Arthroscopically Assisted Coracoclavicular (CC) Stabilization Using a Suture Button Device for Lateral Clavicle Fractures with CC Ligament Injury.

Background: Lateral clavicle fractures represent approximately 10-15% of all clavicle fractures. However, controversy exists regarding the optimal surgical treatment because of instability associated with the coracoclavicular (CC) ligament injury and a small lateral fragment. The purpose of this study was to evaluate the radiological and clinical outcomes of arthroscopically assisted CC stabilization using a suture button device for lateral clavicle fractures accompanied by CC ligament injury. Methods: A retrospective observational study involved six patients with modified Neer type IIB fractures, which were treated with the technique and followed for 12 months. Postoperative range of motion (ROM) and X-rays were evaluated every 3 months. Shoulder functional scores (University of California Los Angeles score, Japanese Orthopedics Association score) and visual analog scale (VAS) scores for pain (at rest, at night, and during motion) and for satisfaction were analyzed 12 months after surgery. Results: Early phase ROM recovery and excellent outcomes were achieved. All patients achieved bone union. Slight superior clavicle displacement and bone hole dilation occurred with no critical complications. Conclusions: Arthroscopically assisted CC stabilization with a suture button device for unstable lateral clavicle fractures can produce satisfactory radiological and clinical results.

Risk Factors for Concussion in Under 18, Under 22 and Professional Men's Rugby Union: A Video Analysis of 14,809 Tackles.

OBJECTIVE: This study aimed to identify the risk factors for tackle-related concussion observed in matches involving under (U) 18, U 22 and professional men's Rugby Union players through video analysis. STUDY DESIGN: Descriptive epidemiology study. METHODS: Twenty Rugby Union matches each for high school (U18), university/college (U22) and professional (Elite) were randomly selected from 202 matches in the 2018/2019 season. Both one-on-one and tackles involving multiple tacklers were analyzed for the 60 matches. The 28 categorical and continuous variables (e.g., tackle characteristics and duration before the tackle) were applied as risk factors to a least absolute shrinkage and selection operator (Lasso) regression analysis. To identify high-risk situations, a simulation model with coefficients obtained from the Lasso regression was used. Statistical analysis was conducted according to tackle direction. RESULTS: A total of 14,809 tackles and 41 concussions involving 1800 players were included in the analyses. The incidence rate of concussions (injuries/1000 tackles) was greater in Elite players (4.0) compared with U18 (1.9) and U22 (2.4) players. The factors most highly associated with concussions were head-in-front tackles (where the tackler's head is placed forward, impeding a ball carrier's forward movements, 11.26/1000 tackles), and were more often observed among U18 players. A simulation model predicted that the highest risk tackle situation in Elite players was a head-in-front, side-on tackle below the hip of the ball carrier (predicted incidence rate 18.07/1000 tackles). CONCLUSION: The risk factors associated with concussion need to be assessed cautiously. Avoiding head-in-front, side-on tackles to the lower extremities of a ball carrier should be considered to reduce injury risks.

Effect of pre-operative HbA1c and blood glucose level on the surgical site infection after lumbar instrumentation surgery.

BACKGROUND: This study aims to investigate the effect of pre-operative hemoglobin A1c (HbA1c) and pre-operative blood glucose control on the rate of surgical site infection (SSI) after posterior lumbar instrumentation surgery in diabetes mellitus (DM) patients. METHODS: A total of 1046 patients who had undergone posterior lumbar instrumentation surgery were reviewed. Based on pre-operative HbA1c, patients were divided into three groups: non-DM group, low HbA1c group (HbA1c < 7.0 % in DM) and high HbA1c group (≥7.0). As well, based on the status of blood glucose control in DM patients immediately before surgery, patients were divided into two groups: good control group (post-prandial blood glucose [PBG] < 200 mg/dl) and poor control group (≥200). The rate of SSI was compared among these groups. RESULTS: SSI occurred in 1.9 % in non-DM group, 2.4 % in low HbA1c group, and 9.3 % in high HbA1c group. Compared with non-DM group, high HbA1c group had significantly higher rate of SSI (p = 0.001). There was not statistically different between non-DM and low HbA1c groups (p = 0.550). SSI occurred in 2.2 % in good control group, and 10.2 % in poor control group. The rate of SSI was significantly lower in good control group (p = 0.013). CONCLUSION: This study showed that the rate of SSI after posterior lumbar instrumentation surgery tend to be higher in DM patients with high HbA1c. However, the rate might be reduced to the same level as that of non-DM group by lowering PBG to <200 mg/dl immediately before surgery.

Association of Lumbar Spondylolytic Spondylolisthesis With the Incidence and Prognosis of Anterior Ring Apophyseal Abnormalities of the Vertebrae in Young Gymnasts.

Background: Although anterior apophyseal abnormalities of the vertebrae and spondylolytic spondylolisthesis (SS) are prevalent in gymnasts during growth spurts, no studies have examined the relationship between apophyseal abnormalities and SS. Hypothesis: A significant relationship will exist between anterior apophyseal abnormalities and SS in young gymnasts. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 306 gymnasts (123 male, 183 female; age range, 6-28 years) with >2 weeks of back pain were enrolled in this study. Apophyseal abnormalities were evaluated using radiography. In the primary analysis, multiple logistic regression analysis was performed to assess the odds ratio (OR) for multivariate factors (age, body mass index, sex, skeletal maturity, competitive level, and presence of spondylolysis or SS) influencing the incidence of apophyseal abnormalities. In the secondary analysis, 90 of the 306 gymnasts were followed up radiographically for a minimum of 2 years, and factors contributing to the worsening of apophyseal abnormalities were identified. Results: In the primary analysis, the chi-square test revealed a relationship between anterior ring apophyseal abnormalities and SS at the L5-S1 segment (OR, 7.6). Multiple logistic regression analysis demonstrated that the presence of SS at L5-S1 (OR, 9.5) and competitive level (international: OR, 6.7; national: OR, 4.5) correlated with the incidence of apophyseal abnormalities. The secondary analysis identified the presence of SS at L5-S1 (OR, 5.9) as a significant factor contributing to the worsening of apophyseal abnormalities. Conclusion: The presence of SS was a factor affecting the incidence and prognosis of anterior apophyseal abnormalities.

Arthroscopic Bankart repair with additional footprint fixation using the double-row technique at the 4 o'clock position anatomically restored the capsulolabral complex and showed good clinical results.

PURPOSE: To investigate the clinical outcome and magnetic resonance imaging (MRI) findings after arthroscopic Bankart repair with additional double anchor footprint fixation (DAFF) at the 4 o'clock position, where the native footprint is widest anatomically, for recurrent anterior shoulder instability. METHODS: Forty-two patients (mean age 27.0 years) with recurrent anterior shoulder instability and without severe glenoid bone defects underwent arthroscopic Bankart repair with additional DAFF at the 4 o'clock position. Using three standard portals, single-row repair was performed at the 2, 3, and 5 o'clock positions, and DAFF with the suture bridging technique was conducted at the 4 o'clock position. MRI was performed preoperatively and at 6 months postoperatively. Patients with follow-up periods of ≥1 year were included in the present study and clinically evaluated at the final follow-up. The morphology at the 2 and 4 o'clock positions on radial MRI slices was compared between the preoperative and 6-month postoperative scans, and the footprint of the repaired capsulolabral complex at 6 months postoperatively was compared between the 2 and 4 o'clock positions. RESULTS: The average follow-up period was 19.5 ± 6.2 months. The rates of dislocation recurrence and positive apprehension test results were 2.4 and 4.8%, respectively. External rotation was restricted by 3.5°. The University of California at Los Angeles and Rowe scores at the final follow-up were 34.5 ± 1.0 points and 97.2 ± 5.7 points, respectively, representing significant improvements over the preoperative scores (p < 0.01). Although the capsulolabral complex at 6 months postoperatively was firmly repaired at both the 2 and 4 o'clock positions compared to its preoperative state, the footprint of the restored capsulolabral complex was wider at the 4 o'clock position than at the 2 o'clock position (p < 0.01). CONCLUSIONS: Additional DAFF at the 4 o'clock position improved the glenohumeral stability and function of the shoulder joint. This study suggests that this technique is a reliable and useful treatment for shoulder instability. LEVEL OF EVIDENCE: IV.

Relationship of superoxide dismutase to rotator cuff injury/tear in a rat model.

Rotator cuff degeneration is one of the several factors that lead to rotator cuff tears. Oxidative stress and superoxide dismutase have been reported to be related to rotator cuff degeneration; however, the precise mechanism still remains unclear. In this study, we investigated the relationship of oxidative stress and superoxide dismutase to the degeneration of the rotator cuff using rat models. Eighty-four rats were used to create a collagenase-induced rotator cuff injury model (injury model) and a rotator cuff tear model (tear model). The controls were administered saline and had only a deltoid incision, respectively. We evaluated degeneration morphology of the rotator cuff using a degeneration score; dihydroethidium fluorescence intensity, which detects oxidative stress; gene expression; and superoxide dismutase activity. The rotator cuffs in the injury and tear models significantly increased degeneration scores and dihydroethidium fluorescence intensity. On the other hand, gene expression of superoxide dismutase isoform, superoxide dismutase 1, and superoxide dismutase activity were significantly decreased in the injury model but showed no significant difference in the tear model. These findings suggested that superoxide dismutase might not be associated with rotator cuff degeneration after tear but may be involved in degenerative rotator cuff without tear. However, we found that rotator cuff degeneration involves oxidative stress both with and without tear. Based on these findings, it is presumed that different treatments may be appropriate, depending on the state of rotator cuff degeneration, because the mechanisms of the degeneration may be different.

Glenoid Bone Loss Is a Risk Factor for Poor Clinical Results After Coracoid Transfer in Rugby Players With Shoulder Dislocations.

BACKGROUND: Although surgical shoulder stabilization via coracoid transfer in collision athletes is effective and has a low reinjury rate, the factors affecting poor clinical results and the superiority of the 2 stabilization procedures (Bristow and Latarjet) remain unclear. PURPOSE: To explore the factor(s) affecting poor clinical results of coracoid transfer in a large cohort of rugby players and to compare postoperative function between the Bristow and Latarjet procedures. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This study included 169 consecutive shoulders of 154 competitive male rugby players who underwent shoulder stabilization surgery (Bankart repair with coracoid transfer) between 2014 and 2018 and had a mean follow-up of 2.7 years (minimum follow-up, 2 years). The Bristow procedure was performed in the first 92 shoulders (84 players), and the Latarjet procedure was performed in the latter 77 shoulders (70 players). A poor clinical result was defined as a postoperative Rowe score of <70 and a postoperative Western Ontario Shoulder Instability Index (WOSI) score of >630. Multiple logistic regression analysis was conducted to identify the factors affecting postoperative functional failure. The postoperative scores and complication rates were also compared between the 2 procedures. RESULTS: In total, 92.3% of the rugby players returned to their preinjury competition level at a mean of 5.9 months postoperatively. The Rowe and WOSI scores showed that shoulder function was improved postoperatively compared with preoperatively. The number of rugby players with a poor clinical result was 18 (10.7%). Multiple logistic regression analysis demonstrated that a poor clinical result was associated with a preoperative glenoid bone defect of >20% of the glenoid width (odds ratio, 9.8), whereas the clinical result was unaffected by the type of coracoid transfer. There were no differences between the 2 procedures in any of the postoperative scores or complication rates. CONCLUSION: The present study indicated that the most effective predictor of postoperative functional scores was the degree of the glenoid bone defect and not the type of coracoid transfer. This information may be useful for the strategic treatment of shoulder dislocations in collision athletes.

Association of Recurrent Tear After Arthroscopic Rotator Cuff Repair and Superoxide-Induced Oxidative Stress.

BACKGROUND: Recurrent tears after arthroscopic rotator cuff repair (ARCR) remain a significant clinical problem. Oxidative stress contributes to the degeneration of the rotator cuff, and a degenerative rotator cuff can lead to recurrent tear after ARCR. However, the correlation between oxidative stress and retear after ARCR is unclear. PURPOSE: To investigate the correlation between superoxide-induced oxidative stress and recurrent tear after ARCR. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 68 patients who underwent ARCR using a suture-bridge technique participated in this study. Specimens were collected from the edge of the torn tendon during surgery. The modified Bonar score was used to evaluate degeneration of the rotator cuff on histological specimens, and fluorescence intensity on dihydroethidium (DHE) staining was used to detect oxidative stress. Superoxide dismutase (SOD) enzyme activity was also measured. The following were used for clinical evaluation: age, tear size on magnetic resonance imaging (MRI) before surgery, Goutallier classification on MRI before surgery, and Japanese Orthopaedic Association score before and 6 months after surgery. After the repaired rotator cuffs were evaluated on MRI 6 months after surgery, the patients were divided into groups: those with a healed rotator cuff (healed group; n = 46) and those with a recurrent tear (retear group; n = 22). The significant differences between the groups were determined with regard to clinical evaluation, modified Bonar score, DHE intensity, and SOD activity. In addition, multivariate logistic regression analysis was performed to investigate risk factors for recurrent tear. RESULTS: Age, tear size, Goutallier classification, modified Bonar score, DHE intensity, and SOD activity were significantly greater in the retear group than in the healed group, although the Japanese Orthopaedic Association score was not significantly different. Multiple logistic regression analysis demonstrated that age, tear size, and SOD activity were significantly correlated with recurrent tear. CONCLUSION: In addition to tear size and age, superoxide-induced oxidative stress may be an exacerbating factor for retear after ARCR.

Unique environmental Symbiodiniaceae diversity at an isolated island in the northwestern Pacific.

Dinoflagellates in the family Symbiodiniaceae are intensively investigated as algal symbionts of corals and other invertebrates, underpinning coral reef ecosystems as primary producers. Diversity, including regional diversification, of free-living communities is less studied. In this study, an environmental Symbiodiniaceae community at an isolated island, Okinotori Island, Japan, was investigated to determine whether the community is endemic or common with other locations near continents and major ocean currents. Symbiotic algae in common corals at the island were the same type as those of the corals from other Japanese waters. In the environmental samples, genera Symbiodinium (formerly clade A), Cladocopium (clade C), Durusdinium (clade D), and clades F (including Freudenthalidium), G, and I, were identified through analysis of internal transcribed spacer region 2 of nuclear ribosomal RNA gene (ITS2) sequences. Interestingly, some sequences found were genetically different from those of previously reported genera/clades. These unknown sequences were genetically included in the Symbiodiniaceae linage, but they were differentiated from the previously known nine clades. The sequences formed a cluster in the phylogenetic tree based on 28S nrDNA. These sequences were thus considered members of a novel clade in the family (clade J). In total, 120 kinds of ITS2 sequences were produced; while 10 were identical to previously reported sequences, the majority were highly divergent. These genetically unique Symbiodiniaceae types, including novel clade J, may have evolved in isolation and reflect the environmental characteristics of the Okinotori Island.

Anatomic Analysis of the Attachment of the Posteroinferior Labrum and Capsule to the Glenoid: A Cadaveric Study.

PURPOSE: To measure the height of the posteroinferior glenohumeral ligament (PIGHL) attachment to the labrum and the depth of the posteroinferior labrum to the glenoid, macroscopically, and to investigate the morphology of the attachment of the posteroinferior labrum to the glenoid, histologically. METHODS: Fifty cadaveric shoulders without exposed subchondral bone on the glenoid and detached posterior labrum were used. We examined the frequency of the heights of the PIGHL attachments to the labrum and the length of the labral attachment on the glenoid rim at the 7, 8, 9, and 10 o'clock positions, macroscopically. According to morphology of the histological labral attachments, it was divided into 3 groups. Labra attached on the articular surface and the glenoid neck were defined as the SN type, while labra attached only to the glenoid neck constituted labra attached to the bone and side of the articular cartilage (Nc type) and labra attached only to bone (Nb type). RESULTS: The PIGHL attached from 7 o'clock to 9 o'clock in 48 shoulders (96%). The mean labral attachment at the 7 o'clock position was 6.3 ± 1.0 mm (range, 4.6-9.4 mm), which was significantly longer than at the other positions (P < .05). Histologically, the frequency of SN type attachment was 49 (98%) shoulders at the 7 o'clock position. CONCLUSIONS: The PIGHL attached between 7 and 9 o'clock in 96% of the shoulders. In 98% of the shoulders, the labrum did not attach to the articular surface, but attached to both the articular cartilage and the bone of the glenoid neck at 7 o'clock. CLINICAL RELEVANCE: The posteroinferior labrum should be repaired widely at the 7 o'clock position and not on the articular surface because the labrum attached anatomically to the glenoid neck.

Supraspinatus Muscle and Tendon Stiffness Changes After Arthroscopic Rotator Cuff Repair: A Shear Wave Elastography Assessment.

Re-tearing after arthroscopic rotator cuff repair (ARCR) frequently occurs, and high stiffness of the rotator cuff may be one of the factors. We investigated changes in stiffness of the supraspinatus muscle and tendon after ARCR as measured by shear wave elastography (SWE) with B-mode ultrasound, and compared the supraspinatus muscle stiffness of patients with recurrent tears and patients with healed rotator cuffs. Sixty patients with supraspinatus tears requiring ARCR underwent serial SWE of their supraspinatus muscles and repaired tendons. SWE was performed before surgery (Pre-Op) and at 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, and 6 months after surgery. Additionally, the repaired rotator cuffs were evaluated using magnetic resonance imaging at 6 months after surgery to classify patients into a healed rotator cuff group and a recurrent tear group. Differences in SWE values between the groups were assessed at each time point. The SWE value of the repaired tendon at 1 week after ARCR was significantly greater than at 3 and 6 months. The SWE value for the supraspinatus muscle at 1 month after ARCR surgery in the healed group was lower than at Pre-Op and 4, 5, and 6 months after surgery, and it was also lower than that at 1 month after surgery in the re-tear group. There were no significant differences between time points in the SWE values of the supraspinatus muscle in the re-tear group. The SWE value of the muscle in the re-tear group was greater than in the healed group at 1 month after surgery (p < 0.05). Increased SWE values at 1 month after ARCR may predict recurrent rotator cuff tears after surgery rather than evaluating the tendon. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:219-227, 2020.

Association of Superoxide-Induced Oxidative Stress With Rotator Cuff Tears in Human Patients.

Rotator cuff degeneration is one of the factors contributing to rotator cuff tears. Oxidative stress is involved in tendon degeneration, and superoxide-induced oxidative stress plays a pathological role in regulating the balance between oxidation and reduction. The role of oxidative stress in rotator cuff tears, however, is unclear. This study, therefore, aimed to investigate the contribution of superoxide-induced oxidative stress to rotator cuff tears. Seventy patients were recruited and divided into two groups: patients with (Ruptured group) and those without (Unruptured group) a rotator cuff tear. Specimens from both groups were collected during surgery. Degeneration morphology was classified according to the degeneration score. Superoxide-induced oxidative stress was assessed according to dihydroethidium (DHE) relative fluorescence intensity, capacity for antioxidation according to superoxide dismutase (SOD) activity, and the balance between oxidation and reduction based on the redox ratio. Data were compared between groups. Correlations between the degeneration score and the oxidative stress factors were calculated. Degeneration score and DHE relative fluorescence intensity were significantly higher in the Ruptured than the Unruptured group. The SOD activity was not significantly different between groups. Degeneration score was positively correlated with both DHE relative fluorescence intensity and SOD activity. Thus, superoxide-induced oxidative stress and tendon degeneration were greater in rotator cuff tear tissues than in those with no tear, suggesting that oxidative imbalance may be involved in degenerative rotator cuff tears. Clinical Relevance: Understanding the mechanisms of superoxide-induced oxidative stress may lead to targeted tissue therapy for degenerative rotator cuff tears. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:212-218, 2020.

Increased Stiffness of Rotator Cuff Tendons in Frozen Shoulder on Shear Wave Elastography.

OBJECTIVES: To evaluate the stiffness and morphologic characteristics of the capsule, rotator cuff tendons and muscles, coracohumeral ligament (CHL), and long head of the biceps in patients with frozen shoulder using shear wave elastography (SWE) with B-mode ultrasound. METHODS: Thirty-two patients with frozen shoulder were divided into freezing and frozen phases. All patients had limitations of their range of motion without rotator cuff tears. Stiffness was measured by SWE in the supraspinatus (SSp) tendon, infraspinatus (ISp) tendon, SSp muscle, ISp muscle, teres minor muscle, upper and lower trapezius muscles, posterior capsule, CHL, and long head of the biceps. The posterior capsule and CHL thicknesses were also investigated with B-mode ultrasound. All values were compared in the affected and unaffected shoulders in each phase. RESULTS: The SWE values for the SSp and ISp tendons in the freezing phase and the CHL in the frozen phase were significantly greater on the affected side than the unaffected side (mean ± SD, 280.4 ± 125.3 versus 178.1 ± 73.3, 318.4 ± 110.7 versus 240.8 ± 91.5, and 287.2 ± 135.3 versus 214.1 ± 91.1 kPa, respectively; P < .05). The posterior capsule in both the freezing and frozen phases and the CHL in the frozen phase were significantly thicker on the affected side than the unaffected side (1.3 ± 0.2 versus 0.9 ± 0.3, 1.2 ± 0.4 versus 0.9 ± 0.3, and 4.4 ± 1.4 versus 3.3 ± 1.1 mm; P < .01). CONCLUSIONS: The SWE values of the both SSp and ISp tendons increased in the freezing phase, and that of the CHL also increased in the frozen phase. Not only the change in thickness of the capsule but also the change in stiffness of the rotator cuff may correlate with frozen shoulder.

The Number of Injury Events Associated With the Critical Size of Bipolar Bone Defects in Rugby Players With Traumatic Anterior Shoulder Instability.

BACKGROUND: The size of a glenoid bone defect is responsible for reduction in shoulder stability and is correlated with the number of instability events. Biomechanical studies have suggested that it should be considered concomitantly with the Hill-Sachs lesion as "bipolar" bone defects for assessing structural degradation, but the definitive number of instability events associated with the critical size has not been investigated. PURPOSE: To (1) confirm that the number of instability events is the predictor of a critical size of bipolar bone defects and (2) demonstrate the cutoff value of the number of instability events for these defects in rugby players with traumatic anterior shoulder instability. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: One-hundred forty-four rugby players with anterior shoulder instability underwent morphologic evaluation for glenoid and Hill-Sachs lesions by computed tomography and determination of the critical (a glenoid bone defect of ≥25% or an off-track Hill-Sachs lesion) and subcritical (a glenoid bone defect of ≥13.5%) size of bipolar bone defects. In the primary analysis, the prevalence of the critical and subcritical size of bipolar bone defects was investigated. In the secondary analysis, the authors explored the predictors for these bone defects and determined the cutoff value correlating with the critical and subcritical size of bipolar bone defects by applying receiver operating characteristic curves. RESULTS: The primary analysis revealed that the prevalence of critical and subcritical size of bipolar bone defects was 20.8% and 61.8% of 144 shoulders, respectively. In the secondary analysis, multiple logistic regression analysis demonstrated that the total number of shoulder instability events and dominant shoulder were the significant factors associated with the critical and subcritical size of bipolar bone defects. The cutoff value for the number of instability events that correlated with critical bipolar bone defects was 6 for the dominant and 9 for the nondominant shoulder, whereas it was 4 for the dominant and 5 for the nondominant shoulder for subcritical bipolar bone defects. CONCLUSION: The number of shoulder instability events and the dominant shoulder were the predictors for the critical and subcritical size of bipolar bone defects for a shoulder with traumatic instability. Four injury events should herald caution when treating rugby players with shoulder instability.

Accelerated Return to Play for Professional Rugby Players After Facial Fractures.

BACKGROUND: Facial fractures may result in a significant time away from competition for professional rugby players. An understanding of the return-to-play times is an integral part of clinical decision making when treating professional athletes. A period of 8 to 12 weeks has been conventionally recommended for returning to collision sports after facial fractures. The conventional time to return to sports of 8 to 12 weeks is usually too long for professional players. However, the time of return to play after such facial fractures in elite athletes has not been well described. PURPOSE: To investigate the return to play after facial fractures in professional rugby players with an accelerated rehabilitation protocol. METHODS: Ten professional rugby players with facial fractures were identified and analyzed. The authors investigated the number of days required to return to training and full-contact play according to the trauma type. The authors also determined the presence or absence of refractures and sequelae. RESULTS: The average age of the patients was 26.9 years. Medial orbital wall fractures were the most represented pattern, followed by orbital floor fractures and zygomatic arch fractures. The players returned to jogging after 9.9 days, to sports-specific training after a mean of 10.8 days, and to full-contact training after 18.3 days. There were no cases of refractures and sequelae. CONCLUSION: Players were able to return to their regular rugby activities, earlier than the time commonly allowed to return to full activity.

The kinematics of 1-on-1 rugby tackling: a study using 3-dimensional motion analysis.

BACKGROUND: Although past studies using video analysis indicated that the arm tackle and head-in-front shoulder tackle are possible risks for shoulder dislocation, the underlying mechanisms of tackling-related shoulder dislocation have not been sufficiently investigated. This study aimed to analyze the kinematic aspects of these tackling motions in 1-on-1 tackles in an experimental setting using a 3-dimensional motion-capture system. METHODS: A total of 65 one-on-one tackles were recorded using a marker-based, automatic, digitizing motion-capture system. A documented tackle was classified into 1 of 3 types, which was decided based on the first point of contact on the ball carrier and the head position at the time of impact: shoulder tackle (reference tackle), arm tackle, and head-in-front tackle. The orientations of the head, trunk, and shoulder at impact were calculated and statistically compared with each other. RESULTS: The distribution of tackles recorded in this study was as follows: 38 shoulder, 23 arm, and 4 head-in-front tackles. In comparison with the shoulder tackle as a reference, shoulder abduction on the side of impact was higher in both the arm and head-in-front tackles, while shoulder external rotation was lower in the head-in-front tackles. In the latter type of tackle, significant decreases in neck extension and ipsilateral neck rotation were also indicated. CONCLUSION: The kinematics in both the arm tackle and the head-in-front tackle is significantly different from that in the shoulder tackle and may represent a distinct risk factor for shoulder dislocation.

Kinematics of Rugby Tackling: A Pilot Study With 3-dimensional Motion Analysis.

BACKGROUND: Although improper tackling technique in rugby can affect the outcome of the tackle and lead to head, neck, and shoulder injuries, the effects of the height of the tackle or the side of the leading leg at the time of impact have not been investigated. Hypothesis/Purpose: The purpose was to characterize the trunk orientation at impact during various tackles. It was hypothesized that 3-dimensional motion analysis would be able to capture the critical kinematic differences in the 4 types of tackles studied. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 66 tackles on a tackle bag were recorded among 13 elite rugby players. Four types of tackles were evaluated: the normal shoulder tackle, in which the tackler's dominant shoulder made impact while the leading foot was on the same side as that shoulder; the low tackle, in which the tackler targeted the lower portion of the tackle bag; the opposite-leg tackle, in which the tackler's leading leg was on the opposite side as the shoulder making impact; and the low and opposite-leg tackle, which was a combination of the previous 2 types of tackles. The orientation of the trunk at impact was calculated, and 2-way repeated-measures analyses of variance were used to compare the characteristics of these tackles. RESULTS: Trunk inclination at impact was lower in the low tackle than in the normal tackle ( P < .01), regardless of the side of the leading leg. Trunk bending to the side of the impacted shoulder was lower in the opposite-leg tackle ( P < .01), and these findings were more significant in the normal-height tackles ( P < .01). Trunk rotation to the side of the impacted shoulder was lower in the opposite-leg tackles ( P < .01) and more significant in the lower-height tackles ( P = .03). CONCLUSION: The 3-dimensional motion capture system was effective in investigating the kinematics of rugby tackling. The kinematics in the low and opposite-leg tackles were significantly different from those in the normal shoulder tackle, which may affect tackle performance and the possible risk of contact injury. CLINICAL RELEVANCE: When a rugby coach provides tackling instructions to players, it is advantageous to have information about the kinematics of different types of tackles.

Shear Wave Elastography Can Predict Passive Stiffness of Supraspinatus Musculotendinous Unit During Arthroscopic Rotator Cuff Repair for Presurgical Planning.

PURPOSE: To determine the feasibility of shear wave elastography (SWE) with B-mode ultrasound in predicting the stiffness of the rotator cuff muscle before arthroscopic rotator cuff repair to evaluate the difficulty of the surgical procedure, as well as to compare SWE with the Goutallier stage on magnetic resonance imaging (MRI). METHODS: Thirty-eight patients with a full-thickness supraspinatus tear requiring arthroscopic rotator cuff repair participated. The Goutallier stage of fatty infiltration on MRI was measured before surgery, as was the SWE modulus of the anterior superficial, anterior deep, posterior superficial, and posterior deep (PD) regions of the supraspinatus muscle. To measure the stiffness of the supraspinatus musculotendinous unit during surgery, the supraspinatus tendon was axially stretched until the anatomic insertion site was reached, and force per deformation was recorded. The correlation between stiffness of the supraspinatus and SWE value in each region of the supraspinatus muscle or Goutallier stage was determined. In addition, patients were divided into 2 groups: (1) In the complete footprint coverage group, greater than 50% of the footprint was covered during the stiffness measurement, and (2) in the incomplete footprint coverage group, less than 50% of the footprint was covered during the stiffness measurement. Differences in SWE value and Goutallier stage were measured between the 2 groups. RESULTS: The best correlation of stiffness with the SWE modulus of the PD muscle of the supraspinatus was R = 0.69, and the correlation of stiffness with the Goutallier stage on MRI was R = 0.48. The SWE value of the PD region was greater in the incomplete footprint coverage group than in the complete footprint coverage group, although the Goutallier stage was not significantly different. CONCLUSIONS: The highest correlation with stiffness of the supraspinatus musculotendinous unit was with the SWE modulus of the PD muscle, as compared with SWE evaluation of the other regions or the Goutallier stage on MRI. Ultrasound SWE can predict the stiffness of the supraspinatus musculotendinous unit best. CLINICAL RELEVANCE: Rotator cuff retraction adds difficulty to arthroscopic rotator cuff repair. Ultrasound SWE may be used for presurgical planning.

Degradation of Cylindrical Poly-Lactic Co-Glycolide/Beta-Tricalcium Phosphate Biocomposite Anchors After Arthroscopic Bankart Repair: A Prospective Study.

The purpose of this study was to examine widening and ossification of anchor holes after arthroscopic Bankart repair with the use of cylindrical biocomposite anchors made of 70% poly-L-lactide-co-glycolide acid (PLGA) and 30% beta-tricalcium phosphate (ß-TCP). Twenty-two patients were enrolled in a clinical trial to acquire marketing approval of a PLGA/ß-TCP biocomposite suture anchor in Japan and underwent arthroscopic Bankart repairs with the anchors. Eleven of 22 patients had computed tomography scans after 2-year follow-up. Three surgeons independently evaluated width and ossification of anchor holes in 4 grades using computed tomography scans. When the evaluations disagreed, the final grade was determined based on the 3 surgeons' consensus. Seven men and 4 women were evaluated at a mean of 30 months (range, 28-32 months) after surgery, and a total of 47 anchors were implanted. Anchor holes were narrowed in 39 (83%) of 47 anchor sites and were almost or completely filled in (type 3 or 4) in 21 (45%) of 47 anchor sites. Ossification was seen in 46 (98%) of 47 anchor sites and was nearly complete or complete (type 3 or 4) in 16 (34%) of 47 anchor sites. There were no significant differences in both anchor hole width and ossification score on comparison of the anteroinferior (4- to 6-o'clock positions in the right shoulder) with other anchor sites. Cylindrical biocomposite anchors made of 70% PLGA/30% ß-TCP showed a low incidence of anchor hole widening and excellent ossification regardless of anchor site. [Orthopedics. 2018; 41(3):e348-e353.].

Midterm Clinical Results in Rugby Players Treated With the Bristow Procedure.

BACKGROUND: Although surgical shoulder stabilization by coracoid transfer is effective for collision athletes and has a low reinjury rate, no reports have described the midterm results of this procedure in specific patient cohorts of sufficient number or provided subjective assessments of these patients. PURPOSE: To evaluate midterm results after treatment of shoulder instability with the Bristow procedure in a large cohort of rugby players. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This study included 176 shoulders of 152 competitive rugby players who underwent shoulder stabilization surgery (Bristow procedure with Bankart repair) with a mean follow-up of 4 years (minimum of 2 years) in our institute. The primary outcome measure was the difference in the presurgical and postsurgical functional Rowe score and Western Ontario Shoulder Instability index (WOSI) score and factors affecting these scores. Complication rates and associated factors were also investigated. RESULTS: In total, 176 shoulders of 152 patients underwent the Bristow procedure with Bankart repair, and 93.2% of the players returned to their preinjury competition level at a mean of 6.3 months postoperatively. All Rowe and WOSI scores were significantly improved after surgery. The numbers of shoulders with functional failure as indicated by the Rowe score, WOSI score, and inability to return to the previous level of play were 28 (15.9%), 54 (30.7%), and 12 (6.8%), respectively. Multiple logistic regression analyses demonstrated that reinjury after surgery (odds ratio [OR] = 35.1) and the number of shoulder dislocations (OR = 11.2-11.4) negatively affected the competition level after return to play, while reinjury (OR = 11.1-17.8), the number of shoulder subluxations (OR = 1.1-2.9), injury in the dominant shoulder (OR = 1.2-2.2), and large bone defects (OR = 1.1-11.5) negatively affected functional scores. Reinjury after shoulder stabilization occurred in 6 of 176 shoulders (3.4%). Multiple logistic regression analysis demonstrated that reinjury after surgery occurred more frequently in players at lower versus higher grade levels of competition (OR = 21.0). Although differences were not significant, a trend was noted toward higher postoperative reinjury rates in forward players, those in the upper categories (professional and college), and those with injury in the nondominant shoulder. CONCLUSION: The Bristow procedure provides good midterm outcomes for competitive collision athletes, while postsurgical reinjury, the number of preoperative dislocations and subluxations, and large bone defects negatively affect postsurgical shoulder function. This information may be useful for treatment of shoulder dislocations in collision athletes.