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Purpose Return to sport (RTS) after ACL reconstruction (ACLR) has been recognized as an important outcome, which is associated with success of the surgery. This study aimed to assess the methods used to determine return to sport after ACLR in the published literature, report on variability of methods and evaluate their strength in establishing accurate RTS data. Methods Electronic databases (PubMed, Cochrane Library and Embase) were searched via a defined search strategy with no limits, to identify relevant studies from January 2008 to December 2020 for inclusion in the review. Defined eligibility criteria included studies specifically measuring and reporting on return to sport after ACLR with a clear methodology. Each included study was assessed for the definition of successful RTS, successful return to pre-injury level of sport and for methods used to determine RTS. Results One hundred and seventy-one studies were included. Of the included studies, six studies (4%) were level of evidence 1 and seventy-two studies (42%) were level of evidence 4. Forty-one studies (24%) reported on return to a specific sport and 130 studies (76%) reported on return to multiple sports or general sport. Sixteen studies (9%) reported on RTS in the pediatric population, 36 (21%) in the adult population and 119 (70%) reported on a mixed-aged population. The most commonly used definition of successful RTS was return to the same sport (44 of 125 studies, 35%). The most common method used to determine RTS was a non-validated study-specific questionnaire (73 studies, 43%), which was administered in various ways to the patients. Time of RTS assessment was variable and ranged between 6 months and 27 years post-surgery. Conclusion This review demonstrates high variability in defining, evaluating and reporting RTS following ACLR. The findings of this study reveal low reliability and unproven validity of methods used to evaluate RTS and highlight the challenges in interpreting and using RTS data reported in literature. Level of evidence IV.

Clinical collaboration between spine professionals in high-income countries (HICs) and low-and-middle-income countries (LMICs) may provide improvements in the accessibility, efficacy, and safety of global spine care. Currently, the scope and effectiveness of these collaborations remain unclear. In this review, we describe the literature on the current state of these partnerships to provide a framework for exploring future best practices. PubMed, Embase, and Cochrane Library were queried for articles on spine-based clinical partnerships between HICs and LMICs published between 2000 and March 10, 2023. This search yielded 1528 total publications. After systematic screening, nineteen articles were included in the final review. All published partnerships involved direct clinical care and 13/19 included clinical training of local providers. Most of the published collaborations reviewed involved one of four major global outreach organizations with the majority of sites in Africa. Participants were primarily physicians and physicians-in-training. Only 5/19 studies reported needs assessments prior to starting their partnerships. Articles were split on evaluative focus, with some only evaluating clinical outcomes and some evaluating the nature of the partnership itself. Published studies on spine-focused clinical partnerships between HICs and LMICs remain scarce. Those that are published often do not report needs assessments and formal metrics to evaluate the efficacy of such partnerships. Toward improving the quality of spine care globally, we recommend an increase in the quality and quantity of published studies involving clinical collaborations between HICs and LICs, with careful attention to reporting early needs assessments and evaluation strategies.

The COVID-19 pandemic significantly affected elite athletes, leading to increased mental health issues such as stress, anxiety, and depression. Sex differences in mental health may exist among athletes during the COVID-19 crisis. This study aimed to perform a systematic review and meta-analysis to examine sex differences in mental health symptoms among elite athletes during the COVID-19 pandemic. We systematically searched the databases including Pubmed, EMBASE, and manually checked previous systematic reviews for relevant studies in March 2024. Authors were also contacted for sex-specific data. Studies were included if they compared mental health symptoms between male and female elite athletes during the COVID-19 pandemic. We used a random-effects model to summarize the rate ratio (RR) between female and male athletes across studies. Risk of bias in studies was assessed using a 9-item tool. We included 18 studies in this review. The results indicated that female athletes reported higher levels of anxiety (RR 1.24, 95% CI = 1.08 to 1.43) and depression (RR 1.36, 95% CI = 1.15 to 1.61) than male athletes during the pandemic. They also had a higher risk of stress or distress (RR 1.27, 95% CI = 0.99 to 1.63) than their male counterparts. No significant differences were found regarding alcohol use or misuse between female and male athletes (RR 1.01, 95% CI = 0.75 to 1.37). Limited evidence was available for eating disorders, gambling, substance use, and sleep problems. In conclusion, female and male athletes differed in mental health symptoms during the COVID-19 pandemic. Female athletes were more likely to report anxiety, depression, and distress. Incorporating mental health resources may be particularly important for women’s sports, which have smaller financial margins and greater career uncertainty than men’s sports.

The Hospital Library Caucus of the Medical Library Association (MLA) follows the practice established in 1953 of developing quality indicators and best practices in the newly developing and fast-changing world of hospital libraries. As these libraries increased in number and prominence, the Joint Commission on the Accreditation of Hospitals (JCAHO) included in 1978 a hospital library standard developed in collaboration with MLA. Subsequent changes in JCAHO, then The Joint Commission (TJC) knowledge management criteria as well as technological changes in the curation and delivery of evidence-based resources influenced standards changes over the years. The 2022 standards mark the most recent edition, replacing the 2007 standards.

Background: Anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET) is being used more frequently in conjunction with anterior cruciate ligament reconstruction (ACLR). However, the knee flexion angle at which fixation of ALLR or LET is performed during the procedure is quite variable based on existing technique descriptions. Purpose/Hypothesis: The purpose of this study was to identify whether flexion angle at the time of ALLR/LET fixation affected postoperative outcomes in a clinical population. It was hypothesized that ALLR/LET fixation at low versus high flexion angles would lead to no statistically significant differences in patient-reported outcome measures and graft failure rates. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed, Embase, and Cochrane Library databases were searched according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify published clinical studies of ACLR with ALLR/LET in which the knee flexion angle at the time of ALLR/LET was reported. A priori, low flexion was defined as 0° to 30°, and high flexion was defined as 60° to 90°. Studies were excluded if the flexion angle was between 31° and 59° because these angles constituted neither low nor high flexion angles and including them in an analysis of high versus low flexion angle at fixation would have biased the study results toward the null. The overall risk of bias was assessed using the Newcastle-Ottawa Scale. The pooled results of the studies were analyzed using the International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores, along with reported graft failure rates. Results: A total of 32 clinical studies (5230 patients) met inclusion criteria: 22 studies (1999 patients) in the low-flexion group and 10 studies (3231 patients) in the high-flexion group. The median Newcastle-Ottawa Scale score was 6. Comparisons of patients with a low flexion angle versus a high flexion angle demonstrated no differences in the IKDC (P = .84), Lysholm (P = .67), or Tegner (P = .44) scores or in graft failure (3.4% vs 4.1%, respectively; P = .69). Conclusion: The results of this review indicated that ACLR performed in conjunction with ALLR/LET provides good to excellent patient-reported outcomes and low graft failure rates when ALLR/LET fixation is performed in either low or high knee flexion.

Study Design: Systematic review. Objective: Indirect decompression via lateral lumbar interbody fusion (LLIF) can ameliorate central and foraminal lumbar stenosis. In severe central stenosis, additional posterior direct decompression is utilized. The aim of this review is to synthesize existing literature on these 2 techniques and identify significant differences in outcomes between isolated indirect decompression via LLIF and combined indirect decompression supplemented with direct posterior decompression. Methods: A database search algorithm was utilized to query MEDLINE, COCHRANE, and EMBASE to identify literature reporting adult decompression study groups that involved an oblique or lateral fusion approach through September 2020. Improvement in outcomes measures and complication rates were pooled and tested for significance. Results: A total of 110 publications were assessed with 15 studies meeting inclusion criteria, including 557 patients and 1008 levels. Mean age was 63.1 years with BMI of 27.5 kg/m2. For the combined indirect and direct decompression cohort, lumbar lordosis (LL) increased 133.9%, from 22.8o to 48.7o, while the indirect decompression cohort LL increased 8.9%, from 41.9o to 45.5o. Difference in LL improvement between cohorts was insignificant (P > .05). Oswestry Disability Index (ODI) decreased from 36.5 to 19.4 in the combined indirect and direct decompression cohort, and from 44.4 to 23.1 in the indirect decompression cohort. ODI reduction was insignificant (P = .053). Conclusions: Prior studies of both indirect decompression as well as combined indirect and direct decompression of lumbar spine stenosis are limited by small samples, heterogeneous populations, and lack of direct comparisons. Both procedures result in improved function and pain postoperatively with direct decompression restoring more lordosis in patients with worse preoperative alignment.

BACKGROUND: Interventional spine procedures, such as discography, epidural steroid injections (ESIs), facet joint procedures, and intradiscal therapies, are commonly used to treat pain and improve function in patients with spine conditions. Although infections are known to occur following these procedures, there is a lack of comprehensive studies on this topic in recent years. OBJECTIVES: To assess and characterize infections following interventional spine procedures. STUDY DESIGN: Systematic review. METHODS: Studies that were published from January 2010 to January 2020 and provided information on infections or infection rates following discography, ESIs, facet joint procedures, and intradiscal therapies were included. PubMed (Medline), EMBASE, and Cochrane Library databases were searched, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Infection data were extracted from included studies, and infection rates were calculated for each procedure type. Case reports and infection-only articles were not included in infection rate calculations. RESULTS: Seventy-two studies met the eligibility criteria and were included in the systematic review. The overall incidence of infection across all studies was 0.12% (231/200,588). The majority of studies (n = 51) were linked to ESIs. Infections related to ESIs were more common than those related to discography or facet joint procedures (0.13% [219/174,431] vs. 0% [0/269] or 0.04% [9/25,697], respectively). Intradiscal therapies had the highest calculated rate of infections (1.05%; 2/191). Quality assessments of the included studies ranged widely. LIMITATIONS: There was an abundance of case reports in comparison to other study designs; to minimize skewing of the analysis, case reports and infection-only articles were not included in the infection rate. Studies that reported combined infection data for multiple procedures could not be included. Many cohort studies and case series were of lower quality because of their retrospective nature. Additionally, the true incidence of infections related to these procedures is unknown because the majority of these infections often go unreported, and information on regions of the spine and procedure details are often lacking. CONCLUSIONS: Based on our systematic review, the risk of infections following interventional spine procedures appears to be low overall. More studies focusing on infectious complications with larger sample sizes are needed, particularly for intradiscal therapies, in which the microbiome may be an underlying cause of disc infection. To achieve a true incidence of the risk of infections with these procedures, large prospective registries that collect complication rates are necessary. KEY WORDS: Infectious complications, infection incidence, interventional spine procedure, epidural steroid injection, discography, facet joint procedure, intradiscal therapies, biologics

Objective: The authors sought to collect qualitative data with support from the literature to elucidate the impact of COVID-19 on U.S. parents and guardians working in the library profession. Methods: The research team conducted a literature search in January 2022, with an update completed in January 2023 of several bibliographic databases and Google including the search terms COVID-19, parents, guardians, librarians, workplace, among others. In addition, requests for participation in a survey was sent out over listservs within and outside of the Medical Library Association (MLA), including regional library groups, and on social media to collect stories from library professionals who were parents or guardians during the second year of the COVID-19 pandemic. Data from the survey and the literature search were analyzed and categorized according to theme. Results: There were 51 respondents to the survey and 90 relevant studies found in the literature search. The most prevalent themes that emerged from the data analysis were “employer support/lack of support,” “childcare issues,” “mental health/stress/burnout,” “remote work–positive outcomes,” and “flexibility.” Conclusion: The COVID-19 pandemic affected parents and guardians who were library professionals beyond childcare issues. While organizations and individual workers have learned to live with the pandemic and minimize risks of transmission, COVID-19 brought to light some of the existing and underlying issues that are specific to parents and guardians who are library workers in the United States. Further research is warranted. Keywords: COVID-19, librarianship, parents, guardians

The impact of COVID-19 was felt by everyone, and anecdotal reports from parents and guardians of young children have been shared widely in the news and on social media. Common experiences parents in the U.S. workforce face have included a lack of affordable childcare or paid parental leave policies. The pandemic brought many pre-existing workplace issues related to parenting to the surface, but to date, little is known about the impact of the pandemic on parents and guardians working in a library setting in the United States. On March 11, 2020, the World Health Organization classified COVID-19 as a global pandemic; in the United States, stay-at-home orders impacted over 50% of the U.S. population. In 2020, a report of a U.S. national survey 2 on the well-being of parents and children during the COVID-19 pandemic stated that \"more than 1 in 4 parents reported worsening mental health.\" Reasons reported in the national survey for the substantial impact the pandemic had on parents and families in the United States included going without usual support systems like childcare or access to services, and food insecurity. In a Pew Research Center study in 2020, 3 35% of parents reported struggling with managing childcare tasks. The authors of this study experienced firsthand the hardships of parenting while working as librarians during the first two years of COVID-19, as well as learned from others in the library profession about burnout at home 5 and in the workplace. After witnessing the impact of the pandemic on library workers, namely mental health issues, the authors were interested in how library administrators and institutions could better support the needs of parents and guardians.