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Background: Numerous studies have reported the incidence and outcomes of injuries in the men's and women's National Basketball Association (NBA and WNBA, respectively). Purpose: To synthesize published data regarding the incidence and outcomes of all injuries in the NBA and WNBA in a comprehensive review. Study Design: Systematic review; Level of evidence, 4. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched 3 electronic databases (PubMed, MEDLINE, Embase) for studies of all levels of evidence since 1990 pertaining to injuries sustained by active players in the NBA and WNBA. Studies were excluded if the cohort of interest included ≤3 active players. Results: The initial search of the 3 databases yielded 1253 unique studies, of which 49 met final inclusion criteria for this review. Only 4 studies included athletes in the WNBA. Based on the mean annual incidence, the 5 most common orthopaedic sports injuries sustained in the NBA were concussions (9.5-14.9 per year), fractures of the hand (3.5-5.5 per year), lower extremity stress fractures (4.8 per year), meniscal tears (2.3-3.3 per year), and anterior cruciate ligament tears (1.5-2.6 per year). Cartilage defects treated using microfracture, Achilles tendon ruptures, and anterior cruciate ligament injuries were 3 injuries that led to significant reductions in performance measurements after injury. Conclusion: With advances in sports technology and statistical analysis, there is rapidly growing interest in injuries among professional basketball athletes. High-quality prospective studies are needed to understand the prevalence and effect of injuries on player performance and career length. This information can inform preventative and treatment measures taken by health care providers to protect players and guide safe return to play at a high level. [ABSTRACT FROM AUTHOR]

Background: As the use of biologic therapies for the management of knee pathology continues to expand, it is more likely that patients will turn to the Internet to gather information on this topic. Given the lack of scientific consensus on the use of biologics, care providers must understand what information is available online.Questions/Purposes: The purpose of this study was to evaluate the quality of websites that patients may use to educate themselves on knee biologics.Methods: Websites were identified using search terms relevant to multiple biologic therapies available for knee pathology. Websites were scored based on an author-derived grading rubric, with a total of 25 possible points relating to the role of knee biologics in the diagnosis, evaluation, and treatment of knee pathology. Websites were categorized based on the source (e.g., physician-operated website vs. industry-related website). Reading level was assessed with the Flesch-Kincaid readability test.Results: The initial search yielded 375 results, with 96 websites meeting final inclusion criteria. Mean website score was poor, at 6.01 of the 25 possible points (24.0%). Physician websites were the most common, with 60% of the articles identified. Industry-related websites scored the lowest (mean, 3.2 ± 0.97) while hospital-related websites scored the highest (mean, 8.3 ± 2.93). Overall, websites published from hospitals or orthopedic professional societies had significantly higher scores than other websites. The search term “knee PRP” yielded higher-quality results than “knee platelet rich plasma.” Similarly, “knee BMAC” led to better results than “knee bone marrow aspirate concentrate.” The average reading level was 11.4.Conclusion: Many online resources are available for patients seeking information about knee biologic therapies, but the quality of websites identified was very poor. Patients should be counseled that the information available online for knee biologic therapy is unreliable. Surgeons should play an increased role in providing resources to patients and educating them on biologic options. [ABSTRACT FROM AUTHOR]

Background: A greater emphasis on providing high-value orthopaedic interventions has resulted in increased health economic reporting. The contingent-valuation method (CVM) is used to determine consumer valuation of the benefits provided by healthcare interventions. CVM is an important value-based health economic tool that is underutilized in orthopaedic surgery.Questions/Purposes: The purpose of this study was to (1) identify previously published CVM studies in the orthopaedic literature, (2) assess the methodologies used for CVM research, and (3) understand how CVM has been used in the orthopaedic cost-benefit analysis framework.Methods: A systematic review of the literature using the MEDLINE database was performed to compile CVM studies. Search terms incorporated the phrase willingness to pay (WTP) or willingness to accept (WTA) in combination with orthopaedic clinical key terms. Study methodology was appraised using previously defined empirical and conceptual criteria for CVM studies.Results: Of the 160 studies retrieved, 22 (13.8%) met our inclusion criteria. The economics of joint arthroplasty (n = 6, 27.3%) and non-operative osteoarthritis care (n = 4, 18.2%) were the most common topics. Most studies used CVM for pricing and/or demand forecasting (n = 16, 72.7%); very few studies used CVM for program evaluation (n = 6). WTP was used in all included studies, and one study used both WTP and WTA. Otherwise, there was little consistency among included studies in terms of CVM methodology. Open-ended questioning was used by only ten studies (45.5%), a significant number of studies did not perform a sensitivity analysis (n = 9, 40.9%), and none of the studies accounted for the risk preference of subjects. Only two of the included studies applied CVM within a cost-benefit analysis framework.Conclusion: CVM is not commonly reported in orthopaedic surgery and is seldom used in the context of cost-benefit analysis. There is wide variability in the methods used to perform CVM. We propose that CVM is an appropriate and underappreciated method for understanding the value of orthopaedic interventions. Increased attention should be paid to consumer valuations for orthopaedic interventions. [ABSTRACT FROM AUTHOR]

Background: There is increased interest in understanding the preoperative determinants of postoperative outcomes. Return to play (RTP) and the patient-reported minimal clinically important difference (MCID) are useful measures of postoperative outcomes after anterior cruciate ligament reconstruction (ACLR). Purpose: To define the MCID after ACLR and to investigate the role of preoperative outcome scores for predicting the MCID and RTP after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: There were 294 active athletes enrolled as part of an institutional ACL registry with a minimum 2-year follow-up who were eligible for inclusion. A questionnaire was administered to elicit factors associated with RTP. Patient demographic and clinical data as well as patient-reported outcome measures were captured as part of the registry. Outcome measures included the International Knee Documentation Committee (IKDC) subjective knee evaluation form, Lysholm scale, and 12-Item Short Form Health Survey (SF-12) physical component summary (PCS) and mental component summary (MCS). Preoperative outcome score thresholds predictive of RTP were determined using a receiver operating characteristic (ROC) with area under the curve (AUC) analysis. The MCID was calculated using a distribution-based method. Multivariable logistic models were fitted to identify predictors for achieving the MCID and RTP. Results: At a mean (6SD) follow-up of 3.7 ± 0.7 years, 231 patients were included from a total 294 eligible patients. The mean age and body mass index were 26.7 ± 12.5 years and 23.7 ± 3.2 kg/m[sup 2] respectively. Of the 231 patients, 201 (87.0%) returned to play at a mean time of 10.1 months. Two-year postoperative scores on all measures were significantly increased from preoper-ative scores (IKDC: 50.1 ± 15.6 to 87.4 ± 10.7; Lysholm: 61.2 ± 18.1 to 89.5 ± 10.4; SF-12 PCS: 41.5 ± 9.0 to 54.7 ± 4.6; SF-12 MCS: 53.6 ± 8.1 to 55.7 ± 5.7; P < .001 for all). The corresponding MCID values were 9.0 (IKDC), 10.0 (Lysholm), 5.1 (SF-12 PCS), and 4.3 (SF-12 MCS). Preoperative score thresholds predictive of RTP were the following: IKDC, 60.9; Lysholm, 57.0; SF-12 PCS, 42.3; and SF-12 MCS, 48.3. These thresholds were not independently predictive but achieved significance as part of the multivariable analysis. In the multivariable analysis for RTP, preoperative SF-12 PCS scores above 42.3 (odds ratio [OR], 2.73; 95% CI, 1.09-7.62) and SF-12 MCS scores above 48.3 (OR, 4.41; 95% CI, 1.80-10.98) were predictive for achieving RTP; an ACL allograft (OR, 0.26; 95% CI, 0.06-1.00) was negatively predictive of RTP. In the multivariable analysis for the MCID, patients with higher preoperative scores were less likely to achieve the MCID (P < .0001); however, a higher preoperative SF-12 MCS score was predictive of achieving the MCID on the IKDC form (OR, 1.27; 95% CI, 1.11-1.52) and Lysholm scale (OR, 1.08; 95% CI, 1.00-1.16). Medial meniscal injuries, older age, and white race were also associated with a decreased likelihood for achieving the MCID. Conclusion: Preoperative SF-12 MCS and PCS scores were predictive of RTP after ACLR; patients scoring above 42.3 on the SF-12 PCS and 48.3 on the SF-12 MCS were more likely to achieve RTP. Additionally, we defined the MCID after ACLR and found that higher SF-12 MCS scores were predictive of achieving the MCID on knee-specific questionnaires. [ABSTRACT FROM AUTHOR]

Background: In the past 16 years, the number of prescription opioids sold in the United States, as well as deaths from prescription opioids, has nearly quadrupled. However, the overall amount of pain reported by patients has not changed significantly. Specific information about opioid prescriptions in the perioperative period is lacking. Of the studies that have been published, investigators have shown that the majority of patients have unused postoperative opioid pills. Moreover, patients appear to lack information about disposal of unused opioid pills. Purpose: To compare the number of pills prescribed versus the numbers left unused after outpatient shoulder surgeries at an orthopaedic surgery institution. Study Design: Case series; Level of evidence, 4. Methods: In this prospective, observational study, 100 patients (age >18 years) undergoing outpatient shoulder surgery (rotator cuff repair, labral repair, stabilization/Bankart repair, debridement) were enrolled. Follow-ups were conducted via surveys on postoperative days (PODs) 7, 14, 28, and 90. The primary outcome was the number of unused pills from the originally prescribed medication. Results: For all procedure types, the median (Q1, Q3) number of prescribed pills was 60 (40, 80). On POD 90, patients reported a median (Q1, Q3) of 13 (0, 32) unused pills; patients who underwent rotator cuff repairs had the lowest number of pills remaining (median [Q1, Q3], 0 [0, 16]), whereas patients who had stabilization/Bankart repairs had the highest number of unused pills (median [Q1, Q3], 37 [29, 50]). Patient satisfaction with pain management ranged from an average of 70% to 90%. Only 25 patients received instructions or education about opioid disposal. Conclusion: Most outpatient shoulder surgery patients who underwent certain operations were prescribed more opioid analgesics than they consumed. Patient education regarding the disposal of opioids was lacking. [ABSTRACT FROM AUTHOR]

Background: Proximal fractures of the fifth metatarsal (zone II and III) are common in the elite athlete and can be difficult to treat because of a tendency toward delayed union, nonunion, or refracture. The purpose of this case series was to report our experience in treating 10 NBA players, determine the healing rate, return to play, refracture rate, and role of foot type in these athletes. Methods: The records of 10 professional basketball players were retrospectively reviewed. Seven athletes underwent standard percutaneous internal fixation with bone marrow aspirate concentrate (BMAC) whereas the other 3 had open bone grafting primarily in addition to fixation and BMAC. Radiographic features evaluated included fourth-fifth intermetatarsal, fifth metatarsal lateral deviation, calcaneal pitch, and metatarsus adductus angles. Results: Radiographic healing was observed at an overall average of 7.5 weeks and return to play was 9.8 weeks. Three athletes experienced refractures. There were no significant differences in clinical features or radiographic measurements except that the refracture group had the highest metatatarsus adductus angles. Most athletes were pes planus and 9 of 10 had a bony prominence under the fifth metatarsal styloid. Conclusion: This is the largest published series of operatively treated professional basketball players who exemplify a specific patient population at high risk for fifth metatarsal fracture. These players were large and possessed a unique foot type that seemed to be associated with increased risk of fifth metatarsal fracture and refracture. This foot type had forefoot metatarsus adductus and a fifth metatarsal that was curved with a prominent base. We continue to use standard internal fixation with bone marrow aspirate but advocate additional prophylactic open bone grafting in patients with high fourth-to-fifth intermetatarsal, fifth metatarsal lateral deviation, and metatarsus adductus angles as well as prominent fifth metatarsal styloids in order to improve fracture healing and potentially decrease the risk of refracture. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

The article presents a systematic review concerning cost effectiveness analyses (CEA) in orthopedic sports medicine in the U.S. It states that the literature was reviewed to grade CEA studies in sports medicine based in the U.S. and compile findings. The predictors of high-quality CEAs was analyzed with one-sided Fisher exact tests. It commented on the paucity of studies with evidence focusing on few procedures, and considers the usefulness of the Quality of Health Economic Studies instrument.

Injury to the superior glenoid labrum is increasingly recognized as a significant source of shoulder pain and dysfunction in the throwing athlete. Several theories have been proposed to explain the pathogenesis of superior labral anterior posterior (SLAP) tears. The clinical examination of the superior labrum–biceps tendon complex remains challenging because of a high association of other shoulder injuries in overhead athletes. Many physical examination findings have high sensitivity and low specificity. Advances in soft tissue imaging such as magnetic resonance arthrography allow for improved detection of labrum and biceps tendon lesions, although correlation with history and physical examination is critical to identify symptomatic lesions. Proper treatment of throwers with SLAP tears requires a thorough understanding of the altered biomechanics and the indications for nonoperative management and arthroscopic treatment of these lesions. [ABSTRACT FROM PUBLISHER]

Background: Rugby union will enter the Olympic arena as Rugby Sevens in 2016.Purpose: To investigate the injury rate, injury type, and nature of injuries sustained in an amateur American rugby union sevens tournament series.Study Design: Descriptive epidemiology study.Methods: The rate, demographics, and characteristics of injury were evaluated in 1536 rugby union sevens players, from 128 sides, competing in 4 amateur 1-day tournaments in a USA Rugby local area rugby union.Results: Forty-eight injuries occurred over 4 tournaments, for an injury rate of 55.4 injuries per 1000 playing hours. Head and neck injuries were most common (33.3% of injuries), followed by upper extremity (31.3%), trunk (18.8%), lower extremity (14.6%), and physiologic injuries (2.1%). The most common type of injury was ligament sprain (25.0%); followed by concussion (14.6%), hematoma/contusion (12.5%), muscle strain (10.4%), and abrasion (8.3%). Tackling was the most common mechanism of injury (74.5%). Males were injured at a significantly higher rate than females (RR, 7.5, P < .01), but no significant difference was observed based on player position (P = .08).Conclusion: Injuries are common among American amateur rugby athletes, with a substantial proportion involving the head and neck region.Clinical Relevance: Understanding injury patterns in an American rugby union will be important for formulating future injury prevention, assessment, and treatment protocols. [ABSTRACT FROM PUBLISHER]

Background: Since 1963, the Orthopaedic In-Training Examination (OITE) has been administered to orthopaedic residents to assess resident knowledge and measure the quality of teaching within individual programs. The OITE has evolved dramatically over the years and now maintains a standardized format consisting of 275 questions divided among 12 sections.Purpose: To provide a detailed analysis of the OITE sports medicine section to identify patterns in question content, recommended references, and resident performance.Study Design: Cross-sectional study.Methods: All OITE sports medicine questions from 2005 to 2009 were analyzed, and the following data were recorded: resident performance scores, tested topics, type of imaging modalities, tested treatment modalities, taxonomy classification, and recommended references.Results: From 2005 to 2009, the sports medicine section composed 7.8% of the OITE. Mean resident performance on the entire OITE as well as on the sports medicine section improved during each year of training. Imaging modalities typically involved questions on radiographs and magnetic resonance imaging and constituted 27.4% of the OITE sports medicine section. Treatment modalities involved 36.8% of the OITE sports medicine section questions, including most treatment questions relating to ligament reconstruction or rehabilitation. The authors’ assessment of taxonomy classification showed that recall-type questions were most common; however, mean resident performance was minimally affected by type of taxonomy question. Finally, there were trends noted in recommended references; namely, the American Journal of Sports Medicine and Orthopaedic Knowledge Update Sports Medicine were the most commonly and consistently cited journal and review book, respectively.Conclusion: The current study provides some unique information relating to content, recommended references, and resident performance on the OITE sports medicine section. It is hoped this information will provide orthopaedic trainees, orthopaedic residency programs, and the American Academy of Orthopaedic Surgeons Evaluation Committee valuable information relating to improving resident knowledge and performance and optimizing sports medicine educational curricula. [ABSTRACT FROM AUTHOR]

Background: Injury patterns in elite athletes over long periods continue to evolve. The goal of this study was to review of the injuries and medical conditions afflicting athletes competing in the National Basketball Association (NBA) over a 17-year period.Design: Descriptive epidemiological study.Methods: Injuries and player demographic information were reported by each team's athletic trainer. Criteria for reportable injuries were those that resulted in (1) physician referral, (2) a practice or game being missed, or (3) emergency care. The demographics, frequency of injury, time lost, and game exposures were tabulated, and game-related injury rates and 95% confidence intervals were calculated.Results: A total of 1094 players appeared in the database 3843 times (3.3 ± 2.6 seasons). Lateral ankle sprains were the most frequent orthopaedic injury (n, 1658; 13.2%), followed by patellofemoral inflammation (n, 1493; 11.9%), lumbar strains (n, 999; 7.9%), and hamstring strains (n, 413; 3.3%). The most games missed were related to patellofemoral inflammation (n, 10 370; 17.5%), lateral ankle sprains (n, 5223; 8.8%), knee sprains (n, 4369; 7.4%), and lumbar strains (n, 3933; 6.6%). No correlations were found between injury rate and player demographics, including age, height, weight, and NBA experience.Conclusion: Professional athletes in the NBA experience a high rate of game-related injuries. Patellofemoral inflammation is the most significant problem in terms of days lost in competition, whereas ankle sprains are the most common injury. True ligamentous injuries of the knee were surprisingly rare. Importantly, player demographics were not correlated with injury rates. Further investigation is necessary regarding the consequences and sport-specific treatment of various injuries in NBA players.Clinical Relevance: Knowledge of these injury patterns can help to guide treatments and provide more accurate guidelines for an athlete to return to play. [ABSTRACT FROM AUTHOR]

Background: Ulnar collateral ligament reconstruction techniques have afforded baseball players up to a reported 90% return to prior or higher level of play. A subpopulation exists with less impressive clinical outcomes potentially related to the presence of a concomitant flexor-pronator mass injury. Hypothesis/Purpose: Combined flexor-pronator and ulnar collateral ligament injuries occur in older players, and results in this group are inferior to those reported for isolated ulnar collateral ligament reconstructions. Study Design: Case Series; Level of evidence, 4. Methods: All baseball players who had ulnar collateral ligament reconstructions by 1 surgeon over a 6-year period were identified, and the authors studied those treated for a combined flexor-pronator and ulnar collateral ligament injury. The ulnar collateral ligament reconstruction was accomplished using the docking technique, and the flexor-pronator injury was treated with debridement if tendinotic or reattachment if torn. A 2-sample t test was conducted to evaluate the likelihood of developing the combined flexor-pronator/ulnar collateral ligament compared with ulnar collateral ligament injury based on age, while a Pearson χ2 test was used to evaluate the likelihood of a patient being ⩾30 years of age in the combined flexor-pronator/ulnar collateral ligament versus ulnar collateral ligament groups. Outcome was assessed using a modified Conway classification. Results: A total of 187 male baseball players between 14 and 42 years of age (mean, 20.7 years) had an ulnar collateral ligament reconstruction by 1 surgeon. Eight (4%) of 187 baseball players were treated for the combined flexor-pronator/ulnar collateral ligament injury. There was a statistically significant difference in age between the ulnar collateral ligament group (20.1 years) and the flexor-pronator/ulnar collateral ligament group (33.4 years) (P < .001). Age ⩾30 years was a statistically significant age limit to predict the presence of a combined flexor-pronator/ulnar collateral ligament injury (88%) compared with an isolated ulnar collateral ligament injury (1%) (P<.001). Outcomes were 1 excellent (12.5%), 2 fair (25%), and 5 poor (62.5%). Conclusion: Combined fflexor-pronator and ulnar collateral ligament injuries in baseball players may portend a worse prognosis, with a 12.5% return to prior level of play. Older age (⩾30 years) is a risk factor in the development of this combined injury. When combined flexor-pronator/ulnar collateral ligament injury is suspected preoperatively, patients should be counseled on expected outcomes appropriately. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic treatment has evolved to become the primary surgical option in the management of anterior shoulder instability as studies show comparable outcomes between open and arthroscopic techniques. Objective: To evaluate prospectively the results of our institutional database for arthroscopic Bankart repairs at a minimum 2-year follow-up for patients with anterior instability treated with suture anchors. Study Design: Case series; Level of evidence, 4. Methods: Eighty-three consecutive patients underwent arthroscopic Bankart repair with suture anchors. The mean age at the time of surgery was 33 years (range, 15-55 years). At an average follow-up of 33 months (range, 24-49 months), 73 patients (61 males, 12 females) were assessed with outcomes scores including the American Shoulder and Elbow Surgeons, L'Insalata, and visual analog scores. The rate of recurrent instability, range of motion, and risk factors for postoperative recurrence were evaluated. Results: Thirteen patients (18%) suffered a recurrence after surgery. Seven patients (10%) had a subsequent dislocation and 6 (8%) a subluxation event or apprehension. Six of the 13 had a traumatic event that resulted in recurrent episodes of instability. Revision surgery was needed for 2 patients (3%) for instability and 2 for postoperative shoulder stiffness. On average there was no significant loss of external rotation postoperatively (average, 71° pre- and postoperatively). The American Shoulder and Elbow Surgeons and L'Insalata scores improved from 75.4 to 94.9 and 66.5 to 90.9, respectively (P\.0001). The visual analog score improved from 2.4 to 0.4 (P<.001). Patient age under 25, ligamentous laxity, and the presence of a large (>250 mm³) Hill-Sachs lesion were associated with recurrence (P<.05). Patients under age 20 had a 37.5% recurrence rate. Conclusion: In the arthroscopic treatment of anterior instability, identification of risk factors for recurrence allows for appropriate patient counseling and consideration of open stabilization. In our series, patients under age 25, with ligamentous laxity, and with a large (>250 mm³) Hill-Sachs lesion were at the greatest risk of recurrence. [ABSTRACT FROM AUTHOR]

Background: Knee joint infection is a potentially devastating complication of anterior cruciate ligament (ACL) reconstruction. There is a theoretical increased risk of infection with the use of allograft material. Hypothesis: An allograft ACL reconstruction predisposes patients to a higher risk of bacterial infection. Study Design: Cohort Study; Level of evidence, 3. Methods: All primary ACL reconstructions performed at our institution between January 2002 and December 2006 were reviewed; 3126 total procedures were identified. A retrospective medical record review was performed to determine the incidence of infection, offending organism, time after surgery until presentation, infection treatment, and graft salvage as an outcome of graft choice. Results: Of the 3126 ACL reconstructions, 1777 autografts and 1349 allografts were performed. Eighteen infections were identified (0.58%). Infections occurred in 6 of the 1349 allografts (0.44%), 7 of the 1430 bone-patellar tendon-bone (BPTB) autografts (0.49%), and 5 of the 347 hamstring autografts (1.44%). Five grafts were removed because of graft incompetence or loosening: 3 hamstring tendon, 1 BPTB, and 1 allograft. The most common organism isolated was Staphylococcus aureus. Hamstring tendon autograft had an increased incidence of infection compared with both BPTB autograft and allograft (P<.05), with a trend toward a more common need for graft removal (P = .09). Allograft reconstructions were equally likely to have graft salvage as autograft reconstructions. Conclusion: Hamstring tendon autografts have a higher incidence of infection than BPTB autografts or allografts. The use of allograft material in ACL reconstructions does not increase the risk of infection or the need for graft removal with infection. [ABSTRACT FROM AUTHOR]

Background: Recent studies have demonstrated predictable healing after arthroscopic rotator cuff repair at a single time point, but few studies have evaluated tendon healing over time. Hypothesis: Rotator cuff tears that are intact on ultrasound at 1 time point will remain intact, and clinical results will improve regardless of healing status. Study Design: Cohort study; Level of evidence, 3. Methods: The Arthroscopic Rotator Cuff Registry was established to determine the effectiveness of arthroscopic rotator cuff repair with clinical outcomes using the American Shoulder and Elbow Surgeons score and ultrasound at 1 and 2 years, postoperatively. Patients were assigned to 1 of 3 groups based on ultrasound appearance: group 1, rotator cuff tendon intact at 1 and 2 years (n = 63); group 2, rotator cuff tendon defect at 1 and 2 years (n = 23); group 3, rotator cuff tendon defect at 1 year but no defect at 2 years (n = 7). Results: The ultrasound appearance was consistent at 1 and 2 years for 86 of the 93 patients (92.5%). The patients in group 1 had a significantly lower mean age (57.8 ± 9.8 years) than the patients of group 2 (63.6 ± 8.6 years; P = .04). Group 2 had a significantly greater rotator cuff tear size (4.36 ± 1.6 cm) than group 1 (2.84 ± 1.1 cm; P = .00025). Each group had a significant improvement in American Shoulder and Elbow Surgeons scores from baseline to 2-year follow-up. Conclusion: All intact rotator cuff tendons at 1 year remained intact at 2 years. A small group of patients with postoperative imaging did not appear healed by ultrasound at 1 year but did so at 2 years. Patients demonstrated improvement in American Shoulder and Elbow Surgeons shoulder scores, range of motion, and strength, regardless of tendon healing status on ultrasound. [ABSTRACT FROM AUTHOR]

Background: The medial collateral ligament is a broad ligament that functions as the primary stabilizer against valgus knee stress, particularly at 30° of flexion. Hypothesis: A double-bundle reconstruction technique that better restores the native medial collateral ligament anatomy will restore valgus and external rotation stability to a medial collateral ligament-deficient knee. Study Design: Controlled laboratory study. Methods: Seven fresh-frozen cadaveric knees were studied. A surgical navigation system was used to determine valgus opening and external rotation at 0° and 30° with a 9.8-N·m valgus stress applied to the tibia graft isometry at multiple points on the tibia and femur. Intact and disrupted medial collateral ligament knees were used as controls. Four repair techniques were tested: Bosworth, modified Bosworth, anatomical single bundle, and anatomical double bundle. Results: Complete sectioning of the medial collateral ligament resulted in an increase in valgus opening of 5° at 0° and 7.7° at 30°. External rotation increased 4.6° at 0° and 9.7° at 30°. Single-bundle techniques (Bosworth, anatomical single bundle) did not restore valgus laxity at 0° or 30°; the anatomical single bundle did not restore external rotation at 0°. Double-bundle techniques (modified Bosworth, anatomical double bundle) restored valgus laxity and external rotation to the native knee conditions at 0° and 30°. At 30°, the modified Bosworth was 0.3° tighter and the anatomical double bundle 0.2° tighter than was the intact knee. The center of the medial collateral ligament origin on the femur to the proximal insertion of the superficial medial collateral ligament resulted in the most isometric graft position. Conclusion: Medial collateral ligament reconstruction configurations that use a double-bundle reconstruction better resist valgus and external rotations in response to valgus stress than do single-bundle techniques. Clinical Relevance: Although the medial collateral ligament often heals without surgical intervention, surgical reconstruction is occasionally necessary in grade III medial collateral ligament and combined ligamentous injuries to the knee. Double-bundle reconstruction of the medial collateral ligament better resists valgus forces across the knee and may allow for better surgical outcome after medial collateral ligament reconstruction. [ABSTRACT FROM AUTHOR]

There are several techniques that have been described for distal biceps tendon repair but there is still controversy regarding the optimal technique. Our hypothesis is that the single-incision technique will have a similar complication rate and functionally equivalent restoration of function compared with the two-incision approach. A retrospective review of consecutive biceps tendon repairs was performed at one institution over a 5-year period. Thirty-six patients met the inclusion criteria and 26 were available for follow-up including subjective assessment, physical examination, and strength testing. Patients were divided into two groups based on the surgical approach utilized: 12 patients underwent single-incision repair and 14 had a two-incision repair. The average follow-up was 33 months (minimum 13; maximum 75). There were no statistically significant differences in regards to flexion strength or endurance, supination strength or endurance, or complication rates between the two techniques. In conclusion, both surgical techniques led to adequate restoration of strength with a low complication rate. Both techniques are safe to perform and should be guided by surgeon comfort with the approach. [ABSTRACT FROM AUTHOR]

Fifty-seven consecutive patients (58 knees) with an acute, isolated, posterior cruciate ligament (PCL) injury were treated nonoperatively. Clinical, radiographic, and functional assessment was performed at a mean follow-up of 6.9 years (range 2 to 19.3 years) after the initial diagnosis. At the time of initial documentation of the injury, the posterior drawer test was grade A in 17 knees and grade B in 41 knees. The mean preinjury Tegner activity level was 7 (range 4 to 10). At latest follow-up, 38 knees had no pain, 14 had mild pain, and 6 had moderate pain on exertion. Fifty-four knees had no swelling, 3 had mild, intermittent swelling, and 1 had a moderate swelling on exertion. The posterior drawer test was grade A in 14 knees and grade B in 44 knees. The mean Lysholm-II knee score was 85.2 points (range 51 to 100 points) and the mean Tegner activity level was 6.6 (range 3 to 10). Based on Lysholm-II knee scoring system, the results were excellent in 23 knees (40%), good in 30 knees (52%), fair in 2 knees (3%), and poor in 3 knees (5%). No statistically significant correlation ( p = 0.097) was seen between the grade of PCL laxity and Lysholm-II knee score. Plain radiographs showed mild (grade I) medial compartment osteoarthritis (OA) in 7 knees, and moderate (grade II) medial compartment OA in 3 knees. Mild patellofemoral OA was seen in 4 knees. We believe that most patients with acute, isolated PCL injuries do well with nonoperative treatment at a mean follow-up of 6.9 years. The level of evidence for this retrospective cohort study is level III. [ABSTRACT FROM AUTHOR]

Background: Rotator cuff tears, Bankart lesions, and superior labral anterior posterior lesions commonly occur in isolation, but there is a subgroup of patients who experience combined injuries. Prior studies have excluded such patients as confounding groups. Hypothesis: In patients with combined lesions of the labrum and rotator cuff, arthroscopic repair of both lesions will restore range of motion and stability and provide good clinical results. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively evaluated the clinical outcomes of a series of patients with combined rotator cuff and labral (Bankart or superior labral anterior posterior) lesions treated arthroscopically. Results: Thirty patients (average age, 47.8 years) with combined rotator cuff and labral lesions were evaluated at a mean follow-up of 2.7 years (range, 24-54 months). Sixteen patients had Bankart lesions and 14 patients had SLAP lesions. Significant improvements in forward flexion (20.5°, P = .005), external rotation (9.0°, P = .008), and internal rotation (2 vertebral levels, P = .016) were observed. The mean L'lnsalata and American Society of Shoulder and Elbow Surgeons scores for all patients were 92.9 and 94.3, respectively. Twenty-seven (90%) patients reported satisfaction as good to excellent, and 23 of 30 (77%) returned to their preinjury level of athletics. Two patients suffered recurrent rotator cuff tears. Conclusion: In patients with rotator cuff and labral lesions, arthroscopic treatment of both lesions yields good clinical outcomes, restoration of motion, and a high degree of patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: The treatment of type II superior labral anterior posterior (SLAP) lesions remains controversial. Many surgeons are reluctant to combine a SLAP repair with an acromioplasty for fear of postoperative shoulder stiffness and a poor clinical outcome. Hypothesis: A SLAP repair and an acromioplasty done concomitantly may yield acceptable outcomes. Study Design: Case series; Level of evidence, 4. Methods: We compared the clinical results of 50 patients who had either an isolated type II SLAP repair (SLAP group, 34 patients) or a combined type II SLAP repair and acromioplasty (combined group, 16 patients). Patients were excluded for full- thickness rotator cuff tears or instability. All patients were evaluated with the L'lnsalata Functional Shoulder Rating Questionnaire, with the American Shoulder and Elbow Surgeons (ASES) questionnaire, and by subjective evaluation. Results: At an average of 3.4 years postoperatively, the L'lnsalata and ASES scores were similar for the 2 groups: 87.1 and 85.8 for the SLAP group and 85.1 and 86.5 for the combined group, respectively (P> .05). Subjectively, only 65% of the patients in the SLAP group reported a ‘good’ or ‘excellent’ satisfaction with the surgery, compared with an 81 % ‘good’ or ‘excellent’ satisfaction rating among the patients in the combined group. Seven patients (21%) in the SLAP group had postoperative clinical impingement, compared with no patients (0%) in the combined group (P < .03). Conclusions: According to our data, these 2 procedures done concomitantly may yield acceptable outcomes. Our findings indicated that a combined type II SLAP repair and acromioplasty had no negative effect clinically and, furthermore, appeared to prevent residual clinical impingement. [ABSTRACT FROM AUTHOR]

The article presents information on aneurysms of the axillary artery and occlusions of the humeral circumflex arteries in elite baseball pitchers. A case of a 29-year-old, left-hand-dominant, major league baseball relief pitcher is discussed. He was referred to the team physician after complaints of left hand coolness and numbness in the index and ring finger after pitching an inning of relief in a spring training game. Physical examination found the left hand of the pitcher cyanotic and cool to touch. The player went through surgery. It recommends that the team physician of throwing athletes should be vigilant for signs and symptoms of upper extremity embolism that can be caused by an axillary artery aneurysm.

Background: It has been assumed that a robust vascular response at the tendon to bone interface during rotator cuff repairs is an integral part to the healing process. There are few studies that have explored this in an in-vivo prospective fashion. Purpose: To prospectively characterize vascular and anatomical patterns in repaired rotator cuff tendons using Power Doppler sonography in a double-blinded fashion. Study Design: Case control study; Level of evidence, 3. Methods: Fifty patients undergoing rotator cuff repair were enrolled: 28 mini-open, 14 open, and 8 arthroscopic repairs; 20 patients were controls. Patients underwent Power Doppler sonography at 6 weeks, 3 months, and 6 months postoperatively. Power Doppler sonography analysis examined 6 areas of the rotator cuff repair: discretely marginated intrasubstance, partial-thickness defects, full-thickness defects, focal thinning of repair, presence of bursal or joint fluid, and location of anchors. A subjective scoring system assessed blood flow in each region. Results: There was a predictable, significant decrease in vascular scores after rotator cuff repair over time. The mean vascular score was 11.6 at 6 weeks, 8.3 at 3 months, 7.0 at 6 months, and 2.4 for controls. There was a significant difference (P < .05) in vascular recruitment scores between each time period, with the most robust flow at the peritendinous region. The lowest vascular score was at the anchor site or cancellous trough. Forty-eight percent of the patients had a rotator cuff repair defect postoperatively. These findings did not correlate with functional assessment and outcome at 6 months. There was no significant difference in vascular scores between the defect and no-defect groups. Mean University of California, Los Angeles; L'lnsalata; and American Shoulder and Elbow Surgeons scores at 6 months were 28.6, 86.3, and 81.5, respectively. Thirty-three percent of asymptomatic controls had a rotator cuff tear that averaged 7.6 × 7.1 mm. Conclusion: The robust vascular response dropped with time, which is not seen in asymptomatic shoulders. Nearly half of the patients demonstrated persistent rotator cuff defects after rotator cuff repair that did not correlate with functional outcome and physical findings at 6 months. [ABSTRACT FROM AUTHOR]

Background: Chronic lateral epicondylitis has been treated with various surgical procedures with varying and often less-than- satisfactory outcomes. Hypothesis: The use of suture anchor repair of the extensor carpi radialis brevis to the lateral epicondyle in the treatment of chronic lateral epicondylitis will result in a more anatomical repair, with resultant improvements in strength, pain, and return to previous sport. Study Design: Case series; Level of evidence, 4. Methods: A total of 20 patients (22 elbows) were treated surgically and were observed for a minimum of 2 years. All patients had debridement of the degenerative tissue, followed by repair of the extensor carpi radialis brevis to the lateral epicondyle with a suture anchor. The average time to follow-up was 4.2 years (range, 2.2-9.5 years). All patients completed a Disabilities of the Arm, Shoulder, and Hand questionnaire to assess residual disability, and 16 patients underwent a physical examination. The objective evaluation included the assessment of range of motion, grip strength, and pinch strength. Pain was assessed preoperatively and postoperatively using a visual analog pain scale. Patients were also questioned with regard to a return to their previous level of activities. Results: The grip and pinch strengths achieved for the operative extremity were 110% and 106%, respectively, of the nonoperative limb. The 16 patients who underwent a physical examination had achieved full range of motion, with 15 (94%) returning to their previous level of activity at an average time of 4.1 months. The mean preoperative pain score was 8.1 (range, 4.0-10.0), whereas the mean postoperative pain score was 0.41 (range, 0-1.5), indicating significant pain relief (P < .001). The Disabilities of the Arm, Shoulder, and Hand scores demonstrated only mild residual disability (mean, 6.6) at follow-up. Conclusion: The use of a suture anchor to repair the extensor carpi radialis brevis to the epicondyle after debridement was a satisfactory procedure for recalcitrant lateral epicondylitis with regard to strength, return to previous activities, and pain relief. [ABSTRACT FROM AUTHOR]

The effect of iliotibial band "lateral sling" augmentation on long-term outcome in ACL reconstruction using free autogenous central-third patellar tendon was evaluated retrospectively. Eighty reconstructions were reviewed; the minimum followup was 2 years and the average was 4 years. Sixty percent of the procedures involved supplementation with a lateral sling. By both clinical evaluation and KT-1000 measurement, there were no differences in the results of patients with lateral sling augmentation and those without it. In addition, 40% of patients had chronic pain and/or swelling related to the lateral sling. We do not currently recommend the routine use of a lateral sling augmentation for ACL reconstruc tion using central-third patellar tendon. [ABSTRACT FROM PUBLISHER]

The biologic fixation (bone ingrowth) of three prosthetic ligament devices (bovine xenograft Xenotech Labora tories, Inc., Irvine, CA; Gore-Tex, W. L. Gore and As sociates, Flagstaff, AZ; and knitted dacron, Stryker, Kalamazoo, MI) and one ligament augmentation device (LAD, braided polypropylene, 3M, St. Paul, MN) were evaluated in vivo. The devices were placed unstressed, in an extraarticular location in the cortical-cancellous bone of the proximal femur and humerus of dogs. Six months following implantation tissue ingrowth was eval uated using high resolution radiography, routine histol ogy, scanning electron microscopy, and biomechanical tensile tests to measure the ultimate (maximum) pull- out strength of the devices.The knitted dacron and Gore-Tex prosthesis showed marked ingrowth of trabecular bone into the interstices of the device with evidence of bone growth around individual fibers of the prosthesis. The bovine xenograft demonstrated bone immediately adjacent to the mate rial with evidence of spicular ingrowth of bone into the natural clefts of the prosthesis. The LAD showed no evidence of bone ingrowth and demonstrated a fibrous tissue interface between the prosthesis and surround ing trabecular bone.Six months following implantation the pull-out strengths of the devices were as follows: knitted dac ron, 445.7 ± 151.ON; Gore-Tex, 438.1 ± 131.94N; bovine xenograft, 332.8 ± 64.2N; and LAD, 78.4 ± 47.9N. Statistical analysis revealed no significant differ ence between the pull-out strengths of the knitted dacron, Gore-Tex, and bovine xenograft. While the pull- out strength of the LAD was significantly lower (P < 0.01) than the other devices it should be noted that this device was designed as a temporary augmentation for biological grafts and as such permanent biological fix ation through bone ingrowth is neither required nor desired. The Gore-Tex, LAD, and bovine xenograft devices all failed by pulling out of the bone tunnel, while all the dacron grafts failed by separation of the dacron outer sleeve of the prosthesis from its inner dacron reinforcement. This rupture occurred at the entrance of the graft into the bone tunnel. [ABSTRACT FROM PUBLISHER]

Describes a case of partial detachment of the deltoid muscle without concomitant rotator cuff injury in which the mechanism of injury may be associated with fast-bowling arm movements involved in the sport of cricket. Case report; Discussion on the case.