A Comprehensive Evaluation of the Association of Radiographic Measures of Lateralization on Clinical Outcomes Following Reverse Total Shoulder Arthroplasty
BACKGROUND:While reverse shoulder arthroplasty (RTSA) has excellent reported outcomes and satisfaction, patients often have postoperative limitations in range of motion (ROM), specifically internal rotation. Increased lateralization is thought to improve ROM following RTSA. The purpose of this study was to evaluate the association between radiographic measurements of lateralization and postoperative ROM and clinical outcome scores following RTSA. The authors hypothesized that increased radiographic lateralization would be associated with improved postoperative ROM, specifically internal rotation, but have no significant association with clinical outcome scores. METHODS:Patients who underwent RTSA with a 135Â° neck shaft angle prosthesis and minimum 2 year clinical and radiographic follow-up were included and retrospectively reviewed. Postoperative radiographs were evaluated for several lateralization measurements including the lateralization shoulder angle (LSA), distance from lateral border of acromion to lateral portion of glenosphere, distance from the glenoid to the most lateral aspect of the greater tuberosity and the distance from the lateral aspect of acromion to the most lateral aspect of the greater tuberosity. Linear regression analyses were utilized to evaluate the independent association of each radiographic measurement of lateralization on forward flexion (FF), external rotation (ER), internal rotation (IR) and the American Shoulder and Elbow Surgeons (ASES) index score at 2 years postoperative. Receiver operator curves (ROC) were constructed to identify and significant thresholds of each radiographic lateralization measurement. RESULTS:203 patients were included. For internal rotation, a greater LSA (p=0.007), shorter acromion to glenosphere distance (meaning more glenoid lateralization) (p=0.005) and a greater acromion to greater tuberosity distance (with the tuberosity more lateral to the acromion) (p=0.021) were associated with improved IR. Overall, ROC analysis demonstrated very little significant data, the most notable of which was the LSA, which had a significant cutoff of 82 degrees (sensitivity 57%, specificity 68%, p = 0.012). CONCLUSION/CONCLUSIONS:Of the numerous radiographic measures of lateralization after RTSA, the LSA is the most significantly associated with outcomes, including improved internal rotation, and a decrease in forward flexion and ASES score. The clinical significance of these statistically significant findings requires further study, as the observed associations were for very small changes that may not represent clinical significance.
Ulnar Collateral Ligament Reconstruction in Javelin Throwers: An Analysis of Return to Play Rates and Patient Outcomes
BACKGROUND:While results following ulnar collateral ligament reconstruction (UCLR) in baseball players have been well documented, the literature is replete regarding the outcomes following UCLR in javelin thrower. PURPOSE/OBJECTIVE:To report outcomes following UCLR in javelin throwers HYPOTHESIS: UCLR in javelin throwers will result in a high rate of return to play (RTP) similar to that of previously published studies from athletes of other sports. METHODS:All patients who were identified preoperatively as javelin throwers and underwent UCLR between 2011 -2017 with a minimum 2-year follow-up were eligible for inclusion. Patients were assessed with Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), Timmerman-Andrews Elbow Score, Conway-Jobe Score, patient satisfaction, return to sport rate questionnaire and the occurrence of any postoperative complications. RESULTS:There were 18 patients who met the inclusion criteria. Complete follow-up was available in 16 (88.9%) patients. The average age at surgery was 21.2 +/- 2.0 (range, 18.6 to 24.9) years. At final follow-up, the average KJOC score and Timmerman-Andrews Elbow Scores were 77.3 (range, 18.7 - 98.4) and 91.8 (range, 70.0 to 100.0), respectively. Outcomes on the Conway-Jobe scale were as follows: excellent (n=6; 37.5%), good (n=4; 25%), fair (n=6; 37.5%). Ten (62.5%) patients returned to play at an average of 12.2 +/- 3.6 (range, 6.0 to 18.0) months after surgery. Two (12.5%) patients sustained a shoulder injury postop; however, neither required surgery. CONCLUSION/CONCLUSIONS:UCLR in javelin throwers results in good outcomes with a low rate of re-injury/re-operation. However, the RTP rate (62.5%) and good/excellent outcomes per the Conway Jobe scale (68.8%) are lower than what has been previously reported in baseball players and javelin throwers. Further investigation regarding outcomes in javelin throwers following UCLR is warranted.
Failed Reverse Total Shoulder Arthroplasty: What Are Our Bailouts?
PURPOSE OF REVIEW/OBJECTIVE:As the population continues to age and indications continue to expand, the number of reverse total shoulder arthroplasty (RSTA) procedures has increased significantly. While RTSA is an effective solution to many shoulder problems, it is not without complications. Furthermore, as the number of RTSA procedures increases, so will the number of complications following this procedure. While some complications can be managed with revision RTSA, there are some complications that, unfortunately, cannot. The purpose of this review is to discuss the revision options for failed RTSA. RECENT FINDINGS/RESULTS:While there has been a significant amount of recent literature surrounding RTSA, much of this literature has been aimed at improving outcomes for primary RTSA by improving glenoid placement, maximizing range of motion, etc., or improving outcomes following conversion of another surgery to RTSA [1â€¢â€¢, 2, 3]. There has been little evidence surrounding options for failed RTSA that cannot be salvaged to a revision RTSA. These options are limited and often involve resection arthroplasty and hemiarthroplasty, although neither option provides patients with significant function of the shoulder [4, 5â€¢]. Complications following RTSA are becoming more common as the number of RTSA continues to increase. Furthermore, as the indications for RTSA expand, the complications will continue to increase as this implant is used to tackle more difficult problems about the shoulder. When possible, the etiology of the problem with the RTSA should be addressed and may involve component revision, bone grafting, etc. When the problem cannot be solved with revision RTSA, then the patient can be converted to a hemiarthroplasty, or have a resection arthroplasty, with the understanding that their shoulder function will be limited.
Do Injury Rates in Position Players Who Convert to Pitchers in Professional Baseball Differ From Players Who Have Always Been Pitchers?
Background/UNASSIGNED:There are some professional baseball players who begin their career as a position player and later convert to a pitcher; injury rates in these players are unknown. Purpose/UNASSIGNED:To compare injury rates of professional baseball players who started their career as position players and converted to pitchers with a control group of pitchers who have been only pitchers throughout their professional career. Hypothesis/UNASSIGNED:Injury rates would be lower in the conversion players. Study Design/UNASSIGNED:Cohort study; Level of evidence, 3. Methods/UNASSIGNED:All players who began their professional baseball career as position players and converted to pitchers between 2011 and 2018 were included. All injuries that occurred after they converted to pitchers were included. The conversion players were matched 1 to 1 with a control group of pitchers who entered professional baseball as pitchers and never changed position. Injury rates were compared between groups. The performance between groups was also compared. Results/UNASSIGNED:= .018). Conclusion/UNASSIGNED:Professional baseball players who convert from position players to pitchers are injured at lower rates than control pitchers. Conversion pitchers have lower pitcher usage, which may contribute to their reduced injury rates.
Rehabilitation and Return to Sport Criteria Following Ulnar Collateral Ligament Reconstruction: A Systematic Review
BACKGROUND/UNASSIGNED:Ulnar collateral ligament (UCL) reconstruction (UCLR) is a viable treatment option for patients with UCL insufficiency, especially in the overhead throwing athlete. Within the clinical literature, there is still no universally agreed upon optimal rehabilitation protocol and timing for return to sport (RTS) after UCLR. HYPOTHESIS/UNASSIGNED:There will be significant heterogeneity with respect to RTS criteria after UCLR. Most surgeons will utilize time-based criteria rather than functional or performance-based criteria for RTS after UCLR. STUDY DESIGN/UNASSIGNED:Systematic review; Level of evidence, 4. METHODS/UNASSIGNED:All level 1 to 4 studies that evaluated UCLR with a minimum 1-year follow-up were eligible for inclusion. Studies lacking explicit RTS criteria, studies that treated UCL injury nonoperatively or by UCL repair, or studies reporting revision UCLR were excluded. Each study was analyzed for methodologic quality, RTS, timeline of RTS, and RTS rate. RESULTS/UNASSIGNED:Overall, 1346 studies were identified, 33 of which met the inclusion criteria. These included 3480 athletes across 21 different sports. All studies reported RTS rates either as overall rates or via the Conway-Jobe scale. Timelines for RTS ranged from 6.5 to 16 months. Early bracing with progressive range of motion (ROM) (93.9%), strengthening (84.8%), and participation in an interval throwing program (81.8%) were the most common parameters emphasized in these rehabilitation protocols. While all studies included at least 1 of 3 metrics for the RTS value assessment, most commonly postoperative rehabilitation (96.97%) and set timing after surgery (96.97%), no article completely defined RTS criteria after UCLR. CONCLUSION/UNASSIGNED:Overall, 93.9% of studies report utilizing bracing with progressive ROM, 84.8% reported strengthening, and 81.8% reported participation in an interval throwing program as rehabilitation parameters after UCLR. In addition, 96.97% reported timing after surgery as a criterion for RTS; however, there is a wide variability within the literature on the recommended time from surgery to return to activity. Future research should focus on developing a comprehensive checklist of functional and performance-based criteria for safe RTS after UCLR.
Effect of COVID-19 on Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers
Background/UNASSIGNED:The coronavirus disease of 2019 (COVID-19) pandemic led to the suspension and shortening of the 2020 Major League Baseball (MLB) season from 162 to 60 regular season games. The effect of this disruption on injury rates, specifically injury to the ulnar collateral ligament (UCL), has not been quantified. Purpose/Hypothesis/UNASSIGNED:The purpose of this study was to compare the rate of UCL reconstruction (UCLR), surgery timing, and pitching workload in MLB pitchers from before and after the COVID-19 pandemic lockdown. We hypothesized that UCLR rates relative to games played would be increased and pitching workload would be decreased in 2020 compared with previous seasons. Study Design/UNASSIGNED:Cohort study; Level of evidence, 3. Methods/UNASSIGNED:An extensive online search using publicly available data was conducted to identify all MLB pitchers who underwent UCLR between January 1, 2017, and December 31, 2020. Only pitchers who were competing at the MLB level when undergoing reconstruction were included. Player characteristics and surgery date, as well as career and season of surgery pitching workload, were collected for all included pitchers. All data were compared as a pooled sample (2017-2019 vs 2020). Results/UNASSIGNED:= .001). Conclusion/UNASSIGNED:MLB pitchers were almost 3 times more likely to undergo UCLR per game after the COVID-19 lockdown. A decreased preseason pitching workload because of the COVID-19 lockdown may have had an effect on per game UCLR rates.
Analysis of Injuries and Pitching Performance Between Major League Baseball and Nippon Professional Baseball: A 2-Team Comparison Between 2015 to 2019
Background/UNASSIGNED:There has been minimal research investigating injury and pitching performance differences between Major League Baseball (MLB) and other professional leagues. Purpose/Hypothesis/UNASSIGNED:This 2-team comparison between MLB and Japan's Nippon Professional Baseball (NPB) involved affiliated players over 5 years. We hypothesized that teams would differ in the injury incidence, mechanism of injury, pitch velocity, and pitch type usage. Study Design/UNASSIGNED:Descriptive epidemiology study. Methods/UNASSIGNED:Between 2015 and 2019, pitching data as well as injury statistics for the highest level and minor league affiliates of the Los Angeles Angels (MLB) and the Hiroshima Toyo Carp (NPB) were reviewed for significant differences in the injury prevalence, injury type, mechanism of injury, and days missed. In total, 3781 MLB and 371 NPB injuries were studied. Results/UNASSIGNED:< .001) compared with the NPB team. Conclusion/UNASSIGNED:This is the first empirical study examining injury trends and pitching characteristics between MLB and NPB athletes. MLB-affiliated pitchers threw faster and relied more on breaking pitches in comparison with NPB-affiliated pitchers. From injury data, MLB players were younger, taller, and heavier with a higher percentage of throwing-related injuries, contact injuries, and injuries sustained outside of competition. Overall, the MLB team indicated a 3.7-fold higher rate of reported injuries with fewer days missed per injury than did the NPB team. Competitive conditions are distinctly different between MLB and NPB, and thus, more extensive research collaborations in the future can identify best practices to advance health and performance for both leagues.
Complications and Readmissions After Reverse and Anatomic Total Shoulder Arthroplasty With Same-day Discharge
BACKGROUND:Recent studies have demonstrated the safety of anatomic total shoulder arthroplasty (TSA) in an outpatient setting. No clinical studies, to date, have specifically analyzed complication and readmission rates after reverse total shoulder arthroplasty (RTSA) with same-day discharge. The purpose of this study was to compare the 90-day complication and readmission rates of patients undergoing TSA and RTSA with same-day discharge. METHODS:Ninety-eight consecutive patients who underwent 104 shoulder arthroplasties with same-day discharge (52 TSA and 52 RTSA) between 2016 and 2019 were analyzed. Suitability for same-day discharge was determined preoperatively using the standardized criteria. Demographic variables, operative time, 90-day readmission, and complication rates were recorded and compared between groups. Differences between the patients undergoing TSA versus RTSA were evaluated with Student t-test, Mann-Whitney test, or Chi square tests as statistically appropriate and reported as P values. RESULTS:Average age in the TSA cohort was significantly lower (60.1 Â± 7.4 versus 67.5 Â± 7.5, respectively; P < 0.001). Total operating room time was significantly shorter in the RTSA cohort (153 Â± 30.1 minutes versus 171 Â± 20.9). Three minor postoperative complications (5.8%) were observed in the TSA cohort (three seromas) within the 90-day postoperative period. There were four postoperative complications (7.7%) in the RTSA cohort (two postoperative seromas, one periprosthetic fracture, and one dislocation). None of the TSA patients required readmission and 1 RTSA (periprosthetic fracture) patient required readmission within 90 days. DISCUSSION/CONCLUSIONS:RTSA with same-day discharge is a safe option for appropriately selected patients despite significantly increased age. 90-day readmission and complication rates between outpatient TSA and RTSA are similar. DATA AVAILABILITY/UNASSIGNED:Yes. TRIAL REGISTRATION NUMBERS/UNASSIGNED:NA. LEVEL OF EVIDENCE/METHODS:III (case-control).
Performance and Return to Sport After Excision of the Fractured Hook of the Hamate in Professional Baseball Players
BACKGROUND:A fracture of the hook of the hamate is a common injury affecting professional baseball players. The treatment for these fractures ranges from nonoperative immobilization to excision of the fragment. PURPOSE/HYPOTHESIS:The purpose was to report the results of surgical treatment of hook of hamate fractures in professional baseball players and determine which factors are associated with return to sport (RTS) and time to RTS. The hypothesis was that there is a high rate of RTS in professional baseball players after surgical treatment of the hook of the hamate fracture with no significant decline in performance after RTS. STUDY DESIGN:Descriptive epidemiology study. METHODS:All professional baseball players who underwent excision of the hook of the hamate between 2010 and 2017 were included. Player characteristic and performance data (before and after surgery) were recorded. Performance metrics were then compared before and after surgery. RESULTS:= .837). CONCLUSION:After surgical excision for hook of hamate fractures in professional baseball players, 84% were able to RTS, with 81% returning to the same or higher level. The median time for players to RTS after surgery was 48 days. Player usage increased after surgery, while hitting efficiency slightly declined.
Ulnar Collateral Ligament Tear Location May Affect Return-to-Sports Rate but Not Performance Upon Return to Sports After Ulnar Collateral Ligament Reconstruction Surgery in Professional Baseball Players
BACKGROUND:The number of ulnar collateral ligament (UCL) tears in professional baseball players is increasing. UCL reconstruction (UCLR) is the treatment of choice in players with failed nonoperative treatment who wish to return to sports (RTS). It is unknown if UCL tear location influences the ability of players to RTS or affects their performance upon RTS. PURPOSE/HYPOTHESIS:The purpose was to compare the RTS rate and performance upon RTS in professional baseball players who underwent UCLR based on UCL tear location (proximal vs distal). It was hypothesized that no difference in RTS rate or performance upon RTS will exist between players with proximal or distal UCL tears. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:All professional baseball players who underwent primary UCLR by a single surgeon between 2016 and 2018 were eligible for inclusion. Players with purely midsubstance tears or revision UCLR were excluded. Tear location was determined based on preoperative magnetic resonance imaging (MRI) and intraoperative findings. RTS rate and performance were compared between players with proximal versus distal UCL tears. RESULTS:= .021) postoperatively. However, the WHIP ([walks + hits]/innings pitched) was not different between players with proximal or distal tears, indicating that efficacy in games was not significantly different between groups. CONCLUSION:Professional baseball players who sustain a distal UCL tear and undergo UCLR may be more likely to RTS than those who sustain a proximal UCL tear and undergo UCLR. Players with distal UCL tears who underwent UCLR saw higher utilization postoperatively than those with proximal UCL tears. Further work is needed in this area to confirm this result.