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Prior studies have demonstrated that conservatively treated rotator cuff tears and rotator cuff tendinopathy may continue to progress. It is unclear whether that rate of progression differs between sides in patients with bilateral disease. This study evaluated the likelihood of progression of rotator cuff disease as confirmed via magnetic resonance imaging (MRI) in individuals with symptomatic bilateral pathology, treated conservatively for a minimum of 1 year.

Although nonoperative treatment is effective for degenerative rotator cuff tears (RCTs), it remains unclear whether the delay created by a trial of nonoperative treatment negatively influences the outcome of a subsequent surgical repair. In March 2020, the COVID-19 pandemic resulted in an involuntary delay in the surgical treatment of rotator cuff disease, creating a natural experiment. The purpose of this study was to evaluate the outcomes and healing of patients who underwent delayed surgical treatment of chronic degenerative RCTs as compared with the nondelayed surgical treatment of RCTs.

The purpose of this study was to determine the association between glenohumeral osteoarthritis (GHOA) and three-dimensional acromial and glenoid morphology.

The purpose of this study was to determine factors associated with early symptomatic acromial and scapular spine fractures in patients who underwent reverse total shoulder arthroplasty (RTSA).

Various surgical strategies have been used for the treatment of sternoclavicular joint instability with variable results. The purpose of this study was to report the clinical results of patients who underwent single-loop allograft reconstruction for sternoclavicular joint instability.

Persistent anterior shoulder pain is an under-reported complication after reverse total shoulder arthroplasty (RTSA). The purpose of this study was to determine the effectiveness of open conjoint tendon release in patients with anterior shoulder pain due to conjoint tendinitis after RTSA.

Revision reverse total shoulder arthroplasty (RTSA) reliably improves shoulder pain and function in patients with failed shoulder arthroplasty, although it can lead to significant postoperative complications. The purpose of this study was to determine the effect of postoperative complications on shoulder pain and function after revision RTSA.

The purpose of this study was to determine the clinical outcomes of arthroscopic labral repair for anteroinferior glenohumeral instability with the use of double-loaded suture anchors.

The purpose of this study was to determine the short-term outcomes for patients who underwent revision surgery for shoulder instability, including both revision arthroscopic repair and Latarjet.

Although surgical shoulder stabilization is a substantial cost nationally within the United States, little information exists to analyze this cost. The purpose of this study was to identify factors associated with variation in direct costs with the arthroscopic treatment of glenohumeral instability.

Proximal humeral bone loss in revision shoulder arthroplasty poses a significant obstacle to achieving stable and reliable fixation of the humeral stem. It is important to identify and classify this bone loss preoperatively, which can range from epiphyseal to substantial diaphyseal bone loss. There are several reconstructive options that can address the varying levels of bone loss, including cemented long-stem fixation, a composite construct using proximal humeral allograft or femoral allograft, proximal humeral endoprosthetic replacement, or total humeral replacement. All of these are viable reconstructive options that have demonstrated adequate to good outcomes.

Snapping scapula syndrome (SSS) can result in crepitus and painful scapulae during motion and may be treated with bursectomy and/or superomedial angle resection. The medial scapula corpus angle (MSCA) measures blade curvature on a transverse plane below the suprascapular fossa and may indicate SSS, yet a large overlapping range in MSCA exists between patients with and without SSS. This study quantified the effects of 3-dimensional scapula orientation in the imaging field, and the resulting variability in scapula type and MSCA.

This study aimed to characterize patient, imaging, and surgical factors associated with re-tear patterns after rotator cuff repair, as well as to identify predictors of type 2 failure in a large patient cohort.

Context: The quality and interprogram variability of publicly available throwing programs have not been assessed.Objective: To (1) identify publicly available interval throwing programs, (2) describe their components and structure, and (3) evaluate their quality, variability, and completeness.Data Sources: Google, Bing, Yahoo; keyword: “interval throwing program.”Study Selection: Baseball-specific publicly available programs.Study Design: Systematic review.Level of Evidence: Level 4.Data Extraction: Independent evaluation by 2 authors using a novel 21-item Quality Assessment Rubric (QAR).Results: Of the 99 included programs, 54% were designed for return from injury/surgery; 42% explicitly stated no expected timeline for completion, and approximately 40% did not provide criteria to initiate the program. Program construction was highly variable. There were broad-ranging shortest (mean: 40±8 ft, range: 20-45 ft) and longest (mean: 150±33 ft, range: 90-250 ft) long toss distances, and variable maximum numbers of mound pitches thrown before returning to game play (range: 40-120, mean: 85). Only 63% of programs provided guidelines for handling setbacks, and standardized warm-ups, arm care, and concomitant training were absent in 32%, 63%, and 47% of programs, respectively. Mean QAR completion rate and QAR item response rate were low (62 ± 4% [range, 24-91%], 62 ± 24% [range, 7-99%], respectively). Finally, only 20 (20%) programs provided at least 1 peer-reviewed reference, most of which were published >10 years ago.Conclusion: Publicly available interval throwing programs are readily available but demonstrate significant interprogram heterogeneity across multiple areas including target audience, program construction, progression, and execution. The quality and consistency of publicly available interval throwing programs is poor at this time, which may limit their utility and effectiveness for baseball players attempting to return to competition. This work identifies a multitude of deficiencies in currently available throwing programs that should be targets of future improvement efforts.

The purpose of this study is to identify and compare demographic, clinical, historical, and intraoperative variables in patients who have received arthroscopic treatment for single vs. multiple anterior shoulder dislocations.

Determining the presence of bacteria in the shoulder prior to shoulder arthroplasty can be challenging especially in the case of revision arthroplasty. An open biopsy provides an opportunity to obtain tissue samples with minimal patient morbidity. The purpose of this study was to characterize the diagnostic utility of an open shoulder biopsy.

Injuries in overhead throwers are common, and there are limited data on return to throw programs in the literature. This article outlines the criteria that baseball players should meet before initiating throwing and further describes an evidence-based throwing program that can be utilized to aid in the rehabilitation of overhead athletes and optimize chances of returning to same level of throwing. These guidelines may be used for rehabilitation after injury is treated operatively or nonoperatively.

Shoulder arthroplasty has advanced considerably in recent decades, but the most recently published long-term outcomes continue to have unacceptably high failure rates, especially in young patients. However, there are several future frontiers that offer the promise of improved implant longevity and function including advances in surgical approach, such as subscapularis-sparing approaches and computer-assisted surgical planning; advances in humeral component fixation, such as stemless, short-stem, and convertible implants; advances in bearing surfaces, such as pyrocarbon, ceramic, and metal-on-metal; and advances in glenoid component geometry and fixation, such as augmented components, in-growth pegs, and inlay glenoid components.

This study compared patients who failed a cartilage restoration procedure and underwent ipsilateral knee arthroplasty with matched control subjects undergoing knee arthroplasty without prior cartilage restoration. Although patients with a failed cartilage procedure derived benefit from knee arthroplasty, their magnitude of improvement and final outcomes scores were lower than the matched control subjects. In this cohort, the cartilage patients also experienced little to no benefit from cartilage restoration, suggesting that unmeasured shared patient characteristics may play a role. This information can be used to counsel this difficult patient population on expected outcomes following arthroplasty procedures. Further research identifying characteristics of responders to treatment remains critical to refine clinical decision-making for this difficult patient group.

Context: The overhand pitch is one of the fastest known human motions and places enormous forces and torques on the upper extremity. Shoulder and elbow pain and injury are common in high-level pitchers. A large body of research has been conducted to understand the pitching motion.Evidence Acquisition: A comprehensive review of the literature was performed to gain a full understanding of all currently available biomechanical and clinical evidence surrounding pitching motion analysis. These motion analysis studies use video motion analysis, electromyography, electromagnetic sensors, and markered motion analysis. This review includes studies performed between 1983 and 2016.Study Design: Clinical review.Level of Evidence: Level 5.Results: The pitching motion is a kinetic chain, in which the force generated by the large muscles of the lower extremity and trunk during the wind-up and stride phases are transferred to the ball through the shoulder and elbow during the cocking and acceleration phases. Numerous kinematic factors have been identified that increase shoulder and elbow torques, which are linked to increased risk for injury.Conclusion: Altered knee flexion at ball release, early trunk rotation, loss of shoulder rotational range of motion, increased elbow flexion at ball release, high pitch velocity, and increased pitcher fatigue may increase shoulder and elbow torques and risk for injury.

One innovation to reduce glenoid loosening in total shoulder arthroplasty (TSA) is a large, central ingrowth peg. However, when bone ingrowth fails to occur, there is often increased bone loss surrounding the central peg which may increase complexity of subsequent revisions. Our goal was to compare outcomes between central ingrowth pegs and non-ingrowth pegged glenoid components during revision to reverse total shoulder arthroplasty (RTSA).

Supplemental Digital Content is available in the text.Surgical management of massive rotator cuff tears is plagued by structural failure rates as high as 94%. Multiple arthroscopic and open techniques have been described, but there is no current gold standard. Biological healing at the tendon footprint is key to avoiding failure. Xenograft patch placement has been described as a possible technique to augment the biology of rotator cuff repair when tendon quality is compromised. The purpose of this article is to describe an all-arthroscopic technique of patch augmentation for repair of massive rotator cuff tears.

Acute proximal humeral fractures are common injuries in elderly patients. These fractures can lead to significant pain and functional loss. Nonoperative treatment offers high rates of satisfactory function and pain relief in the majority of fractures, particularly in elderly patients. Open reduction and internal fixation, closed reduction and percutaneous pinning, and hemiarthroplasty are used for treating displaced proximal humeral fractures, depending on patient and fracture characteristics. Recently, reverse total shoulder arthroplasty has gained popularity for treatment of complex proximal humeral fractures due to a rapid recovery of active elevation and activities of daily living function. Although complications remain a concern, early results of reverse total shoulder arthroplasty for proximal humeral fractures have been promising. Future comparative outcome studies are needed to define the indications for reverse total shoulder arthroplasty instead of nonoperative and other operative options. Optimal treatment of proximal humeral fractures requires clinical judgment based on fracture characteristics, bone quality, patient factors, and surgeon experience with the array of available techniques. [Acute proximal humeral fractures are common injuries in elderly patients. These fractures can lead to significant pain and functional loss. Nonoperative treatment offers high rates of satisfactory function and pain relief in the majority of fractures, particularly in elderly patients. Open reduction and internal fixation, closed reduction and percutaneous pinning, and hemiarthroplasty are used for treating displaced proximal humeral fractures, depending on patient and fracture characteristics. Recently, reverse total shoulder arthroplasty has gained popularity for treatment of complex proximal humeral fractures due to a rapid recovery of active elevation and activities of daily living function. Although complications remain a concern, early results of reverse total shoulder arthroplasty for proximal humeral fractures have been promising. Future comparative outcome studies are needed to define the indications for reverse total shoulder arthroplasty instead of nonoperative and other operative options. Optimal treatment of proximal humeral fractures requires clinical judgment based on fracture characteristics, bone quality, patient factors, and surgeon experience with the array of available techniques. [Orthopedics.2016; 39(3):e465–e473.]

The proximal long head of the biceps tendon and its attachment at the superior glenoid tubercle and labrum are subject to a spectrum of disorders in overhead athletes. Biceps disorders are commonly characterized by intermittent anterior or deep-seated shoulder pain exacerbated by activity. Diagnosis is reached via various physical examination maneuvers; MRI can be uncertain. Nonsteroidal anti-inflammatory medications, targeted ultrasound-guided corticosteroid injections, and supervised physical therapy are the mainstays of nonoperative treatment. Operative treatment, which remains controversial, provides reliable pain relief, restoration of function for activities of daily living, and low complication rates, but return to play can be unpredictable.

Context: Ulnar collateral ligament (UCL) injuries lead to pain and loss of performance in the thrower’s elbow. Ulnar collateral ligament reconstruction (UCLR) is a reliable treatment option for the symptomatic, deficient UCL. Injury to the UCL usually occurs because of chronic accumulation of microtrauma, although acute ruptures occur and an acute-on-chronic presentation is also common.Evidence Acquisition: Computerized databases, references from pertinent articles, and research institutions were searched for all studies using the search terms ulnar collateral ligamentfrom 1970 until 2015.Study Design: Clinical review.Level of Evidence: Level 5.Results: All studies reporting outcomes for UCLR are level 4. Most modern fixation methodologies appear to be biomechanically and clinically equivalent. Viable graft choices include ipsilateral palmaris longus tendon autograft, gracilis or semitendinosus autograft, and allograft. Clinical studies report excellent outcomes of UCLR for both recreational and elite level athletes with regard to return to sport and postoperative performance. Complications, although rare, include graft rerupture or attenuation, ulnar nerve symptoms, stiffness, pain, and/or weakness leading to decreased performance.Conclusion: Injuries to the UCL have become commonplace among pitchers. Nonoperative treatment should be attempted, but the limited studies have not shown promising results. Operative treatment can be performed with several techniques, with retrospective studies showing promising results. Complications include ulnar neuropathy as well as failure to return to sport. Detailed preoperative planning, meticulous surgical technique, and a comprehensive rehabilitation program are essential components to achieving a satisfactory result.

Selection of a treatment course for periprosthetic sepsis about a total hip arthroplasty depends upon many factors. Component retention, irrigation, and debridement, component exchange, infectious disease consultation, and a course of intravenous antibiotics generally are recommended in patients with early postoperative infection or acute hematogenous infection. However, success depends on the infecting organism, and early component removal may be the best option. This paper reviews the most up-to-date recommendations on the management of periprosthetic infections.

Objective: The purpose of this systematic review was to compare activity-based outcomes after microfracture, autologous chondrocyte implantation (ACI), and osteochondral autograft (OAT).Design: Multiple databases were searched with specific inclusion and exclusion criteria for level III and higher studies with activity outcomes after microfracture, OAT, osteochondral allograft, and ACI. Activity-based outcomes included the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner Score, the Cincinnati Knee scores, the International Knee Documentation Committee (IKDC) subjective knee score, the Marx activity score, and/or the rate of return-to-sport.Results: Twenty studies were included (1,375 patients). Although results were heterogeneous, significant advantages were seen for ACI and OAT as compared with microfracture in Tegner scores at 1 year (ACI vs. microfracture, P= 0.0016), IKDC scores at 2 years (ACI vs microfracture, P= 0.046), Lysholm scores at 1 year (OAT vs microfracture, P= 0.032), and Marx scores at 2 years (OAT vs microfracture, P< 0.001). The only score or time point to favor microfracture was Lysholm score at 1 year (ACI vs microfracture, P= 0.037). No other standardized outcome measures or time points were significantly different. Several studies demonstrated significantly earlier return to competition with microfracture. Overall reoperation rates were similar, but of reoperations, a higher proportion of those following ACI were unplanned with the majority of performed for graft delamination or hypertrophy.Conclusions: ACI and OAT may have some benefits over microfracture, although return-to-sport is fastest following microfracture. Heterogeneity in technique, outcome measures, and patient populations hampers systematic comparison within the current literature.

Significant advances have been made in anterior cruciate ligament reconstruction surgical technique. Further progress is being made to improve our ability to replicate anatomy with minimally invasive techniques. Presently, wide intersurgeon variation exists regarding several crucial aspects of the procedure, suggesting that the optimal technique continues to evolve. After reviewing the history of anterior cruciate ligament reconstruction surgical technique and the surgical anatomy, this manuscript outlines the various debated topics in the literature surrounding the method for drilling the femoral tunnel (outside-in vs transtibial vs anteromedial), graft selection and method of fixation as it applies to surgical technique, number of bundles reconstructed (single vs double), and surgical approach (incision vs all-inside). For each, the best available clinical evidence is reviewed to determine advantages and disadvantages. Patient factors that may indicate the use of a certain technique and special considerations such as reconstruction in the skeletally immature are discussed. [ABSTRACT FROM AUTHOR]

Injections of the knee joint and the surrounding structures are one of the most common interventions performed by providers of musculoskeletal care. With appropriate patient selection, injections may provide substantial short-term relief with infrequent complications. Longer-term outcomes, including modification of the underlying disease processes, are debated within the literature. In this review, we provide an overview of injection therapy in and around the knee, with a focus on the indications, complications, pertinent techniques (including preparation, approaches, and aftercare), types of injectables (corticosteroids, viscosupplementation, and platelet-rich plasma), and evidence-based recommendations for roles of injection therapy in both intra- and extra-articular disease processes. [Copyright &y& Elsevier]

Osteogenic sarcoma, also known as osteosarcoma, is a primary malignancy of the bone in which spindle cells produce osteoid. Although rare in the general population, these tumors are the most common primary malignancies of bone and the fifth most common primary malignancy of adolescence. This paper aims to provide a general overview on the presentation, radiographic evaluation, and treatment of osteosarcoma as it presents in the pediatric patient population. Particular focus is placed on the importance of a comprehensive team of physicians, including the pediatric oncologist and orthopedic surgeon, to ensure prompt diagnosis and treatment.

Background: The influence of player workload on hamstring and calf injuries in professional baseball players remains unknown.Hypothesis: Increased workload would significantly increase hamstring and calf strain injury risk.Study Design: Case-control.Level of Evidence: Level 3.Methods: All professional baseball players who sustained a hamstring or calf injury between 2011 and 2017 were identified using the Major League Baseball (MLB) Health and Injury Tracking System (HITS). A separate player usage dataset was used to determine workload. We then compared these variables between player games 2, 6, 12, and >12 weeks before a documented calf strain to player games from a noncalf injury control group. In a paired analysis, we compared the acute workload (2, 6, and 12 weeks) before injury with the injured player’s workload >12 weeks before injury.Results: There were 175 unique calf strains (71% occurred in position players) and 1042 unique hamstring strains (97.8% occurred in position players) documented in the MLB HITS database from 2011 to 2017. In all time periods, position players with fewer days rest, more innings fielded, and more plate appearances were associated with a higher risk of subsequent hamstring and calf strains. Having only 1 day rest was associated with a 2.08-fold increase in percentage of players who sustained a subsequent calf strain compared with those with 4 days rest. Position players with >5 days of rest had a 4.03-fold decrease in percentage of players who sustained a hamstring strain compared with players with 1 day rest. Position players who fielded >9 innings per game had a 2.01-fold increase in percentage of players with a subsequent calf strain and a 3.68-fold increase in percentage of players who sustained a subsequent hamstring strain compared with players who only fielded 1 innings per game.Conclusion: Position players with fewer days rest, more innings fielded, and more plate appearance per game had an increased risk of sustaining a hamstring or calf injury.Clinical Relevance: Increased workload had a direct relationship with risk of hamstring and calf strains in professional baseball players. Teams should consider more days rest for position players to avoid calf injuries.

Historically, imaging osseous detail in three dimensions required a computed tomography (CT) scan with ionizing radiation that poorly visualizes the soft tissues. The purpose of this study was to determine the accuracy and reliability of ultrashort echo time (UTE) magnetic resonance imaging (MRI) in measuring humeral cortical thickness and cancellous density as compared with CT.

The purpose of this study was to determine whether greater tuberosity morphology (1) could be measured reliably on magnetic resonance imaging (MRI), (2) differed between patients with rotator cuff tears (RCT) compared to those without tears or glenohumeral osteoarthritis, or (3) differed between patients with rotator cuff repairs (RCR) that healed and those that did not.

Diabetes mellitus (DM) may be associated with the etiology of rotator cuff disease; however, its effect on healing after surgical rotator cuff repair (RCR) is not well characterized. The purposes of this study are to analyze the association between DM and surgical RCR, the association between DM and revision RCR after RCR, and the association between DM and the cost of RCR.

The etiologies of glenohumeral osteoarthritis (GHOA) and eccentric glenoid wear within GHOA are unknown, but muscular imbalance may play a role. The purpose of the present study was to determine the relationship between deltoid muscle area, GHOA, and eccentric glenoid wear. We hypothesized that patients with GHOA would have overall deltoid atrophy as compared with controls and that increasing posterior deltoid areas would associate with glenoid retroversion in the Walch B-type (eccentric) GHOA group.