Faculty Bibliography

Background/UNASSIGNED:Injury rates among Major League Baseball pitchers have been increasing over the past several years. It is currently unknown whether pitching a complete game (CG) is a risk factor for spending time on the disabled list (DL). Purpose/Hypothesis/UNASSIGNED:The purpose of this study was to determine the relationship between pitching a CG and time on the DL. We hypothesized that pitchers who threw a CG (1) would be at increased risk for spending time on the DL, which would be earlier in the season and for a longer period, than those who did not and (2) would be at further increased risk for spending time on the DL during subsequent seasons than matched controls. Study Design/UNASSIGNED:Descriptive epidemiology study. Methods/UNASSIGNED:Pitchers who threw a CG between 2010 and 2016 at the major league level and were placed on the DL during the same season were included. Timing and length of period on the DL were determined, as well as placement on the DL during subsequent seasons. Matched controls who did not throw a CG were assessed for time spent on the DL during that season and subsequent seasons. Results/UNASSIGNED:< .001). Conclusion/UNASSIGNED:Overall, 74% of pitchers who threw a CG spent time on the DL, as compared with 20% of controls. Pitchers who threw a CG during the study period spent more time in subsequent seasons on the DL than did matched controls who did not throw a CG.

The recognition and management of glenohumeral instability has become an increasingly important aspect of orthopaedic care. Substantial controversy exists with regard to the indications for soft-tissue stabilization versus bony augmentation in patients with glenohumeral instability, particularly among surgeons in the United States and Europe. Although bone loss procedures are frequently performed in the United States and abroad, surgical techniques and indications for bone loss procedures are different. Surgeons should understand current evidence-based indications for arthroscopic versus open soft-tissue stabilization in patients with anterior shoulder instability. Surgeons also should understand the importance of glenoid bone loss with regard to surgical decision making and the indications for Latarjet reconstruction versus allograft reconstruction. Patient-specific factors, including age, sex, sports participation (type and level of play), and the number of instability events that occur before presentation, affect surgical decision making. The technical pearls for successful arthroscopic stabilization, remplissage, open soft-tissue stabilization, and bony reconstruction of the glenoid rim that are discussed in this chapter may increase the likelihood of successful outcomes in patients with glenohumeral instability.

BACKGROUND:Meniscal tears are common in the young, active population. In this group of patients, repair is advised when possible. While inside-out repair remains the standard technique, recent advances in all-inside repair devices have led to a growth in their popularity. Previous reviews on the topic have focused on outdated implants of limited clinical relevance. PURPOSE:To determine the difference in failure rates, functional outcomes, and complications between inside-out and modern all-inside repairs. STUDY DESIGN:Systematic review. METHODS:A systematic review was registered with PROSPERO and performed following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines using the MEDLINE, EMBASE, and Cochrane databases. Inclusion criteria were (1) clinical study reporting on all-inside or inside-out repair, (2) evidence levels 1 to 4, and (3) use of modern all-inside implants for all-inside repairs. Exclusion criteria were (1) use of meniscal arrows or screws and (2) concomitant surgical procedures. Study characteristics, subjects, surgical technique, clinical outcomes, and complications were collected and analyzed. RESULTS:A total of 481 studies were screened and assessed for eligibility, which identified 27 studies for review. Studies defined clinical failure as persistent mechanical symptoms, effusion, or joint line tenderness, while anatomic failure was incomplete or no healing on MRI or second-look arthroscopy. There were no significant differences in clinical or anatomic failure rates between inside-out and all-inside repairs (clinical failure: 11% vs 10%, respectively, P = .58; anatomic failure: 13% vs 16%, respectively, P = .63). Mean ± SD Lysholm and Tegner scores for inside-out repair were 88.0 ± 3.5 and 5.3 ± 1.2, while the respective scores for all-inside repair were 90.4 ± 3.7 and 6.3 ± 1.3. Complications occurred at a rate of 5.1% for inside-out repairs and 4.6% for all-inside repairs. CONCLUSION:The quality of the evidence comparing inside-out and all-inside meniscal repair remains low, with a majority of the literature being evidence level 4 studies. In this review comparing modern all-inside devices with inside-out repair, no differences were seen in failure rates, functional outcome scores, or complication rates.

We conducted a study to determine the rates of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) after high tibial osteotomy (HTO), distal femoral osteotomy (DFO), or tibial tubercle osteotomy (TTO) in patients who did not receive postoperative chemical prophylaxis. All patients who had HTO, DFO, or TTO performed by a single surgeon between 2009 and 2014 were identified. Charts were reviewed to determine presence or absence of DVT or PE. Patient age, smoking status, oral contraceptive (OC) use, and body mass index (BMI) were recorded. Patients received no chemical or mechanical prophylaxis after surgery. We identified 141 patients (44% male, 56% female) who underwent HTO, DFO, or TTO. Mean (SD) age was 34.28 (9.86) years, mean (SD) follow-up was 17.1 (4.1) months, and mean (SD) BMI was 26.88 (5.11) kg/m2. Overall, 36.7% of female patients used OCs, and 13.48% of all patients were smokers. After surgery, 2 patients (1.42%) developed below-knee DVT (unilateral in 1 case, bilateral in the other). The bilateral DVT case progressed to PE. Neither patient smoked, but the bilateral DVT/PE patient was using OCs. DVT patients' mean (SD) age was 48.16 (8.24) years, and their mean (SD) BMI was 23.18 (0.18) kg/m2. HTO, DFO, and TTO patients who did not receive chemical prophylaxis had low rates of DVT (1.42%) and PE (0.71%). Administration of DVT/PE prophylaxis after these osteotomies may not be warranted.

BACKGROUND:Excellent outcomes have been reported for anterior cruciate ligament (ACL) reconstruction (ACLR) in professional athletes in a number of different sports. However, no study has directly compared these outcomes between sports. PURPOSE/OBJECTIVE:To determine if differences in performance-based outcomes exist after ACLR between professional athletes of each sport. STUDY DESIGN/METHODS:Cohort study; Level of evidence, 3. METHODS:National Football League (NFL), National Basketball Association (NBA), National Hockey League (NHL), and Major League Baseball (MLB) athletes undergoing primary ACLR for an acute rupture were identified through an established protocol of injury reports and public archives. Sport-specific performance statistics were collected before and after surgery for each athlete. Return to play (RTP) was defined as a successful return to the active roster for at least 1 regular-season game after ACLR. RESULTS:Of 344 professional athletes who met the inclusion criteria, a total of 298 (86.6%) returned to play. NHL players had a significantly higher rate of RTP (95.8% vs 83.4%, respectively; P = .04) and a shorter recovery time (258 ± 110 days vs 367 ± 268 days, respectively; P < .001) than athletes in all the other sports. NFL athletes experienced significantly shorter careers postoperatively than players in all the other sports (2.1 vs 3.2 years, respectively; P < .001). All athletes played fewer games ( P ≤ .02) 1 season postoperatively, while those in the NFL had the lowest rate of active players 2 and 3 seasons postoperatively (60%; P = .002). NBA and NFL players showed decreased performance at season 1 after ACLR ( P ≤ .001). NFL players continued to have lower performance at seasons 2 and 3 ( P = .002), while NBA players recovered to baseline performance. CONCLUSION/CONCLUSIONS:The data indicate that NFL athletes fare the worst after ACLR with the lowest survival rate, shortest postoperative career length, and sustained decreases in performance. NHL athletes fare the best with the highest rates of RTP, highest survival rates, longest postoperative career lengths, and no significant changes in performance. The unique physical demand that each sport requires is likely one of the explanations for these differences in outcomes.

BACKGROUND:The medial collateral ligament (MCL) is the most frequently injured ligament of the knee, but it infrequently requires surgical treatment. Current literature on MCL reconstructions is sparse and offers mixed outcome measures. PURPOSE/HYPOTHESIS/UNASSIGNED:The purpose of this study was to compare the outcomes of isolated MCL reconstruction and multiligamentous MCL reconstruction. Our hypothesis was that in selective patients, MCL reconstruction would significantly improve objective and subjective patient knee performance measures, those being baseline valgus laxity, range of motion, objective and subjective International Knee Documentation Committee (IKDC) scores, Tegner score, and Lysholm knee activity scores. STUDY DESIGN/METHODS:Systematic review; Level of evidence, 4. METHODS:tests. RESULTS:< .001). Normal or nearly normal range of motion was obtained by 88% of all patients. CONCLUSION/CONCLUSIONS:The systematic review of 10 studies and 275 knees found that the reported patient outcomes after MCL reconstruction were significantly improved across all measures studied, with no significant difference in outcomes between concomitant reconstructions.

Matrix-induced autologous chondrocyte implantation (MACI) is a viable procedure that can be used as both a primary or revision cartilage regenerative procedure in high-functioning individuals without tibiotalar arthritis. Both short-term and midterm follow-up results demonstrate clinical, radiographic, and functional improvements with high rates of return to full activities. Cost remains a chief concern with the use of this technique, but theoretical improvements in the durability of repair with type II cartilage replacement may offer long-term benefits.

BACKGROUND:Tears of the anterior cruciate ligament (ACL) are common in the National Football League (NFL). The impact of these injuries on the careers of NFL linemen is unknown. PURPOSE/OBJECTIVE:To define the percentage of NFL linemen who return to sport (RTS) after ACL reconstruction, the mean time to RTS, and the impact on performance compared with matched controls. STUDY DESIGN/METHODS:Cohort study; Level of evidence, 3. METHODS:Data on NFL offensive and defensive linemen who sustained an ACL tear and underwent ACL reconstruction between 1980 and 2015 were analyzed. Players were identified through NFL team websites, publicly available injury reports, player profiles, and press releases. Demographics and mean in-game performance data preinjury and post-ACL reconstruction were recorded. A player was deemed to have returned to sport if he played in at least 1 NFL game after his ACL reconstruction. A healthy control group was selected to compare in-game performance data and was matched with the study group on several parameters. RESULTS:= .020). CONCLUSION/CONCLUSIONS:Overall, 64.3% of NFL offensive and defensive linemen who undergo ACL reconstruction returned to play. Linemen who RTS do so at a high level, with no difference in in-game performance or career duration when compared with matched controls.