreased odds of men being bothered from sexual dysfunction but not urinary incontinence at 6 months post prostatectomy.

Focal Therapy is a viable treatment for low risk Prostate cancer

Focal therapy (FT) is a promising alternative to definitive therapy for localized prostate cancer (PCa). Rather than simply monitoring cancer through active surveillance (AS) or risking the side effects of robotic radical prostatectomy (RP) it offers an intermediate solution. Azzouzi et al. examined vascular-targeted photodynamic therapy (PDT) for PCa. In this randomized, controlled clinical trial, patients with low-risk and localized PCa with no prior treatment were either assigned to a group undergoing vascular-targeted photodynamic therapy or to another group undergoing AS. Participants in the PDT group had a longer median disease progression time, lower proportion of disease progression at 24 months after treatment, and a higher proportion of negative biopsies at 24 months after treatment than the patients in the AS group. Use of PDT was associated with almost a five-fold decrease in reduction of use of definitive therapy. Cryoablation and high intensity focused ultrasound (HIFU) are additional forms of FT for localized PCa. They have been associated with a 5-year metastasis-free survival rate of up to 98% in low or intermediate risk patients. Patients undergoing salvage RP after FT may also see benefits compared to those who undergo RP after radiation therapy (RT). Ribiero et al. compared toxicity and oncological outcomes of patients who underwent salvage RP (sRP) after FT with those who underwent sRP after RT. Patients who underwent sRP after FT were found to have better continence at 12 months after surgery, almost 3 times less the rate of positive surgical margins, and lower postoperative complication rates within the first 30 days of surgery than those who had sRP after undergoing RT. Methods of FT including PDT, HIFU, and cryoablation provide an intermediate treatment option between AS and RP. Further research should be conducted to look into the potential benefits of FT for localized PCa.