The incidence and pattern of iliopsoas tendinitis following hip arthroscopy.

BACKGROUND: Iliopsoas tendinitis is a known source of extra-articular hip pain and it has been shown to be a common cause of continued hip pain following total hip arthroplasty. While iliopsoas tendinitis after hip arthroscopy is a well-known phenomenon amongst hip arthroscopists, its presentation, course, and treatment has yet to be elucidated. METHODS: An IRB-approved chart review was performed of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) between March 2015 and July 2017. No cases of dysplasia were included. All patients had combined cam/pincer impingement as well as labral pathology. Tendinitis patients were identified. Patient demographics, surgical data, time to onset/diagnosis of iliopsoas tendinitis, treatment (oral anti-inflammatories, corticosteroid injection, physical therapy), and resolution of symptoms were recorded. These cases were age- and sex-matched to a control group that did not develop postoperative iliopsoas tendinitis for comparison. Patient outcomes were measured with the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) recorded from the preoperative and 1-year postoperative visits. RESULTS: Of 258 hip arthroscopy cases, 18 cases (7.0%) of postoperative iliopsoas tendinitis were diagnosed under high resolution ultrasound. On average, iliopsoas tendinitis was diagnosed 2.8 ± 1.8 months after surgery. There were no significant differences in age, sex, and BMI between patients that developed IP tendinitis compared to those that did not. No specific procedures were found to be significantly associated with incidence of postoperative IP tendinitis, including capsular closure.18 patients were treated with corticosteroid injection, which provided mild to moderate improvement for 5 (27.8%) patients and completely resolved symptoms for 13 patients (72.2%). Of all 18 patients with postoperative iliopsoas tendinitis confirmed by response to a diagnostic injection, 10 (55.6%) had symptoms improve within 3 months of diagnosis, 2 (11.1%) between 3 and 6 months, 4 (22.2%) between 6 and 12 months, and 2 (11.1%) after 1 year. No patients went on to have surgery for this problem. Patients with iliopsoas tendinitis had lower MHHS (p = 0.04) and NAHS (p = 0.09) scores at their 1-year postoperative visits. CONCLUSIONS: Iliopsoas tendinitis is a common source of pain following arthroscopic hip surgery and can be effectively diagnosed and treated with ultrasound-guided injection. Therefore, surgeons performing arthroscopic procedures of the hip must remain aware of and include it in their differential when encountering patients with hip flexion pain after surgery. Research should be continued to further evaluate the long-term outcomes and return to sport rates of these patients.

Collagen-Based Bioinductive Implant for Treatment of Partial Thickness Rotator Cuff Tears.

INTRODUCTION: Partial thicknessrotator cuff tears(PTRCT) have low healing potential and tend to progress over time if not addressed surgically. There is a relative paucity of literature discussing optimal treatment for symptomatic PTRCT as compared to full thicknessrotator cuff tears. The available data supports a treatment course of debridement with or without acromioplasty for symptomatic patients with tears less than 50% in thickness combined with the use of repair (conversion to full thickness or transtendinous) for symptomatic patients with tears greater than 50% in thickness. The aim of this study was to evaluate functional and radiographic outcomes following surgical implantation of a collagen-based bioinductive implant for PTRCT. METHODS: Patients with PTRCT who underwent implantation of a collagen-based bioinductive implant over the bursal surface of the rotator cuff were identified. Patients who had an implant placed to augment a standard full thickness repair were excluded from analysis. We administered questionnaires to patients with a minimum of 6 months since surgery and collected patient data including demographics, preoperative and postoperative American Shoulder and Elbow Society (ASES) scores, preoperative and postoperative visual analog scale (VAS) pain scores, complications, and satisfaction level. Magnetic resonance imaging (MRI) was obtained as needed, at 6 months, or at 12 months postoperatively, and tendon thickness was measured on coronal views. RESULTS: Thirty patients were identified who met the inclusion and exclusion criteria. Twenty-four patients (80% response rate) were available for follow-up; 19 were male and five were female. Mean age and body mass index were 54.5 ± 11.6 years and 28.6 ± 5.9 kg/m2 , respectively. Mean tear thickness as measured intraoperatively was 56.6%. There were 16 (66.7%) articular-sided, five (20.8%) bursal-sided, and three (12.5%) intrasubstance tears. Mean survey follow-up time was 19.1 months. Mean ASES scores increased significantly from 45.6 preoperatively to 68.1 postoperatively (p = 0.001). Mean VAS pain scores decreased significantly from 8.3 preoperatively to 3.8 postoperatively (p < 0.001). Mean patient satisfaction level was 7.5. Ten patients had both a preoperative and postoperative MRI available for comparison. Tendon thickness at the tear site increased significantly from 5.7 mm preoperatively to 6.5 mm at mean 9.9 months follow-up (p = 0.007). There were no implant-related complications. One patient suffered a traumatic re-tear 4 months postoperatively. CONCLUSION: Highly porous collagen-based bioinductive implants are safe and effective forreducing pain and improving shoulderfunction in patientswith PTRCT of approximately 50%, with radiographic evidence of new tissue formation. Randomized controlled trials are needed to assess efficacy relative to debridement and standard repair techniques.

Four-Year Outcomes Following Arthroscopic Microfracture of the Hip in Patients with Advanced Chondral Lesions.

PURPOSE: This report examines 4-year patient reported outcomes and procedural survivorship in patients who underwent microfracture during hip arthroscopy compared to a matched group of non-microfracture patients as well as the risk factors for procedural failure following microfracture of articular lesions in the hip. METHODS: Data for 38 consecutive patients undergoing arthroscopic microfracture was retrospectively analyzed. Propensity score matching identified a matched group of hip arthroscopy patients who had Outerbridge grade 3 or grade 4 chondral lesions but did not undergo microfracture. Preoperative modified Harris Hip Scores (mHHS) and NonArthritic Hip Scores (NAHS) were compared to those at 2- and 4-year follow-up. Postoperative rates of ipsilateral revision arthroscopic surgery or hip arthroplasty were assessed. RESULTS: Thirty-three (86.8%) of the 38 microfracture patients were available for 4-year follow-up. Forty-six patients were matched with the microfracture group. Scores including mHHS and NAHS increased postoperatively for both groups (p < 0.05), though there were no significant differences between groups (p > 0.05). Overall reoperations rates were 24.2% and 21.7% (p = 0.873) for the microfracture and non-microfracture groups, respectively. Hip arthroplasty rates were higher among microfracture patients (18.2% vs. 2.2%, p = 0.038), wherein Tonnis grade ≥ 2, cartilage lesions ≥ 400 mm2 , and femoral-sided lesions were associated with failure. CONCLUSIONS: Patients who underwent microfracture treatment of chondral lesions fared no better than a matched group of patients who did not receive microfracture treatment. Risk of reoperation is high for both groups and microfracture patients are more likely to require conversion to total hip arthroplasty or hip resurfacing.

Clinical Outcomes of Hip Arthroscopy in Patients With Systemic Inflammatory Diseases Compared With Matched Controls at a Minimum of 2-Year Follow-Up.

PURPOSE: To evaluate postoperative outcomes and preoperative risk factors for patients with underlying systemic inflammatory disorders after hip arthroscopy. METHODS: A retrospective analysis of patients who had undergone hip arthroscopy, with a history of systemic inflammatory disease, was performed. This included patients with a diagnosis of lupus, a positive antinuclear antibody test, rheumatoid arthritis, psoriatic arthritis, sarcoidosis, inflammatory bowel disease, Reiter syndrome, and mixed connective tissue disease. These cases were 1:2 matched to a control group of patients with no history of systemic inflammatory disease based on age and sex. An a priori power analysis was conducted and A 1:2 case-control ratio was selected to increase study power. Inclusion criteria included all skeletally mature patients with hip pain refractory to nonoperative management who underwent hip arthroscopy for labral tears and femoroacetabular impingement. Skeletally immature patients, those with Tönnis grades of 2 or more (less than 2 mm of joint space), hip dysplasia, patients undergoing revision hip arthroscopy, and patients whose pain failed to improve after intra-articular injection were excluded. The primary outcome was rate of revision hip arthroscopy or total hip arthroplasty 24 months after surgery. Secondary outcomes included 2 patient-reported outcome scores, the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). RESULTS: Twenty patients (21 hip arthroscopy procedures) and 42 controls were included. There was no significant difference in proportion of patients who met failure criteria (28.6% vs 16.7%, P = .271) or 2-year survivorship (76.2% vs 83.3%, P = .496) between the systemic inflammatory disorder and control groups, respectively. Both groups had a significant improvement in mHHS and NAHS at 24 months compared with baseline; however, there was no significant difference in mHHS (P = .28) or NAHS (P = .22) at 24 months between the 2 groups. CONCLUSIONS: Patients with underlying inflammatory conditions have similar 2-year outcomes after hip arthroscopy for intra-articular pathology compared with patients with no history of inflammatory disease. LEVEL OF EVIDENCE: III, retrospective comparative study.

Does a Traumatic Etiology of Hip Pain Influence Hip Arthroscopy Outcomes?

PURPOSE: To determine whether patients who reported a discrete traumatic event precipitating the onset of femoroacetabular impingement syndrome (FAIS) reported similar patient-reported outcomes for the modified Harris Hip Score (mHHS) and the Non-Arthritic Hip Score (NAHS) following hip arthroscopy as patients with atraumatic hip pain associated with FAIS alone. METHODS: A retrospective comparative therapeutic investigation of a prospectively collected database of cases performed by a single surgeon from 2010 to 2015 identified a group of patients who developed FAIS after a discrete traumatic event. This group was compared 1:2 with a body mass index and age-matched group of primary hip arthroscopies with atraumatic hip pain attributed to FAIS. Preoperative mHHS and NAHS were obtained and compared with those at 2-year follow-up. Clinical failure at 2 years was defined as any further ipsilateral hip surgery including revision arthroscopy and conversion to arthroplasty. RESULTS: In the traumatic etiology group, the mean mHHS and NAHS improved from 49.6 to 82.7 (P < .001) and from 46.9 to 84.0 (P < .001), respectively. The mean mHHS and NAHS in the atraumatic group improved from 51.5 to 85.82 (P < .001) and from 49.3 to 85.2 (P < .001), respectively. Survivorship at 2 years was 81.1% for traumatic etiology and 88.3% for atraumatic etiology; adjusted proportional hazards regression analysis demonstrated a difference in survivorship that was not statistically significant between the traumatic and atraumatic cohorts (hazard ratio 1.8, 95% confidence interval 0.8-4.0). CONCLUSIONS: The findings of this study demonstrate that patients presenting with FAIS and history of a traumatic hip injury can expect to experience similar good outcomes at 2 years following primary hip arthroscopy as compared with patients with atraumatic FAIS. LEVEL OF EVIDENCE: Level III (Therapeutic) retrospective comparative study.

Outcome Trends After Hip Arthroscopy for Femoroacetabular Impingement: When Do Patients Improve?

PURPOSE: To determine when patients reach critical thresholds of clinical improvement after hip arthroscopy for femoroacetabular impingement (FAI) using previously defined cutoffs for the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) and to identify risk factors for prolonged recovery. METHODS: Consecutive patients with a diagnosis of FAI who underwent unilateral hip arthroscopy between January 2010 and January 2015 with at least 2 years of clinical follow-up were studied. The modified Harris Hip Score was collected prospectively at 6 consecutive time points. The number of patients reaching the MCID and PASS at each time point was determined. RESULTS: During the study period, 340 consecutive hip arthroscopies were performed in 316 patients with a mean final follow-up period of 50 months (range, 29-84 months). The mean modified Harris Hip Score and percentage of patients reaching the MCID and PASS increased at each time point. At 2 years, 271 patients (93%) surpassed the MCID and 212 patients (73%) achieved the PASS. Female sex, age of 40 years or older, and body mass index of 30 or greater were associated with lower rates of achieving the MCID and PASS at set time points. Patients undergoing labral repair had superior PASS rates at 3 months and beyond than patients undergoing labral debridement alone. Patients who did not achieve the PASS by 3 months were more likely to require reoperation. CONCLUSIONS: Hip arthroscopy for FAI results in increased patient-reported outcome measures at interval follow-up. Most patients reach critical thresholds of minimal and satisfactory clinical improvement. Patients who are female, older, or obese or who undergo labral debridement alone are less likely to reach these milestones at major time intervals. Patients who do not reach the PASS by 3 months are more likely to require reoperation. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

First-Time Traumatic Anterior Shoulder Instability Management in the Young and Active Patient.

Anterior instability of the glenohumeral joint is a common and functionally limiting shoulder condition, particularly in young and active patients. In this population, non-operative management has been increasingly demonstrated to be associated with recurrent instability and increased long-term morbidity. Surgical treatment options include both arthroscopic and open techniques. In appropriately indicated patients, surgical treatment of first-time anterior shoulder instability is a cost-effective and successful treatment option.

Performance outcomes after medial ulnar collateral ligament reconstruction in Major League Baseball positional players.

BACKGROUND: We sought to determine whether professional baseball positional players who underwent medial ulnar collateral ligament (MUCL) reconstruction demonstrate decreases in performance on return to competition compared with preoperative performance metrics and their control-matched peers. METHODS: Data for 35 Major League Baseball positional players who underwent MUCL reconstruction during 31 seasons were obtained. Twenty-six players met inclusion criteria. Individual statistics for the 2 seasons immediately before injury and the 2 seasons after injury included wins above replacement (WAR), on-base plus slugging (OPS), and isolated power (ISO). Twenty-six controls matched by player position, age, plate appearances, and performance statistics were identified. RESULTS: Of the 35 athletes who underwent surgery, 7 did not return to their preinjury level of competition (return to play rate of 80%). In comparing preinjury with postinjury statistics, players exhibited a significant decrease in plate appearances, at-bats, and WAR 2 seasons after injury but did not demonstrate declines in WAR 1 season after injury. Compared with matched controls, athletes who underwent MUCL reconstruction did not demonstrate significant decline in statistical performance, including OPS, WAR, and ISO, after return to play from surgery. Of all positional players, catchers undergoing surgery demonstrated lowest rates of return to play (56%) along with statistically significant decreases in home run rate, runs batted in, and ISO. CONCLUSION: Major League Baseball positional players undergoing MUCL reconstruction can reasonably expect to return to their preinjury level of competition and performance after surgery compared with their peers. Positional players return to play at a rate comparable to that of pitchers; catchers may experience more difficultly in returning to preinjury levels of play.

Performance Outcomes After Hook of Hamate Fractures in Major League Baseball Players.

CONTEXT: Major League Baseball (MLB) players are at risk of hook of hamate fractures. There is a paucity of data assessing the effect of a hook of hamate fracture on MLB players' future athletic performance. OBJECTIVE: To determine if MLB players who sustain hook of hamate fractures demonstrate decreased performance upon return to competition when compared with their performance before injury and that of their control-matched peers. DESIGN: Retrospective case-control design. SETTING: Retrospective database study. PARTICIPANTS: 18 MLB players who sustained hook of hamate fractures. METHODS: Data for 18 MLB players with hook of hamate fractures incurred over 26 seasons (1989-2014) were obtained from injury reports, press releases, and player profiles ( www.mlb.com and www.baseballreference.com ). Player age, position, number of years in the league, mechanism of injury, and treatment were recorded. Individual season statistics for the 2 seasons immediately prior to injury and the 2 seasons after injury for the main performance variable-Wins Above Replacement-were obtained. Eighteen controls matched by player position, age, and performance statistics were identified. A performance comparison of the cohorts was performed. MAIN OUTCOME MEASURES: Postinjury performance compared with preinjury performance and matched-controls. RESULTS: Mean age at the time of injury was 25.1 years with a mean of 4.4 seasons of MLB experience prior to injury. All injuries were sustained to their nondominant batting hand. All players underwent operative intervention. There was no significant change in Wins Above Replacement or isolated power when preinjury and postinjury performance were compared. When compared with matched-controls, no significant decline in performance in Wins Above Replacement the first season and second season after injury was found. CONCLUSION: MLB players sustaining hook of hamate fractures can reasonably expect to return to their preinjury performance levels following operative treatment.

Diffuse Idiopathic Skeletal Hyperostosis (DISH) as a Cause of Failure Following Distal Clavicle Excision A Case Report and Review of the Literature.

Diffuse idiopathic skeletal hyperostosis (DISH) is common spinal condition characterized by increased calcification and ossification of ligaments and entheses, typically in the anterior aspect of the spine. However, extraspinal manifestations of the disease can occur and depending on the degree and location of involvement, may become symptomatic. We present the case of a 63-year-old male with a history of DISH, who failed initial open distal clavicle excision due to the postoperative development of heterotopic bone bridging across the acromioclavicular joint. Revision open distal clavicle excision coupled with postoperative heterotopic ossification prophylaxis led to a successful clinical and functional outcome without heterotopic bone recurrence. The case description is followed by a review of the extraspinal manifestations of DISH and the recommended prophylactic management in patients with DISH and similar risk factors for the development of heterotopic ossification.

Multiple Rib Nonunion: Open Reduction and Internal Fixation and Iliac Crest Bone Graft Aspirate.

PURPOSE: Rib fractures are a common chest injury that can typically be treated nonoperatively. However, a percentage of these will go on to nonunion, either because of unique characteristics of the fracture itself or because of a variety of poor healing factors of the host. If a patient has continued symptomology beyond 3 months, surgeons may consider operative management. METHODS: Although isolated resection of fibrous scar tissue from the nonunion site may be sufficient in some cases, it may also be necessary to provide additional structural integrity to the rib depending on the extent of the fracture pattern and resection. This goal can be achieved operatively with rib plating and bone grafting to promote healing. RESULTS: This video demonstrates the use of plating in the treatment of rib nonunion. It begins with relevant background information on rib fractures and nonunions, then details the approach, open reduction and internal fixation of 3 ribs using plates and bone graft aspirate. Pearls and pitfalls are included during the surgical technique aspect of the video to both help guide surgeons new to the procedure and provide potentially advantageous technical details to more experienced surgeons.

Evaluation and Management of Osteochondral Lesions of the Talus.

Osteochondral lesions of the talus are common injuries that affect a wide variety of active patients. The majority of these lesions are associated with ankle sprains and fractures though several nontraumatic etiologies have also been recognized. Patients normally present with a history of prior ankle injury and/or instability. In addition to standard ankle radiographs, magnetic resonance imaging and computed tomography are used to characterize the extent of the lesion and involvement of the subchondral bone. Symptomatic nondisplaced lesions can often be treated conservatively within the pediatric population though this treatment is less successful in adults. Bone marrow stimulation techniques such as microfracture have yielded favorable results for the treatment of small (<15 mm) lesions. Osteochondral autograft can be harvested most commonly from the ipsilateral knee and carries the benefit of repairing defects with native hyaline cartilage. Osteochondral allograft transplant is reserved for large cystic lesions that lack subchondral bone integrity. Cell-based repair techniques such as autologous chondrocyte implantation and matrix-associated chondrocyte implantation have been increasingly used in an attempt to repair the lesion with hyaline cartilage though these techniques require adequate subchondral bone. Biological agents such as platelet-rich plasma and bone marrow aspirate have been more recently studied as an adjunct to operative treatment but their use remains theoretical. The present article reviews the current concepts in the evaluation and management of osteochondral lesions of the talus, with a focus on the available surgical treatment options.

Synovial Hemangioma Presenting as a Painful Locked Knee A Case Report.

A 39-year-old man presented to orthopaedic care with a painful, fully locked knee. Workup revealed free intraarticular nodules, which were subsequently arthroscopically removed and identified to be synovial hemangioma. To the investigators' knowledge, this is the second reported case of synovial hemangioma presenting as a painful, definitively locked knee. Synovial hemangioma should be considered in the differential diagnosis of knee pain, particularly after more common diagnoses have been ruled out. Efficient and appropriate diagnosis and treatment may result in favorable patient outcomes and avoid long-term disability and dysfunction.

Staphylococcus lugdunensis Septic Arthritis of a Native Knee A Case Report.

A 67-year-old man presented to orthopaedic care with a painful knee. Workup was consistent with septic arthritis of a native knee, and the patient underwent operative treatment. Cultures from the operating room were speciated to Staphylococcus lugdunensis. To the investigators' knowledge, this is the first reported S. lugdunensis infection in a peripheral joint in the absence of an orthopaedic prosthesis. Although traditionally associated with infectious endocarditis, S. lugdunensis has been identified as a causative agent in many organ systems, including orthopaedic infections. This case report emphasizes the importance of familiarity with this emerging pathogen in the treatment of a septic joint.

Systemic Lead Toxicity Secondary to Retained Intraosseous Bullet A Case Report and Review of Literature.

A 35-year-old female presented to orthopaedic clinic with a chief complaint of chronic left hip pain, beginning 17 years prior when she had sustained a gunshot wound to her left buttock. Imaging demonstrated significant left hip arthritis with a retained projectile in the femoral head. Lead levels were also found to be significantly elevated. The patient underwent successful left total hip arthroplasty, with subsequent postoperative pain relief and consistent decrease in serum lead level. This report presents a rare case that emphasizes lead intoxication as a potentially dangerous complication of gunshot wounds and retained projectiles in the orthopaedic patient. Recognition of lead intoxication as a potential complication of retained gunshot projectiles allows for efficient diagnosis and treatment, which may prevent associated future morbidity.

Clinical Outcomes of Hip Arthroscopy in Patients 60 or Older: A Minimum of 2-Year Follow-up.

PURPOSE: To examine clinical outcomes and survivorship in patients aged 60 years or older who underwent hip arthroscopy for management of hip pain. METHODS: Prospectively collected data for patients 60 or older undergoing hip arthroscopy were obtained. All patients were indicated for hip arthroscopy based on standard preoperative examination as well as routine and advanced imaging. Demographic data, diagnosis, and details regarding operative procedures were collected. Baseline preoperative modified Harris Hip Scores (mHHS) and Non-arthritic Hip Scores (NAHS) were compared to mHHS and NAHS at the 2-year follow-up. Survivorship was assessed to determine failure rates, with failure defined as any subsequent ipsilateral revision arthroscopic surgery and/or hip arthroplasty. RESULTS: Forty-two patients met inclusion criteria. Mean age (standard deviation) and body mass index were 65.8 years (4.5 years) and 26.1 (4.7), respectively. Baseline mean mHHS and NAHS for all patients improved from 47.8 (±12.5) and 47.3 (±13.6) to 75.6 (±17.6) and 78.3 (±18.6), respectively (P < .001 for both). Five patients (11.9%) met failure criteria and underwent additional surgery at an average of 14.8 (8-30) months. Three underwent conversion to total hip arthroplasty (7.1%), whereas 2 had revision arthroscopy with cam/pincer resection and labral repair for recurrent symptoms (4.7%). One- and 2-year survival rates were 95.2% and 88.9%, respectively. CONCLUSIONS: Our results suggest that in patients 60 or older with Tonnis grade 0 or 1 osteoarthritic changes on initial radiographs-treatment with hip arthroscopy can lead to reliable improvement in early outcomes. As use of hip arthroscopy for treatment of mechanical hip pain increases, additional studies with long-term follow-up are needed. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Arthroscopic Treatment of Traumatic Hip Dislocation.

Traumatic hip dislocations are high-energy injuries that often result in considerable morbidity. Although appropriate management improves outcomes, associated hip pathology may complicate the recovery and lead to future disability and pain. Historically, open reduction has been the standard of care for treating hip dislocations that require surgical intervention. The use of hip arthroscopy to treat the sequelae and symptoms resulting from traumatic hip dislocations recently has increased, however. When used appropriately, hip arthroscopy is a safe, effective, and minimally invasive treatment option for intra-articular pathology secondary to traumatic hip dislocation.

Performance Outcomes After Metacarpal Fractures in National Basketball Association Players.

Background: The aim was to determine whether players in the National Basketball Association (NBA) who sustain metacarpal fractures demonstrate decreased performance upon return to competition when compared with their performance before injury and that of their control-matched peers. Methods: Data for 32 NBA players with metacarpal fractures incurred over 11 seasons (2002-2003 to 2012-2013) were obtained from injury reports, press releases, and player profiles (www.nba.com and www.basketballreference.com). Player age, body mass index (BMI), position, shooting hand, number of years in the league, and treatment (surgical vs nonsurgical) were recorded. Individual season statistics for the 2 seasons immediately prior to injury and the 2 seasons after injury, including player efficiency rating (PER), were obtained. Thirty-two controls matched by player position, age, and performance statistics were identified. A performance comparison of the cohorts was performed. Results: Mean age at the time of injury was 27 years with an average player BMI of 24. Players had a mean 5.6 seasons of NBA experience prior to injury. There was no significant change in PER when preinjury and postinjury performances were compared. Neither injury to their shooting hand nor operative management of the fracture led to a decrease in performance during the 2 seasons after injury. When compared with matched controls, no significant decline in performance in PER the first season and second season after injury was found. Conclusion: NBA players sustaining metacarpal fractures can reasonably expect to return to their preinjury performance levels following appropriate treatment.

Return to Play and Performance After Jones Fracture in National Basketball Association Athletes.

BACKGROUND: Basketball players are at risk for foot injuries, including Jones fractures. It is unknown how this injury affects the future play and performance of athletes. HYPOTHESIS: National Basketball Association (NBA) players who sustain Jones fractures of the base of the fifth metatarsal have high rates of return to play and do not experience a decrease in performance on return to competition when compared with preinjury and with control-matched peers. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 5. METHODS: Data on 26 elite basketball players with Jones fractures over 19 NBA seasons (1994-1995 to 2012-2013) were obtained from injury reports, press releases, player profiles, and online public databases. Variables included age, body mass index (BMI), player position, experience, and surgical treatment. Individual season statistics pre- and postinjury were collected. Twenty-six controls were identified by matched player position, age, and performance statistics. RESULTS: The mean age at the time of injury was 24.8 years, mean BMI was 24.7 kg/m(2), and the mean experience prior to injury was 4.1 NBA seasons. Return to previous level of competition was achieved by 85% of athletes. There was no change in player efficiency rating (PER) when pre- and postinjury performance was compared. When compared with controls, no decline in PER measured performance was identified. CONCLUSION: The majority of NBA players sustaining a Jones fracture return to their preinjury level of competition. These elite athletes demonstrate no decrease in performance on their return to play. CLINICAL RELEVANCE: Jones fractures are well-studied injuries in terms of etiology, diagnosis, and management. However, the effect of these injuries on future performance of athletes is unknown. Using the findings of our study, orthopaedic surgeons may be better prepared to counsel and educate elite athletes who sustain a Jones fracture.