Background: The treatment of Rockwood Grade-III acromioclavicular (AC) joint separation has been widely disputed since the introduction of the classification system. The present literature does not reach consensus on whether operative or nonoperative management is more advantageous, nor does it effectively distinguish between operative measures. We hypothesized that nonoperative treatment of Rockwood Grade-III AC joint separation would be more cost-effective when compared with surgical options. Methods: We created a decision-tree model outlining the treatment of Rockwood Grade-III separations using nonoperative management or hook-plate, suture-button, or allograft fixation. After nonoperative intervention, the possible outcomes predicted by the model were uneventful healing, delayed operative management, a second round of sling use and physical therapy, or no reduction and no action; and after operative intervention, the possible outcomes were uneventful healing, loss of reduction and revision, and depending on the implant, loss of reduction and no action, or removal of the implant. A systematic review was conducted, and probabilities of each model state were averaged. A cost-effectiveness analysis was conducted both through rollback analysis yielding net monetary benefit and through incremental cost-effectiveness ratios (ICERs). Thresholds of $50,000/quality-adjusted life-year (QALY) and $100,000/QALY were used for ICER analysis. Furthermore, a sensitivity analysis was utilized to determine whether differential probabilities could impact the model. Results: Forty-five papers were selected from a potential 768 papers identified through our literature review. Nonoperative treatment was used as our reference case and showed dominance over all 3 of the operative measures at both the $50,000 and $100,000 ICER thresholds. Nonoperative treatment also showed the greatest net monetary benefit. Nonoperative management yielded the lowest total cost ($6,060) and greatest utility (0.95 QALY). Sensitivity analysis showed that allograft fixation became the favored technique at a willingness-to-pay threshold of $50,000 if the rate of failure of nonoperative treatment rose to 14.6%. Similarly, at the $100,000 threshold, allograft became dominant if the probability of failure of nonoperative treatment rose to 22.8%. Conclusions: The cost-effectiveness of nonoperative treatment is fueled by its notably lower costs and overall high rates of success in Grade-III separations. It is important to note that, in our analysis, the societal cost (measured in lost productivity) of nonoperative treatment neared that of surgical treatment, but the cost from the health-care system perspective was minimal. Physicians should bear in mind the sensitivity of these conclusions and should consider cost-effectiveness analyses in their decision-making guidelines. Level of Evidence: Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.

Objectives/Hypothesis Determine the postoperative Nasal Obstruction Symptom Evaluation (NOSE) score stability between 1 and ≥6 months after septoplasty with inferior turbinate reduction (ITR). Education level and occupation were evaluated to determine their effects on NOSE score stability during the postoperative period. Study Design Retrospective case series. Methods This was a retrospective case series. Patients were included if they underwent septoplasty with ITR for nasal obstruction due to septal deviation and inferior turbinate hypertrophy. NOSE scores were collected preoperatively, and at 1 and ≥6 months postoperatively. Education level and occupation were collected postoperatively via telephone survey. Changes in NOSE scores were compared between the different time points. Education level and occupation were analyzed to determine if they affected NOSE scores. Results There were 98 patients included, and 56 were male (57.1%). Mean NOSE scores preoperatively and at 1 and ≥6 months postoperatively were 72.1, 17.1, and 12.0, respectively. Patients demonstrated a statistically and clinically significant reduction in NOSE score at 1 month (−54.9, P < .001) and at ≥6 months postoperatively (−60.0, P < .001). The mean 6.2‐point decrease in NOSE score from 1 to ≥6 months was statistically, but not clinically significant. There were no significant differences in NOSE score changes based on educational level and occupation. Conclusions Patients achieved statistically and clinically significant reductions in NOSE scores at 1 months, with no clinically significant differences in NOSE scores at ≥6 months, suggesting NOSE score stability between these postoperative time points. Neither education level nor occupation influenced NOSE scores. Level of Evidence 4 Laryngoscope, 131:E2105–E2110, 2021

The incidence and mortality data for patients with breast cancer in the United States are important to healthcare administrators for planning healthcare measures such as screening mammograms. In this study, we examined breast cancer incidence and incidence-based mortality in the United States from 2004-2018 using the Surveillance, Epidemiology, and End Results (SEER) database. We reviewed 915,417 cases of breast cancer diagnosed between 2004 and 2018. Overall, the data showed an increased incidence rate of breast cancer among all races and a decreased mortality rate among all races. Breast cancer incidence rates increased by 0.3% (95% CI, 0.1, 0.4, p<0.001) per year over the study period. Breast cancer incidence rates increased for all age, race, and stage groups except for stage regional, which showed a statistically significant decrease in the incidence of -0.9% (95% CI, -1.1, -0.7, p<0.001). The highest decrease in mortality was observed among white patients, with an overall statistically significant decrease in rates by -14.3% (95% CI, -18.1, -10.4, p <0.001). The highest decrease in rates was observed between 2016 and 2018: -48.6 (95% CI, -52.6, -44.3, p <0.001). In black/African American patients, the overall incidence-based mortality decreased by -11.6% (95% CI -15.9, -7.1 p <.001), with the highest decrease in rates observed between 2016 and 2018 with a decrease of -51.3% (95% CI -56.6, -45.3, p <0.001). In Hispanic Americans, the overall incidence-based mortality decreased by -12.3% (95% CI -16.9, -7.4, p <.001), which is lower than in white Americans.

Purpose: To quantify the financial impact of an anterior cruciate ligament (ACL) injury on the remaining career earnings of National Basketball Association (NBA) players. Methods: We performed a retrospective review of all NBA players who had an ACL rupture between 2000 and 2019. Players were matched to healthy controls by age, position, body mass index, and player efficiency rating at the time of injury (index year). Player information collected included demographic information, position, team role, draft pick, date of injury, contract length, and earnings during the 3 years before and 7 years after the index year, as well as new contract length and earnings after injury. Results: A total of 12 players (22%) did not return to play (RTP). No statistically significant difference in annual earnings was present at any time point between cohorts. When we examined the mean difference in earnings between the first 3 post-index seasons and the 3 pre-index seasons, both the ACL and control cohorts showed increased salaries as players' careers progressed, without a significant difference in earnings. When comparing cohorts, we found no significant difference in the length and earnings of contracts during the index year. Furthermore, there was no significant difference in the length or earnings of the first new contract signed after the index year between cohorts. Additionally, NBA players who were able to RTP after ACL reconstruction were more likely to experience increased earnings if they had greater experience and performance prior to their injury (P < .01). Conclusions: Our study found that NBA players did not experience diminished earnings after RTP from an ACL reconstruction when compared with matched controls. Furthermore, no differences were seen in lengths of new contracts or in contract earnings between cohorts. Players with greater experience and performance prior to injury were more likely to have increased earnings after ACL reconstruction. Level of Evidence: Level III, retrospective casecontrol study.A nterior cruciate ligament (ACL) ruptures are common and potentially career-altering injuries in National Basketball Association (NBA) athletes. 1,2 Despite surveillance modalities, the annual incidence of ACL ruptures in NBA players is estimated to be 2.54 per year, with roughly 80% to 90% of players able to return to play (RTP) in the NBA. [2][3][4] The average timing of RTP after ACL reconstruction in NBA players is approximately 11.6 months (95% confidence interval, 7.5-15.7 months). 4 Additionally, it has been shown that these athletes may have shorter careers after ACL reconstruction, which may impact their potential career earnings. 4,5 However, recent literature has shown that NBA athletes RTP at high levels of performance after

Light chain (AL) amyloidosis is a plasma cell dyscrasia that results in an overproduction of immunoglobulins of the lambda or kappa light chains. These monoclonal ALs begin to form fibrils with each other and exert their toxic effect by depositing in different organs around the body. Disease presentation is indistinct, but it is ideal to diagnose this disorder before end-organ damage is caused. Once the diagnosis of AL amyloidosis is confirmed, the best treatment is autologous stem cell transplantation once a candidate is deemed fit for it; however, there are other chemotherapy agents whose patients can be administered until they undergo stem cell transplantation. In this case presentation and systematic review of AL amyloidosis, we discuss a patient who presented with septic shock and further workup leading to a diagnosis of advanced-stage amyloidosis. We also take a deeper look at AL amyloidosis providing a comprehensive review of the disease process and its treatment options.