Richard Ma's research while affiliated with Auckland University of Technology and other places

Background Osteochondral allograft transplantation (OCAT) allows the restoration of femoral condyle osteochondritis dissecans (OCD) lesions using an osteochondral unit. When OCD lesions are irreparable, or treatments have failed, OCAT is an appropriate approach for revision or salvage surgery. Based on its relative availability, cost-effectiveness, lack of donor site morbidity, and advances in preservation methods, OCAT is also an attractive option for primary surgical treatment for femoral condyle OCD. Hypothesis OCAT for large femoral condyle OCD lesions would be highly successful (>90%) based on significant improvements in knee pain and function, with no significant differences between primary and salvage procedure outcomes. Study Design Cohort study; Level of evidence, 3. Methods Patients were enrolled into a registry for assessing outcomes after OCAT. Those patients who underwent OCAT for femoral condyle OCD and had a minimum of 2-year follow-up were included. Reoperations, treatment failures, and patient-reported outcomes were compared between primary and salvage OCAT cohorts. Results A total of 22 consecutive patients were included for analysis, with none lost to the 2-year follow-up (mean, 40.3 months; range, 24-82 months). OCD lesions of the medial femoral condyle (n = 17), lateral femoral condyle (n = 4), or both condyles (n = 1) were analyzed. The mean patient age was 25.3 years (range, 12-50 years), and the mean body mass index was 25.2 kg/m ² (range, 17-42 kg/m ² ). No statistically significant differences were observed between the primary (n = 11) and salvage (n = 11) OCAT cohorts in patient and surgical characteristics. Also, 91% of patients had successful outcomes at a mean of >3 years after OCAT with 1 revision in the primary OCAT cohort and 1 conversion to total knee arthroplasty in the salvage OCAT cohort. For both primary and salvage OCATs, patient-reported measures of pain and function significantly improved at the 1-year and final follow-up, and >90% of patients reported that they were satisfied and would choose OCAT again for treatment. Conclusion Based on the low treatment failure rates in conjunction with statistically significant and clinically meaningful improvements in patient-reported outcomes, OCAT can be considered an appropriate option for both primary and salvage surgical treatment in patients with irreparable OCD lesions of the femoral condyles.

Background Women’s Rugby-7’s continues to experience growth in its player involvement and subsequent popularity in the United States. Objective Evaluate the medical cost and severity profile associated with player injuries in U.S. Women’s Rugby-7’s. Design Prospective epidemiological study. Setting U.S. Women’s Rugby-7’s regional tournaments between 2010–2015. Participants 248 injury encounters during 79 U.S. tournament match days between 2010–2015. Interventions The Rugby Injury Survey & Evaluation (RISE) Report methodology was applied, following the rugby consensus statement. After injury data collection, International Classifications of Diseases -10 – Clinical Modifications (ICD-10-CM) injury diagnosis codes and Current Procedural Terminology (CPT) programs were evaluated for cost analysis using institutional charges in US dollars (US$). Main Outcome Measurements The costs (U.S. Dollars $) of injuries are sorted by year of play, positions, body regionality, and ICD-10-CM codes. Time lost due to injury, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) were also formulated for injuries. Results The average annual costs of injuries among U.S. Women’s Rugby-7 players were $7,443 between 2010–2015. With over a 2.3-time increase in costs between 2011 and 2012. Back positions encountered the most cost when injured. Fractures of all types constituted the highest cost incurred among all ICD-10-code types. Conclusions By using a standardized medical coding system involving injury diagnosis, it would allow teams and stakeholders to be prepared for regional tournaments and the injuries encountered As a result, there is a more significant initiative to explore player injury epidemiology of this contact sport. However, there is a paucity of literature that addressed The purpose of this study was to evaluate the medical costs and severity associated with player injuries in U.S. Women’s Rugby-7’s.

Objective Rugby-7s is gaining popularity in the U.S. among the university population. The aim was to quantify the incidence and causes for concussions among U.S. university rugby-7s players. Design Prospective, descriptive, epidemiological study. Setting USA rugby-sanctioned tournaments (2011–2016). Participants 4458 university-level athletes (male=3411, female=1047) in 953 matches (mean age=21.4 years). Assessment of Risk Factors Match concussion injury rates, causes, and mechanisms. Outcome Measures Injury incidence (per 1000 player-hour (ph)) was captured using RISERugby Injury Registry. Main Results Total incidence of concussions was 11.55/1000ph (CI=8.09–15.99; n=36). There were no significant sex differences in concussion incidence (male=10.98/1000ph; CI=7.24–15.98; n=27) (female=13.68/1000ph; CI=6.25–25.96; n=9) (P=0.56). The phase of play most likely to result in concussion was the tackle (9.30/1000ph; CI=6.23–13.36; n=29) compared to all other phases of play (1.60/1000ph; CI=0.52–3.74; n=5) (P<0.01). Concussions were more likely to result from impact with another player (9.30/1000ph; CI=6.23–13.36; n=29) than with the ground (1.28/1000ph; CI=0.35–3.29; n=4) (P<0.01). The second half of play had a higher incidence of concussions (14.76/1000ph; CI=9.36–22.14) than the first (5.77/1000ph; CI=2.64–10.96; P=0.01). Conclusions Incidence of concussions in the collegiate population was higher than the general U.S. rugby-7s playing population. Differences were noted between half-of-match, contact type, and phases of play. Upholding proper technique in the tackle and using player replacement options for fatigued players in the second half should be emphasized to reduce dangerous player-to-player contact involving the head. University programs need more conditioning and training periods to counter fatigue and loss of technique involved in rugby-7s.

Objective To determine the head, neck, and face (HNF) match injury rates in US rugby-7s. Design Prospective descriptive epidemiology study. Setting USA Rugby-sanctioned tournaments (2010–2016). Participants 42,054 adult U.S. players (3,481 teams and 7,673 rugby-7s matches). Assessment of Risk Factors Match injury rates, site, type, and severity. Outcome Measures Incidence (per 1000 player-hour (ph)) and severity were captured using RISERugby Injury Registry. All-injuries (medical-attention and time-loss) and time-loss injuries were defined. Days (d) absent before return-to-training/competition were recorded. Main Results A total of 498 HNF injuries were encountered (all-injury rate=16.7/1000ph; men=17.3/1000ph; women=15.5/1000ph; IRR:1.1; CI:0.9–1.4). Head/face was the most commonly injured site (all-injuries=90.8%; time-loss=86.8%) followed by neck/cervical spine (all-injuries=9.2%; time-loss=13.2%). Concussions were the most common type of injury (36.7%) followed by facial lacerations (28.7%). Incidence of concussions was similar between sexes (IRR:1.0; CI:0.7–1.3). Longer return-to-sport were seen among women (46.4d) than men (32.1d; P=0.047) post-concussion. Time-loss injuries occurred similarly among both sexes (IRR:1.5; CI:1.0–2.6; P=0.061). HNF injury severity was similar between sexes (29.3±32.4 days absent from play). The tackle (71.5%) was the most common injury event, with men injured with direct contact with another player (P=0.023), and women with impact with the playing surface (P=0.032). Conclusions Incidence of HNF injuries were similar between sexes among U.S. rugby-7s players. Sex differences were noted with concussion severity and contact mechanism of HNF injuries. Recognition of sex-based HNF injury patterns will allow for a more effective injury prevention plan.

Objective To investigate the medical diagnosis and procedural coding cost of concussions in U.S. rugby-7s. Design Prospective descriptive epidemiological study. Setting USA Rugby rugby-7s geographic union tournament series (79 tournament-days, 2010–2015). Participants Tournament players (n=164; female=27%; male=73%) sustaining acute head injuries during matches in the RISERugby Injury Registry. Assessment of Risk Factors Injury diagnosis and medical billing coding for concussion diagnosis, and the financial cost of tournament-treatment interventions. Outcome Measures International Classification of Diseases, Tenth Revision (ICD-10) and Current Procedural Terminology (CPT) were computed after player concussion injury encounters. Financial cost (US$=dollars) was calculated after initial encounter, evaluation/recommendation for further treatment and follow-up were made for each player. Main Results Tournament series encountered head injuries (15.1%; n=164) most often coded as a wound and/or laceration (74%), followed by fractures (9%). Costs were most often in the form of sideline evaluation, first aid/wound care, ice/compression, and post-match cephalic imaging (n=153). Meanwhile, 13.4% (n=22; male=15, female=7) of all head injuries which were coded by the ICD-10 system as an acute concussive injury without any additional co-diagnosis. Concussions at 18.2% (n=4) needed hospitalization and further imaging studies. The total estimated direct medical costs of concussive injuries was US$4,332 (US$197 per player concussion). Conclusions Head injuries were common in our US Rugby-7s cohort, with men being treated for concussions more than women players. Concussed players needing higher institutional care supports tournaments series will need quality acute sideline treatment to address these injuries.

Objective To identify the differences in risk-factors between sexes and age in US rugby-7s. Design Logistic regression. Setting USA Rugby tournaments (U-19 to Elite; 2010–2016). Participants 1,307 (68%=men, 31%=women) injured U.S. Rugby-7s players. Assessment of Risk Factors A cross-sectional analysis using the RISERugby Injury Registry. Anthropometric data, injury mechanism, and other factors were tabulated by HNF injuries. Logistic regression determined relationship between sex and HNF injuries. A multivariable model was used to calculate the probability of HNF injuries and differences between sex. Results From 2010–2016, 1,679 match injuries were seen (68%=men, 32%=women). A total of 474 (28%) HNF injuries were documented. The most commonly injured body part was the head (48%) with concussions (40%). Final model revealed sex, age, position during contact, contact surface, and play legality were significantly associated with HNF injuries. Controlling for play-legality and position during contact, U18-men injured during contact with an opposing player had the highest probability of HNF injuries (51%) and a higher probability than U18 women (P=0.004). Meanwhile, women 18–24 (P=0.019) and over 30 (P=0.042) had a higher probability of HNF injury when injured during contact with the ground. Conclusions Under-18 male players involved in contact with players were most at risk for HNF injuries. Adult women 18–24 and 30-years old had a higher probability of sustaining a HNF injury during contact with the ground. Tackle techniques/execution, break falls, including collisions, employed by new rugby-7s players, should be studied for injury reduction.

Numerous in vitro studies suggest higher osmolarity irrigation fluids potentiate a chondroprotective environment, and a recent clinical study using hyperosmolar saline for shoulder arthroscopy reported potential clinical advantages. This prospective randomized double-blind controlled clinical trial was designed to assess initial clinical outcomes associated with use of a hyperosmolar irrigation solution in patients undergoing arthroscopic knee surgery. With institutional review board approval and informed consent, patients scheduled for arthroscopic knee surgery were randomized to surgery with either isotonic lactated Ringer's (273 mOsm/L) or hyperosmolar saline (593 mOsm/L) irrigation solution. Outcomes included perioperative blood pressure, knee girth, visual analogue scale (VAS) pain scores, and narcotic pain medication consumption. Forty-six patients underwent arthroscopic knee surgery with isotonic (n = 23) or hyperosmolar (n = 23) irrigation fluids. There were 11 males and 12 females (mean age = 44.0 years) in the isotonic cohort and 8 males and 15 females (mean age = 40.2 years) in the hyperosmolar cohort. There were no significant differences with respect to surgical duration (pump time) or amount of irrigation fluid used between the two cohorts. There were no significant differences with respect to change in knee girth, blood pressure, or VAS pain scores. However, patients treated with hyperosmolar saline consumed less narcotic medication on postoperative day 3 (4.0 ± 7.6 vs. 15.5 ± 17.4 mg, p = 0.01). The results of this randomized clinical trial suggest that a hyperosmolar irrigation solution is safe and relatively inexpensive for use in patients undergoing arthroscopic knee surgery and contributes to a reduction in initial postoperative narcotic pain medication consumption. A hyperosmolar saline irrigation fluid was not associated with any detrimental effects on the execution of the surgical procedure, postoperative pain, or periarticular fluid extravasation. Taken together with previous basic science, translational, and clinical studies, hyperosmolar saline irrigation fluid is promising alternative to traditional isotonic irrigation fluids for knee arthroscopy. This study is a prospective trial and reflects level of evidence I.