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Background: Chronic attritional midsubstance capsular tears arising from repetitive throwing stress are a rare but important source of pain and dysfunction in elite baseball players; however, little is known regarding outcomes after arthroscopic capsular repair., Purpose: To evaluate the patient-reported outcomes and return-to-sport (RTS) rates after arthroscopic capsular repair in elite baseball players., Study Design: Case series; Level of evidence, 4., Methods: We identified 11 elite-level baseball players who were treated with arthroscopic repair for a midsubstance glenohumeral capsular tear by a single surgeon with a uniform approach and a standardized postoperative protocol between 2012 and 2019. All players had at least 2 years of follow-up data. Demographic data and concomitant surgical procedures were recorded. Preoperative and postoperative Kerlan-Jobe Orthopaedic Clinic (KJOC) scores and Single Assessment Numeric Evaluation (SANE) scores were collected in a subset of the cohort, and statistical comparisons were made. A telephone survey was conducted to determine the patients' RTS level and outcome scores. Statistical comparisons between preoperative and postoperative outcomes scores were made using t tests., Results: Eight major league players, 1 minor league player, and 2 collegiate players were included. There were 9 pitchers, 1 catcher, and 1 outfielder. All patients had debridement of the posterosuperior labrum and rotator cuff. Two pitchers underwent a rotator cuff repair, and 1 outfielder underwent a posterior labral repair. The mean age at the time of surgery was 26.9 years (range, 20-34 years), with a mean follow-up of 3.5 years (range, 2.6-5.9 years). There were significant preoperative versus postoperative improvements in the mean KJOC (20.6 vs 89.8; P = .0002) and SANE (28.3 vs 86.7; P = .001) scores. All patients reported a high degree of satisfaction. At a mean of 16.3 months (range, 6.5-25.4 months), 10 of 11 (90.1%) players met the Conway-Jobe good or excellent criteria for RTS., Conclusion: Arthroscopic capsular repair provided significant improvements in functional outcomes in elite baseball players, high levels of patient satisfaction, and high levels of RTS., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: W.J.U. has received grant support from Arthrex; education payments from Arthrex and Smith & Nephew; and hospitality payments from Gemini Medical and DePuy Synthes. N.S.E. has received education payments from Goode Surgical and Micromed; and speaking fees and royalties from Arthrex. A.C. has received grant support from Arthrex; education payments from Smith & Nephew; and hospitality payments from Stryker. O.L. has received education payments from Micromed; consulting fees and speaking fees from Arthrex; and royalties from Linvatec. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2023.)

In 1979, George A. Albright, MD (1931-2020) published a controversial editorial in Anesthesiology that raised the question of bupivacaine cardiotoxicity. In it, he presented several cases of rapid cardiovascular collapse after administration of the highly lipophilic local anesthetic and called for further investigation. Although the scientific community initially resisted Dr Albright's idea, his editorial would ultimately lead to several important advancements in anesthesiology. In 1983, the US Food and Drug Administration issued a black box warning that recommended against the use of 0.75% bupivacaine in obstetric anesthesia. This warning would remain in place until 1999. In addition, Dr Albright's article led to the following changes: laboratory research that proved the cardiotoxicity of bupivacaine; the development of safer, stereoselective agents like ropivacaine; and the acceptance of lipid emulsion as a treatment for local anesthetic toxicity. In this article, C. Philip Larson, Jr, MDCM, Editor-in-Chief of Anesthesiology at the time of publication of Albright's manuscript, provides a unique perspective on the bupivacaine story., Competing Interests: Conflicts of Interest: See Disclosures at the end of the article., (Copyright © 2022 International Anesthesia Research Society.)

Background: Graft-tunnel mismatch is an avoidable complication in anterior cruciate ligament (ACL) reconstruction. Patient height and sex may be predictors of patellar tendon length (PTL) and intra-articular ACL length (IAL). Understanding these relationships may assist in reducing graft-tunnel mismatch during ACL reconstruction with bone-patellar tendon-bone (BTB) autograft., Purpose: To determine the association of patient height and sex with PTL and IAL., Study Design: Cross-sectional study; Level of evidence, 3., Methods: Magnetic resonance imaging (MRI) studies were obtained on the healthy knees of 100 male and 100 female patients. Patients with prior surgery, open physes, significant degenerative changes, ACL rupture, or extensor mechanism injury were excluded. Three independent readers measured PTL, IAL, and Caton-Deschamps Index (CDI) on MRI. Bivariate and linear regression analysis was performed to detect the association of anthropometric data with anatomic parameters measured on MRI studies., Results: The mean age and body mass index were not significantly different between the male and female patients; however, male patients were significantly taller than female patients (1.75 vs 1.72 m, respectively; P < .001). There was a substantial agreement between the 3 readers for all parameters (κ > 0.75). Overall, female patients had significantly longer PTL (47.38 vs 43.92 mm), higher CDI (1.146 vs 1.071), and shorter IAL (33.05 vs 34.39 mm) ( P < .001 for all). Results of the linear regression analysis demonstrated that both height and female sex were predictive of longer PTL. Further, height was independently predictive of IAL but sex was not., Conclusion: PTL was correlated more with patient sex than height. IAL was also correlated with patient sex. Longer BTB grafts are expected to be harvested in female patients compared with male patients of the same height despite shorter IAL. These associations should be considered during BTB ACL reconstruction to minimize graft-tunnel mismatch., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.L.C. has received education payments from Arthrex and Micromed and grants from Arthrex. D.Y. has received hospitality payments from Medical Device Business Services. C.A.U. has received consulting fees and nonconsulting fees from Arthrex; hospitality payments from Arthrex; and education payments from Smith & Nephew. O.L. has received consulting fees from Arthrex and Linvatec; nonconsulting fees from Arthrex; education payments from Arthrex; and royalties from Linvatec. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Hip surgical techniques have evolved significantly, transitioning from open techniques to arthroscopic techniques. Hip arthroscopy has many advantages over open techniques, including reduced trauma to surrounding tissues, reduced risk of infection, and improved patient-reported outcome measures. Hip arthroscopic techniques are now commonly used for pathologies such as femoroacetabular impingement (FAI). FAI can include cam, pincer, or mixed impingement. Through hip arthroscopy, FAI may be treated with a femoroplasty and acetabuloplasty along with addressing any labral pathology that may exist. Owing to the capsule playing an integral role in hip stability, surgeons are now mindful of the initial approach and closure on completion of the intra-articular procedure. The most common approach for capsulotomy is the inside-out approach. However, this approach can be difficult in patients with a large pincer deformity. The authors describe an outside-in approach to arthroscopic hip capsulotomy. This capsular approach helps protect the labrum and articular cartilage while preserving capsular tissue., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

Background: In response to the COVID-19 pandemic, many US health systems suspended elective surgery at the recommendation of the US Surgeon General. This dramatically decreased case volumes for orthopaedic sports medicine fellows at academic institutions., Purpose: To describe how the COVID-19 pandemic has affected the education of the sports medicine fellowship class of 2020 as well as the subsequent effects on their career plans and psychological well-being., Study Design: Cross-sectional study., Methods: A 33-item survey was distributed via email to all American Orthopaedic Society for Sports Medicine (AOSSM) 2020 fellow members on April 22, 2020. Frequencies are presented as raw totals and percentages of respondents. The Fisher exact test was used to determine statistical significance between nominal variables, with significance set at P < .05., Results: Of 210 registered fellows, 101 (48.1%) responded. Before the COVID-19 outbreak, the typical case volume per week for most fellows (47.5%) was 11 to 15 cases. From the enactment of COVID-19 mitigation policies to the date of survey completion, 90.1% of fellows had performed fewer than 20 cases. A total of 32 fellows were presented with redeployment options by their fellowship program, with 10 redeployed mandatorily to other hospital departments. Fellows reported that web-based didactics (n = 100) and web-based journal clubs (n = 72) were utilized as alternative supplements in the absence of clinical education. There were 8 respondents who had either their prior contract or job offer rescinded, while 1 had a signed contract voided. As a result, 6 fellows now plan to matriculate into a previously unplanned fellowship. Also, 10 respondents' intended practice start date was being delayed by their employer. Respondents whose postfellowship plans were affected were statistically more likely to experience doubts about readiness for practice (58.8% vs 20.3%, respectively; P = .005), anxiety about future career plans (94.4% vs 63.8%, respectively; P = .01), anxiety about their financial situation (86.7% vs 50.8%, respectively; P = .018), stress in personal relationships (58.8% vs 29.9%, respectively; P = .045), and signs or symptoms of depression (41.2% vs 11.1%, respectively; P = .007) compared with those whose plans were not affected., Conclusion: This survey illustrates that during the early stages of the COVID-19 pandemic and the subsequent suspension of elective surgery, there have been downstream effects to this group's education, careers, board certification timeline, and potentially their social and/or emotional well-being., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was sponsored by the American Orthopaedic Society for Sports Medicine (AOSSM). The AOSSM was responsible for distributing the survey to its members. O.L. has received consulting fees from Arthrex and Linvatec, nonconsulting fees from Arthrex, and royalties from Linvatec. M.B. has received educational support from Arthrex, consulting fees from Stryker, nonconsulting fees from Arthrex and Vericel, and honoraria from Vericel. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Water polo places significant stress on the hip joint requiring repetitive hip flexion and rotation to elevate the body out of water for passing, shooting and blocking. Femoroacetabular impingement (FAI) is common in water polo athletes; however, no study to date has investigated the results of hip arthroscopy in this patient population. The purpose of this study was to determine return to play rates and satisfaction following hip arthroscopy for FAI in a cohort of elite level water polo players. A retrospective review of our surgical database was performed. Collegiate water polo players with clinical and radiographic FAI who underwent hip arthroscopy were identified. Pre- and post-operative modified Harris hip scores (mHHSs) were obtained. Patient surveys were administered to determine return to play rates, level of return to play, timing of return and patient satisfaction. A Wilcoxon ranked sum test was performed to compare pre- and post-operative outcome scores. Ten patients met inclusion criteria. Average age was 19.5 years old (SD  ±1.08). All patients were male Division 1 collegiate water polo players. Median mHHS improved from 66.0 (SD  ±7.9) pre-operatively to 89.5 (SD  ±3.2) at average 1.6 years (range: 0.4-3.6 years) post-operatively. Patient survey responses demonstrated a 100% return to water polo and 100% return to the same level of play (NCAA Division 1) at mean 5.75 months (SD  ±1.8). All patients (10/10) reported being satisfied with their surgical result. Our study results, suggest that return to sport rates and patient satisfaction are high in water polo players who undergo hip arthroscopy for FAI., (© The Author(s) 2020. Published by Oxford University Press.)