No abstract

Chronic anterior knee pain is a common clinical entity, more so in the active individual. The incidence and risk factors, however remain unexplored. We investigated the correlation of demographic and occupational risk factors as well as the incidence of chronic anterior knee pain in an active military population. We performed a retrospective review of all U. S. Military active duty service members with the diagnosis of chondromalacia patellae, representative of the clinical syndrome of chronic anterior knee pain, between 2006 and 2012 using the Defense Medical Epidemiology Database. The demographic and occupation risk factors were categorized and the subgroup and overall incidence rates were determined via multivariable analysis. A total of 42,040 cases of chondromalacia patellae were identified in an at-risk population of 9,723,449, corresponding to an incidence rate of 4.32 cases per 1,000 person-years. Increasing chronological age, female sex, Black race, junior enlisted rank, and primary ground forces (Marines and Army) significantly correlated with an increased risk for chronic anterior knee pain. This study is the first report of incidence and risk factors for chondromalacia patellae in a large athletic population. We determined that sex, age, race, branch of service, and rank all correlated with the incidence of chondromalacia patellae in an active population.

either the pulmonary embolism severity index (risk classes I or II) or in accordance with the Hestia Criteria for outpatient PE treatment, both validated methods. Outpatient management was defined by hospitalization lasting ,24 hours. In one study, all patients were treated with low-molecular-weight heparin (LMWH) and vitamin K antagonist (VKA). In the other study, outpatients were treated with rivaroxaban, whereas inpatients received local standard of care (typically bridging therapy with heparin and then VKA or direct oral anticoagulant). Outcomes included all-cause mortality, reoccurrence of PE at 90 days, and major bleeding (fatal or clinically symptomatic bleeding into a critical area, bleeding leading to fall in hemoglobin$2 g/L, or transfusion$2 units). Pooled analysis did not demonstrate any significant difference between outpatient versus inpatient groups for 30-day mortality (relative risk [RR], 0.33; 95% CI, 0.01-8.0), 90-day mortality (RR, 0.98; 95% CI, 0.06-16), major bleeding at 14 days (RR, 4.9; 95% CI, 0.24-102), major bleeding at 90 days (RR, 6.9; 95% CI, 0.36-132), or recurrent PE at 90 days (RR, 3.0; 95% CI, 0.12-72). The small number of included studies, patients, and reported events with wide confidence intervals raises the possibility of missing a small difference in outcomes. Additional studies with larger sample sizes are recommended.A 2020 systematic review and meta-analysis identified three additional prospective cohort studies (N5234), in addition to the two RCTs included in the above review that evaluated the safety and efficacy of home versus hospital management of acute PE 2 . Inclusion criteria were RCTs or prospective cohort studies comparing outpatient versus inpatient treatment of adults 18 years or older with acute PE. Home management was defined as hospitalization lasting ,72 hours. Low-risk classification in the cohort studies varied, with one using an unvalidated prediction tool and the two others using the absence of a variety of risk factors such as hemodynamic instability, high-risk comorbid conditions, hypoxia, increased bleeding risk, or contraindications to LMWH. All patients in the cohort studies were treated with LMWH with VKA or LMWH alone. Outcomes included all-cause mortality and major bleeding (same definition as above). Pooled data from the prospective cohort studies did not reveal any significant difference in 30 day all-cause mortality (RR, 0.81; 95% CI, 0.42-1.6), 90 day all-cause mortality (RR, 0.81; 95% CI, 0.42-1.6), or major bleeding at 90 days (RR, 2.7; 95% CI, 0.11-63). Limitations of the cohort studies include variability in low-risk stratification and high risk of bias because of the lack of adequate adjustment for possible confounders, objective assessment of outcomes, and loss of follow-up information.