Faculty Bibliography

BACKGROUND:Vitamin D is a fat-soluble hormone that plays a role in bone health, muscle function, and athletic performance. Studies have shown that low levels of vitamin D can lead to slower muscle recovery and function, increased rates of stress fractures, and even poorer athletic performance. Insufficient vitamin D levels have been demonstrated in professional basketball and football players, however, there have been no studies to date reviewing vitamin D insufficiency in professional hockey players. PURPOSE/HYPOTHESIS/UNASSIGNED:The purpose of this study was to perform a cross-sectional review to determine the prevalence of vitamin D deficiency and insufficiency in professional hockey players. The hypothesis was that there would be a high percentage of players with vitamin D insufficiency. STUDY DESIGN/METHODS:Cross-sectional study; Level of evidence, 3. METHODS:The preseason serum 25-hydroxy (OH) vitamin D laboratory test results of 105 professional hockey players were retrospectively reviewed. All players on 3 National Hockey League (NHL) teams were included. Player parameters evaluated included age, height, weight, body mass index, and 25(OH) vitamin D level. Players were divided into 4 groups based on serum vitamin D levels: deficient (<20 ng/mL), insufficient (20-31.9 ng/mL), sufficient (≥32 ng/mL), and ideal (≥40 ng/mL). Descriptive statistics were performed, in addition to 2-group and 3-group comparisons. RESULTS:= .018). All other player parameters demonstrated no significant difference between groups. CONCLUSION/CONCLUSIONS:Despite playing a winter sport and spending a great deal of time training indoors, professional hockey players have low levels of vitamin D insufficiency.

BACKGROUND: Femoroacetabular impingement (FAI) has been increasingly recognized as a cause of hip pain in athletes at all levels of competition, specifically ice hockey players. PURPOSE/HYPOTHESIS: The purpose of this study was to define the prevalence of cam and pincer radiographic deformity in elite ice hockey players. The hypothesis was that elite hockey players will have a higher prevalence of radiographic hip abnormalities compared with the general population. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Anteroposterior and frog-leg lateral radiographs on 137 elite ice hockey players were prospectively obtained during the 2014-2015 preseason entrance examinations. Study participants included National Hockey League roster players as well as the respective farm team members. Demographic data were collected, including age, position, shooting side, and any history of hip pain or hip surgery. Patients with a history of hip surgery were excluded from the analysis. A single sports medicine fellowship-trained orthopaedic surgeon used standard radiographic measurements to assess for the radiographic presence of cam or pincer deformity. Radiographs with an alpha angle >/=55 degrees on a frog-leg lateral view were defined as cam-positive. Each participant underwent a preseason physical examination with an assessment of hip range of motion and impingement testing. RESULTS: A total of 130 elite ice hockey players were included in the analysis; 180 (69.4%) hips met radiographic criteria for cam-type deformity. The prevalence in right and left hips was 89 (69.5%) and 91 (70.0%), respectively; 70 (60.8%) players demonstrated bilateral involvement. Hips with cam deformity had a mean alpha angle of 67.7 degrees +/- 8.3 degrees on the right and 68.9 degrees +/- 9.0 degrees on the left. Of the patients with alpha angles >/=55 degrees , 5.6% (5/89) had a positive anterior impingement test of the right hip, while 11% (10/91) had positive anterior impingement test of the left. Players with radiologic cam deformity had a statistically significant deficit in external rotation of the right hip, as well as in both internal and external rotation of the left hip, compared with those with normal alpha angles. When assessing for crossover sign, 64 of 107 (59.8%) had a positive radiographic finding. Forty-one players (38.3%) had evidence of a crossover sign of the right hip and 42 (39.3%) of the left. When comparing position players, goalies had the highest prevalence of cam-type deformity (93.8%) and the least acetabular coverage. CONCLUSION: The study data suggest that elite ice hockey players have a significantly higher prevalence of radiographic cam deformity in comparison to what has been reported for the general population.

BACKGROUND: Intra-articular hip injuries are thought to be common in professional ice hockey; however, injury incidence and missed playing time have not been previously documented. Furthermore, it is not known if injury incidence differs between player positions. HYPOTHESIS: The incidence of symptomatic intra-articular hip injuries in goaltenders is higher than that of other position players. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A database containing the injury surveillance of National Hockey League (NHL) players from the years 2006 to 2010 was used to identify athletes who had sustained a hip or groin injury. From this database, players diagnosed with an intra-articular hip injury were identified. The incidence of intra-articular hip injuries per 1000 player-hours played and per 1000 player-game appearances was compared between goaltenders, defensemen, and forwards. RESULTS: Ninety-four hip injuries, accounting for 10.6% (94/890) of all hip and groin injuries, were identified as intra-articular in nature during the time of the surveillance. Most injuries occurred during the regular season (71.2%; 67/94) and during a game (44.6%; 42/94). Players who sustained intra-articular hip injuries had significantly higher total man-games missed compared with those with all other groin injuries (mean +/- SD, 8.5 +/- 23.0 vs. 1.2 +/- 4.2 missed games; P = .0001). The most frequent intra-articular hip diagnoses made in this cohort were hip labral tear (69.1%), followed by hip osteoarthritis (13.8%), hip loose body (6.3%), and hip femoroacetabular impingement (5.3%). The incidence of intra-articular hip injuries per 1000 player-game hours was not different between goaltenders (1.97) and other on-ice players (defensemen, 1.43; forwards, 1.38) (relative risk [RR], 1.40; 95% CI, 0.86-1.40; P = .22). However, injuries per 1000 player-game appearances were significantly higher in goaltenders (1.84) compared with other on-ice players (defensemen, 0.47; forwards, 0.34) (RR, 4.78; 95% CI, 2.94-7.76; P < .0001). CONCLUSION: Hip labral tears are the most frequently encountered intra-articular hip injury in the NHL player and can lead to an average of 8 man-games missed per injury. Goaltenders were not at higher risk when measuring injuries per hours played but were at significantly greater risk of an intra-articular hip injury than other on-ice players (RR, 4.7) when measured per game played.

BACKGROUND:There are conflicting reports in the literature regarding the outcome of superior labral anterior posterior (SLAP) repairs in overhead athletes and a paucity of data demonstrating ability to return to prior level of competition. HYPOTHESIS/OBJECTIVE:Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score provides more accurate assessment of shoulder function and ability to return to previous level of athletic competition after SLAP lesion repair than does the conventional American Shoulder and Elbow Surgeons scoring system. STUDY DESIGN/METHODS:Cohort study; Level of evidence, 3. METHODS:Twenty-three elite (collegiate or professional) overhead athletes who were more than 1-year status postarthroscopic repair of type II SLAP lesions were evaluated using both the Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score and American Shoulder and Elbow Surgeons score. P values were computed using the analysis of variance model. Postoperative American Shoulder and Elbow Surgeons and Kerlan-Jobe Orthopaedic Clinic scores from subjects were compared with control values obtained from a healthy athletic cohort; the relationship between the scores was investigated using the linear regression model and assessed using Pearson correlations. RESULTS:At a mean 38-month follow-up, 13 athletes were playing pain free at the time of the questionnaire administration, 6 were playing with pain, and 4 were not playing because of pain. Regarding American Shoulder and Elbow Surgeons scores, 22 athletes (96%) had good-excellent scores, whereas 1 (4%) had a fair score. The Kerlan-Jobe Orthopaedic Clinic scores revealed 9 excellent (39%), 3 good (13%), 4 fair (17%), and 7 poor (30%) results for the same study group. Of the 23 patients, 13 (57%) had returned to their pain-free preinjury levels of competition at final follow-up. The inability to return to this level of competition correlated with the presence of a partial-thickness rotator cuff tear (P = .0059). The Kerlan-Jobe Orthopaedic Clinic demonstrated better overall accuracy (85%) than did the American Shoulder and Elbow Surgeons (70%) in evaluating return to pain-free preinjury levels. CONCLUSION/CONCLUSIONS:Return to preinjury level of competition for elite overhead athletes after type II SLAP lesion repairs was 57%, despite high American Shoulder and Elbow Surgeons scores. Return to play status correlated with the presence of a partial-thickness rotator cuff tear. The Kerlan-Jobe Orthopaedic Clinic score, designed specifically for the evaluation of the overhead athlete, was a more accurate assessment tool than was the American Shoulder and Elbow Surgeons in this population of elite overhead athletes with SLAP tears.

The purpose of this paper is to report the clinical signs, symptoms, imaging findings and treatment of an isolated pectoralis minor tendon tear in a professional hockey player.

Massive rotator cuff tears pose a distinct clinical challenge for the orthopaedist. In this review, we will discuss the classification, diagnosis, and evaluation of massive rotator cuff tears before discussing various treatment options for this problem. Nonoperative treatment has had inconsistent results and proven unsuccessful for chronic symptoms while operative treatment including debridement and partial and complete repairs have had varying degrees of success. For rotator cuff tears that are deemed irreparable, treatment options are limited. The use of tendon transfers in younger patients to reconstruct rotator cuff function and restore shoulder kinematics can be useful in salvaging this difficult problem.

BACKGROUND:Superior labral anterior posterior tears have been described as symptomatic lesions in shoulders of patients of varying ages. It is unknown if age affects clinical outcome of arthroscopic fixation of type II superior labral anterior posterior repairs. HYPOTHESIS/OBJECTIVE:Clinical outcome of arthroscopic fixation of isolated type II superior labral anterior posterior tears differs between younger (<40 years) and older (> or =40 years) patients. STUDY DESIGN/METHODS:Cohort study; Level of evidence, 3. METHODS:Clinical results of arthroscopic fixation of isolated unstable type II superior labral anterior posterior repairs were compared between 25 patients younger than 40 years (group 1) and 25 patients aged 40 years or older (group 2). Patients with concomitant procedures, prior/subsequent shoulder surgeries, and use of non-suture anchor devices were excluded. Outcomes at a minimum 1-year follow-up were assessed using range of motion measurements and the American Shoulder and Elbow Surgeons questionnaire as compared with preoperative data. Ability and time to return to prior level of activity were assessed. RESULTS:At a mean 3-year follow-up, there were statistically significant improvements in American Shoulder and Elbow Surgeons scores for both groups (P < .0001) but no significant difference between final American Shoulder and Elbow Surgeons scores (group 1, 91; group 2, 87; P > .198). Both groups demonstrated good or excellent results in >80% of patients. A traumatic mechanism of injury (P = .0346) and presence of osteoarthritis (P = .0401) were independent factors resulting in significantly lower postoperative scores. There were statistically significant differences in preoperative and postoperative range of motion for internal rotation (group 1, P = .0321) and forward elevation (group 2, P = .0003). Return to prior level of activity was similar between younger and older age groups: 80% versus 74%. Time to return to sport was prolonged for group 2 (11.0 months) compared with group 1 (8.45 months). Patients without osteoarthritis were significantly more likely to return to previous levels of activity than were those who had osteoarthritis (P = .0044). CONCLUSION/CONCLUSIONS:Good to excellent results and high return to prior level of activity can be expected for the majority of properly indicated patients who undergo isolated type II superior labral anterior posterior repairs, regardless of age. Subtle deficits in range of motion were experienced by both age groups; this did not seem to affect final outcomes. The presence of osteoarthritis was associated with lower American Shoulder and Elbow Surgeons scores and inability to return to prior level of activity. Time to return to activity was prolonged for the older group.

The success of revision surgery for failed Bankart repair is not well known. This purpose of this study was to report the success rates achieved using arthroscopic techniques to revise failed Bankart repairs. Twelve arthroscopic revision Bankart repairs were performed on patients with recurrent unidirectional shoulder instability after open or arthroscopic Bankart repair. Follow-up was available on 11 of the 12 patients at a mean of 34.4 months (range, 25-56 months). The surgical findings, possible modes of failure, shoulder scores (Rowe score, University of California Los Angeles [UCLA], Simple Shoulder Test), and clinical outcome were evaluated. Various modes of failure were recognized during revision arthroscopic Bankart repairs. Good-to-excellent results were obtained in 8 patients (73%) undergoing revision stabilization according to Rowe and UCLA scoring. A subluxation or dislocation event occurred in 3 (27%) of the 11 patients at a mean of 8.7 months (range, 6-12 months) postoperatively. Arthroscopic revision Bankart repairs are technically challenging procedures but can be used to achieve stable, pain-free, functional shoulders with return to prior sport. Owing to limited follow-up and the small number of patients in this study, we were unable to conclude any pattern of failure or selection criteria for this procedure