High Return to Play and Low Reinjury Rates in National Collegiate Athletic Association Division I Football Players Following Anterior Cruciate Ligament Reconstruction Using Quadrupled Hamstring Autograft.

PURPOSE: The purpose of this study was to examine the outcomes of anterior cruciate ligament (ACL) reconstruction using quadrupled hamstring (QH) autograft in a cohort of National Collegiate Athletic Association (NCAA) Division I football players. METHODS: A retrospective analysis was performed on NCAA Division I football players at a single institution who had transtibial ACL reconstruction using QH autograft between 2001 and 2016. Primary outcomes were ACL reinjury and return to play (RTP). Secondary outcomes were position, percent of eligibility used after surgery, graft diameter, Tegner-Lysholm scores, concomitant injuries/surgeries, and postcollegiate professional play. RESULTS: Between 2001 and 2016, 34 players had QH autograft ACL reconstruction, and 29 players achieved RTP. Of the 29, 2 (6.9%) sustained ACL reinjuries. The average RTP was 318 days (range 115-628) after surgery. Players used 79.5% of their remaining collegiate eligibility after surgery. Nine players sustained multiligamentous knee injuries. This did not have a significant effect on RTP (P = 0.709; mean 306±24 days for isolated ACL, mean of 353±51 for 2 ligaments, mean of 324±114 for 3 + ligaments) and none sustained reinjury. Associated meniscal injuries were sustained by 28, and 8 sustained chondral injuries. The mean postoperative Tegner-Lysholm score was 90.7 of 100, with mean follow-up of 102 months. Of these players, 18 went on to play professionally, with 17 joining National Football League rosters and 1 an arena team roster. CONCLUSION: QH demonstrated an ACL reinjury and RTP rates similar to those in previously published, predominantly bone-patella tendon-bone ACL reinjury data in elite athletes. This study demonstrates that QH autograft may be a viable option in elite athletes. LEVEL OF EVIDENCE: IV, case series.

Evolving management of middle-third clavicle fractures in the National Football League.

BACKGROUND: Clavicle fractures have historically been managed nonoperatively. Recent literature suggests a subset of clavicle fractures may be best treated with primary surgical treatment. PURPOSE: To review the National Football League (NFL) experience in the management of middle-third clavicle fractures over a 5-year period. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective review of clavicle fractures that occurred during a 5-season period was obtained from the NFL Injury Surveillance System. A detailed questionnaire was also sent to the medical staff of all 32 NFL teams. RESULTS: Nineteen players sustained a middle-third clavicle fracture over the 5-year period. Six fractures were nondisplaced or minimally displaced. All 6 healed at an average time of 7.3 weeks. Thirteen fractures were 100% displaced. Six of the 13 underwent acute surgical fixation that resulted in fracture healing without complication at an average of 8.8 weeks. The remaining 7 players with a completely displaced fracture were initially treated nonoperatively. Three of these 7 healed clinically without sequela at an average of 13.3 weeks after injury; however, 4 players sustained a refracture within 1 year of the initial injury. CONCLUSION: Over the past 5 years, nearly 50% of NFL players with a completely displaced middle-third clavicle fracture were treated successfully with acute surgical fixation without sequela and healed at an average of 8.8 weeks. Three of these players were able to return to play during the same season. In addition, 4 of 7 players initially treated nonoperatively for a completely displaced middle-third clavicle fracture refractured their clavicle within a 1-year period from their initial injury. The 4 players missed an average of 1.5 seasons because of their clavicle injury and subsequent clinical course. Based on this review, it may be reasonable to consider acute surgical treatment of this injury in the NFL player to enable a successful clinical outcome in a predictable time frame.

A biomechanical evaluation of ulnar collateral ligament reconstruction using a novel technique for ulnar-sided fixation.

BACKGROUND: Techniques for ulnar collateral ligament (UCL) reconstruction have evolved since its original description. HYPOTHESIS: Ulnar collateral ligament reconstruction using the ZipLoop for ulnar-sided fixation, as combined with the humeral docking technique supplemented with an interference screw, will restore valgus stability similar to that of the Jobe technique and the native ligament. STUDY DESIGN: Controlled laboratory study. METHODS: Kinematic testing was performed on 8 matched pairs of cadaver elbows with an electromagnetic tracking system through an arc of motion for the intact, disrupted, and reconstructed states of the UCL in an unloaded and loaded condition. From each pair, the docking technique using the ZipLoop for ulnar fixation and humeral docking technique supplemented with an interference screw and the traditional Jobe technique were performed with matched gracilis allograft tendons. After kinematic testing, both reconstruction groups were tested to failure at 70 degrees of flexion. RESULTS: Kinematic results for the unloaded condition showed that both reconstruction techniques significantly overcorrected (less valgus angulation) the specimens between 40 degrees and 120 degrees of flexion when compared with the intact ligament (all P values < .027). Under loaded conditions, the ulnar trajectories for both reconstruction techniques exhibited significantly greater valgus angulation (undercorrection) at 20 degrees of flexion (Jobe, P = .0084; ZipLoop, P = .0289) when compared with the intact ligament but were not significantly different over the remaining arc of motion. Failure testing resulted in no significant statistical difference between the 2 reconstruction groups. Failure testing demonstrated that humeral tunnel egress, midsubstance elongation, and ulnar tunnel egress of the ligament were similar between the reconstruction techniques. CONCLUSION: The docking technique using the ZipLoop for ulnar-sided fixation is biomechanically equivalent to the Jobe technique for UCL reconstruction. Both reconstruction techniques restore valgus stability similar to that of the native UCL ligament. CLINICAL RELEVANCE: This modification in the docking technique restores elbow kinematics while eliminating the risk of ulnar bone bridge fracture, and it allows for retensioning of the graft after cortical fixation.