Editorial Commentary: Surgical Modifications Should Be Considered Preoperatively in Individuals With Knee Hyperextension Beyond Neutral to Avoid a Retear Post-Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament retears are a multifactorial process, which makes it difficult for risk assessment metrics to predict chances of recurrence. However, these metrics provide surgeons with recommendations as to when additional safeguards should be implemented. Since a key goal in any surgical procedure is positive long-term patient outcomes, understanding predictive metrics and associated limitations is imperative for positive outcomes.

Editorial Commentary: Platelet-Rich Plasma May Be Superior to Corticosteroid Injection for Rotator Cuff Disease Because of Improved Chance of Healing, Longer-Lasting Pain Relief, and No Detriment if Surgery Is Needed.

Both corticosteroid and platelet-rich plasma (PRP) injections have benefits for patients with rotator cuff tendinopathy. Currently, the published clinical differences are small, and statistical differences aren't as significant without a clinical difference, so the answer is personal. PRP is expensive, but rotator cuff healing is possible, resulting in the best chance to avoid surgery. And, if surgery is required, PRP results in no detriment, unlike corticosteroid. PRP may result in lasting pain relief. Based on the current literature, we prefer PRP despite the cost.

Editorial Commentary: Causes of Patient Dissatisfaction May Be Modifiable.

Adapting Tolstoy, "Satisfied patients are all alike; every dissatisfied patient is dissatisfied in their own way." We need to learn the reasons why patients are dissatisfied. Whereas happy patients receive the same procedures for similar indications as unhappy patients, evidence supports a clear association between negative psychological function and worse preoperative and postoperative patient-reported outcome measures. Thus, the unhappy patient might be where we can make most improvement in patient care. The first step could be to standardize reasons for patient displeasure, such as adverse events, poor patient-reported outcomes, failure to meet the patient acceptable symptomatic state, failure to return to sport or work at the same level, or failure to meet patient's expectations. Next, when possible, modifiable factors should be addressed preoperatively. Next, we should evaluate whether addressing modifiable factors (i.e., depression or smoking) improves outcome. Clinicians should be mindful of patient psychosocial and refer for treatment of modifiable factors when possible.

Determinants of Major League Baseball Pitchers' Career Length.

PURPOSE: To investigate variables (injury, position, performance, and pitching volume) that affect the career longevity of Major League Baseball pitchers. METHODS: To be eligible, pitchers must have entered Major League Baseball between 1989 and 1992 without missing information for the variables on the website http://www.baseball-reference.com. The variables assessed were average innings pitched per year before and after age 25 years, earned run average, walks and hits divided by innings pitched, strikeout to walk ratio, pitching position, time on the disabled list, length of career, and starting and retirement age. We used analysis of variance to compare the differences between groups and a regression model to assess the relationship between variables before age 25 years and career length. RESULTS: Mean retirement age for the group was 31.74 (95% confidence interval 30.83-32.65) and mean career length was 10.97 (95% confidence interval, 10.02-11.92) years. Innings pitched after age 25 years increased slightly, but not significantly, from the number of innings pitched before age 25 years, 85.35 versus 74.25, P = .5063. Career earned run average was not significantly different after age 25 years compared with before age 25 years, 4.83 versus 5.58, respectively, P = .8834. Both strikeout to walk ratio, 1.55 to 1.77, P = .0022, and walks and hits divided by innings pitched, 1.63 to 1.50, P = .0339, improved significantly after age 25 years compared with before age 25 years. The position the player started and ended his career (starter or reliever) did not influence career length. Multiple regression analysis comparing the variables from before age 25 revealed only the number of innings pitched before age 25 were positively related to career length, R2 = 0.1408, P < .0001. All other variables analyzed before age 25 years were not significantly related to career length. CONCLUSIONS: The only studied variable that had significant relationship, which was weak to low, with career length was innings pitched per year before age 25 years. All other variables analyzed before age 25 years were not significantly related to career length. LEVEL OF EVIDENCE: Level IV, case series.

Relationship between iHOT12 and HOS scores in hip pain patients.

To determine if scores of the International Hip Outcome Tool-12 (iHOT12) and the Hip Outcome Score (HOS) correlate with one another in hip pain patients. Patients reporting to an orthopedic clinic for their scheduled appointment for hip pain were given a paper survey consisting of the iHOT12 and the HOS. Demographic information [age, weight, height and body mass index (BMI)] was obtained by chart review. Overall, 114 patients were invited to voluntarily complete the surveys of which 23 declined. Our sample consisted of 91 (57 female and 34 male) patients (80% response rate). The HOS (iHOT12) explained 62% of the variation in iHOT12 (HOS) by using a linear model (Pearson's correlation(r) is 0.79, P < 0.001). Age, weight, BMI, gender and arthritis did not show a statistically significant predictive power explaining HOS. However, only gender had a 'statistically' significant predictive power explaining iHOT12 (P = 0.007). The relationship between the two scores are stronger for males (r = 0.81, P < 0.001) compared with females (r = 0.77, P < 0.001). The proportion of variations explained on one of the scores by the other are 0.66 for males and 0.59 for females. HOS score together with gender explained 64% of the variation in iHOT12 by using a linear model. iHOT12 together with the non-statistically significant gender term explained 62% of the variation in HOS by using a linear model. It may not be necessary to collect both the iHOT12 and HOS, since the predictive power of one on the other is high. Collecting HOS together with information on gender is preferable compared with collecting iHOT12. Level of evidence: Level III.