Showing papers in "American Journal of Sports Medicine in 2015"
TL;DR: Younger age, higher activity level, and allograft graft type were predictors of increased odds of ipsilateral graft failure and higher activity and younger age were found to be risk factors in contralateral ACL tears.
Abstract: Background:Anterior cruciate ligament (ACL) reinjury results in worse outcomes and increases the risk of posttraumatic osteoarthritis.Purpose:To identify the risk factors for both ipsilateral and contralateral ACL tears after primary ACL reconstruction (ACLR).Study Design:Cohort study; Level of evidence, 3.Methods:Data from the Multicenter Orthopaedic Outcomes Network (MOON), a prospective longitudinal cohort, were used to identify risk factors for ACL retear. Subjects with primary ACLR, no history of contralateral knee surgery, and a minimum of 2-year follow-up data were included. Age, sex, Marx activity score, graft type, lateral meniscal tear, medial meniscal tear, sport played at index injury, and surgical facility were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear.Results:A total of 2683 subjects with average age of 27 ± 11 years (1498 men; 56%) met all study inclusion/exclusion criteria. Overall there were 4.4% ipsilateral graft tears and 3.5% contra...
407 citations
TL;DR: The estimated number of nationally reported SRCs has increased within specific sports, however, it is unknown whether these increases are attributable to increased reporting or frequency of concussions.
Abstract: Background:The epidemiology of sports-related concussion (SRC) among student-athletes has been extensively researched. However, recent data at the collegiate level are limited.Purpose:To describe the epidemiology of SRC in 25 National Collegiate Athletic Association (NCAA) sports.Study Design:Descriptive epidemiology study.Methods:SRC data from the NCAA Injury Surveillance Program during the 2009-2010 to 2013-2014 academic years were analyzed. Concussion injury rates, rate ratios (RRs), and injury proportion ratios were reported with 95% CIs. National estimates were also calculated to examine linear trends across time.Results:During the study period, 1670 SRCs were reported, representing a national estimate of 10,560 SRCs reported annually. Among the 25 sports, the overall concussion rate was 4.47 per 10,000 athlete-exposures (AEs) (95% CI, 4.25-4.68). Overall, more SRCs occurred in competitions (53.2%). The competition rate (12.81 per 10,000 AEs) was larger than the practice rate (2.57 per 10,000 AEs) (c...
405 citations
TL;DR: There is an independent risk of injury and serious overuse injury in young athletes who specialize in a single sport, and injured young athletes were older and spent more hours per week in organized sports.
Abstract: Background:Data are lacking regarding the independent risk of injury related to intense single-sport training or growth rate in young athletes.Purpose:To determine whether sports specialization, weekly training volumes, and growth rates are associated with increased risk for injury and serious overuse injury in young athletes.Study Design:Case-control study; Level of evidence, 3.Methods:Injured athletes aged 7 to 18 years were recruited from 2 hospital-based sports medicine clinics and compared with healthy controls from affiliated primary care clinics undergoing sports physicals (2010-2013). Participants completed surveys reporting hours per week spent in organized sports, physical education class, and free play, as well as degree of sports specialization and Tanner stage. Heights and weights were measured. Injury details were obtained from athlete surveys and electronic medical records.Results:Of 1214 athletes enrolled, 1190 (50.7% male) had data satisfactory for analysis. There were 822 injured partici...
396 citations
TL;DR: Evaluating the effect of glenoid bone loss, especially in subcritical bone loss (below the 20%-25% range), on outcomes assessments and redislocation rates after an isolated arthroscopic Bankart repair for anterior shoulder instability found bone loss was predictive of outcome as assessed by the WOSI score.
Abstract: Background:Glenoid bone loss is a common finding in association with anterior shoulder instability. This loss has been identified as a predictor of failure after operative stabilization procedures. Historically, 20% to 25% has been accepted as the “critical” cutoff where glenoid bone loss should be addressed in a primary procedure. Few data are available, however, on lesser, “subcritical” amounts of bone loss (below the 20%-25% range) on functional outcomes and failure rates after primary arthroscopic stabilization for shoulder instability.Purpose:To evaluate the effect of glenoid bone loss, especially in subcritical bone loss (below the 20%-25% range), on outcomes assessments and redislocation rates after an isolated arthroscopic Bankart repair for anterior shoulder instability.Study Design:Cohort study; Level of evidence, 3.Methods:Subjects were 72 consecutive anterior instability patients (73 shoulders) who underwent isolated anterior arthroscopic labral repair at a single military institution by 1 of ...
387 citations
TL;DR: This study demonstrates that a combined reconstruction can be an effective procedure without specific complications at a minimum follow-up of 2 years and is demonstrated to improve the results of ACL treatment.
Abstract: Background:The anterolateral ligament has recently been identified as an important structure involved in rotational laxity after anterior cruciate ligament (ACL) rupture. Results of a combined ACL and anterolateral ligament (ALL) reconstruction technique have never been reported.Purpose:To report subjective and objective outcomes after combined ACL and minimally invasive ALL reconstruction with a minimum 2-year follow-up.Study Design:Case series; Level of evidence, 4.Methods:A total of 92 patients underwent a combined ACL and ALL reconstruction. Indications for a combined procedure were associated Segond fracture, chronic ACL lesion, grade 3 pivot shift, high level of sporting activity, pivoting sports, and radiographic lateral femoral notch sign. Patients were assessed pre- and postoperatively with objective and subjective International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale. Instrumented knee testing was performed with the Rolimeter arthrometer. The Knee inju...
380 citations
TL;DR: In spite of a dramatic increase in the number of publications per year, there is little evidence that the results of rotator cuff repair are improving and the information needed to guide the management of this commonly treated and costly condition is seriously deficient.
Abstract: Background:Rotator cuff tears are common, and rotator cuff repair represents a major health care expense. While patients often benefit from rotator cuff repair, anatomic failure of the repair is not unusual.Purpose:To identify the published evidence on the factors associated with retears and with suboptimal clinical outcomes of rotator cuff repairs.Study Design:Systematic review and meta-analysis of articles with evidence levels 1-4.Methods:A total of 2383 articles on rotator cuff repairs published between 1980 and 2012 were identified. Only 108 of these articles, reporting on over 8011 shoulders, met the inclusion criteria of reporting quantitative data on both imaging and clinical outcomes after rotator cuff repair. Factors related to the patients, their shoulders, the procedures, and the results were systematically categorized and submitted for meta-analysis.Results:While the number of relevant articles published per year increased dramatically over the period of the study, the clinical and anatomic re...
344 citations
TL;DR: The biomechanical analysis suggests that most traditional soft tissue grafts are sufficient for ALL reconstruction, and defined ALL attachment locations can be reproducibly identified with intraoperative landmarks or radiographs.
Abstract: Background:Recent publications have described significant variability in the femoral attachment and overall anatomy of the anterolateral ligament (ALL). Additionally, there is a paucity of data describing its structural properties.Purpose:Quantitative data characterizing the anatomic and radiographic locations and the structural properties of the ALL may be used to guide graft selection and placement and to facilitate the future development of an evidence-based approach to ALL reconstructions.Study Design:Descriptive laboratory study.Methods:Identification of the ALL was performed by a combined outside-in and inside-out anatomic dissection of 15 nonpaired fresh-frozen cadaveric knees. Quantitative anatomic relationships were calculated using a 3-dimensional coordinate measuring device. Measurements on anteroposterior (AP) and lateral radiographs were obtained by use of a picture archiving and communications system program. Structural properties were characterized during a single pull-to-failure test using...
298 citations
TL;DR: It is shown that both traditional ECC and HSR yield positive, equally good, lasting clinical results in patients with Achilles tendinopathy and that the latter tends to be associated with greater patient satisfaction after 12 weeks but not after 52 weeks.
Abstract: Background:Previous studies have shown that eccentric training has a positive effect on Achilles tendinopathy, but few randomized controlled trials have compared it with other loading-based treatment regimens.Purpose:To evaluate the effectiveness of eccentric training (ECC) and heavy slow resistance training (HSR) among patients with midportion Achilles tendinopathy.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 58 patients with chronic (>3 months) midportion Achilles tendinopathy were randomized to ECC or HSR for 12 weeks. Function and symptoms (Victorian Institute of Sports Assessment–Achilles), tendon pain during activity (visual analog scale), tendon swelling, tendon neovascularization, and treatment satisfaction were assessed at 0 and 12 weeks and at the 52-week follow-up. Analyses were performed on an intention-to-treat basis.Results:Both groups showed significant (P < .0001) improvements in Victorian Institute of Sports Assessment–Achilles and visual analog scale ...
277 citations
TL;DR: The anterolateral ligament is an important stabilizer of internal rotation at flexion angles greater than 35°; however, it is minimally loaded during anterior drawer at allflexion angles.
Abstract: Background:Recent anatomic investigations of the lateral structures of the knee have identified a new ligament, called the anterolateral ligament (ALL). To date, the anterolateral ligament has not been biomechanically tested to determine its function.Hypothesis:The ALL of the knee will resist internal rotation at high angles of flexion but will not resist anterior drawer forces.Study Design:Controlled laboratory study.Methods:Eleven cadaveric knees were subjected to 134 N of anterior drawer at flexion angles between 0° and 90° and separately to 5 N·m of internal rotation at the same flexion angles. The in situ forces of the ALL, anterior cruciate ligament (ACL), and lateral collateral ligament (LCL) were determined by the principle of superposition.Results:The contribution of the ALL during internal rotation increased significantly with increasing flexion, whereas that of the ACL decreased significantly. At knee flexion angles greater than 30°, the contribution of the ALL exceeded that of the ACL. During ...
277 citations
TL;DR: PRP does not provide a superior clinical improvement with respect to HA, and therefore it should not be preferred to viscosupplementation as injective treatment of patients affected by knee cartilage degeneration and OA.
Abstract: Background:Osteoarthritis (OA) is a common disease that will affect almost half the population at some point in their lives through pain and decreased functional capacity. New nonoperative options are being proposed to treat earlier stages of joint degeneration to provide symptomatic relief and delay surgical intervention.Purpose:To evaluate the benefit provided by platelet-rich plasma (PRP) injections to treat knee joint degeneration in comparison with hyaluronic acid (HA), the most common injective treatment currently adopted for this condition.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 443 patients were screened, and 192 of them were enrolled in the study according to the following inclusion criteria: (1) unilateral symptomatic knee with history of chronic pain (at least 4 months) or swelling and (2) imaging findings of degenerative changes (Kellgren-Lawrence score of 0-3 at radiographs or MRI evidence of degenerative chondropathy). Patients underwent 3 weekly int...
265 citations
TL;DR: Investigating the preventive effect of the NHE on the incidence and severity of hamstring injuries in male amateur soccer players found it does not reduce hamstring injury severity, but it significantly reduces hamstring injury incidence.
Abstract: Background:Hamstring injuries are the most common muscle injuries in soccer, and they have a high rate of recurrence. Eccentric hamstrings strength is recognized as an important modifiable risk factor. This led to the development of prevention exercises such as the nordic hamstring exercise (NHE). The effectiveness of the NHE on hamstring injury prevention has never been investigated in amateur soccer.Purpose:To investigate the preventive effect of the NHE on the incidence and severity of hamstring injuries in male amateur soccer players.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:Male amateur soccer players (age, mean ± SD, 24.5 ± 3.8 years) from 40 teams were randomly allocated to an intervention (n = 20 teams, 292 players) or control group (n = 20 teams, 287 players). The intervention group was instructed to perform 25 sessions of NHE in a 13-week period. Both the intervention and control groups performed regular soccer training and were followed for hamstring injury incidenc...
TL;DR: This is the first study to determine the patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) and the Hip Outcome Score (HOS) in patients with FAI treated with arthroscopic hip surgery.
Abstract: Background:There is minimal information available on the threshold at which patients consider themselves to be well for patient-reported outcome measures used in patients treated with hip arthroscopy for femoroacetabular impingement (FAI).Purpose:To determine the patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) and the Hip Outcome Score (HOS) in patients with FAI treated with arthroscopic hip surgery.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:A consecutive series of patients at a single institution with FAI who were treated with arthroscopic labral surgery, acetabular rim trimming, and femoral osteochondroplasty were eligible. The mHHS (score range, 0-100) and the HOS (score range, 0-100) were administered at baseline and at 12 months postoperatively. An external anchor question at 1 year postoperatively was utilized to determine PASS values: “Taking into account all the activities you have during your daily life, your level of pain, and also yo...
TL;DR: Rehabilitation after ACL reconstruction needs to focus on maximizing quadriceps strength, which likely will lead to more symmetrical knee biomechanics.
Abstract: Background:Quadriceps strength deficits are observed clinically after anterior cruciate ligament (ACL) injury and reconstruction and are often not overcome despite rehabilitation. Given that quadriceps strength may be important for achieving symmetrical joint biomechanics and promoting long-term joint health, determining the magnitude of strength deficits that lead to altered mechanics is critical.Purpose:To determine if the magnitude of quadriceps strength asymmetry alters knee and hip biomechanical symmetry as well as functional performance and self-reported function.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 73 patients were tested at the time they were cleared for return to activity after ACL reconstruction. Quadriceps strength and activation, scores on the International Knee Documentation Committee form, the hop for distance test, and sagittal plane lower extremity biomechanics were recorded while patients completed a single-legged hop.Results:Patients with high and m...
TL;DR: Delayed ACL reconstruction increased the risks of secondary meniscal and chondral injuries in this population of pediatric patients.
Abstract: Background:In pediatric patients, anterior cruciate ligament (ACL) reconstruction is controversial; however, delaying surgery until skeletal maturity is complete may increase the risk of secondary meniscal and articular cartilage injury.Purpose:To assess the risk of meniscal and chondral injuries with delay of ACL reconstruction.Study Design:Cohort study; Level of evidence, 3.Methods:Records were reviewed in patients younger than 17 years (median age, 14 years) who had ACL reconstruction. Patients were consecutively enrolled and assigned to 1 of 3 surgical groups based on timing of surgery: acute ( 3 months). The type and grade of meniscal injuries was documented according to the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS) meniscal classification criteria. International Cartilage Repair Society (ICRS) criteria were used to document location and grade of chondral injuries. Associations between patie...
TL;DR: This study demonstrated that it was possible to establish a concise classification system to group patients with meniscal root tears by tear morphology and that recognition of tear pattern would affect treatment choice.
Abstract: Background:Meniscal root tears present in many forms and can have profound consequences on the health of knee articular cartilage. While the biomechanics, natural history, and treatment of root tears have been increasingly investigated, the spectrum of meniscal root tear patterns observed during arthroscopic examination has yet to be defined and categorized.Purpose:To establish a classification system for meniscal root tears by reporting the morphology of meniscal root tears from a consecutive series of arthroscopic surgeries. It was hypothesized that meniscal root tears could be grouped into types by distinct tear patterns and that recognition of tear pattern would affect treatment choice.Study Design:Case series; Level of evidence, 4.Methods:All patients who underwent arthroscopic surgery from April 2010 to May 2014 by a single orthopaedic surgeon were included. After arthroscopic examination, data regarding the integrity of the meniscal roots were prospectively recorded in a data registry. Tear morphol...
TL;DR: Recurrent patellar dislocation is associated with an increased prevalence of patella alta, increased TT-TG distance, rotational deformity, and trochlear dysplasia compared with patients with no histories of patellite dislocation.
Abstract: Background:Anatomic factors, including patella alta, increased tibial tubercle–trochlear groove (TT-TG) distance, rotational deformities, and trochlear dysplasia, are associated with dislocation of the patella. Identifying the presence of these anatomic factors both in isolation and in combination may influence treatment in patients with patellar dislocation.Purpose:The aim of this study was to compare the prevalence and combined prevalences of these anatomic factors using magnetic resonance imaging in a group of patients with and without histories of recurrent dislocation of the patella.Study Design:Case-control study; Level of evidence, 3.Methods:The prevalence and combined prevalences of patella alta, increased TT-TG distance, rotational deformity, and trochlear dysplasia on magnetic resonance imaging were reported and compared in 60 patients (60 knees) with and 120 patients (120 knees) without histories of recurrent patellar dislocation.Results:Patients with recurrent patellar dislocation possessed hi...
TL;DR: It is recommended that future outcomes studies use PCL stress radiographs to determine objective outcomes and that evidence level 1 and 2 studies be performed to assess outcomes between transtibial and tibial inlay reconstructions and also between single- and double-bundle PCL reconstructions.
Abstract: The posterior cruciate ligament (PCL) is recognized as an essential stabilizer of the knee. However, the complexity of the ligament has generated controversy about its definitive role and the recommended treatment after injury. A proper understanding of the functional role of the PCL is necessary to minimize residual instability, osteoarthritic progression, and failure of additional concomitant ligament graft reconstructions or meniscal repairs after treatment. Recent anatomic and biomechanical studies have elucidated the surgically relevant quantitative anatomy and confirmed the codominant role of the anterolateral and posteromedial bundles of the PCL. Although nonoperative treatment has historically been the initial treatment of choice for isolated PCL injury, possibly biased by the historically poorer objective outcomes postoperatively compared with anterior cruciate ligament reconstructions, surgical intervention has been increasingly used for isolated and combined PCL injuries. Recent studies have more clearly elucidated the biomechanical and clinical effects after PCL tears and resultant treatments. This article presents a thorough review of updates on the clinically relevant anatomy, epidemiology, biomechanical function, diagnosis, and current treatments for the PCL, with an emphasis on the emerging clinical and biomechanical evidence regarding each of the treatment choices for PCL reconstruction surgery. It is recommended that future outcomes studies use PCL stress radiographs to determine objective outcomes and that evidence level 1 and 2 studies be performed to assess outcomes between transtibial and tibial inlay reconstructions and also between single- and double-bundle PCL reconstructions.
TL;DR: Most athletes who were not playing sport at 1 year had returned to some form of sport within 2 years after ACL reconstruction, which may suggest that athletes can take longer than the clinically expected time of 1 year to return to sport.
Abstract: Background A return to their preinjury level of sport is frequently expected within 1 year after anterior cruciate ligament (ACL) reconstruction, yet up to two-thirds of athletes may not have achieved this milestone. The subsequent sports participation outcomes of athletes who have not returned to their preinjury level sport by 1 year after surgery have not previously been investigated. Purpose To investigate return-to-sport rates at 2 years after surgery in athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction. Study design Case series; Level of evidence, 4. Methods A consecutive cohort of competitive- and recreational-level athletes was recruited prospectively before undergoing ACL reconstruction at a private orthopaedic clinic. Participants were followed up at 1 and 2 years after surgery with a sports activity questionnaire that collected information regarding returning to sport, sports participation, and psychological responses. An independent physical therapist evaluated physical function at 1 year using hop tests and the International Knee Documentation Committee knee examination form and subjective knee evaluation. Results A group of 122 competitive- and recreational-level athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction participated. Ninety-one percent of the athletes returned to some form of sport after surgery. At 2 years after surgery, 66% were playing sport, with 41% playing their preinjury level of sport and 25% playing a lower level of sport. Having a previous ACL reconstruction to either knee, poorer hop-test symmetry and subjective knee function, and more negative psychological responses were associated with not playing the preinjury level sport at 2 years. Conclusion Most athletes who were not playing sport at 1 year had returned to some form of sport within 2 years after ACL reconstruction, which may suggest that athletes can take longer than the clinically expected time of 1 year to return to sport. However, only 2 of every 5 athletes were playing their preinjury level of sport at 2 years after surgery. When the results of the current study were combined with the results of athletes who had returned to sport at 1 year, the overall rate of return to the preinjury level sport at 2 years was 60%. Demographics, physical function, and psychological factors were related to playing the preinjury level sport at 2 years after surgery, supporting the notion that returning to sport after surgery is multifactorial.
TL;DR: Elevated pain-related fear of movement/reinjury, quadriceps weakness, and reduced IKDC score distinguish patients who are unable to return to preinjury sports participation because of fear of reinjury/lack of confidence.
Abstract: Background:Fear of reinjury and lack of confidence influence return-to-sport outcomes after anterior cruciate ligament (ACL) reconstruction. The physical, psychosocial, and functional recovery of patients reporting fear of reinjury or lack of confidence as their primary barrier to resuming sports participation is unknown.Purpose:To compare physical impairment, functional, and psychosocial measures between subgroups based on return-to-sport status and fear of reinjury/lack of confidence in the return-to-sport stage and to determine the association of physical impairment and psychosocial measures with function for each subgroup at 6 months and 1 year after surgery.Study Design:Case-control study; Level of evidence, 3.Methods:Physical impairment (quadriceps index [QI], quadriceps strength/body weight [QSBW], hamstring:quadriceps strength ratio [HQ ratio], pain intensity), self-report of function (International Knee Documentation Committee [IKDC]), and psychosocial (Tampa Scale for Kinesiophobia–shortened for...
TL;DR: This study shows that lateral meniscal root injury further destabilizes the ACL-deficient knee and thus advances the concept that the lateral meniscus is a secondary stabilizer of the knee under pivot-shift loading.
Abstract: Background:Meniscal root tears are an increasingly recognized subset of meniscal injury. The menisci are critical secondary stabilizers of the anterior cruciate ligament (ACL). The kinematic effect of lateral meniscus posterior root tear in the setting of ACL injury is not known.Purpose/Hypothesis:The purpose of this study was to determine the effect of tear of the lateral meniscal root on stability of the ACL-deficient knee. The hypothesis was that disruption of the lateral meniscal root will further destabilize the ACL-deficient knee during a simulated pivot shift.Study Design:Controlled laboratory study.Methods:Pivot-shift testing of 8 fresh-frozen cadaveric knees was performed after attachment of photoreflective flags and preparation of CT scans. Each knee was mounted in a custom activity simulator and dynamically loaded from 15° to 90° of flexion with all the permutations of the following: iliotibial band force (50, 75, 100, 125, 150, and 175 N), internal rotation moments (1, 2, and 3 N·m), and valgu...
TL;DR: Pitchers have a high prevalence of UCL reconstruction in professional baseball, with 25% of major league pitchers and 15% of minor league pitchers having a history of the surgery.
Abstract: Background:While the high rate of ulnar collateral ligament (UCL) injuries in professional baseball is widely discussed in the media and medical literature, the actual prevalence of UCL reconstruction has not been documented.Hypothesis:The prevalence of UCL reconstruction will be higher among pitchers than nonpitchers, and Major League Baseball (MLB) pitchers will have a higher prevalence than will minor league pitchers.Study Design:Descriptive epidemiology study.Methods:An online questionnaire was distributed to all 30 MLB organizations. Certified athletic trainers from each team administered the questionnaire to all players in the organization, including major league players and 6 levels of minor league players. Demographic data were compared between major and minor league players. Continuous variables (age, years of professional baseball, country of origin, etc) were compared with Student t tests (P < .05). Categorical variables (level, position, etc) were compared using chi-square analysis (P < .05).R...
TL;DR: According to this database of a privately insured population, UCLR was performed significantly more in patients aged 15 to 19 than any other age group, and this database showed that the number of UclR procedures is increasing over time.
Abstract: Background:Overuse injuries to the elbow in the throwing athlete are common. Ulnar collateral ligament reconstruction (UCLR), commonly known as Tommy John surgery, is performed on both recreational and high-level athletes. There is no current literature regarding the incidence and demographic distribution of this surgical procedure in relation to patient age, location within the Unites States, and sex.Purpose:To determine the current demographic distribution of UCLR within the US population included in the PearlDiver database.Study Design:Descriptive epidemiology study.Methods:A retrospective analysis of the PearlDiver supercomputer database, a private-payer database, was performed to identify UCLR procedures performed between 2007 and 2011. The Current Procedural Terminology (CPT) code 24346 (reconstruction of the ulnar collateral ligament of the elbow with the use of a tendinous graft) was used.Results:Between 2007 and 2011, a total of 790 patients underwent UCLR. The average (±SD) annual incidence was ...
TL;DR: Sports medicine clinicians should be aware of these findings and develop a preventive plan that addresses this study’s findings to reduce pitchers’ risk of shoulder injury and surgery.
Abstract: Background:Shoulder injuries from repetitive baseball pitching continue to be a serious, common problem.Purpose:To determine whether passive range of motion of the glenohumeral joint was predictive of shoulder injury or shoulder surgery in professional baseball pitchers.Study Design:Cohort study; Level of evidence, 2.Methods:Passive range of motion of the glenohumeral joint was assessed with a bubble goniometer during spring training for all major and minor league pitchers of a single professional baseball organization over a period of 8 successive seasons (2005-2012). Investigators performed a total of 505 examinations on 296 professional pitchers. Glenohumeral external and internal rotation was assessed with the pitcher supine and the arm abducted to 90° in the scapular plane with the scapula stabilized anteriorly at the coracoid process. Total rotation was defined as the sum of internal and external glenohumeral rotation. Passive shoulder flexion was measured with the pitcher supine and the lateral bor...
TL;DR: Restoration of symmetric quadriceps strength after ACL reconstruction is associated with more symmetric mechanics during a single-leg drop-landing movement, and this appears to be multifactorial.
Abstract: Background:Young athletes who have had anterior cruciate ligament (ACL) reconstruction demonstrate suboptimal rates of return to sport, high rates of second ACL injuries, and persistent movement asymmetries. Therefore, the influence of musculoskeletal impairments on movement mechanics in this population needs to be further evaluated.Hypothesis:The primary hypothesis was that among young athletes who have had ACL reconstruction, those with greater quadriceps strength asymmetry would demonstrate altered single-leg drop-landing mechanics at return to sport compared with individuals with more symmetric quadriceps strength and also compared with healthy controls (ie, those with no ACL reconstruction). A second hypothesis was that quadriceps strength symmetry would predict single-leg drop-landing symmetry in individuals who have undergone ACL reconstruction.Study Design:Controlled laboratory study.Methods:The study entailed a total of 103 participants (age, 17.4 years) at the time of return to sport after ACL r...
TL;DR: The 5-year revision-free and CACLR-free survival rate in this study was 95.1% and 95.8%, respectively, and factors associated with higher risk of revision ACLR and contralateral ACLR were as follows: allografts, hamstring autografteds, male sex, younger age, lower body mass index (BMI), and being white as opposed to black.
Abstract: Background:Patients generally choose to undergo anterior cruciate ligament reconstruction (ACLR) to return to their active lifestyles. However, returning to their previous activity level may result in a retear of their reconstructed knee or an injury to their contralateral anterior cruciate ligament (CACL).Purpose:To determine the risk factors associated with revision ACLR and contralateral ACLR (CACLR), compare the survival of the reconstructed ACL with the CACL, and determine how the risk factors associated with revision ACLR compare with those for CACLR.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective cohort study of prospectively collected data from the Kaiser Permanente ACLR registry between February 1, 2005, and September 30, 2012, was conducted. Primary ACLR cases without history of contralateral knee ACL injury were included. The study endpoints included revision ACLR and CACLR. Graft type (bone–patellar tendon–bone [BPTB] autograft, hamstring autograft, and allograft) was t...
TL;DR: Arthroscopy for borderline/mild hip dysplasia would lead to improved outcomes but be inferior to arthroscopic for femoroacetabular impingement (FAI).
Abstract: Background:Reports regarding arthroscopy for mild hip dysplasia have conflicting results.Hypothesis:Arthroscopy for borderline/mild hip dysplasia would lead to improved outcomes but be inferior to arthroscopy for femoroacetabular impingement (FAI).Study Design:Cohort study; Level of evidence, 3.Methods:A total of 88 hips (77 patients, 71% female; mean age, 33.9 years) with dysplastic radiographic findings were retrospectively reviewed at a mean follow-up of 26.0 months after hip arthroscopy. Specific procedures included labral repair (76%), labral debridement (23%), capsular repair/plication (82%), and femoral osteochondroplasty (72%). Radiographic parameters included lateral center-edge angle, neck-shaft angle, Tonnis angle, extrusion index, femoral head lateralization, and break in the Shenton line. Pre- and postoperative function were evaluated prospectively with the modified Harris Hip Score (mHHS), 12-Item Short Form Health Survey, and visual analog scale for pain. The results of the dysplastic cohor...
TL;DR: Soccer players and adolescents had an increased risk of revision surgery after ACL reconstruction, with a respective factor of 1.5 and 2.5.
Abstract: Background:Revision surgery is one of the most important endpoints during follow-up after anterior cruciate ligament (ACL) reconstruction.Purpose:To investigate if commonly known patient factors can predict revision surgery after ACL reconstruction.Study Design:Cohort study; Level of evidence, 2.Methods:This prospective cohort study was based on data from the Swedish National Knee Ligament Register during the period of January 1, 2005, through December 31, 2013. Patients who underwent primary ACL reconstruction with hamstring tendon or bone–patellar tendon–bone autografts were included. Follow-up started on the date of primary ACL reconstruction, and follow-up ended with ACL revision surgery, after 24 months of follow-up, or on December 31, 2013, whichever occurred first. The analyzed patient variables were activity at the time of injury, sex, age, height, weight, body mass index, smoking, and the use of smokeless tobacco. The primary study endpoint was revision surgery, defined as replacement of a primar...
TL;DR: The incidence of distal biceps tendon ruptures in this study was higher than previously reported and smoking and elevated body mass index were found to be associated with increased likelihood of injury, while diabetes mellitus showed no association.
Abstract: Background:The incidence of distal biceps tendon ruptures was studied more than 10 years ago in a small patient cohort. Recent diagnostic advancements have improved the ability to detect this rare injury.Hypothesis:The incidence of distal biceps tendon ruptures will be significantly greater than previously reported.Study Design:Descriptive epidemiologic study.Methods:A query of the PearlDiver Technologies national database containing public and private insurance patients was used to estimate the national incidence of distal biceps tendon ruptures in the United States. A retrospective chart review of our local population identified demographic groups and risk factors that increased likelihood of injury.Results:The estimated national incidence of distal biceps tendon rupture was 2.55 per 100,000 patient-years. The local incidence was 5.35 per 100,000 patient-years. The mean and median ages of patients in our regional cohort were 46.3 and 46 years, respectively. Males composed the majority of the injured pop...
TL;DR: An increased LTPS is associated with an increased risk for early ACL graft failure, regardless of graft type, and orthopaedic surgeons should consider measuring the LTPS as part of the preoperative assessment of ACL-injured patients.
Abstract: Background:The lateral tibial posterior slope (LTPS) has been reported in multiple studies to correlate with an increased risk for native anterior cruciate ligament (ACL) tearing To date, no study has examined the effect of an increased LTPS as measured on magnetic resonance imaging (MRI) on the likelihood of ACL graft failureHypothesis:An increased LTPS as measured on MRI would correlate with an increased risk for ACL graft failureStudy Design:Case-control study; Level of evidence, 3Methods:Fifty-eight patients were initially identified who experienced graft failure after primary ACL reconstruction and underwent revision between 1998 and 2009 Exclusion criteria were clinical follow-up of less than 4 years, graft failure occurring greater than 2 years after primary surgery, skeletal immaturity, deep infection, lack of available preoperative MRI, and history of trauma to the proximal tibia This left 35 patients with early (within 2 years) failure of primary ACL reconstruction These patients were mat
TL;DR: These findings show that the selection of graft attachment points and graft course affects length change pattern during knee flexion, and provide a surgical rationale for lateral extra-articular soft tissue reconstruction in terms of femoral graft fixation site and graft route.
Abstract: Background:Lateral extra-articular soft tissue reconstructions in the knee may be used as a combined procedure in revision anterior cruciate ligament surgery as well as in primary treatment for patients who demonstrate excessive anterolateral rotatory instability. Only a few studies examining length change patterns and isometry in lateral extra-articular reconstructions have been published.Purpose:To determine a recommended femoral insertion area and graft path for lateral extra-articular reconstructions by measuring length change patterns through a range of knee flexion angles of several combinations of tibial and femoral insertion points on the lateral side of the knee.Study Design:Controlled laboratory study.Methods:Eight fresh-frozen cadaveric knees were freed of skin and subcutaneous fat. The knee was then mounted in a kinematics rig that loaded the quadriceps muscles and simulated open-chain knee flexion. The length changes of several combinations of tibiofemoral points were measured at knee flexion...