Background:Tears of the ulnar collateral ligament (UCL) of the elbow are common injuries in overhead athletes that may be career-ending if left untreated.Purpose:The goal of this systematic review was to review all published reports of UCL reconstruction in overhead athletes, determine which techniques were associated with better outcomes, and assess the strengths and weaknesses of current data.Study Design:Systematic review.Methods:A systematic review of published studies evaluating reconstruction of the UCL in overhead athletes was performed using the Ovid Medline database. All studies with a cohort of athletes who underwent UCL reconstruction with a minimum of 1 year follow-up were included, resulting in a total of 8 Level III (retrospective cohort) studies. A database compiled variables of interest, including demographic variables, surgical techniques, Conway-Jobe ratings, and percentage and type of complications. Additionally, studies were evaluated for evidence of selection, performance, detection, ...

The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review.

Injuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries. A systematic computerized literature search was conducted on following databases were accessed: PubMed, Medline, Cochrane, CINAHL and Embase databases. At a young age, injury to the physis can result in limb deformities and leg-length discrepancy. Weight-bearing joints including the hip, knee and ankle are at risk of developing osteoarthritis (OA) in former athletes, after injury or in the presence of malalignment, especially in association with high impact sport. Knee injury is a risk factor for OA. Ankle ligament injuries in athletes result in incomplete recovery (up to 40% at 6 months), and OA in the long term (latency period more than 25 years). Spine pathologies are associated more commonly with certain sports (e.g. wrestling, heavy-weight lifting, gymnastics, tennis, soccer). Evolution in arthroscopy allows more accurate assessment of hip, ankle, shoulder, elbow and wrist intra-articular post-traumatic pathologies, and possibly more successful management. Few well-conducted studies are available to establish the long-term follow-up of former athletes. To assess whether benefits from sports participation outweigh the risks, future research should involve questionnaires regarding the health-related quality of life in former athletes, to be compared with the general population.

/pdf/sport-injuries-a-review-of-outcomes-7f5sp50h6h.pdf

Sport injuries: a review of outcomes.

Corticosteroids Reduce Postoperative Morbidity After Third Molar Surgery: A Systematic Review and Meta-Analysis

Background: Gastrocnemius recession is performed to correct an isolated gastrocnemius equinus contracture of the ankle that may accompany foot and ankle pathology in the adult. It has been proposed...

Gastrocnemius Recession to Treat Isolated Foot Pain

Background:The medial ulnar collateral ligament (UCL) is the primary static stabilizer to valgus stress of the elbow. Injuries to the UCL are common in baseball pitchers. In the 1970s, reconstructive surgery was developed. Return-to-play (RTP) rates of 67% to 95% after reconstruction have been reported. There is a paucity of published studies among professional baseball players reporting RTP with nonoperative treatment.Purpose:To identify professional baseball players’ ability to RTP after the nonoperative treatment of UCL injuries based on the magnetic resonance imaging (MRI) grade.Study Design:Case series; Level of evidence, 4.Methods:A review of elbow injuries among a professional baseball organization from 2006 to 2011 was performed. MRI was performed on all players. Forty-three UCL injuries were diagnosed. Treatment included rehabilitation, surgery, or both. Rates of RTP and return to the same level of play or higher (RTSP) were calculated and correlated with the MRI grade, location of injury, and pl...

Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings

In the absence of bony deformity, ankle equinus is generally the result of shortening within the gastrocnemius-soleus complex Restriction of ankle dorsiflexion as a proxy for equinus contracture has been linked to increased mechanical strains and resultant foot and ankle pathology for a long time This entity has many known causes, and data suggest it can manifest as either an isolated gastrocnemius or combined (Achilles) contracture Numerous disorders of the foot and ankle have been linked with such "equinus disease", and although some of these relationships remain controversial, a reasonably convincing relationship between equinus contracture and the development of flatfoot exists What is still perhaps most misunderstood is the temporal association between these two pathologies, and hence higher levels of evidence are needed in the future to define more precisely the interplay between flatfoot deformity and gastrocnemius-soleus tightness

https://www.foot.theclinics.com/article/S1083-7515(07)00018-6/pdf

The Role of Isolated Gastrocnemius and Combined Achilles Contractures in the Flatfoot

Ulnar collateral ligament (UCL) insufficiency is potentially a career threatening, or even a career ending, injury, particularly in overhead throwing athletes. The evolution of treating modalities provides afflicted athletes with the opportunity to avoid premature retirement. There have been several clinical and basic science research efforts which have investigated the pathophysiology of UCL disruption, the biomechanics specific to overhead throwing, and the various types of treatment modalities. UCL reconstruction is currently the most commonly performed surgical treatment option. An in depth analysis of the present treatment options, both non‐operative and operative, as well as their respective results and biomechanical evaluation, is lacking in the literature to date. This article provides a comprehensive current review and comparative analysis of these modalities. Over the last 30 years there has been an evolution of the original UCL reconstruction. Yet, despite the variability in modifications, such as the docking technique, interference screw fixation, and use of suture anchors, the unifying concepts of UCL reconstruction are that decreased dissection of the flexor‐pronator mass and decreased handling of the ulnar nerve leads to improved outcomes.

/pdf/evolution-of-the-treatment-options-of-ulnar-collateral-11qsfidev9.pdf

Evolution of the treatment options of ulnar collateral ligament injuries of the elbow

Background: Recent literature reflects a substantial increase in interest surrounding lateral talar process fractures. Previous anatomic investigations discovered that excision of a 1 cm3 fracture fragment from the lateral talar process involves approximately 100% of the lateral talocalcaneal ligament origin and 10% to 15% of both the posterior and anterior talofibular ligament insertions. The objective of this study was to determine the effect that excision of this 1 cm3 fragment has on ankle and subtalar joint stability. Methods: Ten fresh-frozen cadaver lower limbs were thawed before testing and placed in a clinical stress apparatus (Model SE 20, Telos, Marburg, Germany). Radiographs were taken before and after application of a 150 N of force. Three views (lateral, anteroposterior, 30-degree Broden) were used to asses anterior tibiotalar translation (AT), talar tilt (TT), medial talocalcaneal motion (TCM), and talocalcaneal tilt (TCT) before and after excision of the 1 cm3 fragment the lateral talar pr...

In vitro evaluation of the effect lateral process talar excision on ankle and subtalar joint stability.

Background: Fractures of the lateral process of the talus have become more frequent as the sport of snowboarding has gained popularity. The anatomy of the ligamentous attachments to the process has...

Proximity of the lateral talar process to the lateral stabilizing ligaments of the ankle and subtalar joint.

Background: MRI is being used with increasing frequency and seems to have become more popular as a screening tool rather than as an adjunct to narrow specific diagnoses or plan operative interventions. Our hypothesis was that the rising accessibility of this test may be resulting in its overuse. Methods: We retrospectively reviewed 221 consecutive patients referred over a 3-month period for treatment of a lower extremity problem to determine: (1) the number of patients who presented with an MRI already obtained from an outside source, (2) the number of patients who obtained an MRI from the foot and ankle specialist after referral, and (3) the number of times the foot and ankle specialist used these studies or found them helpful in the care of the patient. Fractures (20) were excluded. Results: Of the 201 patients without fractures included in the study, 19.9% (40 of 201) had MRI scans during the course of their treatment; 15.4% (31 of 201) presented to their initial visit with an MRI scan from an outside ...

Phillip Langer

Papers

The Role of Isolated Gastrocnemius and Combined Achilles Contractures in the Flatfoot

Evolution of the treatment options of ulnar collateral ligament injuries of the elbow

In vitro evaluation of the effect lateral process talar excision on ankle and subtalar joint stability.

Proximity of the lateral talar process to the lateral stabilizing ligaments of the ankle and subtalar joint.

The diagnostic value of MRI in foot and ankle surgery