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Several all-arthroscopic techniques have been described to address patellar instability. Most arthroscopic procedures focus on soft tissue plication or “tightening” of the medial retinacular structures to correct lateral patellar instability. We found these techniques to be ineffective when the medial stabilizers were avulsed from the patella. As a result, we have developed an arthroscopic technique to repair medial patellofemoral ligament avulsions to the patella using suture anchors. [ABSTRACT FROM AUTHOR]

Background: Retears of the rotator cuff are not uncommon after arthroscopic and mini-open rotator cuff repairs. In most studies, the clinical results in patients with persistent defects demonstrated significantly less pain and better function and strength compared with their preoperative state at an early follow-up. Hypothesis: The clinical and structural outcomes of patients with known rotator cuff defects will remain unchanged after a longer period of follow-up. Study Design: Case series; Level of evidence, 4. Methods: This study was performed in 15 patients (18 shoulders) from a previous study who had recurrent rotator cuff defects 3.2 years after repair. Each patient completed the American Shoulder and Elbow Surgeons Scoring Survey, the Simple Shoulder Test, the L'Insalata Scoring Survey, and a visual analog scale for pain. Eleven patients (13 shoulders) were clinically reexamined at an average of 7.9 years for range of motion and strength, with targeted ultrasound. Results: At the 7.9 year follow-up the average scores were 95 (American Shoulder and Elbow Surgeons), 95 (L'Insalata), 11 (Simple Shoulder Test), and 0 (visual analog for pain), which were not statistically significantly different from the scores at 3.2 years. There was no change in the average range of motion; however, there was a statistically significant reduction in forward flexion strength and external rotation strength, as measured by a dynamometer. The average external rotation strength decreased by a mean of 42% and the mean forward flexion strength decreased by a mean of 45% (P < .001). Furthermore, there was a statistically significant increase in the mean size of the defect, from 273 mm2 to 467 mm2 (P < .001). Finally, the size of the defect increased in all patients, and no defects healed structurally. Conclusion: At an average of 7.9 years, patients with recurrent defects after rotator cuff repair still had an improvement in terms of pain, function, and satisfaction. However, the rotator cuff defect significantly increased in size, and there was a progression of strength deficits. These findings suggest that patients with recurrent defects can remain asymptomatic over the long term but will predictably lose strength in the involved extremity. Furthermore, the study demonstrated that defects after rotator cuff repair increase in size but often remain asymptomatic. [ABSTRACT FROM AUTHOR]

Inicialmente se consideraba que la artroscopia de codo no era segura por el pequeño tamaño de la cápsula articular del codo y su proximidad a varias estructuras neurovasculares importantes. Sin embargo, durante la pasada década, el método se ha hecho más seguro y eficaz. Estas mejoras pueden atribuirse a un mejor conocimiento de la anatomía del codo y de sus trastornos, así como a los avances en los equipos artroscópicos y la técnica quirúrgica. Las indicaciones más frecuentes de la artroscopia de codo comprenden la extracción de cuerpos libres, la sinovectomía, el desbridamiento y/o la extirpación de osteofitos, la liberación capsular, y la evaluación y el tratamiento de la osteocondritis disecante. Los avances más recientes han ampliado las indicaciones en el codo para incluir el tratamiento de fracturas (p. ej. fracturas de la cabeza radial) y el manejo de la epicondilitis. [ABSTRACT FROM AUTHOR]

Background: Medial ulnar collateral ligament insufficiency of the elbow can be a devastating injury in the throwing athlete. Reconstruction of the medial ulnar collateral ligament was initially described by Jobe and associates; good clinical results have been described after this procedure. The authors' experience with this technique raised several concerns, and thus the ‘docking’ procedure was developed as an alternative method for medial ulnar collateral ligament reconstruction of the elbow. The early results of the docking technique were good. The authors wish to investigate the intermediate-term clinical results of this method in a large group of athletes. Hypothesis: The docking technique can return overhead-throwing athletes to sport with minimal perioperative morbidity. Study Design: Case series; Level of evidence, 4. Methods: During a 3-year period, 100 consecutive overhead-throwing athletes were treated with surgical reconstruction using the docking technique. The inclusion criteria were as follows: (1) a history of medial elbow pain that prevented throwing, (2) a preoperative standard noncontrast magnetic resonance image demonstrating medial ulnar collateral ligament injury, (3) clinically apparent medial ulnar collateral ligament insufficiency, and (4) an overhead-throwing athlete. At the time of surgery, all patients underwent routine arthroscopic assessment. The ulnar nerve was transposed in 22 cases. The mean follow-up was 36 months (range, 24–60 months). Results: Ninety of 100 (90%) patients were able to compete at the same or a higher level than before medial ulnar collateral ligament injury for more than 12 months as noted at the follow-up interval; 7 patients were able to compete at a lower level. Only 3 patients suffered postoperative complications. Conclusion: The docking technique reliably returns athletes to competitive throwing with a low perioperative morbidity. [ABSTRACT FROM AUTHOR]

The article presents a study which examined a surgical technique which combines the anterior tibial tubercle elevation with lateral facetectomy for the treatment of isolated lateral facet patellofemoral osteoarthritis. It states that soft tissue realignment procedure can be indicated for patellofemoral arthritis with radiographic evidence of tilt without subluxation or instability.

The article presents a study on three adolescent athletes who presented with a delay in diagnosis and who underwent arthoscopic repair of subscapularis avulsion injuries. It states that the athletes with isolated rupture of the subscapularis tendon with avulsion fracture of the lesser tuberosity is an extremely rare injury. The rarity of the injury causes the delay in diagnosis, which also contributed to the increase in morbidity. The authors claim that open shoulder surgery has been shown to be effective for the injury, but it has also disadvantages associated with greater post-operative pain and longer rehabilitation and larger postoperative scars in an adolescent population as well.

Introduction: The effect of platelet-rich plasma (PRP) treatment on recovery in acute hamstring injuries is controversial. Previous study results are inconsistent, and a standardized therapeutic approach has not been established yet. Purpose: To assess the treatment effect using a combination of hematoma aspiration and muscle strain PRP injection in partial hamstring muscle tears (grade 2 strains) in athletes. Methods : Magnetic resonance imaging of athletes with grade 2 hamstring strains were reviewed from 2013 to 2018. From 2013 to 2015, athletes were treated conservatively, and from 2016 to 2018, with a combination of ultrasound-guided hematoma aspiration and PRP muscle strain injection. The outcome, including return-to-play (in days) and recurrence rate, was compared retrospectively between both groups (conservative vs aspiration/PRP) using ANOVA and Fisher's exact test. There was no significant difference in age, type of sport, and muscle involvement (including injury grade/location, hamstring muscle type, and length/cross-sectional area of the strain). Results : Fifty-five athletes (28 treated conservatively, 27 with hematoma aspiration/PRP injection) were included. Average return-to-play time (mean) was 32.4 d in the conservative group and 23.5 d in the aspiration/PRP group (P < 0.001). Recurrence rate of the hamstring strain was 28.6% (8/28) in the conservative treatment group and less than 4% (1/27) in the aspiration/PRP group (P = 0.025). Conclusions : Athletes with grade 2 hamstring strains treated with a combination of hematoma aspiration and PRP injection had a significantly shorter return-to-play and a lower recurrence rate compared with athletes receiving conservative treatment. [ABSTRACT FROM AUTHOR]

Background: There is consensus that most complete ulnar collateral ligament (UCL) injuries in throwers would benefit from surgical intervention. Optimal treatment for partial UCL tears remains controversial. Stress ultrasonography has become a well-accepted diagnostic modality for assessing UCL injury. Hypothesis: Partial UCL tears will result in an intermediate increase in ulnohumeral joint space gapping as compared with that of an intact UCL and a complete UCL tear, but the degree of joint space gapping will vary by anatomic location of the partial tear. Study Design: Controlled laboratory study. Methods: Twenty-one cadaveric elbows were divided into 7 groups representing different anatomic locations of UCL partial tears. Partial tears were simulated by cutting 50% of the measured width of the UCL at 6 locations: distal anterior/posterior, midsubstance anterior/posterior, and proximal anterior/posterior. A seventh partial tear was created by partially elevating the undersurface of the distal UCL to simulate the radiographic "T-sign." Valgus stress (15 daN) was applied to each cadaveric elbow at 30° of flexion using a standardized device. Each specimen was tested intact, partially torn, and completely torn. At each state, joint space was measured using stress ultrasonography, and the difference in joint space from unstressed to stressed (delta) was recorded. Results: There were 10 right and 11 left upper extremity specimens. The mean delta was 0.58 mm for the intact state and <0.75 mm in all groups. Both distal partial tear groups had mean deltas <0.75 mm, similar to intact elbows. Proximal tears and the T-sign demonstrated intermediate deltas (0.99-1.23 mm). Midsubstance partial tears demonstrated the largest deltas (1.57-2.03 mm), similar to those of the complete tears. All complete tear groups had a mean delta >1.5 mm (1.54-3.03 mm). Conclusion: These findings suggest that partial tears introduce a spectrum of instability from functionally intact to completely torn. As a result, some may be biomechanically amenable to nonoperative treatment, while others would be indicated for early reconstruction. Further research into the biological and biomechanical determinants of nonoperative treatment failure will assist with more precise treatment recommendations. Clinical Relevance: Describing the biomechanical consequences of different, clinically significant partial UCL tears potentially allows more precise recommendations for operative and nonoperative treatment. [ABSTRACT FROM AUTHOR]

Background: Stress ultrasonography (SUS) has provided clinicians with an alternative means of evaluating ulnar collateral ligament (UCL) injury by dynamically assessing ulnohumeral joint space gapping under applied valgus stress. However, 3 previous cadaveric studies have evaluated the biomechanical effect of partial UCL tears at different anatomic locations with conflicting results. Purpose/Hypothesis: The purpose of this study was to use in vivo data from patients with magnetic resonance (MR)–confirmed partial UCL tears to determine if anatomic partial tear location influenced the resultant stability of the elbow in terms of ulnohumeral joint gapping on SUS. It was hypothesized that no difference would be seen in the amount of ulnohumeral joint gapping based on MR-identified anatomic partial UCL tear location. Study Design: Cohort study; Level of evidence, 3. Methods: All patients diagnosed with elbow injury from 2015 to 2020 were screened to identify competitive baseball pitchers with a partial UCL tear who received an SUS. Partial UCL tear was diagnosed via surgeon and radiologist interpretation of elbow MR imaging (MRI) as well as confirmation at the time of surgery as documented in the operative report. Demographic, injury, and treatment data were collected from the clinic notes, MRI reports, and stress ultrasound reports. Ulnohumeral joint gapping on SUS was calculated as the difference between ulnohumeral joint gapping without valgus stress versus ulnohumeral joint gapping with valgus stress (delta) as performed by a musculoskeletal radiologist. Results: Overall, 60 male baseball pitchers (age, 19.2 ± 2.1 years), including 22 (37%) high school, 26 (43%) collegiate, and 12 (20%) professional pitchers, were evaluated. Regarding the location of partial UCL tears, 32 (53%) pitchers had proximal tears and 28 (47%) had distal tears. The mean delta value cohort was 2.1 ± 1.1 mm, and 34 pitchers (57%) had delta values >2.0 mm. Ulnohumeral joint gapping (high school [1.9 mm] vs collegiate [2.6 mm] vs professional [1.6 mm]; P =.004) and the percentage of pitchers with delta values >2.0 mm (45% vs 77% vs 33%; P =.017) differed based on level of competition. After controlling for age, body mass index, and level of competition in a multivariate linear regression, tear location was not related to ulnohumeral joint gapping (P =.499). Conclusion: No difference was observed in the amount of ulnohumeral joint gapping on SUS in symptomatic baseball pitchers with MR-identified partial UCL tears at differing anatomic locations. The findings of this study are contrary to previous cadaveric studies that have evaluated the effects of UCL tear characteristics on delta laxity. [ABSTRACT FROM AUTHOR]

Background: Injury of the ulnar collateral ligament (UCL) has become increasingly common, particularly in overhead athletes. There is no consensus on management of the ulnar nerve in UCL reconstruction (UCLR) in patients with preoperative ulnar nerve symptoms, as literature supports both not decompressing the nerve as well as ulnar nerve transposition (UNT). Hypothesis/Purpose: The purpose of this study was to compare subjective clinical outcomes and return-to-sports (RTS) metrics between patients who received UNT during UCLR and a matched cohort who underwent UCLR alone. We hypothesized that there would be no significant difference in patient outcomes or RTS metrics between the cohorts. Study Design: Cohort study; Level of evidence, 3. Methods: Using an institutional database, patients who underwent UCLR with UNT between 2007 and 2017 were retrospectively identified. These patients were matched based on sex, age at surgery (±3 years), and body mass index (±2 kg/m2) to a comparison group that underwent UCLR alone. Patients completed the Kerlan-Jobe Orthopaedic Clinic Shoulder & Elbow (KJOC) score, the Timmerman and Andrews elbow score, the Conway-Jobe scale, and custom patient satisfaction and RTS questionnaires. Results: Thirty patients who underwent UCLR with concomitant UNT and 30 matched patients who underwent UCLR without UNT were available for follow-up at a mean of 6.9 (3.4-9.9) and 8.1 (3.4-13.9) years, respectively. The UNT group reported similar KJOC (78.4 in UNT vs 76.8; P =.780), Conway-Jobe (60% excellent in UNT vs 77% excellent; P =.504), Timmerman and Andrews (86.2 in UNT vs 88.8; P =.496), and satisfaction scores (85.3% in UNT vs 89.3%; P =.512) compared with UCLR group. In terms of RTS rate (84% in UNT vs 93% in UCLR; P =.289) and duration required to RTS (11.1 months in UNT vs 12.5 months in UCLR; P =.176), the 2 groups did not significantly differ. Finally, despite significant differences in preoperative ulnar nerve symptoms (100% in UNT vs 7% in UCLR; P <.001), the 2 groups did not statistically differ in the proportion of patients who experienced postoperative ulnar nerve symptoms (13% in UNT vs 0% in UCLR; P =.112). Conclusion: This matched cohort analysis showed no statistically significant differences in patient-reported outcomes and RTS between patients undergoing UCLR with and without UNT. [ABSTRACT FROM AUTHOR]

The article discusses a study which evaluated medial elbow instability in a cadaveric model using stress ultrasound (SUS). Results show a mean increase in ulnohumeral valgus joint gapping of 3.4 millimeters (mm) caused by the release of the entire anterior bundle. It concluded that different amounts of gapping are observed on SUS with sectioning of the medial elbow stabilizers.

The article reports a study which was conducted to evaluate the utility of arthroscopic capsular plication in overhead athletes. The results revealed that arthroscopic capsular plication for anterior instability related to isolated capsular redundancy is an effective procedure that yields a high rate of patient satisfaction and return to overhead athletic activity with an acceptably low failure rate. Patients with associated rotator cuff injury may be at higher risk for treatment failure.

Background: Ulnar collateral ligament (UCL) reconstruction is an established surgical technique to restore UCL deficiency, especially in the overhead throwing athlete. Over the past decade, the number of patients requiring UCL reconstruction has increased significantly, particularly in the adolescent patient population. Return-to-play rates after UCL reconstruction reported in the literature have ranged from 33% to 92%, and a recent systematic review noted a return-to-play rate of 89.40% in all high school athletes. Purpose: To evaluate the outcomes, particularly return-to-play rates and subjective outcome scores, of UCL reconstruction of the elbow in adolescent throwing athletes. Study Design: Systematic review. Methods: A systematic review of the literature was conducted via the electronic databases Embase, PubMed, and Cochrane. Studies that reported on outcomes, particularly return-to-play rates, in adolescent throwing athletes met the inclusion criteria and were included in our analysis. Studies that did not report on adolescent throwing athletes and studies that reported on adolescent throwing athletes but did not specify the return-to-play outcomes for these athletes were excluded from our analysis. Results: Nine studies met the inclusion criteria and were included in this review. There were 404 baseball players and 10 javelin throwers included in our analysis. A total of 349 of the 414 patients (84.30%) were successfully able to return to play at the same level of competition or higher. Successful rates of return to prior performance ranged from 66.67% to 91.49% in our analysis. Javelin throwers had a mean 80.00% rate of return to prior performance, while baseball players had a mean return-to-play rate of 84.40%. Complications were evaluated for 8 (88.9%) studies and 283 (68.4%) patients. There were 11 (3.9%) reported complications and 5 (1.8%) reoperations. Conclusion: The findings of this systematic review revealed that adolescent patients are generally able to return to their preinjury level of performance or higher with limited complications. Further investigation is necessary to determine long-term outcomes for return to play after UCL reconstruction of the elbow in adolescent throwing athletes. [ABSTRACT FROM AUTHOR]

Purpose: To date, there is no consensus for the appropriate timing or functional evaluation for safe return to play following patellar instability surgery. The purpose of this study is to develop a consensus-based return to play checklist following patellar stabilization surgery using the Delphi method.Methods: A 3-part survey series was conducted following the systematic guidelines of the Delphi technique for gathering consensus from experts in the management of patellofemoral instability. All surveys were completed between July and November of 2017. A literature search was performed in SCOPUS and PubMed to identify existing sources on return to play following patellar instability surgery and determining patellofemoral joint strength in athletes, which served as the basis for the surveys.Results: 12 of the 19 selected participants (63%) completed the first-round survey, 11 of those 12 participants (92%) completed the second-round survey, and 10 of these 11 participants (91%) completed the final survey. Of the final ten participants, there was representation from seven different states in the USA. Nine of the ten (90%) respondents endorsed the final checklist. The final checklist included eight overarching domains with defined and reproducible objective criteria.Conclusion: The standardized list of objective and reproducible criteria for rehabilitation outlined below should help practitioners focus more on patient-centred factors and less on arbitrary timelines. No prior study has gathered consensus from experts on this topic; therefore, this study should serve as a benchmark to help guide patients back to sport safely.Level Of Evidence: V. [ABSTRACT FROM AUTHOR]

Background: Female athletes are 2 to 8 times more prone to anterior cruciate ligament (ACL) rupture than males. Furthermore, reinjury to the ipsilateral or contralateral knee can occur in >20% of athletes. Female sex and younger age are known risk factors for graft failure. The optimal graft choice for young females remains unknown and poorly studied. Purpose/Hypothesis: The authors aimed to compare clinical outcomes in young females who underwent ACL reconstruction (ACLR) with bone–patellar tendon–bone (BTB) and quadrupled hamstring (HS) autografts. It was hypothesized that no significant differences in outcomes exist between graft choices. Study Design: Cohort study; Level of evidence, 3. Methods: Female patients aged 15 to 25 years who underwent primary ACLR with BTB or HS autograft were included for review. Patients were subdivided into 2 age groups: 15 to 20 years and 21 to 25 years. The occurrence of chondral, meniscal, or ligamentous injury to either knee was recorded for comparison. Results: A total of 256 females were included (BTB, n = 175; HS, n = 81). The majority of patients were between the ages of 15 and 20 years (BTB, 80%; HS, 77.8%). Overall, graft rupture occurred in 23 patients (9%) and contralateral ACL tear occurred in 18 (7%). Subgroup analysis showed that 75% of BTB and 100% of HS graft retears occurred in females aged 15 to 20 years. Within this age group, there was a significantly lower rate of graft ruptures in the BTB group (6.4%) as compared with the HS group (17.5%, P =.02). Allograft augmentation was used in 4 of the 11 HS grafts that retore. When allograft-augmented grafts were excluded, there was no significant difference in graft failure rate between graft choices. Fifteen patients in the BTB group (12%) as opposed to 1 in the HS group (2%) reported extreme difficulty or the inability to kneel on the front of the knee (P =.04). Conclusion: In females aged 15 to 20 years undergoing ACLR, BTB autograft may lead to fewer graft ruptures than HS autograft. While this difference was not observed in females aged 21 to 25 years, a larger sample may be required to accept the null hypothesis in this age group. BTB autograft significantly increased the risk of kneeling pain as compared with HS regardless of age. [ABSTRACT FROM AUTHOR]

Abstract Background Humerus fractures caused by the throwing motion are extremely rare. They have been reported mostly in recreational adult athletes in their third or later decades of life. A pediatric thrower's fracture is even less common, with few reported cases. The pediatric version of this fracture is located in the proximal to midshaft humerus, distinguishing it from the adult type, which occurs in the middle to distal shaft. Case Report A 12-year-old male pitcher experienced a "snap" in his right arm while throwing a pitch in a baseball game. He presented to the Emergency Department with right arm pain and deformity. He was misdiagnosed with a right glenohumeral dislocation and a reduction maneuver was attempted prior to any radiographic imaging. Upon further review of the imaging and outpatient follow-up, he was found to have a humeral spiral fracture consistent with a "ball-thrower's fracture." The fracture healed with conservative treatment and he returned to unrestricted sports participation. Why Should an Emergency Physician Be Aware of This? Recognition of this fracture is important to avoid unnecessary and potentially harmful treatment of the pediatric patient. A thrower's fracture of the pediatric humerus is rare, but glenohumeral dislocation without direct trauma is even less common and has never been reported as a result of the throwing motion in a pediatric patient. Radiographic imaging is important, and consideration of the thrower's fracture should be in the differential for any patient presenting with acute pain and deformity of the arm resulting from throwing any object. [ABSTRACT FROM AUTHOR]

Background: Medial patellofemoral ligament (MPFL) reconstruction and repair continue to gain acceptance as viable treatment options for recurrent patellar instability in patients who wish to return to sports after surgery. Return-to-play guidelines with objective or subjective criteria for athletes after MPFL surgery, however, have not been uniformly defined. Purpose: To determine whether a concise and objective protocol exists that may help athletes return to their sport more safely after MPFL surgery. Study Design: Systematic review. Methods: The clinical evidence for return to play after MPFL reconstruction was evaluated through a systematic review of the literature. Studies that measured outcomes for isolated MPFL surgery with greater than a 12-month follow-up were included in our study. We analyzed each study for a return-to-play timeline, rehabilitation protocol, and any measurements used to determine a safe return to play after surgery. Results: Fifty-three studies met the inclusion criteria, with a total of 1756 patients and 1838 knees. The most commonly cited rehabilitation guidelines included weightbearing restrictions and range of motion restrictions in 90.6% and 84.9% of studies, respectively. Thirty-five of 53 studies (66.0%) included an expected timeline for either return to play or return to full activity. Ten of 53 studies (18.9%) in our analysis included either objective or subjective criteria to determine return to activity within their rehabilitation protocol. Conclusion: Most studies in our analysis utilized time-based criteria for determining return to play after MPFL surgery, while only a minority utilized objective or subjective patient-centric criteria. Further investigation is needed to determine safe and effective guidelines for return to play after MPFL reconstruction and repair. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to evaluate the clinical outcomes and revision rates of skeletally mature patients aged 25 years or younger who have undergone either BPTB autograft or deep-frozen, non-irradiated BPTB allograft ACL reconstruction by a single surgeon.Methods: Two hundred and twenty-four patients aged 25 or younger at the time of surgery were identified as having a transtibial ACL reconstruction with either a BPTB autograft or deep-frozen, non-irradiated BPTB allograft by one senior surgeon (101 autografts vs. 123 allografts) over the study time period. Primary outcome measure included the need for ACL revision. One hundred and nineteen patients with at least 2-year clinical follow-up agreed to participate in secondary outcome measurement arm of the study and were administered the Lysholm Knee Scoring Scale and IKDC Subjective Knee Evaluation Form.Results: The median Lysholm scores were 95 (40-100) and 95 (68-100) and the median IKDC scores were 95.4 (54.0-100) and 95.4 (72.4-100) in the allograft and autograft groups, respectively. The differences in the Lysholm scores and the IKDC scores were not statistically significant (P = n.s.). There were 13 patients requiring ACL revision, 12 allograft versus one autograft (P = 0.005).Conclusion: Although there is no significant difference in patient-rated outcome between ACL reconstructions using BPTB autografts versus BPTB allografts, a significantly higher rate of ACL revision was found in allograft patients. The results of our study support a growing body of literature that BPTB autograft reconstruction leads to lower retear rates in younger individuals, an important factor in the graft selection process for these patients.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the use of stress sonography of the ulnar collateral ligament (UCL) of the elbow in professional baseball pitchers. It claims that stress ultrasound (US) of the elbow enables the testing of both the UCL and the ulnohumeral joint space at rest and with stress. Among the factors that were examined in the study are ligament thickness, ulnohumeral joint space width and ligament abnormalities.

Background: Femoroacetabular impingement (FAI) is an increasingly common diagnosis in active patients with hip pain. Surgical options for FAI include arthroscopy, open surgical dislocation, or mini–direct anterior approaches. Arthroscopic and open treatments of FAI have been commonly performed and have had promising results in athletes. Hypothesis/Purpose: We hypothesized that the mini–direct anterior approach would provide the advantages of a minimally invasive procedure and still allow adequate exposure of the hip joint to successfully treat FAI in an athletic population. The purpose of this study was to determine if a mini-open approach for the treatment of FAI in athletic patients would allow a return to preoperative activity. Study Design: Case series; Level of evidence, 4. Methods: A total of 234 patients (257 hips) with FAI were treated by a mini-open approach; 59 were athletic patients (66 hips) with a preoperative University of California, Los Angeles (UCLA) activity score of 7 or higher or Super Simple Hip (SUSHI) activity score of 70 or greater. Forty-four of the 59 athletic patients (47 hips) have reached 1-year minimum follow-up. No patients were lost to follow-up. The mini-open approach was performed through a 4-cm incision and modified Smith-Peterson approach with no muscle detachment. All patients were prospectively evaluated using the following outcome measures: preoperative and postoperative UCLA activity, Short-Form 36 Health Survey (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC), modified Harris Hip Score (HHS), and SUSHI scores. Results:The average age at the time of surgery was 32 years (range, 17-60 years), with an average follow-up of 22 months. Labral changes—whether tear, detachment, or ossification—were present in all patients, and 84% had chondral lesions. The mean HHS improved from 55 preoperatively to 79 postoperatively (P < .001). The WOMAC scores also improved from 47.9 to 8.3 (P < .001). Mean SF-36 scores improved from 65 to 85 postoperatively (P < .001). The mean preoperative SUSHI general score was 31.1, pain score was 26.6, and limitation score was 28.9. The mean postoperative SUSHI general score was 53.6, pain score was 47.5, and limitation score was 51.6 (P < .001). There was minimal change from preinjury to postoperative UCLA (8.0 to 8.7, respectively; P = .07) or SUSHI activity scores (76.3 to 67.7, respectively; P = .048), indicating a reliable return to preinjury activity levels. Twenty-four of 44 patients (55%) reported a return to their specific preoperative sports. Nine patients (20%) developed meralgia paresthetica postoperatively, which resolved within 1 year. Conclusion: The mini-open approach for the treatment of FAI is a safe and effective procedure that allows surgical treatment of FAI in athletic patients and a successful return to high activity levels. The outcome of the mini-open approach for athletes may be comparable with open and arthroscopic treatment of FAI. [ABSTRACT FROM AUTHOR]

Background: Superior labral anterior-posterior (SLAP) lesions are a common cause of pain and disability in athletes. Individual studies have suggested low patient satisfaction with SLAP repairs in throwing athletes in particular and it is unclear how frequently athletes return to their previous level of competetion.Questions/purposes: We systematically reviewed the literature to determine (1) patient satisfaction and (2) return to play at previous level of competition among throwing athletes compared to all athletes who underwent repair of Type II SLAP tears using various types of fixation.Methods: We searched databases for English-language articles in peer-reviewed journals from 1950 to 2010 reporting Type II SLAP repairs with 2-year followup for our systematic review. A total of 506 patients with Type II SLAP tears were reviewed from 14 studies; of these, 327 had SLAP lesions repaired by anchor, 169 by tacks, and 10 by staples. Of the 506 patients, 198 were overhead athletes with a pooled subset of 81 identified baseball players.Results: For the entire patient population, 83% had "good-to-excellent" patient satisfaction and 73% returned to their previous level of play whereas only 63% of overhead athletes returned to their previous level of play. Anchor repair in overhead athletes resulted in a higher percentage of "good-to-excellent" patient satisfaction (88% versus 74%) and a slightly higher return to play rate (63% versus 57%) compared with tack repair.Conclusions: Repair of Type II SLAP tears leads to a return to previous level of play in most patients. Overhead athletes appear to have a lower rate of return to level of previous of play. Anchor fixation appears to be the most favorable fixation in both subjective scores and return to previous level of play. [ABSTRACT FROM AUTHOR]

Background: Humerus fractures caused by the throwing motion are extremely rare. They have been reported mostly in recreational adult athletes in their third or later decades of life. A pediatric thrower's fracture is even less common, with few reported cases. The pediatric version of this fracture is located in the proximal to midshaft humerus, distinguishing it from the adult type, which occurs in the middle to distal shaft.Case Report: A 12-year-old male pitcher experienced a "snap" in his right arm while throwing a pitch in a baseball game. He presented to the Emergency Department with right arm pain and deformity. He was misdiagnosed with a right glenohumeral dislocation and a reduction maneuver was attempted prior to any radiographic imaging. Upon further review of the imaging and outpatient follow-up, he was found to have a humeral spiral fracture consistent with a "ball-thrower's fracture." The fracture healed with conservative treatment and he returned to unrestricted sports participation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Recognition of this fracture is important to avoid unnecessary and potentially harmful treatment of the pediatric patient. A thrower's fracture of the pediatric humerus is rare, but glenohumeral dislocation without direct trauma is even less common and has never been reported as a result of the throwing motion in a pediatric patient. Radiographic imaging is important, and consideration of the thrower's fracture should be in the differential for any patient presenting with acute pain and deformity of the arm resulting from throwing any object. [ABSTRACT FROM AUTHOR]

A letter to the editor and a response are presented regarding the article "The Long-Term Outcome of Recurrent Defect After Rotator Cuff Repair," by Dodson and colleagues in the January 2010 issue.