110 results on '"ElAttrache NS"'
Search Results
2. Single-row versus double-row rotator cuff repair: techniques and outcomes.
- Author
-
Dines JS, Bedi A, Elattrache NS, Dines DM, Dines, Joshua S, Bedi, Asheesh, ElAttrache, Neal S, and Dines, David M
- Published
- 2010
3. Simulated type II superior labral anterior posterior lesions do not alter the path of glenohumeral articulation: a cadaveric biomechanical study.
- Author
-
Youm T, Tibone JE, ElAttrache NS, McGarry MH, and Lee TQ
- Abstract
BACKGROUND: Previous studies have demonstrated increased glenohumeral translations with simulated type II superior labral anterior posterior lesions, which may explain the sensation of instability in the overhead-throwing athlete. It is unknown whether this amount of increased translation alters glenohumeral kinematics. PURPOSE: To determine whether type II superior labral anterior posterior lesions significantly alter glenohumeral kinematics as defined by path of glenohumeral articulation in a simulated cadaveric model of the throwing shoulder. STUDY DESIGN: Controlled laboratory study. METHODS: Six cadaveric shoulders were tested for glenohumeral rotational range of motion and translation using a custom shoulder testing system and the Microscribe 3DLX. The path of glenohumeral articulation was measured by calculating the humeral head center with respect to the glenoid articular surface at maximal internal rotation, 30 degrees, 60 degrees, 90 degrees, and maximal external rotation. Data were recorded for vented intact shoulders, shoulders with arthroscopically created type II superior labral anterior posterior lesions, and shoulders with arthroscopically repaired superior labral anterior posterior lesions. RESULTS: A subtle but significant increase in external rotation (2.7 degrees) was seen after creating a type II lesion. Small increases in glenohumeral translation were found in the anterior (0.9 mm) and inferior (0.9 mm) directions with application of a 15-N force in the superior labral anterior posterior group. Increases in glenohumeral rotation and translation were restored to the intact state after repair of the lesion. No significant differences were found in the path of glenohumeral articulation for the superior labral anterior posterior condition compared with the intact shoulder. CONCLUSION: The small amounts of increased external rotation and translation found with arthroscopically created type II superior labral anterior posterior lesions do not significantly affect glenohumeral kinematics in this passive motion model as quantified by the path of glenohumeral articulation. CLINICAL RELEVANCE: Findings suggest that in the absence of pain or mechanical symptoms, type II superior labral anterior posterior lesions that do not significantly involve the superior and middle glenohumeral ligaments may not need surgical repair. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
- View/download PDF
4. Arthroscopic anteroinferior suture plication resulting in decreased glenohumeral translation and external rotation. Study of a cadaver model.
- Author
-
Alberta FG, Elattrache NS, Mihata T, McGarry MH, Tibone JE, Lee TQ, Alberta, Frank G, Elattrache, Neal S, Mihata, Teruhisa, McGarry, Michelle H, Tibone, James E, and Lee, Thay Q
- Abstract
Background: The consequences of arthroscopic plication for the treatment of anterior shoulder instability are unknown. The purpose of this study was to evaluate the effects of arthroscopic plication on glenohumeral translation, the rotational range of motion, and the positions of the glenohumeral center of rotation.Methods: Six cadaver shoulders were tested in the intact state, after simulation of anterior instability by anterior capsular stretching, after creation of arthroscopic portals, and following a 10-mm anteroinferior arthroscopic suture plication. Capsulolabral build-up was measured to quantify the increase after plication.Results: Stretching resulted in a significant increase, compared with the intact state, in external rotation (mean increase, 23.2 degrees [14.3%]; p < 0.001) but not in glenohumeral translation (mean increase, 0.8 mm [7.4%] under a 20-N translational load; p = 0.06). After plication, external rotation decreased significantly (by 12.6 degrees [6.7%], p = 0.003) compared with that following the stretching. After plication, the glenohumeral center of rotation was significantly shifted posteriorly at 60 degrees , 90 degrees , and 120 degrees of external rotation and inferiorly at 90 degrees and 120 degrees . Plication also resulted in significant decreases in anterior translation (mean decrease, 61.1% under a 15-N translational load and 49.8% under a 20-N translational load; p < 0.001), posterior translation (mean decrease, 11.4% under a 15-N translational load and 13.1% under a 20-N translational load; p = 0.002 and p < 0.001, respectively), and inferior translation (mean decrease, 3.2% under a 20-N load; p = 0.04). The height of the capsulolabral "bumper" increased from 2.9 mm in the intact state to 6.4 mm following plication (p = 0.001).Conclusions: Arthroscopic anteroinferior plication effectively reduces anterior translation and external rotation. Capsulolabral buildup may help limit anterior translation without affecting rotation. Plication resulted in a shift of the glenohumeral center of rotation posteriorly and inferiorly. [ABSTRACT FROM AUTHOR]- Published
- 2006
5. Elbow medial ulnar collateral ligament insufficiency alters posteromedial olecranon contact.
- Author
-
Ashmad CS, Park MC, and ElAttrache NS
- Abstract
BACKGROUND: The effect of elbow medial ulnar collateral ligament injury on posteromedial compartment contact is unknown. HYPOTHESIS: Medial ulnar collateral ligament injury causes altered contact area and pressure in the posteromedial compartment of the elbow. STUDY DESIGN: Controlled laboratory study. METHODS: Seven elbow cadaveric specimens were tested in an apparatus that positioned the elbow at 30 degrees and 90 degrees of flexion. Partial and full tears were simulated by releasing the medial ulnar collateral ligament. Pressure-sensitive film was placed in the posteromedial compartment for each condition. Valgus torques of 1.25 and 2.0 N.m were applied for each ligament condition, and kinematic data were obtained at each flexion angle using a 3-dimensional digitizer. RESULTS: Both ligament condition and valgus load had significant effects on contact area and pressure (P<.05). For a given load and flexion angle, the contact area decreased and the pressure increased with increasing medial ulnar collateral ligament insufficiency. Within these trends, statistical significance was found at 30 degrees of elbow flexion for both area and pressure (P<.05); at 90 degrees of elbow flexion, increasing medial ulnar collateral ligament insufficiency did not significantly affect contact area or pressure (P>.05). DISCUSSION: Medial ulnar collateral ligament insufficiency alters contact area and pressure between the posteromedial trochlea and olecranon and helps explain the development of posteromedial osteophytes. [ABSTRACT FROM AUTHOR]
- Published
- 2004
6. Reconstruction of the lateral collateral ligament of the knee with patellar tendon allograft: report of a new technique in combined ligament injuries.
- Author
-
Latimer HA, Tibone JE, ElAttrache NS, and McMahon PJ
- Abstract
This is a retrospective study of 10 patients with combined cruciate ligament and posterolateral instability who underwent surgical reconstruction between 1991 and 1994. All knees had at least 20 degrees increased external rotation at 30 degrees of knee flexion and from 1+ to 3+ varus instability. Five knees with posterior cruciate ligament ruptures had at least a 2+ Lachman test result. (One knee had both anterior and posterior cruciate ligament injuries). In all cases the lateral collateral ligament was reconstructed with a bone-patellar tendon-bone allograft secured with interference screws. Fixation tunnels were placed in the fibular head and at the isometric point on the femur. The cruciate ligaments were reconstructed with autograft or allograft material. The average follow-up was 28 months. Excessive external rotation at 30 degrees of flexion was corrected in all but one knee. Six patients had no varus laxity, and four patients had 1+ varus laxity at 30 degrees of flexion. The posterior drawer test result decreased, on average, to 1+, and the Lachman test result decreased to between 0 and 1+. The average Tegner score was 4.6, with five patients returning to their preinjury level of activity and four returning to one level lower. These results indicate that this is a promising new procedure for patients with instability resulting from lateral ligament injuries of the knee. [ABSTRACT FROM AUTHOR]
- Published
- 1998
- Full Text
- View/download PDF
7. Contemporary elbow surgery: consider your abilities and patients' expectations.
- Author
-
Levine WN, Ahmad CS, ElAttrache NS, McKee MD, Morrey BF, and Yamaguchi K
- Published
- 2008
8. Rotator cuff repair: current concepts and applications.
- Author
-
ElAttrache NS, Ahmad CS, Burkhart SS, and Snyder SJ
- Published
- 2008
9. A normative population profile of glenohumeral internal and external rotation motion in the uninjured high school baseball pitcher.
- Author
-
Hurd WJ, Morrey BF, Kaufman KR, Kaplan KM, ElAttrache NS, and Jobe FW
- Published
- 2010
10. Current Concepts in the Business of Orthopaedics.
- Author
-
Rahman OF, Limpisvasti O, Kharrazi FD, and ElAttrache NS
- Subjects
- Humans, United States, Commerce, Ownership, Quality of Health Care, Orthopedics, Orthopedic Procedures
- Abstract
Practice management within orthopaedic surgery demands a multifaceted skillset including clinical expertise, technical proficiency, and business acumen, yet the latter is rarely taught during orthopaedic training. As the healthcare system evolves in the United States, surgeons continue to face challenges such as decreasing reimbursements, increased regulatory burdens, and potential for practice acquisition. To remain competitive and provide exceptional care for patients, orthopaedic surgeons must cultivate a business-minded approach. This article highlights the growing significance of the business of orthopaedics and offers guidance on ambulatory surgical center ownership models, effective management of ancillary services, the effect of private equity in orthopaedic practice, real estate investment opportunities in medical office buildings, and the importance of brand recognition. By understanding these concepts, orthopaedic surgeons can exercise greater control over their practice's finances while providing quality care for their patients., (Copyright © 2023 by the American Academy of Orthopaedic Surgeons.)
- Published
- 2024
- Full Text
- View/download PDF
11. Assessing the Effectiveness of Arthroscopic Capsular Repair in Elite Baseball Players: Response.
- Author
-
Uffmann WJ 3rd and ElAttrache NS
- Abstract
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 DePuy Synthes, Gemini Medical, and Stryker. N.S.E. has received research support from Arthrex, education payments from Goode Surgical and Micromed, speaking fees from Arthrex, and royalties from Arthrex and Wolters Kluwer–Lippincott Williams and Wilkins.
- Published
- 2023
- Full Text
- View/download PDF
12. Return to Sport After Arthroscopic Capsular Repair in Elite Baseball Players.
- Author
-
Uffmann WJ, ElAttrache NS, Youssefzadeh K, Carbone A, and Limpisvasti O
- Abstract
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.)
- Published
- 2023
- Full Text
- View/download PDF
13. Prevalence of femoroacetabular impingement in elite baseball players.
- Author
-
Uquillas CA, Sun Y, Van Sice W, ElAttrache NS, and Banffy MB
- Abstract
CAM-type femoroacetabular impingement continues to be an underrecognized cause of hip pain in elite athletes. Properties inherent to baseball such as throwing mechanics and hitting may enhance the risk of developing a cam deformity. Our goal is to gain an appreciation of the radiographic prevalence of cam deformities in elite baseball players. Prospective evaluation and radiographs of 80 elite baseball players were obtained during the 2016 preseason entrance examination. A sports medicine fellowship-trained orthopedic surgeon with experience treating hip disorders used standard radiographic measurements to assess for the radiographic presence of cam impingement. Radiographs with an alpha angle >55° on modified Dunn views were defined as cam positive. Of the 122 elite baseball players included in our analysis, 80 completed radiographic evaluation. Only 7.3% (9/122) of players reported hip pain and 1.6% (4/244) had a positive anterior impingement test. The prevalence of cam deformities in right and left hips were 54/80 (67.5%) and 40/80 (50.0%), respectively. The mean alpha angle for cam-positive right and left hips were 64.7 ± 6.9° and 64.9 ± 5.8°, respectively. Outfielders had the highest risk of right-sided cam morphology (Relative Risk (RR) = 1.6). Right hip cam deformities were significantly higher in right-handed pitchers compared with left-handed pitchers ( P = 0.02); however, there was no significant difference in left hip cam deformities between left- and right-handed pitchers ( P = 0.307). Our data suggest that elite baseball players have a significantly higher prevalence of radiographic cam impingement than the general population., (© The Author(s) 2022. Published by Oxford University Press.)
- Published
- 2022
- Full Text
- View/download PDF
14. Return to play after ulnar collateral ligament reconstruction with concurrent posterior-compartment decompression.
- Author
-
Heaps BM, Haselman WT, and ElAttrache NS
- Subjects
- Adult, Decompression, Humans, Retrospective Studies, Return to Sport, Young Adult, Baseball injuries, Collateral Ligament, Ulnar injuries, Collateral Ligament, Ulnar surgery, Collateral Ligaments injuries, Collateral Ligaments surgery, Elbow Joint surgery, Ulnar Collateral Ligament Reconstruction methods, Elbow Injuries
- Abstract
Background: Medial ulnar collateral ligament (UCL) injuries and posterior elbow impingement commonly affect throwing athletes. Surgical intervention for each of these pathologies individually has been demonstrated to be successful with high return-to-play (RTP) rates. Our purpose was to report RTP rates for patients treated with concurrent UCL reconstruction (UCLR) and arthroscopic posterior débridement performed by the senior author., Materials and Methods: We retrospectively reviewed all elbow medial UCL procedures performed by the senior author from January 2016 through September 2020. The inclusion criteria included an elbow medial UCL operation with arthroscopic posterior-compartment débridement in a throwing athlete. The exclusion criteria included isolated UCLR surgery, non-primary surgery, and revision UCLR with either autograft or allograft. Using a chart review and publicly available information, we were able to determine patients' playing levels after their operations., Results: Twelve patients met the inclusion and exclusion criteria. The average age was 24.27 years (standard deviation, 4.92 years). Of the 12 patients, 10 returned to play at the same level (4 Major League Baseball players and 1 Triple A player) or at a higher level (2 players from Single A to Double A, 1 player from National Collegiate Athletic Association Division I to Single A, 1 player from rookie league to Single A, and 1 player from high school to National Collegiate Athletic Association Division I), 1 did not return to play, and 1 returned to play at a lower level, with an average RTP time of 14.64 months (standard deviation, 2.64 months). Of the 12 patients, 11 were pitchers; of these 11 pitchers, 9 had statistics available both before and after UCLR. Before UCLR, the average statistics for the pitchers were as follows: earned run average, 4.11 ± 0.85; walks and hits per inning pitched, 1.42 ± 0.26; strikeout-to-walk ratio, 3.00 ± 1.83; strikeouts per 9 innings, 8.80 ± 1.14; and innings pitched, 234.88 ± 316.74. After UCLR, their average statistics were as follows: earned run average, 5.24 ± 2.18 (P = .189); walks and hits per inning pitched, 1.55 ± 0.34 (P = .379); strikeout-to-walk ratio, 2.15 ± 0.98 (P = .263); strikeouts per 9 innings, 9.67 ± 1.91 (P = .293); and innings pitched, 138.71 ± 162.97 (P = .487)., Discussion and Conclusion: Although surgical intervention to address both posterior impingement and UCL injury is relatively rare (comprising 8.5% of all the senior author's UCLR procedures), our experience demonstrates that primary UCLR with concurrent arthroscopic posterior decompression is a reliable, safe, and successful surgical treatment for patients with UCL injury and posterior impingement and our results show no significant difference in statistical performance in pitchers before surgery vs. after surgery., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
15. Outcomes After Medial Ulnar Collateral Ligament Graft Repair in Professional Baseball Pitchers With Minimum 2-Year Follow-up.
- Author
-
Steffes MJ, Heaps BM, ElAttrache NS, and Haselman WT
- Abstract
Background: Rerupture of the reconstructed ulnar collateral ligament (UCL) is becoming more frequent at the professional level of baseball. However, there is no literature describing outcomes after UCL graft repair., Purpose: To evaluate rerupture rate, return to play, performance upon return, and patient-reported outcomes after a novel UCL graft repair technique., Study Design: Case series; Level of evidence, 4., Methods: All included patients underwent UCL graft repair after a previous UCL reconstruction, pitched in at least 1 professional baseball game before repair, and were at least 2 years postprocedure within the same 10-year time period. The authors evaluated patient characteristics and performance metrics, including wins, losses, win percentage, earned run average, innings pitched, walks and hits per inning pitched, for the 2 seasons before and after the procedure. Patients were contacted to assess UCL rerupture, timing of return to sport, current level of competition, Conway score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score., Results: Six players met the inclusion criteria. All had proximal UCL graft ruptures and underwent flexor-pronator tendon repair in combination with graft repair. At a mean (±SD) follow-up of 56.7 ± 37.8 months, no reruptures were encountered, and the mean KJOC score was 87.9 ± 14.6. Of the 6 pitchers who underwent UCL graft repair, 4 (67%) returned to professional pitching at a mean of 17 ± 6 months. Three of the 6 (50%) achieved an excellent Conway score, signifying a return to prior level of sport. There was no significant difference in demographic or preoperative pitching performance metrics between players who did and did not return to pitching. For those players who returned to professional pitching, there was no significant difference between preprocedure and postprocedure performance statistics., Conclusion: Repair of the UCL graft appears to yield comparable rates of return to play and performance with revision UCL reconstruction. This technique serves as a viable alternative for proximal avulsion ruptures of the UCL graft., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.J.S. has received grant support from Arthrex and Stryker and education payments from Micromed and Smith & Nephew. B.M.H. has received grant support from Arthrex and education payments from Micromed and Smith & Nephew. N.S.E. has received education payments from Arthrex and Micromed and speaking fees and royalties from Arthrex. 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) 2022.)
- Published
- 2022
- Full Text
- View/download PDF
16. Ulnar Neuritis and Its Affect on Outcomes of Elbow Ulnar Collateral Ligament Reconstruction.
- Author
-
De Giacomo AF, Keller RA, Banffy M, and ElAttrache NS
- Subjects
- Cohort Studies, Elbow, Humans, Return to Sport, Baseball, Collateral Ligament, Ulnar surgery, Collateral Ligaments surgery, Elbow Joint surgery, Ulnar Collateral Ligament Reconstruction, Ulnar Neuropathies surgery
- Abstract
Background: No study has specifically evaluated how ulnar neuritis and ulnar nerve transposition affect outcomes in baseball players undergoing ulnar collateral ligament (UCL) reconstruction (UCLR)., Purpose: To evaluate the effects of ulnar neuritis and ulnar nerve transposition in baseball pitchers undergoing UCLR in regard to return to sport, time to return to sport, and need for revision or additional surgery., Study Design: Cohort study; Level of evidence, 3., Methods: At a single institution, all consecutive baseball pitchers undergoing UCLR between 2002 and 2015 were identified. Ulnar neuritis was diagnosed preoperatively by the following criteria: ulnar nerve symptoms, Tinel sign at the elbow, symptomatic subluxation, and numbness/paresthesia in an ulnar nerve distribution of the hand. The primary outcome of the study was return to sport. The secondary outcomes of the study were time to return to sport, length of playing career, and revision or additional surgery., Results: A total of 578 UCLRs were performed in baseball players; of these, 500 UCLRs were performed in pitchers. Ulnar neuritis was diagnosed in 97 (19.4%) baseball pitchers presenting with UCL injury. There were no significant differences in patient characteristics or surgical techniques performed for reconstruction between baseball pitchers with and without ulnar neuritis. In review of injury characteristics, ulnar neuritis was significantly more likely to be diagnosed in pitchers with an acute onset of UCL injury ( P = .03). Transposition of the ulnar nerve was more commonly performed in players with ulnar neuritis (47%) versus those without ulnar neuritis (10%; P = .0001). The players who had ulnar neuritis and underwent UCLR had a significantly lower odds of returning to sport (odds ratio, 0.45; P = .04); however, no significant difference was found for time to return to sport and length of playing career for those with and without ulnar neuritis ( P = .38 and .51, respectively)., Conclusion: The study suggests that ulnar neuritis, when present preoperatively in baseball pitchers undergoing UCLR, may adversely affect their ability to return to sport, whereas ulnar nerve transposition at the time of UCLR does not alter the ability to return to sport.
- Published
- 2022
- Full Text
- View/download PDF
17. Biomechanical Comparison of UCL Repair Using Suspensory Fixation Versus UCL Reconstruction.
- Author
-
Mead RN, Nelson TJ, Limpisvasti O, ElAttrache NS, and Metzger MF
- Abstract
Background: Medial ulnar collateral ligament (mUCL) repair is growing in popularity as a treatment for younger athletes with mUCL tears. One of the most recent techniques utilizes a collagen-coated suture tape to augment the repair. The most popular repair technique uses a screw for proximal fixation in the humerus. We present an alternative technique that uses suspensory fixation in the proximal humerus., Purpose: To biomechanically compare elbow valgus stability and load to failure of a novel alternative repair technique with suspensory fixation to an mUCL reconstruction., Study Design: Controlled laboratory study., Methods: Eighteen fresh-frozen cadaveric elbows were dissected to expose the mUCL. Medial elbow stability was tested with the mUCL in an intact, deficient-either repaired or reconstructed-state. The repair technique used a suspensory fixation with suture augmentation, and the docking technique was used on all reconstructions. A 3-N·m valgus torque was applied to the elbow, and valgus rotation of the ulna was recorded via motion tracking cameras as the elbow was cycled through a full range of motion. After kinematic testing, specimens were loaded to failure at 70° of elbow flexion., Results: Both ulnar collateral ligament reconstruction and repair restored valgus stability to levels that were not statistically different from intact at all angles of flexion. There was no significant difference in the ultimate torque to failure between repaired and reconstructed mUCLs., Conclusion: There was no significant difference in the valgus strength between the mUCL repair with suspensory fixation and the mUCL reconstruction., Clinical Relevance: Suspensory fixation is an alternative method for proximal fixation in the mUCL without compromising the strength of the construct., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A portion of this study was funded by a research grant from Arthrex. Arthrex also provided loaner sets for the medial ulnar collateral ligament reconstruction and repair. R.N.M. has received grant support from Arthrex and educational support from Arthrex and Smith & Nephew. O.L. has received educational support, consulting fees, and nonconsulting fees from Arthrex and consulting fees and royalties from Linvatec. N.S.E. has received nonconsulting fees and royalties from Arthrex. 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.)
- Published
- 2021
- Full Text
- View/download PDF
18. Anterior Cruciate Ligament Reconstruction Graft Preference Most Dependent on Patient Age: A Survey of United States Surgeons.
- Author
-
Bowman EN, Limpisvasti O, Cole BJ, and ElAttrache NS
- Subjects
- Age Factors, Humans, Male, Middle Aged, Multivariate Analysis, United States epidemiology, Anterior Cruciate Ligament transplantation, Anterior Cruciate Ligament Reconstruction statistics & numerical data, Health Surveys, Surgeons
- Abstract
Purpose: The purpose of this study was to define the anterior cruciate ligament (ACL) reconstruction (ACLR) graft preference of surgeons and to explore factors associated with their predilection., Methods: A 15-question survey regarding ACLR graft preference in various situations was completed by 514 American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America surgeons. Surgeon and practice demographics, along with various patient factors, were evaluated with bivariate and multivariable models for association with surgeon preference. Surgeons were also queried about their preference for their own ACLR. For surgeons who personally sustained an ACL, an additional 6 questions inquired about their experience., Results: Surgeons reported the 5 most important factors in patient graft choice, in order: patient age, graft failure in literature and practice, pivot sport, and patient preference. Autograft patellar and quadriceps tendon were strongly preferred for younger, pivoting athletes (P < .001), among those with fellowship training (47% vs 33%, P = .006), in academic practices (52% vs 44%, P = .003), and in more sports medicine-specific practices, with a higher number of ACLRs performed per year (P < .001). Northeast, Southeast, Midwest, and Southwest surgeons had lower hamstring autograft preference (P < .001). Non-fellowship-trained surgeons preferred hamstring autograft (P = .010). Allograft was preferred for older patients (P < .001). Nonsignificant predictors included highest level of athlete for whom an ACLR had been performed, level of athlete serving as team physician, and years in practice. No factors were associated with surgeon preference for their own ACLR despite deeming these factors important for patients. ACL tears were reported by 13% of respondents, with 86% stating it influenced their decision to enter orthopaedics., Conclusions: Patient age was the most important factor in graft choice, with patellar and quadriceps tendon autograft the preferred graft for ACLR for younger, pivoting athletes. Fellowship training and practice demographics were also correlated with graft choice for patients., Clinical Relevance: Graft preference for ACLR varies among surgeons and is associated with surgeon experience and patient characteristics, including patient age, type of sport, and patient preference., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
19. Anterior cruciate ligament reconstruction femoral tunnel drilling preference among orthopaedic surgeons.
- Author
-
Bowman EN, Freeman TH, Limpisvasti O, Cole BJ, and ElAttrache NS
- Subjects
- Anterior Cruciate Ligament surgery, Anterior Cruciate Ligament Injuries surgery, Cross-Sectional Studies, Humans, Internship and Residency, Middle Aged, Time Factors, United States, Anterior Cruciate Ligament Reconstruction methods, Femur surgery, Orthopedic Surgeons education, Orthopedic Surgeons statistics & numerical data
- Abstract
Background: Anterior cruciate ligament reconstruction (ACLR) technique for femoral tunnel drilling varies substantially, each with advantages and disadvantages. The purpose of this study was to define ACLR femoral tunnel technique predilection among surgeons and to explore factors associated with their preference., Methods: An 11-question survey regarding ACLR femoral tunnel technique was completed by 560 AANA/AOSSM members. Surgeon and practice demographics and residency and fellowship experiences were evaluated with bivariate and multivariable models for association with surgeon preference., Results: In current practice, 55% of surgeons prefer anteromedial (AM) portal drilling, 32% retrograde, and 14% transtibial (TT). Sports Medicine fellowship experience was the strongest predictor of current practice (p < 0.001), followed by residency technique (p = 0.014). A significant increase in TT drilling was noted for those practicing >15 years TT (29% vs 3%, p < 0.001), with an inverse relationship for retrograde drilling (38% vs 21%, p < 0.001). Number of ACLRs/year and percent Sports specific practice were significant predictors for AM drilling (p < 0.001). Though less than AM and retrograde, TT was more common for those in private practice (17% vs 8%, p < 0.001), and more prevalent in the Midwest/Southeast (19% vs 10%, p = 0.003). Non-significant predictors included highest level of athlete for whom an ACLR had been performed, level of athlete serving as team physician, and Certificate of Added Qualifications status., Conclusion: Surgeon training, practice setting, and years in practice significantly predict preference for femoral tunnel drilling technique. Surgeon comfort and confidence in attaining an anatomic reconstruction should drive choice of technique., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
20. Decision making in treatment after a first-time anterior glenohumeral dislocation: A Delphi approach by the Neer Circle of the American Shoulder and Elbow Surgeons.
- Author
-
Tokish JM, Kuhn JE, Ayers GD, Arciero RA, Burks RT, Dines DM, Duralde XA, ElAttrache NS, Millett PJ, St Pierre P, Provencher MT, Tibone JE, Ticker JB, and Cordasco FA
- Subjects
- Adolescent, Adult, Athletic Injuries surgery, Athletic Injuries therapy, Bone Resorption surgery, Bone Resorption therapy, Clinical Competence, Clinical Decision-Making methods, Consensus, Delphi Technique, Female, History, 21st Century, Humans, Male, Orthopedics history, Orthopedics standards, Recurrence, Secondary Prevention, Shoulder Injuries, Societies, Medical history, Societies, Medical standards, United States, Young Adult, Joint Instability surgery, Joint Instability therapy, Shoulder Dislocation surgery, Shoulder Dislocation therapy, Shoulder Joint surgery
- Abstract
Background: The treatment of patients who sustain a first-time anterior glenohumeral dislocation (FTAGD) is controversial. The purpose of this study was to find consensus among experts using a validated iterative process in the treatment of patients after an FTAGD., Methods: The Neer Circle is an organization of shoulder experts recognized for their service to the American Shoulder and Elbow Surgeons. Consensus among 72 identified experts from this group was sought with a series of surveys using the Delphi process. The first survey used open-ended questions designed to identify patient-related features that influence treatment decisions after an FTAGD. The second survey used a Likert scale to rank each feature's impact on treatment decisions. The third survey used highly impactful features to construct 162 clinical scenarios. For each scenario, experts recommended surgery or not and reported how strongly they made their recommendation. These data were analyzed to find clinical scenarios that had >90% consensus for recommending treatment. These data were also used in univariate and multivariate mixed-effects models to identify odds ratios (ORs) for different features and to assess how combining these features influenced the probability of surgery for specific populations., Results: Of the 162 scenarios, 8 (5%) achieved >90% consensus for recommending surgery. All of these scenarios treated athletes with meaningful bone loss at the end of their season. In particular, for contact athletes aged > 14 years who were at the end of the season and had apprehension and meaningful bone loss, there was >90% consensus for recommending surgery after an FTAGD, with surgeons feeling very strongly about this recommendation. Of the scenarios, 22 (14%) reached >90% consensus for recommending nonoperative treatment. All of these scenarios lacked meaningful bone loss. In particular, surgeons felt very strongly about recommending nonoperative treatment after an FTAGD for non-athletes lacking apprehension without meaningful bone loss. The presence of meaningful bone loss (OR, 6.85; 95% confidence interval, 6.24-7.52) and apprehension (OR, 5.60; 95% confidence interval, 5.03-6.25) were the strongest predictors of surgery. When these 2 features were combined, profound effects increasing the probability of surgery for different populations (active-duty military, non-athletes, noncontact athletes, and contact athletes) were noted, particularly non-athletes., Conclusion: Consensus for recommending treatment of the FTAGD patient was not easily achieved. Certain combinations of patient-specific factors, such as the presence of meaningful bone loss and apprehension, increased the probability of surgery after an FTAGD in all populations. Over 90% of shoulder instability experts recommend surgery after an FTAGD for contact athletes aged > 14 years at the end of the season with both apprehension and meaningful bone loss. Over 90% of experts would not perform surgery after a first dislocation in patients who are not athletes and who lack apprehension without meaningful bone loss., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
21. Presidential Address of the American Orthopaedic Society for Sports Medicine: Journey to Excellence-Lessons From Our Mentors.
- Author
-
ElAttrache NS
- Published
- 2019
- Full Text
- View/download PDF
22. Biomechanical Evaluation of a Modified Internal Brace Construct for the Treatment of Ulnar Collateral Ligament Injuries.
- Author
-
Urch E, Limpisvasti O, ElAttrache NS, Itami Y, McGarry MH, Photopoulos CD, and Lee TQ
- Abstract
Background: Ulnar collateral ligament (UCL) repair augmented with the "internal brace" construct for the management of acute UCL injuries has recently garnered increasing interest from the sports medicine community. One concern with this technique is excessive bone loss at the sublime tubercle, should revision UCL reconstruction be required. In an effort to preserve the bony architecture of the sublime tubercle, an alternative internal brace construct is proposed and biomechanically compared with the gold standard UCL reconstruction., Hypothesis: The internal brace repair construct will restore valgus laxity and rotation to its native state and demonstrate comparable load-to-failure characteristics with the 3-strand reconstruction technique., Study Design: Controlled laboratory study., Methods: For this study, 8 matched pairs of fresh-frozen cadaveric elbows were randomized to undergo either UCL reconstruction with the 3-ply docking technique or UCL repair with a novel internal brace construct focused on augmenting the posterior band of the anterior bundle of the ligament (modified repair-IB technique). Valgus laxity and rotation measurements were quantified through use of a MicroScribe 3DLX digitizer at various flexion angles of the native ligament, transected ligament, and repaired or reconstructed ligament. Laxity testing was performed from maximum extension to 120° of flexion. Each specimen was then loaded to failure, and the method of failure was recorded., Results: Valgus laxity was restored to the intact state at all degrees of elbow flexion with the modified repair-IB technique, and rotation was restored to the intact state at both full extension and 30°. In the reconstruction group, valgus laxity was not restored to the intact state at either full extension or 30° of flexion ( P < .001 and P = .004, respectively). Laxity was restored at 60° of flexion, but the elbow was overconstrained at 90° and 120° of flexion ( P = .027 and P = .003, respectively). In load-to-failure testing, the reconstruction group demonstrated significantly greater yield torque (19.1 vs 9.0 N·m; P < .005), yield angle (10.2° vs 5.4°; P = .007), and ultimate torque (23.9 vs 17.6 N·m; P = .039)., Conclusion: UCL repair with posterior band internal bracing was able to restore valgus laxity and rotation to the native state. The construct exhibited lower load-to-failure characteristics when compared with the reconstruction technique., Clinical Relevance: In selected patients with acute, avulsion-type UCL injuries, ligament repair with posterior band internal bracing is a viable alternative surgical option that, by preserving bone at the sublime tubercle, may decrease the complexity of future revision procedures., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Funding for the study was provided by the Cedars-Sinai Hospital Systems. E.U. has received grant support from DJO and educational support from Arthrex and Smith & Nephew. O.L. has received consulting fees from Arthrex and Linvatec and royalties from Linvatec. N.S.E. has received research support, consulting fees, and royalties from Arthrex. C.D.P. has received grant support from Linvatec; educational support from Arthrex, DePuy, and Smith & Nephew; and hospitality payments from Stryker. T.Q.L. has received research support and consulting fees from Arthrex. 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) 2019.)
- Published
- 2019
- Full Text
- View/download PDF
23. Hamstring Injuries in Major League Baseball Pitchers: Implications in Graft Selection for Ulnar Collateral Ligament Reconstruction.
- Author
-
Howard DR, Banffy MB, and ElAttrache NS
- Subjects
- Adult, Humans, Male, Return to Sport, Risk Factors, Transplant Donor Site, Transplantation, Autologous, Young Adult, Baseball injuries, Collateral Ligament, Ulnar injuries, Hamstring Muscles injuries, Hamstring Tendons transplantation, Ulnar Collateral Ligament Reconstruction methods
- Abstract
Background: Hamstring tendons are commonly harvested as autograft for ulnar collateral ligament reconstruction. There is no consensus in the literature whether the hamstring tendon should be harvested from the ipsilateral (drive) leg or contralateral (landing) leg of baseball pitchers undergoing ulnar collateral ligament reconstruction. Hamstring injuries commonly occur in baseball players, but there are no reports on their incidence specifically among Major League Baseball (MLB) pitchers, nor are there reports on whether they occur more commonly in the drive leg or the landing leg., Hypothesis: Hamstring injuries occur more commonly in the landing legs of MLB pitchers., Study Design: Descriptive epidemiology study., Methods: MLB pitchers who sustained hamstring injuries requiring time spent on the disabled list were identified from publicly available sources over 10 seasons. Demographics of the pitchers and injury and return-to-sport data were collected. Hamstring injuries to the drive leg were compared with injuries to the landing leg., Results: Sixty-five pitchers had 78 disabled list stints due to hamstring injuries over 10 seasons. The landing leg was injured in 67.9% of cases, and the most common mechanism of injury was pitching. There were no significant differences in demographics between pitchers who sustained drive leg and landing leg injuries. There was no significant difference in mechanism of injury or time to return to sport between pitchers who sustained drive leg and landing leg injuries., Conclusion: The landing leg is more commonly injured than the drive leg among MLB pitchers who sustain hamstring injuries. There is no difference in time to return to sport between pitchers who sustain drive leg and landing leg injuries. More research is required to determine whether there is a difference in performance or future injury between hamstring tendons harvested from the drive leg and the landing leg for ulnar collateral ligament reconstruction among pitchers.
- Published
- 2019
- Full Text
- View/download PDF
24. Video Analysis of Anterior Cruciate Ligament Tears in Professional American Football Athletes: Response.
- Author
-
Brophy RH, Johnston JT, Schub D, Rodeo SA, Matava MJ, Silvers HJ, Cole B, ElAttrache NS, McAdams TR, and Mandelbaum BR
- Subjects
- Athletes, Humans, United States, Anterior Cruciate Ligament Injuries surgery, Anterior Cruciate Ligament Reconstruction, Football, Knee Injuries
- Published
- 2018
- Full Text
- View/download PDF
25. Medial Elbow Pain During the Return-to-Throwing Period After Ulnar Collateral Ligament Reconstruction in Pitchers.
- Author
-
Keller RA, Marshall NE, Limpisvasti O, DeGiacomo AF, Banffy M, and ElAttrache NS
- Abstract
Background: Ulnar collateral ligament reconstruction (UCLR) is common in the sport of baseball, particularly among pitchers. Postoperative return-to-sport protocols have many players beginning to throw at 4 to 5 months and returning to full competition between 12 and 16 months after surgery. Medial elbow pain during the return-to-throwing period often occurs and can be difficult to manage., Purpose: To evaluate the incidence of medial elbow pain and associations with outcomes and revision surgery during the return-to-throwing period after UCLR., Study Design: Case-control study; Level of evidence, 3., Methods: Between the years of 2002 and 2014, all pitchers who underwent UCLR at a single institution were identified. Charts were reviewed for incidence of medial elbow pain during return to throwing, return to sport, and subsequent operative interventions, including revision ulnar collateral ligament surgery., Results: Of a total of 616 pitchers who underwent UCLR during the study period, 317 were included in this study. Medial elbow pain was experienced by 45.1% (143 of 317), with a mean time of complaint of 9.75 months after surgery. The groups with and without pain did not differ statistically with regard to age (pain, 20.6 years; no pain, 20.9 years) or level of competition. Of those who experienced medial elbow pain, 10.5% did not return to sport; 5.6% underwent revision UCLR; and 19.6% underwent other operative procedures at the elbow. Among those who did not experience medial elbow pain when returning to throw, 8.7% did not return to sport, with only 1.7% undergoing revision UCLR and 6.9% undergoing other operative elbow procedures., Conclusion: Of the pitchers evaluated in the study, approximately half reported pain during the return-to-throwing phase after UCLR. Those who experienced medial elbow pain had a higher rate of subsequent surgical intervention., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: R.A.K. has received educational support from Zimmer Biomet, Arthrex, Smith & Nephew, and DJO. O.L. is a consultant for Arthrex and receives royalties from ConMed Linvatec. A.F.D. has received educational support from Arthrex, Smith & Nephew, and DJO. M.B. is a paid speaker/presenter for Arthrex, has received educational support from Mako Surgical, and is a consultant for Stryker. N.S.E. receives royalties from Arthrex and Wolters Kluwer Health–Lippincott Williams & Wilkins and is a paid speaker/presenter for Arthrex. 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.
- Published
- 2018
- Full Text
- View/download PDF
26. Pitching Performance After Ulnar Collateral Ligament Reconstruction at a Single Institution in Major League Baseball Pitchers.
- Author
-
Marshall NE, Keller RA, Limpisvasti O, and ElAttrache NS
- Subjects
- Adult, Cohort Studies, Humans, Male, Young Adult, Baseball statistics & numerical data, Return to Sport statistics & numerical data, Ulnar Collateral Ligament Reconstruction statistics & numerical data
- Abstract
Background: Ulnar collateral ligament (UCL) reconstruction (UCLR) has shown reliable rates of return to play, with conflicting results on pitching performance after players' return., Purpose: To evaluate Major League Baseball (MLB) pitching performance before and after UCLR performed at a single institution., Study Design: Cohort study; Level of evidence, 3., Methods: MLB pitchers (minor league players were excluded) who underwent UCLR at our institution between 2002 and 2016 were identified. Player information and return to play were determined including pitching level (MLB vs minor league) and total number of years played after surgery. Pitching performance statistics were evaluated for 3 years before surgery and for 3 years after returning to play including earned run average (ERA), walks plus hits per inning pitched (WHIP), innings pitched, wins above replacement, runs above replacement, and pitch velocity., Results: A total of 54 MLB pitchers were identified, with 46 primary and 8 revision reconstructions. The mean time to return to play was 13.8 months (primary reconstruction: 13.7 months). The majority returned to play with a 94% return rate (primary reconstruction: 96%), and 80% returned to MLB play (primary reconstruction: 82%). Three primary reconstructions required revision surgery. Pitchers played a mean of 3.2 years in MLB and 4.6 years total after surgery (39% still playing). Pitching workload and performance were maintained or improved after surgery. The preoperative ERA was 4.63 versus 4.13 after returning to play ( P = .268). Fastball velocity ( P = .032), ERA ( P = .003), and WHIP ( P = .001) worsened the first year after surgery and then improved the second year (ERA: 4.63 to 4.06 [ P = .380]; WHIP: 1.35 to 1.32 [ P = .221]; fastball velocity: 91.3 to 91.9 mph [ P = .097]). Compared with a matched control group, pitchers who had UCLR showed improvements or maintained performance after reconstruction including improved ERA ( P = .007), WHIP ( P = .025), and fastball velocity ( P = .006)., Conclusion: MLB players experienced a high rate of return to play and previous level of play after UCLR. Pitching workload was maintained after returning to play. Pitching performance initially decreased the first year after returning and then improved or reverted to previous levels after the first year from UCLR.
- Published
- 2018
- Full Text
- View/download PDF
27. The biomechanical evaluation of a novel 3-strand docking technique for ulnar collateral ligament reconstruction in the elbow.
- Author
-
Williams PN, McGarry MH, Ihn H, Schulz BM, Limpisvasti O, ElAttrache NS, and Lee TQ
- Subjects
- Adult, Aged, Biomechanical Phenomena, Cadaver, Female, Humans, Male, Middle Aged, Range of Motion, Articular, Rotation, Torque, Collateral Ligaments surgery, Suture Techniques, Ulnar Collateral Ligament Reconstruction methods
- Abstract
Background and Hypothesis: The original 2-strand docking technique for elbow ulnar collateral ligament reconstruction has recently been modified to use a 3-strand graft. To date, no biomechanical study has compared the 2 techniques. We hypothesized that the 3-strand docking technique would restore valgus laxity to its native state, with comparable load-to-failure characteristics to the 2-strand docking technique., Materials and Methods: Sixteen fresh cadaveric elbows were matched to the corresponding contralateral side from the same individual to create 8 matched pairs and were then randomized to undergo ulnar collateral ligament reconstruction using either the 2- or 3-strand technique. Valgus laxity and rotation measurements were quantified using a MicroScribe 3DLX digitizer at various flexion angles for the native state, transected state, and 1 of the 2 tested reconstructed ligaments. Each reconstruction was then tested to failure., Results: Valgus laxity for the intact state at elbow flexion angles of 30°, 60°, 90°, and 120° was 7° ± 2°, 7° ± 2°, 6° ± 1°, and 5° ± 2°, respectively. These values were similar to those of both reconstruction techniques. On load-to-failure testing, there was no significant difference in any parameter recorded. Yield torques for the 3- and 2-strand reconstructions were 13.4 ± 4.80 N/m and 11.8 ± 4.76 N/m, respectively (P = .486). The ultimate torques were 15.7 ± 6.10 N/m and 14.4 ± 5.58 N/m for the 3- and 2-strand techniques, respectively (P = .582)., Conclusion: The 3-strand docking technique was able to restore valgus laxity to the native state, with similar load-to-failure characteristics to the 2-strand docking technique., (Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
28. Osteochondritis Dissecans Lesion of the Radial Head.
- Author
-
Patel DN, ElAttrache NS, and Banffy MB
- Subjects
- Adolescent, Arthroscopy, Humans, Magnetic Resonance Imaging, Male, Osteochondritis Dissecans therapy, Physical Therapy Modalities, Treatment Outcome, Cartilage, Articular surgery, Elbow Joint surgery, Osteochondritis Dissecans diagnostic imaging
- Abstract
This case shows an atypical presentation of an osteochondritis dissecans (OCD) lesion of the radial head with detachment diagnosed on plain radiographs and magnetic resonance imaging (MRI). OCD lesions are rather uncommon in the elbow joint; however, when present, these lesions are typically seen in throwing athletes or gymnasts who engage in activities involving repetitive trauma to the elbow. Involvement of the radial head is extremely rare, accounting for <5% of all elbow OCD lesions. Conventional radiographs have low sensitivity for detecting OCD lesions and may frequently miss these lesions in the early stages. MRI, the imaging modality of choice, can detect these lesions at the earliest stage and provide a clear picture of the involved articular cartilage and underlying bone. Treatment options can vary between nonoperative and operative management depending on several factors, including age and activity level of the patient, size and type of lesion, and clinical presentation. This case represents a radial head OCD lesion managed by arthroscopic débridement alone, resulting in a positive outcome., Competing Interests: Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.
- Published
- 2018
- Full Text
- View/download PDF
29. Is There a Role for Internal Bracing and Repair of the Anterior Cruciate Ligament? A Systematic Literature Review.
- Author
-
van Eck CF, Limpisvasti O, and ElAttrache NS
- Subjects
- Humans, Anterior Cruciate Ligament surgery, Anterior Cruciate Ligament Injuries surgery, Anterior Cruciate Ligament Reconstruction methods, Arthroscopy methods, Braces statistics & numerical data, Tissue Scaffolds statistics & numerical data
- Abstract
Background: Renewed interest has arisen in arthroscopic anterior cruciate ligament (ACL) repair techniques., Hypothesis: ACL repair with or without some form of internal bracing could lead to good outcomes in a carefully selected subset of patients., Study Design: Systematic review., Methods: An electronic database search was performed to identify 89 papers describing preclinical and clinical studies on the outcome of ACL repair., Results: Proximal ACL tear patterns showed a better healing potential with primary repair than distal or midsubstance tears. Some form of internal bracing increased the success rate of ACL repair. Improvement in the biological characteristics of the repair was obtained by bone marrow access by drilling tunnels or microfracture. Augmentation with platelet-rich plasma was beneficial only in combination with a structural scaffold. Skeletally immature patients had the best outcomes. Acute repair offered improved outcomes with regard to load, stiffness, laxity, and rerupture., Conclusion: ACL repair may be a viable option in young patients with acute, proximal ACL tears. The use of internal bracing, biological augmentation, and scaffold tissue may increase the success rate of repair.
- Published
- 2018
- Full Text
- View/download PDF
30. Revision Ulnar Collateral Ligament Reconstruction.
- Author
-
Bruce JR, ElAttrache NS, and Andrews JR
- Subjects
- Collateral Ligament, Ulnar surgery, Humans, Treatment Outcome, Baseball injuries, Collateral Ligament, Ulnar injuries, Reoperation methods, Ulnar Collateral Ligament Reconstruction methods
- Abstract
Ulnar collateral ligament injuries continue to occur despite efforts to educate pitchers, coaches, and families at the amateur and professional levels about pitch counts, mechanics, and injury prevention. Although the data on the incidence of ulnar collateral ligament reconstructions are inconclusive, an increase in these reconstructions may mean a corresponding increase in the number of reconstruction failures and revision reconstruction surgeries. Less is known about the outcomes of revision ulnar collateral ligament reconstruction; not unexpectedly, early results are not as promising as those observed with primary reconstruction. In response, interest in revision techniques, rehabilitation, and outcomes of revision ulnar collateral ligament reconstruction surgeries has grown.
- Published
- 2018
- Full Text
- View/download PDF
31. Clinical outcomes of a single-tunnel technique for coracoclavicular and acromioclavicular ligament reconstruction.
- Author
-
Banffy MB, van Eck CF, and ElAttrache NS
- Subjects
- Acromioclavicular Joint diagnostic imaging, Acromioclavicular Joint physiopathology, Adult, Arthroplasty adverse effects, Athletic Injuries diagnostic imaging, Athletic Injuries physiopathology, Female, Follow-Up Studies, Humans, Joint Dislocations diagnostic imaging, Male, Middle Aged, Muscle Strength, Postoperative Complications etiology, Postoperative Complications surgery, Radiography, Range of Motion, Articular, Return to Sport, Acromioclavicular Joint surgery, Arthroplasty methods, Athletic Injuries surgery, Joint Dislocations surgery, Ligaments, Articular surgery
- Abstract
Background: A large number of surgical techniques have been described to treat acromioclavicular (AC) joint separations. Despite the high success rates with double-tunnel reconstruction, this method has been associated with the risk of coracoid and clavicle fractures. This study aimed to evaluate the outcomes of the first cohort of patients who underwent single-tunnel AC and coracoclavicular (CC) ligament reconstruction. It was hypothesized that this technique would result in maintenance of reduction and a minimal risk of fracture of the coracoid and clavicle., Methods: All patients who underwent single-tunnel AC joint reconstruction between 2012 and 2015 via the technique with 2-year follow-up were included. Objective outcomes recorded were maintenance of reduction as measured by the CC distance on radiographs, shoulder range of motion, strength, return to sports, and complications. Subjective outcomes included maintenance of reduction on visual inspection and various patient-reported outcomes., Results: Seventeen patients were included with a mean age of 41 ± 12 years. Separation types included types III, IV, and V. The mean follow-up period was 29 ± 9 months (range, 16-45 months). The CC distance improved from 37.4 to 30.0 mm on plain radiographs (P = .006), the American Shoulder and Elbow Surgeons score improved from 67.0 to 90.1 (P = .094), and the Single Assessment Numeric Evaluation score improved from 30.5 to 91.1 (P = .025). Reduction on visual inspection was maintained in 16 patients (94.1%). Regarding sports participation, 14 patients (82.4%) returned to their preinjury level. The most common complication was a prominent suture knot stack, occurring in 3 patients (17.6%), which was removed in all 3 in a second procedure. There were no clavicle or coracoid fractures., Conclusion: The described technique results in satisfactory objective and patient-reported outcomes and return to sports while avoiding coracoid and clavicle fractures., (Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
32. Biomechanical Evaluation of a Single- Versus Double-Tunnel Coracoclavicular Ligament Reconstruction With Acromioclavicular Stabilization for Acromioclavicular Joint Injuries.
- Author
-
Banffy MB, Uquillas C, Neumann JA, and ElAttrache NS
- Subjects
- Acromioclavicular Joint physiopathology, Biomechanical Phenomena, Cadaver, Clavicle injuries, Clavicle surgery, Female, Fractures, Bone surgery, Humans, Joint Capsule surgery, Ligaments, Articular physiopathology, Male, Middle Aged, Risk Factors, Suture Anchors, Suture Techniques, Acromioclavicular Joint injuries, Acromioclavicular Joint surgery, Arthroplasty methods, Ligaments, Articular injuries, Ligaments, Articular surgery
- Abstract
Background: An anatomic double-tunnel (DT) reconstruction technique has been widely adopted to reconstruct the ruptured coracoclavicular (CC) ligaments seen with high-grade acromioclavicular (AC) joint injuries. However, the anatomic DT reconstruction has been associated with the risk of clavicle fractures, which may be problematic, particularly for contact athletes. Purpose/Hypothesis: The purpose was to compare a single-tunnel (ST) CC ligament reconstruction for AC joint injuries with the native state as well as with the more established anatomic DT CC ligament reconstruction. The hypothesis was that ST CC ligament reconstruction would demonstrate biomechanical properties similar to those of the native state and the DT CC ligament reconstruction., Study Design: Controlled laboratory study., Methods: Eighteen fresh-frozen human cadaveric shoulders (9 matched pairs) with mean ± SD age of 55.5 ± 8.5 years underwent biomechanical testing. One specimen of each matched pair underwent a ST CC ligament reconstruction and the second, a DT CC ligament reconstruction. The ST and DT CC ligament reconstruction techniques involved a 5-mm distal clavicle excision, avoided coracoid drilling, and utilized a 3.0-mm suture anchor to fix the excess lateral limb to reconstruct the superior AC joint capsule. The ST CC ligament reconstruction technique additionally included a 1.3-mm suture tape to help avoid a sawing effect, as well as a dog-bone button over the clavicular tunnel to increase stability of the construct. All specimens were tested to 70 N in 3 directions (superior, anterior, and posterior) in the intact and reconstructed states. The ultimate load, yield load, stiffness, and mode of failure of the reconstructed specimens were tested., Results: There were no significant differences in translation at 70 N in the superior ( P = .31), anterior ( P = .56), and posterior ( P = .35) directions between the ST CC ligament reconstruction and the intact state. The ultimate load to failure, yield load, and stiffness in the ST and DT groups were also not significantly different. There were no distal clavicle fractures in load-to-failure testing in the ST or DT group., Conclusion: In this biomechanical study, ST CC ligament reconstruction demonstrates biomechanical properties comparable to the intact state. Additionally, use of the ST CC ligament reconstruction shows biomechanical properties similar to the DT CC ligament reconstruction technique while theoretically posing less risk of clavicle fracture., Clinical Relevance: This study suggests that the ST CC ligament reconstruction has biomechanical properties equivalent to the DT CC ligament reconstruction with less theoretical risk of clavicle fracture.
- Published
- 2018
- Full Text
- View/download PDF
33. Video Analysis of Anterior Cruciate Ligament Tears in Professional American Football Athletes.
- Author
-
Johnston JT, Mandelbaum BR, Schub D, Rodeo SA, Matava MJ, Silvers-Granelli HJ, Cole BJ, ElAttrache NS, McAdams TR, and Brophy RH
- Subjects
- Athletes, Cohort Studies, Humans, Knee Joint pathology, Male, Movement, Retrospective Studies, Rotation, United States, Anterior Cruciate Ligament Injuries physiopathology, Football injuries, Knee Injuries physiopathology
- Abstract
Background: Anterior cruciate ligament (ACL) injuries are prevalent in contact sports that feature cutting and pivoting, such as American football. These injuries typically require surgical treatment, can result in significant missed time from competition, and may have deleterious long-term effects on an athlete's playing career and health. While the majority of ACL tears in other sports have been shown to occur from a noncontact mechanism, it stands to reason that a significant number of ACL tears in American football would occur after contact, given the nature of the sport. Hypothesis/Purpose: The purpose was to describe the mechanism, playing situation, and lower extremity limb position associated with ACL injuries in professional American football players through video analysis to test the hypothesis that a majority of injuries occur via a contact mechanism., Study Design: Case series; Level of evidence, 4., Methods: A retrospective cohort of National Football League (NFL) players with ACL injuries from 3 consecutive seasons (2013-2016) was populated by searching publicly available online databases and other traditional media sources. Of 156 ACL injuries identified, 77 occurred during the regular season and playoffs, with video analysis available for 69 injuries. The video of each injury was independently viewed by 2 reviewers to determine the nature of the injury (ie, whether it occurred via a noncontact mechanism), the position of the lower extremity, and the football activity at the time of injury. Playing surface, player position, and time that the injury occurred were also recorded., Results: Contrary to our hypothesis, the majority of ACL injuries occurred via a noncontact mechanism (50 of 69, 72.5%), with the exception of injury to offensive linemen, who had a noncontact mechanism in only 20% of injuries. For noncontact injuries, the most common football activity at the time of injury was pivoting/cutting, and the most common position of the injured extremity included hip abduction/flexion, early knee flexion/abduction, and foot abduction/external rotation. There was no association between injury mechanism and time of injury or playing surface in this cohort., Conclusion: In this study of players in the NFL, the majority of ACL tears involved a noncontact mechanism, with the lower extremity exhibiting a dynamic valgus moment at the knee. These findings suggest that ACL injury prevention programs may reduce the risk of noncontact ACL tears in American football players.
- Published
- 2018
- Full Text
- View/download PDF
34. Ulnar Collateral Ligament Repair With Suture Bridge Augmentation.
- Author
-
Urch E, DeGiacomo A, Photopoulos CD, Limpisvasti O, and ElAttrache NS
- Abstract
The gold standard for management of elbow ulnar collateral ligament (UCL) injuries in elite athletes is reconstruction of the UCL with a tendon graft. Over the past several years, UCL repair for acute tears, as well as partial tears, in young athletes has gained increasing popularity, with studies reporting good outcomes and high rates of return to sports. Additionally, there is increased interest in ligament augmentation using the InternalBrace concept. A recent technique paper describes a direct repair of the UCL augmented with a spanning suture bridge. Although clinical outcomes for this method are promising, one possible concern when using this technique is bone loss at the ulnar origin of the UCL should revision reconstruction be required. We propose an alternative augmentation method that allows for stress shielding of the healing native ligament while minimizing bone compromise in the face of UCL reconstruction at a later time point.
- Published
- 2018
- Full Text
- View/download PDF
35. The Development and Validation of a Subjective Assessment Tool for the Hip in the Athletic Population.
- Author
-
Papaliodis DN, Banffy MB, Limpisvasti O, Mohr K, Mehran N, Photopoulos CD, Kvitne R, and ElAttrache NS
- Subjects
- Adolescent, Adult, Cross-Sectional Studies, Female, Hip Injuries etiology, Humans, Male, Range of Motion, Articular, Surveys and Questionnaires, United States, Young Adult, Athletes, Groin injuries, Health Status Indicators, Hip Injuries physiopathology
- Abstract
Background: No validated functional assessments are available that are designed specifically to evaluate the performance and function of the athletic hip. Subsections of some validated outcome assessments address recreation, but a full assessment dedicated to athletic hip function does not exist. Current hip scoring systems may not be sensitive to subtle changes in performance and function in an athletic, younger population., Hypothesis: The patient-athlete subjective scoring system developed in this study will be validated, reliable, and responsive in the evaluation of hip function in the athlete., Study Design: Cross-sectional study; Level of evidence, 3., Methods: Based on the results of a pilot questionnaire administered to 18 athletic individuals, a final 10-item questionnaire was developed. Two hundred fifty competitive athletes from multiple sports completed the final questionnaire and 3 previously validated hip outcome assessments. Each athlete was self-assigned to 1 of 3 injury categories: (1) playing without hip/groin trouble; (2) playing, but with hip/groin trouble; and (3) not playing due to hip/groin trouble. The injury categories contained 196, 40, and 14 athletes, respectively. Correlations between the assessment scores and injury categories were measured. Responsiveness testing was performed in an additional group of 24 injured athletes, and their scores before and after intervention were compared., Results: The Kerlan-Jobe Orthopaedic Clinic (KJOC) Athletic Hip Score showed high correlation with the modified Harris Hip Score, the Nonarthritic Hip Score, and the International Hip Outcome Tool. The new score stratified athletes by injury category, demonstrated responsiveness and accuracy, and varied appropriately with improvements in injury category after treatment of injuries., Conclusion: The new KJOC Athletic Hip Score is valid, reliable, and responsive for evaluation of the hip in an athletic population. The results support its use for the functional assessment of the hip in future studies.
- Published
- 2017
- Full Text
- View/download PDF
36. Erratum to: Platelet-rich Plasma and Other Cellular Strategies in Orthopedic Surgery.
- Author
-
Williams PN, Moran G, Bradley JP, ElAttrache NS, and Dines JS
- Published
- 2017
- Full Text
- View/download PDF
37. Partial-thickness tears involving the rotator cable lead to abnormal glenohumeral kinematics.
- Author
-
Pinkowsky GJ, ElAttrache NS, Peterson AB, Akeda M, McGarry MH, and Lee TQ
- Subjects
- Aged, Cadaver, Female, Glenoid Cavity, Humans, Humeral Head, Male, Middle Aged, Range of Motion, Articular physiology, Rotator Cuff Injuries physiopathology, Shoulder Joint physiopathology
- Abstract
Hypothesis: The objective of this study was to determine the biomechanical function of the rotator cable when a partial-thickness (>50%) tear is present. We compared intact specimens with partial tears of the anterior cable followed by partial anterior and posterior tears in regard to glenohumeral kinematics and translation. The hypothesis was that partial-thickness tears will lead to abnormal glenohumeral biomechanics, including glenohumeral translation and path of glenohumeral articulation., Methods: Five fresh frozen cadaveric shoulders with intact labrum, rotator cuff, and humerus were tested using a custom shoulder testing system in the scapular plane. Glenohumeral translation was measured after applying an anterior load of 30 N at different angles of external rotation. The path of glenohumeral articulation was measured by calculating the humeral head center with respect to the glenoid articular surface at 30°, 60°, 90°, and 120° of external rotation., Results: With an anterior force of 30 N, there was a significant increase in anterior and total translation at 30° of external rotation after the anterior cable was cut (P < .05). When the tear was extended to the posterior cable, there was a significant increase in anterior, inferior, and total translation at 30° and 120° of external rotation (P < .05). With respect to the path of glenohumeral articulation , the humeral head apex was shifted superiorly at 90° and 120° of external rotation after the posterior cable was cut (P < .05)., Conclusion: Partial-thickness articular-sided rotator cuff tears with a thickness >50% involving the rotator cable increased glenohumeral translation and changed kinematics in our cadaveric biomechanical model., (Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
38. A Single-Tunnel Technique for Coracoclavicular and Acromioclavicular Ligament Reconstruction.
- Author
-
Banffy MB, van Eck CF, Stanton M, and ElAttrache NS
- Abstract
Acromioclavicular (AC) joint separation is a common injury seen in the young adult athletic population. Both the indications for surgical management and the best operative technique remain controversial. One of the most popular reconstruction techniques is the anatomic double-tunnel coracoclavicular (CC) ligament reconstruction. However, there have been several case reports of clavicle fractures with this technique. This article presents a single-tunnel reconstruction technique that aims to restore both the CC and AC ligament function, while minimizing fracture risk.
- Published
- 2017
- Full Text
- View/download PDF
39. Treatment of the ulnar nerve for overhead throwing athletes undergoing ulnar collateral ligament reconstruction.
- Author
-
Conti MS, Camp CL, Elattrache NS, Altchek DW, and Dines JS
- Abstract
Ulnar nerve (UN) injuries are a common complaint amongst overhead athletes. The UN is strained during periods of extreme valgus stress at the elbow, especially in the late-cocking and early acceleration phases of throwing. Although early ulnar collateral ligament (UCL) reconstruction techniques frequently included routine submuscular UN transposition, this is becoming less common with more modern techniques. We review the recent literature on the sites of UN compression, techniques to evaluate the UN nerve, and treatment of UN pathology in the overhead athlete. We also discuss our preferred techniques for selective decompression and anterior transposition of the UN when indicated. More recent studies support the use of UN transpositions only when there are specific preoperative symptoms. Athletes with isolated ulnar neuropathy are increasingly being treated with subcutaneous anterior transposition of the nerve rather than submuscular transposition. When ulnar neuropathy occurs with UCL insufficiency, adoption of the muscle-splitting approach for UCL reconstructions, as well as using a subcutaneous UN transposition have led to fewer postoperative complications and improved outcomes. Prudent handling of the UN in addition to appropriate surgical technique can lead to a high percentage of athletes who return to competitive sports following surgery for ulnar neuropathy., Competing Interests: Conflict-of-interest statement: Authors declare no conflict of interests for this article.
- Published
- 2016
- Full Text
- View/download PDF
40. Diseases of Subchondral Bone 2.
- Author
-
Lerebours F, ElAttrache NS, and Mandelbaum B
- Subjects
- Arthroscopy adverse effects, Humans, Magnetic Resonance Imaging, Osteonecrosis diagnostic imaging, Range of Motion, Articular, Risk Factors, Femur diagnostic imaging, Knee Joint diagnostic imaging, Knee Joint physiopathology, Osteonecrosis etiology, Osteonecrosis surgery
- Abstract
Osteonecrosis of the knee can be divided into the following 3 categories: primary or Spontaneous osteonecrosis of the knee (SONK), secondary osteonecrosis (ON), and postarthroscopic osteonecrosis. Patient characteristics as well as underlying risk factors can help categorize the type of osteonecrosis and guide treatment. SONK was first described by Ahlback et al in 1968. It is described as a disease of subchondral bone that leads to focal ischemia and bone marrow edema, necrosis, and possible subsequent structural collapse. SONK typically presents in the older women with frequent involvement of the medial femoral condyle. Secondary osteonecrosis is typically present in patients below 55 years of age. Unlike SONK, secondary ON presents multiple foci of bone marrow involvement with extension into the metaphysis and diaphysis. Postarthroscopic ON has been described after arthroscopic meniscectomy, shaver-assisted chondroplasty, anterior cruciate ligament reconstruction, and laser or radiofrequency-assisted debridement.
- Published
- 2016
- Full Text
- View/download PDF
41. Articular Cartilage Repair Techniques.
- Author
-
Mandelbaum BR and ElAttrache NS
- Subjects
- Cartilage Diseases surgery, Cartilage, Articular injuries, Humans, Cartilage, Articular surgery
- Published
- 2016
- Full Text
- View/download PDF
42. Diseases of Subchondral Bone 1.
- Author
-
Lerebours F, ElAttrache NS, and Mandelbaum B
- Subjects
- Bone and Bones diagnostic imaging, Contusions pathology, Humans, Magnetic Resonance Imaging, Osteochondritis Dissecans diagnostic imaging, Osteochondritis Dissecans etiology, Bone and Bones injuries, Contusions diagnostic imaging, Knee Joint diagnostic imaging, Osteochondritis Dissecans therapy
- Abstract
The subchondral zone plays an important role in both the structural and biochemical maintenance of articular cartilage. Knowledge of the structure, function, and pathophysiology of the normal subchondral bone/articular surface interface is essential for an understanding of the pathogenesis of many of the disease entities that we will review in this chapter.
- Published
- 2016
- Full Text
- View/download PDF
43. Media perceptions of Tommy John surgery.
- Author
-
Conte SA, Hodgins JL, ElAttrache NS, Patterson-Flynn N, and Ahmad CS
- Subjects
- Adult, Athletic Injuries surgery, Collateral Ligaments injuries, Cross-Sectional Studies, Cumulative Trauma Disorders surgery, Female, Humans, Male, Middle Aged, Movement, Perception, Public Opinion, Return to Sport, Risk Factors, Surveys and Questionnaires, Ulna, Elbow Injuries, Arm Injuries surgery, Baseball injuries, Collateral Ligaments surgery, Elbow Joint surgery, Health Knowledge, Attitudes, Practice, Mass Media, Orthopedic Procedures
- Abstract
Objectives: The prevalence of medial ulnar collateral ligament (UCL) reconstruction is increasing in professional athletes and the delivery of baseball news by the media exerts a powerful influence on public opinion of the injury and surgery. The purpose of this investigation was to examine the media's perception regarding the causes of UCL injury as well as the indications, risks, benefits, and rehabilitation related to UCL reconstruction., Study Design: Cross-sectional survey study, Level 3., Methods: This study utilized an online thirty-question survey designed to assess an individual's perception of UCL reconstruction with regard to risk factors for injury, indications, benefits, surgical details, and rehabilitation. Eligible study participants were members of the media including print, internet, radio and/or television directly involved in the coverage of Major League Baseball (MLB)., Results: A total of 516 members of the media with a mean age of 43.6 years completed the survey. In nearly half (47.8%), professional baseball represented 76-100% of their total sports coverage responsibility., Indications: although the majority answered correctly, 45% did not know if an athlete needed an elbow injury as a prerequisite for UCL reconstruction and 25% believed the primary indication was performance enhancement. As percentage of baseball coverage increased, media members were less likely to believe that an elbow injury was not required (p = 0.038)., Benefits: eighty percent recognized that pitching speed is typically reduced following surgery, but the remaining 20% felt that velocities actually increased compared with pre-injury velocities. Return to play: fifty-two percent overestimated the ability of pitchers to return to back to professional baseball and 51.2% believed return would occur in 12 or less months. Estimates were higher in those of older age (p = 0.032) and increased percentage of baseball coverage (p < 0.001). Overuse injuries: less than half (48.4%) believed the use of pitch counts to be important in the prevention of UCL injury and 33.2% felt that throwing injuries were not preventable in adolescent baseball., Conclusion: Common misconceptions exist regarding UCL reconstruction within the professional baseball media. Efforts for physicians to educate the media on the risks of overuse throwing injuries with emphasis on accurate indications, outcomes, and recovery of Tommy John Surgery are encouraged.
- Published
- 2015
- Full Text
- View/download PDF
44. Impact of fellowship training on clinical practice of orthopaedic sports medicine.
- Author
-
Yin B, Gandhi J, Limpisvasti O, Mohr K, and ElAttrache NS
- Subjects
- Health Services Needs and Demand statistics & numerical data, Humans, Joint Diseases diagnosis, Joint Diseases therapy, Knee surgery, Orthopedic Procedures methods, Orthopedics statistics & numerical data, Population Surveillance, Program Evaluation, Shoulder surgery, Shoulder Joint surgery, Sports Medicine statistics & numerical data, United States, Clinical Competence statistics & numerical data, Education, Medical, Graduate economics, Fellowships and Scholarships statistics & numerical data, Orthopedics education, Sports Medicine education
- Abstract
Background: Approximately 90% of current orthopaedic graduates are engaging in fellowship training, with sports medicine being the most commonly chosen specialty. The purpose of this study was to evaluate the impact of fellowship training on clinical decision-making by fellowship-trained sports medicine surgeons., Methods: A survey was designed to assess the importance of fellowship on common clinical decisions made in the nonoperative and surgical treatment of knee, shoulder, and elbow disorders. The survey also included questions for the respondents on their comfort level with a variety of routine and complex surgical procedures. The survey was sent to alumni of 113 orthopaedic sports medicine programs across the United States., Results: Completed surveys were returned by 310 surgeons who had been in practice for an average of 9.0 years. They represented alumni of twenty-nine orthopaedic sports medicine fellowship programs across sixteen states. Fellowship was considered very important for surgical decision-making in the knee and shoulder. For nonoperative treatment, fellowship had a greater impact on shoulder disorders than on knee or elbow disorders. Fellowship was significantly more important than residency (p < 0.001) for determining preferred surgical equipment, implants, and braces. Among the surgical procedures assessed, respondents were least comfortable with the treatment of multi-ligamentous knee injuries, posterior cruciate ligament injuries, and shoulder instability with bone loss., Conclusions: Fellowship has a significantly higher impact than residency on industry-related decision-making. Fellowship-trained sports surgeons should consider seeking additional training in the treatment of multi-ligamentous knee injuries, posterior cruciate ligament injuries, shoulder instability with bone loss, and elbow disorders. The current findings were limited by the relatively small respondent pool, which represented only 26% of sports medicine fellowship programs in the United States., (Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.)
- Published
- 2015
- Full Text
- View/download PDF
45. Shoulder functional performance status of Minor League professional baseball pitchers.
- Author
-
Fronek J, Yang JG, Osbahr DC, Pollack KM, ElAttrache NS, Noonan TJ, Conte SA, Mandelbaum BR, and Yocum LA
- Subjects
- Adult, Cross-Sectional Studies, Humans, Male, Risk Factors, Young Adult, Baseball, Health Status Indicators, Shoulder, Shoulder Joint
- Abstract
Background and Hypothesis: The Overhead Shoulder and Elbow Score (Kerlan-Jobe Orthopaedic Clinic [KJOC] score) among healthy or uninjured professional baseball pitchers is lacking. We hypothesized that shoulder function and performance status measured by the KJOC score among active Minor League professional baseball pitchers were high at pre-participation and that the pitchers who had not been previously treated for a shoulder injury and were playing without arm trouble had significantly higher KJOC scores than their counterparts., Methods: In this cross-sectional survey, data on pre-participation KJOC scores, along with other study measures, were collected from a cohort of Minor League professional baseball pitchers. Generalized estimating equations with a Poisson distribution were used for analysis., Results: A total of 366 Minor League professional pitchers were included, with a mean KJOC score of 92.8 points (SD, 12.1 points), suggesting that participating pitchers' shoulder function and performance were high. Participating pitchers who had not received treatment for a shoulder injury had significantly higher KJOC scores than those who had received treatment, either surgical or nonsurgical (β = 0.0238, P = .0495). In addition, pitchers who were not currently injured, were playing without arm trouble, or had not missed games in the past 12 months because of a shoulder injury also had statistically significantly higher KJOC scores than their counterparts., Conclusion: This study provides an empirical profile of the KJOC score for a large sample of active Minor League professional baseball pitchers and identifies risk factors associated with decreased KJOC scores., (Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
46. Arthroscopic Single-Row Versus Double-Row Repair for Full-Thickness Posterosuperior Rotator Cuff Tears: A Critical Analysis Review.
- Author
-
Roth KM, Warth RJ, Lee JT, Millett PJ, and ElAttrache NS
- Published
- 2014
- Full Text
- View/download PDF
47. Biomechanical comparison of the interval throwing program and baseball pitching: upper extremity loads in training and rehabilitation.
- Author
-
Slenker NR, Limpisvasti O, Mohr K, Aguinaldo A, and Elattrache NS
- Subjects
- Acceleration, Analysis of Variance, Baseball injuries, Biomechanical Phenomena physiology, Humans, Kinetics, Male, Rotation, Torque, Video Recording, Young Adult, Baseball physiology, Upper Extremity physiology
- Abstract
Background: The interval throwing progression has been part of baseball rehabilitation and conditioning for decades, yet little is known about the upper extremity loads an athlete is subjected to during this progression., Hypothesis: A biomechanical comparison of fastball pitching, variable-effort pitching, and throwing various flat-ground distances will show significant torque differences in the throwing shoulder and elbow., Study Design: Descriptive laboratory study., Methods: Twenty-nine healthy college baseball pitchers were analyzed using a quantitative motion analysis system. The participants threw from flat ground at distances of 18, 27, 37, and 55 m, having been instructed to throw "hard, on a horizontal line." The participants then threw fastballs 18.4 m from a mound at 3 different effort levels: 60%, 80%, and full effort. The kinetic values for humeral internal rotational torque (HIRT) and elbow valgus load (EVL) were extracted for each throw. Repeated-measures analyses of variance (ANOVAs) were used to compare all 7 throwing conditions within pitchers. The kinetic data were also compared against ball velocity to evaluate throwing efficiency. A separate analysis was conducted using a 3-level repeated-measures ANOVA with post hoc paired t tests comparing just the variable-effort throws from the mound., Results: No statistically significant differences were found in either HIRT or EVL between any of the flat-ground distances and throwing from the mound (P > .05). Despite similar biomechanical loads compared with the mound, throwing from flat ground showed significantly decreased ball velocity (82% of maximum). Statistically significant differences were found in humeral internal rotational torque and elbow valgus load between fastball pitching off the mound at 60% and 100%, as these parameters increased with throwing effort (P < .05). At 60% perceived effort from the mound, pitchers generated forces of 76% and ball speeds approaching 84% of maximum., Conclusion: Partial-effort pitching demonstrates significantly lower loads on the shoulder and elbow. Flat-ground throwing at even the shortest distances had similar biomechanical loads compared with pitching from the mound, yet at significantly lower ball velocity. This illustrates the mechanical advantage and increased efficiency of throwing from a mound. No increase in shoulder or elbow loads was seen with increasing distances from flat ground, as pitchers began using a "crow hop" for the longer distances, facilitating the throw with their lower extremity. The mechanical advantage of throwing from a mound or using the crow hop is likely protective during rehabilitation and training throws., Clinical Relevance: The findings of this study may be used to improve rehabilitation programs designed for baseball players returning from shoulder or elbow injury.
- Published
- 2014
- Full Text
- View/download PDF
48. The effect of ketorolac tromethamine, methylprednisolone, and platelet-rich plasma on human chondrocyte and tenocyte viability.
- Author
-
Beitzel K, McCarthy MB, Cote MP, Apostolakos J, Russell RP, Bradley J, ElAttrache NS, Romeo AA, Arciero RA, and Mazzocca AD
- Subjects
- Adult, Anesthetics, Local pharmacology, Cell Survival drug effects, Cells, Cultured, Chondrocytes physiology, Female, Humans, Male, Time Factors, Adrenal Cortex Hormones pharmacology, Anti-Inflammatory Agents, Non-Steroidal pharmacology, Chondrocytes drug effects, Ketorolac Tromethamine pharmacology, Methylprednisolone pharmacology, Platelet-Rich Plasma, Tendons cytology
- Abstract
Purpose: The purpose of this study was to evaluate the effect on cell viability of the isolated and combined use of allogeneic platelet-rich plasma (PRP) and ketorolac tromethamine on human chondrocytes and tenocytes in a highly controlled in vitro environment., Methods: PRP was produced from 8 subjects. Human chondrocytes (Lonza, Hopkinton, MA) and tenocytes isolated from samples of the long head of the biceps tendons were treated in culture with PRP, ketorolac tromethamine, and methylprednisolone, both alone and in combination. Control samples were treated in media containing 2% or 10% fetal bovine serum (FBS). Cells were exposed for 1 hour. Luminescence assays were obtained to examine cell viability after 24 hours and long-term effects on cell viability after 120 hours. Radioactive thymidine assay was used to measure proliferation after 120 hours., Results: For chondrocytes, cell viability (120 hours) increased significantly with the treatment of PRP alone (43,949 ± 28,104 cells; P < .001) and with the combination of ketorolac tromethamine and PRP (43,276 ± 31,208; P < .001), compared with the 2% FBS group (7,397 ± 470). Cell viability decreased significantly after exposure to methylprednisolone (1,323 ± 776; P < .001) and its combination with PRP (4,381 ± 5,116; p < .001). For tenocytes, cell viability (120 hours) was significantly higher with the treatment of PRP (61,287 ± 23,273; P < .001) and the combined treatment of ketorolac tromethamine and PRP (52,025 ± 17,307; P < .001), compared with the 2% FBS group (23,042 ± 2,973). Cell viability decreased significantly after exposure to methylprednisolone (3,934 ± 1,791; P = .001) and its combination with PRP (5,201 ± 2,834; P = .003), compared with 2% FBS., Conclusions: Tendon and cartilage cells showed increased cell viability after an exposure to allogeneic PRP and ketorolac tromethamine. Exposure to methylprednisolone alone decreased cell viability, and addition of PRP could partially reverse this negative effect., Clinical Relevance: Intra-articular injections of pain-modifying or anti-inflammatory drugs are routinely given in orthopaedic practice. Among the many agents available for intra-articular injection, corticosteroids and local anesthetics are the most common in clinical practice. Potential detrimental side effects of intra-articular injections of corticosteroids and local anesthetics have prompted investigation into alternative treatment options such as combinations of PRP and ketorolac tromethamine. In vitro evaluation of their effect on cell viability might build a basis for further translational research and clinical application., (Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
49. Functional outcomes following revision ulnar collateral ligament reconstruction in Major League Baseball pitchers.
- Author
-
Jones KJ, Conte S, Patterson N, ElAttrache NS, and Dines JS
- Subjects
- Adult, Collateral Ligaments injuries, Humans, Male, Recovery of Function, Reoperation, Retrospective Studies, Return to Work, Treatment Outcome, Young Adult, Elbow Injuries, Baseball injuries, Collateral Ligaments surgery, Elbow Joint surgery
- Abstract
Background: There is a paucity of data regarding outcomes following revision ulnar collateral ligament (UCL) reconstruction in Major League Baseball (MLB) pitchers. A single case series comprised of 4 MLB pitchers has reviewed outcomes in this cohort and reported a 75% rate of return to pitching. We hypothesize that MLB pitchers demonstrate a low rate of return to their pre-injury pitch workload following revision surgery., Methods: Clinical outcomes were reviewed with an emphasis on return to pre-injury pitch workload. Utilizing MLB player performance statistics, the postoperative pitch workload (appearances for relief pitchers and games started/innings pitched for starting pitchers) was calculated to determine if players were able to resume pre-injury throwing activity. Position-specific analyses for pitchers (starter vs relief) were also performed utilizing objective pitching statistics., Results: Overall, 78% (14/18) of pitchers were able to return to MLB play within 2 full seasons. Relief pitchers were able to resume 50% of their pre-injury pitch workload, while starting pitchers only reached 35% of their prior workload (P = .52). Relievers demonstrated better pitching statistics (ERA [earned run average], K/9 [strikeouts per 9 innings], and BB/9 [walks per 9 innings]) when compared to starters. Two starting pitchers were reassigned to relief roles by their teams, resulting in improvement in their postoperative pitch workload (mean 94%)., Conclusion: The overall rate of return to pre-injury pitch workload following revision UCL reconstruction is low among professional pitchers. Starting pitchers may be at higher risk for treatment failure in the revision setting, given the increased demands of the position, and may benefit from reassignment to a relief role., (Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
50. Pitch velocity is a predictor of medial elbow distraction forces in the uninjured high school-aged baseball pitcher.
- Author
-
Hurd WJ, Jazayeri R, Mohr K, Limpisvasti O, Elattrache NS, and Kaufman KR
- Abstract
Background: Medial elbow injuries are common among baseball pitchers. Easily accessed methods to assess medial elbow stress may be useful in identifying individuals with increased injury risk., Hypothesis: Pitch velocity (PV) is positively associated with higher medial elbow adduction moments., Study Design: Cohort study; Level of evidence, 2., Methods: Participants included 26 uninjured high school pitchers, 15 to 18 years in age. Three-dimensional data and PV were collected as athletes threw 10 fastballs for strikes to a regulation-distance target. Variables of interest were the normalized peak internal elbow adduction moment and peak PV. Linear regression was performed to evaluate the influence of PV on the adduction moment., Results: For the group, mean PV was 71 mph (range, 58-81 mph), and the adduction moment was 0.558 Nm/Ht × mass (range, 0.378-0.723). PV was positively associated with the adduction moment (P < 0.01, R(2)= 0.373)., Conclusions: Talented young pitchers may be more susceptible to elbow injuries as a consequence of a biomechanical coupling between PV and upper extremity joint moments., Clinical Relevance: PV may be measured easily and serve as an indicator of medial elbow stress.
- Published
- 2012
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.