Faculty Bibliography

BACKGROUND:Galeazzi fractures are a rare injury to occur in adults, which are typically associated with high energy trauma. To our knowledge, the reported cases in the literature have only been associated with motor vehicle accidents, falls from a height, or athletic endeavors. The application of the force in the setting of a Galeazzi fracture has been disputed, but it is believed to occur with the wrist in hyperextension and pronation. CASE REPORT/METHODS:We describe a 27-year-old male who presented with multiple gunshot wounds that included his right forearm. The injury sustained to his right forearm resulted in a Galeazzi fracture, which after open reduction and internal fixation, demonstrated subluxation of the distal radioulnar joint in pronation. CONCLUSIONS:We provide a novel mechanism of a Galeazzi fracture that demonstrates a method for sustaining the fracture pattern without the wrist in the typical position of hyperextension and pronation.

PURPOSE/OBJECTIVE:The purpose of this investigation is to determine the proportion of sports medicine studies that are labeled as Level I Evidence in 5 journals and compare the quality of surgical and nonsurgical studies using simple quality assessment tools (Consolidated Standards of Reporting Trials [CONSORT] and Jadad). METHODS:By use of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines over the prior 2 years in the top 5 (citation and impact factor based) sports medicine journals, only Level I Evidence studies were eligible for inclusion and were analyzed. All study types (therapeutic, prognostic, diagnostic, and economic) were analyzed. Study quality was assessed with the level of evidence, Jadad score, and CONSORT 2010 guidelines. Study demographic data were compared among journals and between surgical and nonsurgical studies by use of χ(2), 1-way analysis of variance, and 2-sample Z tests. RESULTS:We analyzed 190 Level I Evidence studies (10% of eligible studies) (119 randomized controlled trials [RCTs]). Therapeutic, nonsurgical, single-center studies from the United States were the most common studies published. Sixty-two percent of studies reported a financial conflict of interest. The knee was the most common body part studied, and track-and-field/endurance sports were the most common sports analyzed. Significant differences (P < .05) were shown in Jadad and CONSORT scores among the journals reviewed. Overall, the Jadad and CONSORT scores were 2.71 and 77%, respectively. No differences (P > .05) were shown among journals based on the proportion of Level I studies or appropriate randomization. Significant strengths and limitations of RCTs were identified. CONCLUSIONS:This study showed that Level I Evidence and RCTs comprise 10% and 6% of contemporary sports medicine literature, respectively. Therapeutic, nonsurgical, single-center studies are the most common publications with Level I Evidence. Significant differences across sports medicine journals were found in study quality. Surgical studies appropriately described randomization, blinding, and patient enrollment significantly more than nonsurgical studies. LEVEL OF EVIDENCE/METHODS:Level I, systematic review of Level I studies.

BACKGROUND:Condition-specific questionnaires are important components in evaluation of outcomes of surgical interventions. No condition-specific study methodological quality questionnaire exists for evaluation of outcomes of articular cartilage surgery in the knee. PURPOSE/OBJECTIVE:To develop a reliable and valid knee articular cartilage-specific study methodological quality questionnaire. STUDY DESIGN/METHODS:Cross-sectional study. METHODS:A stepwise, a priori-designed framework was created for development of a novel questionnaire. Relevant items to the topic were identified and extracted from a recent systematic review of 194 investigations of knee articular cartilage surgery. In addition, relevant items from existing generic study methodological quality questionnaires were identified. Items for a preliminary questionnaire were generated. Redundant and irrelevant items were eliminated, and acceptable items modified. The instrument was pretested and items weighed. The instrument, the MARK score (Methodological quality of ARticular cartilage studies of the Knee), was tested for validity (criterion validity) and reliability (inter- and intraobserver). RESULTS:A 19-item, 3-domain MARK score was developed. The 100-point scale score demonstrated face validity (focus group of 8 orthopaedic surgeons) and criterion validity (strong correlation to Cochrane Quality Assessment score and Modified Coleman Methodology Score). Interobserver reliability for the overall score was good (intraclass correlation coefficient [ICC], 0.842), and for all individual items of the MARK score, acceptable to perfect (ICC, 0.70-1.000). Intraobserver reliability ICC assessed over a 3-week interval was strong for 2 reviewers (≥0.90). CONCLUSION/CONCLUSIONS:The MARK score is a valid and reliable knee articular cartilage condition-specific study methodological quality instrument. CLINICAL RELEVANCE/CONCLUSIONS:This condition-specific questionnaire may be used to evaluate the quality of studies reporting outcomes of articular cartilage surgery in the knee.

BACKGROUND:Skiing and snowboarding have become increasingly popular since the inception of the winter X-Games in 1997. PURPOSE/OBJECTIVE:To determine (1) rate of return to sport (RTS) to the winter X-Games following anterior cruciate ligament (ACL) reconstruction and (2) performance upon RTS following ACL reconstruction. HYPOTHESES/OBJECTIVE:There is a high rate of RTS to the winter X-Games in subjects undergoing ACL reconstruction. There is no difference in performance upon RTS following ACL reconstruction versus preinjury. STUDY DESIGN/METHODS:Case series; Level of evidence, 4. METHODS:Skiers and snowboarders competing in the winter X-Games who tore their ACL and underwent ACL reconstruction between 1997 and 2012 were evaluated. Athlete data were extracted from winter X-Games media websites, ESPN, injury reports, player profiles/biographies, and press releases. All athlete, knee, and surgical demographic data were analyzed. RTS and performance as it related to the number of gold, silver, and bronze medals won both pre- and postoperatively in the X-Games were analyzed. RESULTS:Fifteen skiers (19 knees) and 10 snowboarders (10 knees) were analyzed. There were 13 males and 12 females, with a mean subject age of 22.6 ± 4.45 years. The rate of RTS in the X-Games following ACL reconstruction was 80% overall (20/25 subjects). The rate of RTS in winter X-Games following ACL reconstruction in skiers was 87% (13/15 subjects) and in snowboarders was 70% (7/10 subjects). The rate of RTS in winter X-Games following ACL reconstruction in males and females was 85% (11/13 subjects) and 75% (9/12 subjects), respectively. The rate of revision ACL reconstruction due to ACL tear following primary ACL reconstruction was 4% (1/25 subjects). There were more left- than right-sided tears (18 vs 11). Skiers and snowboarders competed in the X-Games for 3.84 ± 2.73 and 3.40 ± 2.84 years prior to ACL reconstruction and 2.56 ± 2.06 and 7.29 ± 3.30 years after ACL reconstruction, respectively. Skiers earned 22 medals prior to ACL reconstruction (9 gold, 5 silver, 8 bronze) and 24 medals after ACL reconstruction (16 gold, 2 silver, 6 bronze). Snowboarders earned 7 medals prior to ACL reconstruction (4 gold, 1 silver, 2 bronze) and 19 medals after ACL reconstruction (7 gold, 7 silver, 5 bronze). CONCLUSION/CONCLUSIONS:Winter X-Games skiers and snowboarders have a high rate of RTS after ACL reconstruction. Skiers earned a similar number of medals preinjury and postsurgery, while snowboarders earned more medals following surgery.

BACKGROUND:Use of microfracture in the knees of National Basketball Association (NBA) players is controversial. HYPOTHESES/OBJECTIVE:(1) There would be a high rate of return to sport (RTS) in NBA players following microfracture, (2) players would RTS the season following surgery, (3) preoperative player performance would not be significantly different on RTS, and (4) there would be no significant difference in RTS rate or postoperative performance in players undergoing microfracture in comparison with an age-, position-, NBA experience-, and performance-matched control group. STUDY DESIGN/METHODS:Cohort study; Level of evidence, 3. METHODS:NBA players undergoing microfracture were evaluated. Age-, body mass index-, position-, NBA experience-, and performance-matched controls were selected from the NBA during the same years as those undergoing microfracture. An index year was selected (controls) to match the number of seasons of NBA experience in microfracture cases. RTS and performance were analyzed and compared between cases and controls. Student t tests were performed for analysis of within- and between-group variables. RESULTS:A total of 41 NBA players underwent microfracture and were compared with 41 demographic- and performance-matched controls. Rate of RTS after microfracture was 73% in the NBA and 83% in professional basketball (NBA, D-league, and International Basketball Federation [FIBA]). Time to RTS in NBA was 9.20 ± 4.88 months. Seventy-one percent (29/41) of players RTS the season following microfracture. Length of NBA career following microfracture (4.10 ± 3.91 years) was not significantly different from controls. After microfracture, case athletes played fewer games per season and with fewer points and steals per game (relative to premicrofracture; P < .05). Performance was better in control (after index year) versus case players (after microfracture) with regard to points per game, games played per season, and field goal and free throw percentage (P < .05). CONCLUSION/CONCLUSIONS:Eighty-three percent of NBA players undergoing microfracture returned to professional basketball. Career length was not significantly different between players undergoing microfracture and controls. However, following microfracture, players competed in fewer games per season with fewer points and steals.

BACKGROUND:Anterior cruciate ligament (ACL) rupture is a significant injury in National Basketball Association (NBA) players. HYPOTHESES/OBJECTIVE:NBA players undergoing ACL reconstruction (ACLR) have high rates of return to sport (RTS), with RTS the season following surgery, no difference in performance between pre- and postsurgery, and no difference in RTS rate or performance between cases (ACLR) and controls (no ACL tear). STUDY DESIGN/METHODS:Case-control. METHODS:NBA players undergoing ACLR were evaluated. Matched controls for age, body mass index (BMI), position, and NBA experience were selected during the same years as those undergoing ACLR. RTS and performance were compared between cases and controls. Paired-sample Student t tests, chi-square, and linear regression analyses were performed for comparison of within- and between-group variables. RESULTS:Fifty-eight NBA players underwent ACLR while in the NBA. Mean player age was 25.7 ± 3.5 years. Forty percent of ACL tears occurred in the fourth quarter. Fifty players (86%) RTS in the NBA, and 7 players (12%) RTS in the International Basketball Federation (FIBA) or D-league. Ninety-eight percent of players RTS in the NBA the season following ACLR (11.6 ± 4.1 months from injury). Two players (3.1%) required revision ACLR. Career length following ACLR was 4.3 ± 3.4 years. Performance upon RTS following surgery declined significantly (P < 0.05) regarding games per season; minutes, points, and rebounds per game; and field goal percentage. However, following the index year, controls' performances declined significantly in games per season; points, rebounds, assists, blocks, and steals per game; and field goal and free throw percentage. Other than games per season, there was no significant difference between cases and controls. CONCLUSION/CONCLUSIONS:There is a high RTS rate in the NBA following ACLR. Nearly all players RTS the season following surgery. Performance significantly declined from preinjury level; however, this was not significantly different from controls. ACL re-tear rate was low. CLINICAL RELEVANCE/CONCLUSIONS:There is a high RTS rate in the NBA after ACLR, with no difference in performance upon RTS compared with controls.

The purpose of this review is to determine if there is a difference in outcomes after: (1) nonsurgical vs surgical treatment of FAI; (2a) surgical dislocation with greater trochanteric osteotomy, (2b) anterior mini-open, (2c) arthroscopic plus mini-open, and (2d) arthroscopic surgery for FAI; (3) difference in complication and re-operation rates; and (4a) labral refixation and (4b) labral debridement for labral injuries. A systematic review of multiple databases was performed after PROSPERO registration and using PRISMA guidelines. Level I-IV evidence clinical studies with minimum 2-year follow-up were included. Data were compared using 2-sample and 2-proportion Z-test calculators. Study methodological quality was analyzed using Modified Coleman Methodology Score (MCMS). Recommendations were made using SORT (Strength Of Recommendation Taxonomy). Twenty-nine studies were included (2369 subjects; 2507 hips). MCMS was poor. Mean subject age was 34.4+/-8.4 years and mean follow-up was 3.1+/-0.9 years. Statistically significant differences were observed following both nonsurgical and surgical treatment, with greater (P < 0.05) improvements following surgery (SORT B), without consistent significant differences observed between different surgical techniques (SORT C). There was a greater (P < 0.05) reoperation and complication rate following surgical dislocation vs mini-open and arthroscopic techniques (SORT A). Clinical outcomes were significantly better (P < 0.05) following labral refixation vs debridement (SORT B). Outcomes of operative treatment of femoroacetabular impingement are significantly better than nonsurgical management. Surgical treatment significantly improves outcomes, with no consistent significant differences exhibited between open and arthroscopic techniques. Open surgical dislocation has significantly greater reoperation and complication rates vs mini-open and arthroscopic techniques. Outcomes of labral refixation are significantly better than debridement in patients with labral injuries.

BACKGROUND:Anterior cruciate ligament (ACL) rupture is a significant injury in male Major League Soccer (MLS) players in the United States. PURPOSE/OBJECTIVE:To determine (1) return-to-sport (RTS) rate in MLS following ACL reconstruction (ACLR), (2) timing of RTS, (3) performance upon RTS, and (4) the difference in RTS and performance between players who underwent ACL reconstruction (ACLR) and controls. STUDY DESIGN/METHODS:Case-control study; Level of evidence, 3. METHODS:MLS players undergoing ACLR between 1996 and 2012 were evaluated. Player data were extracted from publically available sources. All demographic data were analyzed. A control group of players matched by age, body mass index (BMI), sex, position, performance, and MLS experience (occurred at 2.6 years into career, designated "index year") was selected from the MLS during the same years as those undergoing ACLR. The RTS and performance in the MLS were analyzed and compared between cases and controls. Student ttests were performed for analysis of within- and between-group variables. RESULTS:A total of 52 players (57 knees) that met inclusion criteria underwent ACLR while in the MLS. Mean player age was 25.6 ± 3.98 years. Forty players were able to resume play (77%). Of the 40 players (45 knees), 38 (43 knees; 95%) resumed play the season following ACLR (mean, 10 ± 2.8 months after surgery). Mean career length in the MLS after ACLR was 4.0 ± 2.8 years. The revision rate was 10%. There was a significant increase in the incidence of ACL tears in the MLS by year (P < .001), and there was a significantly (P= .002) greater number of ACL tears on the left knee as opposed to the right. Performance in the MLS upon RTS after ACLR was not significantly different versus preinjury. There was no significant difference in survival in the MLS between cases and controls after ACLR or index year. The only significant performance differences between cases and controls were that cases had significantly greater shots taken per season (P= .005) and assists (P= .005) than did controls after the index year. CONCLUSION/CONCLUSIONS:There is a high RTS rate in the MLS following ACLR. Nearly all players resumed play the season after surgery. Performance was not significantly different from preinjury. Only 2 performance measures (shots taken and assists) were significantly different between cases and controls. A significantly greater number of ACL tears occur in the left versus the right knee.

PURPOSE/OBJECTIVE:(1) To evaluate the quality of knee articular cartilage surgery literature using established methodologic quality instruments, and (2) to assess whether study quality has improved with time. METHODS:A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies of autologous chondrocyte implantation (ACI), osteochondral autograft and allograft transplant, and microfracture were analyzed. Study methodologic quality was assessed by the level of evidence and 9 different methodologic quality questionnaires. Comparisons were made between different surgical technique groups by use of Student's t tests. Assessment of study quality improvement with time was performed by comparison of the Coleman Methodology Score (CMS) from the included studies (2004 to present) and CMS from a prior study assessing quality of articular cartilage studies (1985 to 2004). Furthermore, assessment of study quality improvement with time was performed over the period of the included studies (2004 to present). RESULTS:We included 194 studies (11,787 subjects). Most evidence was Level IV (76%) and nonrandomized (91%). ACI was the most commonly reported technique (62% of studies). Only 34% of studies denied the presence of a financial conflict of interest. The mean subject age was 33.5 ± 8.2 years, and the mean length of follow-up was 3.7 ± 2.3 years. By use of study quality questionnaires, the methodologic quality of articular cartilage studies was poor. However, study quality (after 2004) was significantly improved versus that reported from a prior study (before 2004) using the CMS (P < .01). The mean level of evidence, CMS, CONSORT (Consolidated Standards of Reporting Trials) score, and Jadad score showed no significant improvement over the period of the included studies (P > .05). The quality of randomized controlled trials (RCTs) was significantly higher than that of non-RCTs (P < .05). The most common study weaknesses included blinding, subject selection process, study type, sample size calculation, and outcome measures and assessment. CONCLUSIONS:The methodologic quality of knee articular cartilage surgery studies was poor overall and also for individual techniques (ACI, osteochondral autograft transplant, osteochondral allograft transplant, and microfracture). However, the overall quality of the investigations in this review (after June 2004) has significantly improved in comparison to those published before 2004. The quality of RCTs was significantly higher than that of non-RCTs. Level of evidence, CMS, CONSORT score, and Jadad score did not significantly improve with later publication date within the period of the studies analyzed. Methodologic quality deficiencies identified in this investigation may be used to guide future articular cartilage studies' design, conduct, and reporting. LEVEL OF EVIDENCE/METHODS:Level IV, systematic review of studies with Levels of Evidence I-IV.