Factors associated with return to play following conservative treatment for lumbar spondylolysis among young athletes: A retrospective case series using structural equation modeling.

INTRODUCTION: Lumbar spondylolysis is the most common underlying cause of lower back pain (LBP) in young athletes. Conservative treatment methods are often used to reduce pain and promote healing. Several parameters may affect the duration of conservative treatment, such as the time to return to play (RTP), patient behavior, and physical parameters; however, no study has comprehensively assessed the factors that affect the time to RTP. OBJECTIVES: This study aimed to determine the factors associated with the time required for RTP among young athletes with early-stage spondylolysis receiving conservative treatment using structural equation modeling (SEM). METHODS: In this retrospective case series, 137 young athletes (128 males and 9 females, aged 9-18 years) with early-stage lumbar spondylolysis were enrolled. All patients were examined using plain radiography and magnetic resonance imaging and treated conservatively (sports cessation, wearing a corset, therapeutic exercises, and low-intensity pulsed ultrasound radiation). SEM was used to investigate the factors affecting the time to RTP in these patients. RESULTS: The final model included the following factors: spondylolysis laterality, symptom duration, lower-extremity flexibility, treatment interval, patient adherence, and residual LBP. SEM revealed that patient adherence to physician orders (p < 0.01), treatment interval (p < 0.001), and spondylolysis laterality (p < 0.001) contributed directly to shortened RTP. CONCLUSION: Patient adherence is essential for reducing the time to RTP among young athletes receiving conservative treatment for early-stage spondylolysis.

Low-Intensity Pulsed Ultrasound for Early-Stage Lumbar Spondylolysis in Young Athletes.

OBJECTIVE: To examine the effect of low-intensity pulsed ultrasound (LIPUS) on early-stage spondylolysis in young athletes. DESIGN: Case-control study. SETTING: A single outpatient orthopedic and sports clinic. PATIENTS: A total of 82 young athletes (80 boys and 2 girls; mean age, 14.8 years; range, 10-18 years) with early-stage lumbar spondylolysis were enrolled in this study. All patients were examined by plain radiography and magnetic resonance imaging. INTERVENTIONS: Patients received either standard conservative treatment combined with LIPUS (n = 35) or without LIPUS (n = 47), according to the sequence of admission. The standard conservative treatment included thoracolumbosacral brace, sports modification, and therapeutic exercise. MAIN OUTCOME MEASURES: The time required to return to previous sports activities was analyzed by using Kaplan-Meier methods with the log-rank test. RESULTS: The baseline parameters of both groups were not significantly different. The median time to return to previous sports activities was 61 days [95% confidence interval (CI): 58-69 days] in the group treated with LIPUS, which was significantly shorter than that of the group treated without LIPUS (167 days, 95% CI: 135-263 days; P < 0.01). CONCLUSIONS: These results suggest that LIPUS combined with conservative treatment for early-stage lumbar spondylolysis in young athletes could be a useful therapy for quick return to playing sports.

Labral shape after arthroscopic Bankart repair: comparisons between the anchor and Caspari methods.

PURPOSE: Morphological changes after repair of the glenoid labrum were examined using fresh cadavers and clinical cases to compare the anchor and Caspari methods. TYPE OF STUDY: Cadaveric and case series. METHODS: The depth of the glenoid concavity after Bankart repair was measured in 4 shoulders from 2 fresh cadavers. We made positive models of the glenoid cavity with gypsum and measured the distance from the lateral-most extent of the anterior labrum to the medial extent of the glenoid cavity. We also compared the depth of glenoid concavity in clinical cases between the anchor and Caspari methods using air computed tomography arthrography and magnetic resonance imaging. RESULTS: We determined the effective depth as the distance from the lateral-most extent of the anterior labrum to the medial extent of the glenoid cavity. The effective depth in fresh cadaver experiments after the anchor method showed substantial differences at the superior and middle levels of the glenoid labrum compared with the Caspari method. Mean effective depths in clinical cases were 5.8 mm (range, 4.2 to 6.8 mm) after the anchor method and 3.5 mm (range, 2.0 to 5.0 mm) after the Caspari method. Effective depth following the anchor method was significantly greater than that of the Caspari method. CONCLUSIONS: During repair of Bankart lesions for traumatic anterior instability of the shoulder, effective depth was higher following use of the anchor method than with the Caspari method. CLINICAL RELEVANCE: Understanding the shape of the anterior labrum and glenoid concavity after use of the anchor and Caspari methods may help to improve the surgical technique and clinical results of arthroscopic Bankart repair.