Search

Background: Recent evidence has demonstrated that athletes are at greater risk for a lower extremity injury following a return-to-sport (RTS) after sport-related concussion (SRC). The reason for this is not completely clear, but it has been hypothesized that persistent deficits in neurocognitive factors may be a contributing factor., Hypothesis/purpose: This study assessed simple reaction time, processing speed, attention, and concentration in a group of athletes, post-concussion upon clearance for RTS for potential deficits that may result in slower reaction time, processing speed, attention, and concentration. The researchers hypothesized that the concussion group would demonstrate worse scores on both assessments compared to a sex-, age-, and sport-matched cohort., Study Design: Case-controlled study., Methods: Twelve participants who had suffered a SRC and eight healthy individuals who were matched to the concussed group by age, sex, and sport were evaluated. Those with a concussion had been cleared for RTS by a licensed healthcare provider. Each participant underwent neurocognitive tests that included a simple reaction time test (SRT) and the King-Devick Test (K-D). Independent t-tests were performed to compare the groups with significance set a priori at p<0.05., Results: There was a significant difference (p =0.024) between groups for SRT with the concussed group demonstrating a better SRT than the control group. There were no significant differences (p =0.939) between the groups for the K-D., Conclusion: With no significant differences between groups in the K-D assessment and, surprisingly, the concussed group having a better SRT compared to the healthy group, our hypothesis was not supported., Clinical Relevance: These specific measures, compounded with extensive post-concussion time lapse until RTS clearance, may have limited capacity in revealing potential persistent deficits in relevant neurocognitive characteristics., Level of Evidence: Level of Evidence 3., Competing Interests: The authors report no conflicts of interest.

Background: Despite an abundance of injury research focusing on European professional soccer athletes, there are limited injury data on professional soccer players in the United States., Purpose: To describe the epidemiology of injury across multiple years in Major League Soccer (MLS) players., Study Design: Descriptive epidemiology study., Methods: A web-based health management platform was used to prospectively collect injury data from all MLS teams between 2014 and 2019. An injury was defined as an incident that required medical attention and was recorded into the health management platform anytime over the course of the 2014-2019 seasons. Injuries and exposure data were recorded in training and match settings to calculate injury incidence., Results: A total of 9713 injuries were recorded between 2014 and 2019. A mean 1.1 injuries per year per player were identified, with midfielders sustaining the largest number of injuries. The most common injuries were hamstring strains (12.3%), ankle sprains (8.5%), and adductor strains (7.6%). The mean time missed per injury was 15.8 days, with 44.2% of injuries resulting in no days missed. Overall injury incidence was 8.7 per 1000 hours of exposure, declining over the course of the investigation, with a 4.1-times greater mean incidence during matches (14.0/1000 h) than training (3.4/1000 h)., Conclusion: Between 2014 and 2019, the most commonly reported injuries in MLS players were hamstring strains, ankle sprains, and adductor strains. Injury incidence during matches was 4.1 times greater when compared with training, while overall injury incidence was found to decline during the course of the study period., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.F. has received grants from Arthrex and Stryker, research support from Smith & Nephew, education payments from Medwest, consulting fees from Stryker, and personal fees from Elsevier and has stock/stock options in Jace Medical. M.D.C. has received education payments from Smith & Nephew and hospitality payments from Abbott, Misonix, and Stryker. D.H. has received hospitality payments from Horizon Pharma and Sentnyl Therapeutics. B.R.M. has received consulting fees from Arthrex, Biomarin, DePuy, and Exactech; speaking fees from Arthrex; and hospitality payments from Aesculap, Bioventus, Ferring, Flexion, Sanofi, and Stryker. L.L. has received consulting fees from Aesculap and hospitality payments from Ferring, Fidia, Flexion, Orthofix, Pacira, Sanofi, and Si-bone. E.G. has received education payments from Sequoia; consulting fees from Arthrex, Ipsen, MedShape, and Zimmer; royalties from Arthrex and Zimmer; honoraria from In2Bones; and hospitality payments from ACELL, Evolution Surgical, Integra, Steelhead Surgical, and Stryker. 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.)

Purpose: To investigate whether pullout strength in the acellular dermal allograft matrix (ADM) used for superior capsule reconstruction depends on the distance from the edge of the graft., Methods: ADM used for superior capsule reconstruction was obtained and cut into 30 squares. Two sutures were placed through the center of each graft by using a loaded Keith needle and forming a simple stitch. The grafts were divided into 3 groups of 10 grafts with a distance of 5 mm, 10 mm or 15 mm from the closest edge of the graft, respectively. The grafts were then preloaded to 5 N and pulled to failure at a rate of 12 mm/s on an MTS 858 MiniBionix servohydraulic mechanical test frame. The load to failure was recorded as well as the stiffness of each graft., Results: The mean load to failure was 34.5 N (SD 7.89) for the 5 mm grafts, 31.7 N (SD 5.99) for the 10 mm grafts, and 66.2 N (SD 18.4) for the 15 mm grafts. There was a significant difference (< 0.0001) between the large grafts (15 mm) and the 2 smaller grafts (10 mm, 5 mm). There was no significant difference in stiffness between the groups of graft ( P 0.40)., Conclusion: Placing the suture at least 15 mm from the edge of the graft increases the graft's ultimate yield strength to suture pullout., Clinical Relevance: The depths of the suture in ADM could improve pullout strength for constructs of superior capsular reconstructions., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier Inc.)

Context: Currently, there is a national focus on establishing and disseminating standardized guidelines for return to play for athletes at all levels of competition. As more data become available, protocols and guidelines are being refined and implemented to assist physicians, coaches, trainers, players, and parents in making decisions about return to play. To date, no standardized criteria for returning to play exist for injuries to the spine., Evidence Acquisition: Electronic databases including PubMed and MEDLINE and professional orthopaedic, neurosurgical, and spine organizational websites were reviewed between 1980 and 2015., Study Design: Clinical review., Level of Evidence: Level 4., Results: Although clinical guidelines have been published for return to play after spine injury, they are almost exclusively derived from expert opinion and clinical experience rather than from well-designed studies. Furthermore, recommendations differ and vary depending on anatomic location, type of sport, and surgery performed., Conclusion: Despite a lack of consensus and specific recommendations, there is universal agreement that athletes should be pain free, completely neurologically intact, and have full strength and range of motion before returning to play after spinal injury., (© 2015 The Author(s).)

Time is the greatest negative financial burden that you accept as a sports medicine physician, because the only way to produce revenue as a physician is with your time. This cost measured in time of doing business as a team physician can be high. Unless being a team physician is very rewarding to you through personal satisfaction or the other intangible indirect benefits associated with the role, being a team physician may not be a good financial decision for you as a person and a physician, or for your practice and your family.

Purpose: Evaluation of an arthroscopically assisted ankle arthrodesis technique for clinical and radiographic union, function, and patient satisfaction., Type of Study: Retrospective analysis and review of the literature., Methods: Twenty-one patients with a mean age of 52.7 years who underwent arthroscopic ankle arthrodesis were examined at an average follow-up time of 34 months. The mean duration of symptoms was 4.4 years. The most common diagnosis for patients who underwent arthrodesis was post-traumatic arthritis (19 of 21) with 1 patient having a diagnosis of avascular necrosis of the talus and the other patient having rheumatoid arthritis. All patients described severe mechanical pain as the most important reason for undergoing the procedure., Results: Fusion occurred in 20 of 21 patients. The average time to clinical and radiographic union was 8.9 weeks. Nine patients were graded as excellent; no pain, limp, or occupational restriction, and a stable fusion. Eleven were graded as good; mild pain, occasional limp, or occupational restriction with a stable fusion. One was graded as poor; failed union and pain. The failure had extensive avascular necrosis involving approximately 50% of the talus as a preoperative diagnosis., Conclusions: The advantages of the arthroscopic technique include a high fusion rate, decreased time to fusion, and decreased cost. There are considerable advantages to the arthroscopic technique in appropriately selected patients with no or mild angular deformity and no avascular necrosis greater than 30% of the talus. There is a substantial reduction in time to fusion in the arthroscopic procedure compared with published reports on open procedures for ankle arthrodesis. While this procedure is not indicated in all instances, selected patients with disabling ankle arthrosis may be more appropriately treated with an arthroscopic arthrodesis than by open surgery.

Arthroscopic subacromial decompression has become an accepted treatment for patients with impingement syndrome; however, its use for full thickness rotator cuff tears continues to be controversial. The purpose of this study is to determine if the results of arthroscopic subacromial decompression alone for full thickness rotator cuff tears deteriorate at long-term follow-up. We reevaluated all 25 patients with full thickness rotator cuff tears who underwent arthroscopic subacromial decompression from our original study group. Based on the University of California at Los Angeles shoulder rating, 68% of patients were rated as excellent or good at the present mean follow-up of 45.8 months (range 36-72 months). This represents a significant decrease from our initial report of 84% satisfactory results at a mean follow-up of 24.6 months. There was a significant decrease in ratings with regard to pain and function; however, no significant deterioration was noted with regard to motion and strength. Two additional patients required open rotator cuff repair since the time of initial follow-up for a total of six. Large and massive rotator cuff tears fared worse over time as compared with small and moderate size tears. Although 1- to 3-year results of arthroscopic subacromial decompression and rotator cuff debridement were favorable, the long-term follow-up demonstrates deterioration of results. We therefore cannot support the use of decompression and debridement alone in the treatment of repairable full thickness rotator cuff tears.

Endoscopic carpal tunnel release has been shown to decrease postoperative recovery time in patients undergoing surgery for carpal tunnel syndrome. There is, however, some controversy concerning the safety and reliability of the procedure. We performed endoscopic carpal tunnel release utilizing the two portal technique described by Chow on 20 fresh cadaver specimens. There were no injuries noted in any of the vital structures including the ulnar artery, superficial palmar arch, third common digital nerve or flexor tendons. The transverse carpal ligament was found to be completely transected in 95% of the specimens. Hyperextension of the wrist significantly displaces the vital structures both dorsally and distally. The use of a slotted cannula and specially designed blades protect the surrounding structures during the procedure. Based on this study, endoscopic carpal tunnel release using the technique described by Chow may be performed reliably without injury to any of the vital structures.

Arthroscopic subacromial decompression has become an accepted treatment for patients with impingement syndrome; however, its use for full-thickness rotator cuff tears is controversial. We observed 25 patients with full-thickness rotator cuff tears treated by arthroscopic subacromial decompression and cuff debridement alone with a minimum of 1 year follow-up observation. Based on the University of California at Los Angeles shoulder rating, 84% of the cases were rated as excellent or good. There was significant improvement in pain, function, motion, and strength. Eighty-eight percent of the patients were satisfied with the procedure. Although all tear sizes improved significantly, smaller tears fared better than larger tears. The preliminary results of arthroscopic subacromial decompression with cuff debridement compare favorably to open techniques of rotator cuff repair with or without acromioplasty and should be considered in selected patients with full-thickness rotator cuff tears.

A case of bilateral osteochondral flaps of the wrists in a competitive weight lifter is presented. Diagnosis and treatment were both provided by wrist arthroscopy. osteochondral flaps should be considered in the differential diagnosis of chronic wrist pain.