Pure-Water-Fed Forward-Bias Bipolar Membrane CO2 Electrolyzer.

Coupling renewable electricity to reduce carbon dioxide (CO2) electrochemically into carbon feedstocks offers a promising pathway to produce chemical fuels sustainably. While there has been success in developing materials and theory for CO2 reduction, the widespread deployment of CO2 electrolyzers has been hindered by challenges in the reactor design and operational stability due to CO2 crossover and (bi)carbonate salt precipitation. Herein, we design asymmetrical bipolar membranes assembled into a zero-gap CO2 electrolyzer fed with pure water, solving both challenges. By investigating and optimizing the anion-exchange-layer thickness, cathode differential pressure, and cell temperature, the forward-bias bipolar membrane CO2 electrolyzer achieves a CO faradic efficiency over 80% with a partial current density over 200 mA cm-2 at less than 3.0 V with negligible CO2 crossover. In addition, this electrolyzer achieves 0.61 and 2.1 mV h-1 decay rates at 150 and 300 mA cm-2 for 200 and 100 h, respectively. Postmortem analysis indicates that the deterioration of catalyst/polymer-electrolyte interfaces resulted from catalyst structural change, and ionomer degradation at reductive potential shows the decay mechanism. All these results point to the future research direction and show a promising pathway to deploy CO2 electrolyzers at scale for industrial applications.

Toward decentralized wastewater treatment: A flow-through module using microtubular gas diffusion electrodes for micropollutants removal.

Electro-Fenton (EF) represents an eco-friendly and cost-effective advanced oxidation process that can remove highly persistent and hazardous pharmaceuticals, e.g., contrast media agents, from water bodies. However, up to date, EF modules incorporate a planar carbonaceous gas diffusion electrode (GDE) cathode containing fluorinated compounds as polymeric binders. Here, we introduce a novel flow-through module that deploys freestanding carbon microtubes (CMT) as microtubular GDEs, omitting any risks of secondary pollution by highly-persistent fluorinated compounds (e.g., Nafion). The flow-through module was characterized for electrochemical hydrogen peroxide (H2O2) generation and micropollutant removal via EF. H2O2 electro-generation experiments illustrated high production rates (1.1 ± 0.1-2.7 ± 0.1 mg cm-2 h-1) at an applied cathodic potential of - 0.6 V vs. SHE, depending on the porosity of CMTs. Diatrizoate (DTZ), as the model pollutant, with a high initial concentration of 100 mg L-1 was successfully oxidized (95-100 %), reaching mineralization (TOC-total organic carbon removal) efficiencies up to 69 %. Additionally, Electro-adsorption experiments demonstrated the capability of positively charged CMTs to remove negatively charged DTZ with a capacity of 11 mg g-1 from a 10 mg L-1 DTZ solution. These results reveal the potential of the as-designed module to serve as an oxidation unit coupled with other separation techniques, e.g., electro-adsorption or membrane processes.

The Influence of Industry Affiliation on Randomized Controlled Trials of Platelet-Rich Plasma for Knee Osteoarthritis.

BACKGROUND: Industry funding and corporate sponsorship have played a significant role in the advancement of orthopaedic research and technology. However, this relationship raises concerns for how industry association may bias research findings and influence clinical practice. PURPOSE: To determine whether industry affiliation plays a role in the outcomes of randomized controlled trials (RCTs) investigating platelet-rich plasma (PRP). STUDY DESIGN: Meta-analysis; Level of evidence, 2. METHODS: A search of the PubMed, Cochrane, and MEDLINE databases for RCTs published between 2011 and the present comparing PRP versus hyaluronic acid, corticosteroid, or placebo for the treatment of knee osteoarthritis was performed. To determine industry affiliation, the conflict of interest, funding, and disclosure sections of publications were assessed, and all authors were assessed through the American Academy of Orthopaedic Surgeons disclosure database and the Centers for Medicare & Medicaid Services open payments database. Studies were classified as industry affiliated (IA) or non-industry affiliated (NIA). The outcomes of each study were rated as favorable, analogous, or unfavorable according to predefined criteria. RESULTS: A total of 37 studies (6 IA and 31 NIA) were available for analysis. Overall, 19 studies (51.4%) reported PRP as favorable compared with other treatment options, while 18 studies (48.6%) showed no significant differences between PRP and other treatment methods. There was no significant difference in qualitative conclusions between the IA and NIA groups, with the IA group having 3 favorable studies and 3 analogous studies and the NIA group having 16 favorable studies and 15 analogous studies (P = .8881). When comparing IA versus NIA studies using 6- and 12-month Western Ontario and McMaster Universities Arthritis Index and International Knee Documentation Committee scores, there were no significant differences in outcomes. CONCLUSION: The results of this study demonstrated that qualitative conclusions and outcome scores were found to not be associated with industry affiliation. Although the results of this study suggest that there is no influence of industry involvement on RCTs examining PRP, it is still necessary to carefully evaluate pertinent commercial affiliations when reviewing recommendations from studies before adopting new treatment approaches, such as the use of PRP for knee osteoarthritis.

Micromodel of a Gas Diffusion Electrode Tracks In-Operando Pore-Scale Wetting Phenomena.

Utilizing carbon dioxide (CO2 ) as a resource for carbon monoxide (CO) production using renewable energy requires electrochemical reactors with gas diffusion electrodes that maintain a stable and highly reactive gas/liquid/solid interface. Very little is known about the reasons why gas diffusion electrodes suffer from unstable long-term operation. Often, this is associated with flooding of the gas diffusion electrode (GDE) within a few hours of operation. A better understanding of parameters influencing the phase behavior at the electrolyte/electrode/gas interface is necessary to increase the durability of GDEs. In this work, a microfluidic structure with multi-scale porosity featuring heterogeneous surface wettability to realistically represent the behavior of conventional GDEs is presented. A gas/liquid/solid phase boundary was established within a conductive, highly porous structure comprising a silver catalyst and Nafion binder. Inoperando visualization of wetting phenomena was performed using confocal laser scanning microscopy (CLSM). Non-reversible wetting, wetting of hierarchically porous structures and electrowetting were observed and analyzed. Fluorescence lifetime imaging microscopy (FLIM) enabled the observation of reactions on the model electrode surface. The presented methodology enables the systematic evaluation of spatio-temporally evolving wetting phenomena as well as species characterization for novel catalyst materials under realistic GDE configurations and process parameters.

Comparison of a Smartphone App to Manual Knee Range of Motion Measurements.

Background: Digital technology has emerged as a useful tool for preoperative and postoperative patient engagement and for remote patient monitoring. Smartphones are equipped with motion-sensing technology, and apps can be designed which use these features to create a simple method for measuring range of motion. The purpose of this study was to determine the accuracy of digital technology in assessing knee range of motion using a smartphone app, compared to traditional goniometric measurements in an office setting. Methods: Fifty-three (53) patients in a clinical practice were enrolled between October 2019 and March 2020. Three separate measurements were taken during the patient encounter: (1) the surgeon, (2) the app, and (3) the physical therapist. Intraclass correlations were computed to assess the agreement between (1) the surgeon and app and (2) that between the physical therapist and surgeon. Results: When measuring flexion, the correlation between either the surgeon or therapist with the app was good, whereas the comparison between the surgeon and therapist was moderate. All extension measurement comparisons, between the app, surgeon, and therapist, showed moderate correlation. Limits of agreements showed that 80% of the difference between surgeon and app is within 10 degrees for extension and 11 degrees for flexion. Body mass index did not affect the accuracy of the measurements. Conclusion: Digital app measurements were comparable to measurements made by either a surgeon or physical therapist with a manual goniometer in the clinical setting and may be beneficial for measuring and monitoring patients' range of motion remotely.

Treatment of Medial Collateral Ligament Injury During Total Knee Arthroplasty With Internal Suture Brace Augmentation: A Cadaveric and Biomechanical Study.

Intraoperative medial collateral ligament (MCL) injury during total knee arthroplasty (TKA) is a serious complication. External bracing and/or conversion to a constrained implant has previously been studied. The technique of using an internal high-strength suture brace to augment an MCL repair has been evaluated in the nonarthroplasty patient and could provide an alternate solution. The goal of this study was to determine whether MCL repair with internal suture bracing restores stability of the implanted knee joint. A robotic simulator completed laxity testing on 5 cadaveric knee specimens in 4 sequential phases: (1) intact knee, (2) after implantation with TKA, (3) after sectioning of the MCL, and (4) after MCL repair with suture brace augmentation. Laxity was compared between the different test phases throughout range of motion. Subsequently, the internal brace was tested to failure under valgus load. The MCL repair with internal bracing was effective at restoring laxity in varus-valgus, internal-external, and medial-lateral degrees of freedom through midflexion, with limited support at deeper flexion angles and in anterior-posterior laxity. Rotational laxity was not significantly different than intact knee laxity. Generally, medial-lateral translations were less and anterior-posterior translations were greater and were significantly different at 30° to 45° and 90°, respectively. The mean failure moment was 46.4±9.1 Nm, with the primary mode of failure being MCL repair. Primary MCL repair with internal bracing using a high-strength suture augment showed the potential to provide adequate stability and strength to correct MCL incompetence in TKA without the use of an external knee brace or constrained implants. [Orthopedics. 2022;45(5):e269-e275.].

Ulnar Neuritis and Its Affect on Outcomes of Elbow Ulnar Collateral Ligament Reconstruction.

BACKGROUND: No study has specifically evaluated how ulnar neuritis and ulnar nerve transposition affect outcomes in baseball players undergoing ulnar collateral ligament (UCL) reconstruction (UCLR). PURPOSE: To evaluate the effects of ulnar neuritis and ulnar nerve transposition in baseball pitchers undergoing UCLR in regard to return to sport, time to return to sport, and need for revision or additional surgery. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: At a single institution, all consecutive baseball pitchers undergoing UCLR between 2002 and 2015 were identified. Ulnar neuritis was diagnosed preoperatively by the following criteria: ulnar nerve symptoms, Tinel sign at the elbow, symptomatic subluxation, and numbness/paresthesia in an ulnar nerve distribution of the hand. The primary outcome of the study was return to sport. The secondary outcomes of the study were time to return to sport, length of playing career, and revision or additional surgery. RESULTS: A total of 578 UCLRs were performed in baseball players; of these, 500 UCLRs were performed in pitchers. Ulnar neuritis was diagnosed in 97 (19.4%) baseball pitchers presenting with UCL injury. There were no significant differences in patient characteristics or surgical techniques performed for reconstruction between baseball pitchers with and without ulnar neuritis. In review of injury characteristics, ulnar neuritis was significantly more likely to be diagnosed in pitchers with an acute onset of UCL injury (P = .03). Transposition of the ulnar nerve was more commonly performed in players with ulnar neuritis (47%) versus those without ulnar neuritis (10%; P = .0001). The players who had ulnar neuritis and underwent UCLR had a significantly lower odds of returning to sport (odds ratio, 0.45; P = .04); however, no significant difference was found for time to return to sport and length of playing career for those with and without ulnar neuritis (P = .38 and .51, respectively). CONCLUSION: The study suggests that ulnar neuritis, when present preoperatively in baseball pitchers undergoing UCLR, may adversely affect their ability to return to sport, whereas ulnar nerve transposition at the time of UCLR does not alter the ability to return to sport.

Freestanding Nitrogen-Doped Carbons with Hierarchical Porosity for Environmental Applications: A Green Templating Route with Bio-Based Precursors.

Powdery hierarchical porous carbons serve as cost-effective, functional materials in various fields, namely energy storage, heterogeneous catalysis, electrochemistry, and water/wastewater treatment. Such powdered activated carbons (PAC) limit new module designs and require further preparation steps, for example, adding polymeric binders, to be shaped into a standalone geometry. Polymeric binders, however, can block PACs' catalytic and active sites and, more importantly, pose the risk of secondary pollution for environmental purposes, especially in the context of clean water supply. This study introduces a novel synthesis method for fabricating freestanding nitrogen-doped carbons with hierarchical porosity using chitosan and sucrose as green precursors. Chitosan supplies nitrogen and acts as a backbone, giving a freestanding geometry to the final product, and sucrose is a carbon-rich precursor. The proposed method employs ice- and hard-templating for macropores and mesopores and combines carbonization and activation steps with no required activating agent. Final freestanding carbons function as adsorbents for removing persistent pollutants, as binder-free electrodes with high specific surface area and capacitive current, and as tubular gas diffusion electrodes for oxygen reduction reactions. These freestanding carbons enable new module designs and can be scaled-up by numbering-up, serving as bio-based functional materials for a wide range of applications involving porous heteroatom-doped carbons.

Taxonomy and model for valuing the contribution of digital water meters to sustainability objectives.

Water security is an issue across the world as communities face ageing infrastructure, population increases and climate change. The application of digital water metering (DWM) to properties has had a demonstrable impact on water savings at the property and network levels, on efficiencies within water utilities, as well as on improvements to customer satisfaction scores. Gathering and processing near-real-time water usage data is very important for both end-users and utilities, as well as demand and supply management planning. The potential contribution of DWM to the three pillars of water sustainability (environmental, economic development and social equity) is often overlooked. In Australia and other jurisdictions water utilities are facing up to the challenge of climate change. However, business cases promoting DWM are often unsuccessful because the benefit side falls short of the cost side. This study sought to identify possible DWM benefits not previously considered through an extensive review of academic and industry literature, and then to view those benefits through the lens of sustainability. The 77 identified benefits of DWM were catalogued and a taxonomy was created. The study elicited the opinions of experts, before quantifying them, thus identifying two distinct contexts of benefit value; subsequently, it surveyed the views of customers and developed a stochastic model of benefit value. The model, named DWM360, was applied to the project data of a large metropolitan water utility in Australia to model their DWM proposal for cost savings, contribution to sustainability and uplift in customer satisfaction. This paper presents a novel focus on how the benefits of DWM assist water sustainability. It considers differing social norms that impact consumer acceptance of changes in metering and water charges. The study will be of interest to researchers as well as practitioners looking to identify sustainability aspects of DWM.

Quantifying Patient Engagement in Total Joint Arthroplasty Using Digital Application-Based Technology.

BACKGROUND: Digital patient engagement has been suggested as a mean to increase patient activation and patient satisfaction after total joint arthroplasty. The purpose of this study was to assess patient engagement with application-based educational tools and to explore what content was most useful to patients in the perioperative period surrounding total hip arthroplasty (THA) and total knee arthroplasty (TKA), respectively. METHODS: Patients undergoing THA and TKA between October 2017 and January 2020 were enrolled to use an application-based digital technology. The App provides comprehensive patient education using a series of modules delivered at set intervals preoperatively and postoperatively. Patient engagement was defined as patients viewing at least one time the modules that were sent, or marking them as completed. Patient satisfaction was assessed using an in-application survey. RESULTS: Complete data were available on 207 patients of which 95 (46%) underwent THA and 112 (54%) underwent TKA. The average age was 60 years. 54% with patients invited to the program completed registration. An average compliance rate of 48% (41 modules engaged out of 83) was observed. Of all modules completed, the top three most popular categories included physical therapy/exercise videos, health literacy, and anxiety/stress/pain management. The least viewed category was nutrition planning and education. CONCLUSION: When presented educational material related to THA and TKA, patients had a high rate of compliance. Digital technology platforms provide a scalable, meaningful approach to engaging patients throughout the continuum of joint replacement care and may serve as a cost-effective adjunct to traditional methods.

A scalable bubble-free membrane aerator for biosurfactant production.

The bioeconomy is a paramount pillar in the mitigation of greenhouse gas emissions and climate change. Still, the industrialization of bioprocesses is limited by economical and technical obstacles. The synthesis of biosurfactants as advanced substitutes for crude-oil-based surfactants is often restrained by excessive foaming. We present the synergistic combination of simulations and experiments towards a reactor design of a submerged membrane module for the efficient bubble-free aeration of bioreactors. A digital twin of the combined bioreactor and membrane aeration module was created and the membrane arrangement was optimized in computational fluid dynamics studies with respect to fluid mixing. The optimized design was prototyped and tested in whole-cell biocatalysis to produce rhamnolipid biosurfactants from sugars. Without any foam formation, the new design enables a considerable higher space-time yield compared to previous studies with membrane modules. The design approach of this study is of generic nature beyond rhamnolipid production.

Orientation mapping of graphene using 4D STEM-in-SEM.

A scanning diffraction technique is implemented in the scanning electron microscope. The technique, referred to as 4D STEM-in-SEM (four-dimensional scanning transmission electron microscopy in the scanning electron microscope), collects a diffraction pattern from each point on a sample which is saved to disk for further analysis. The diffraction patterns are collected using an on-axis lens-coupled phosphor/CCD arrangement. Synchronization between the electron beam and the camera exposure is accomplished with off-the-shelf data acquisition hardware. Graphene is used as a model system to test the sensitivity of the instrumentation and develop some basic analysis techniques. The data show interpretable diffraction patterns from monolayer graphene with integration times as short as 0.5 ms with a beam current of 245 pA (7.65×105 incident electrons per pixel). Diffraction patterns are collected at a rate of ca. 100/s from the mm to nm length scales. Using a grain boundary as a 'knife-edge', the spatial resolution of the technique is demonstrated to be ≤5.6nm (edge-width 25 % to 75 %). Analysis of the orientation of the diffraction patterns yields an angular (orientation) precision of ≤0.19∘ (full width at half maximum) for unsupported monolayer graphene. In addition, it is demonstrated that the 4D datasets have the information content necessary to analyze complex and heterogeneous multilayer graphene films.

Cognitive short- and long-term effects of coffee cherry extract in older adults with mild cognitive decline.

There has been increasing interest in food- and dietary supplement-based materials that may support healthy cognition. However, few studies have quantitatively measured bioavailability, bioactivity, or cognitive short- and long-term effects of these materials against placebo. Earlier clinical studies reported ability of coffee cherry extract (CCE) to a.) reduce levels of reactive oxygen species (ROS) in human blood and b.) to increase serum and exosomal levels of brain-derived neurotrophic factor (BDNF), a neuroprotein essential for neurogenesis. Here, we examined CCE influence on cognitive performance. Seventy-one adults with mild cognitive decline completed this double blind, randomized, placebo-controlled, 28-day regimen. Participants engaged in a cognitive challenge that involved working memory processes. Our results suggest that effects of CCE were notable during the first week and persisted throughout the study period. Specifically, participants on the CCE regimens had significant reductions in reaction time compared to placebo when comparing baseline to days 7 and 28 (p = 0.040, partial η2  = 0.130). A main effect of group was not identified for accuracy; however, strong trends were noted between the placebo group and two of the three CCE groups. These results suggest CCE, when taken in the morning or twice per day, is associated with improvements in reaction times and trends toward indications of improved accuracy. Although further research is required, these observations may be indicative of underlying processes such as increased processing speed, sustained attention, and/or focus.

Major League Baseball Pitching Performance After Tommy John Surgery and the Effect of Tear Characteristics, Technique, and Graft Type.

BACKGROUND: Return to play and player satisfaction have been quite high after ulnar collateral ligament reconstruction (UCLR); however, there has been little reported on how outcomes are affected by surgical technique, graft type, and tear characteristics. PURPOSE: To evaluate surgical techniques, graft type, and tear characteristics on Major League Baseball (MLB) performance after UCLR. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: MLB pitchers who underwent primary UCLR at a single institution were included. Tear characteristics included tear location, tear grade, and acuity. Surgical technique and graft type were also collected. Pitching performance statistics, including earned run average (ERA), walks and hits per innings pitched (WHIP), innings pitched, and fastball velocity were evaluated 3 years before and after UCLR. RESULTS: Forty-six MLB pitchers were identified as having primary UCLR. Return to play was 96%, with 82% returning to MLB play. Technique performed showed no difference in performance. As compared with pitchers with gracilis grafts, pitchers with palmaris grafts were younger ( P = .043), played longer after surgery ( P = .012), and returned to play at 100% (35 of 35) versus 82% (9 of 11, P = .010). When compared with pitchers with proximal tears, pitchers with distal tears pitched at higher velocity (93.0 vs 90.6 mph, P = .023) and had better performance before surgery (ERA, P = .003; WHIP, P = .021); however, those with proximal tears improved to match this performance and velocity after reconstruction. As compared with those having partial tears, pitchers with complete tears played longer after surgery (5.9 vs 4.0 years, P = .033), had a better ERA before injury ( P = .041), and had better WHIP ( P = .037) and strikeouts per 9 innings ( P = .025) after reconstruction. Pitchers with chronic tears had a significant improvement in postoperative ERA, from 4.49 to 3.80 ( P = .040). CONCLUSION: Technique performed and graft type used did not affect performance; however, pitchers with palmaris grafts returned at a higher rate than those with gracilis grafts. Distal tears occurred in pitchers with greater velocity and better performance before injury, yet pitchers with proximal tears matched this performance after reconstruction. Pitchers with complete tears played longer after reconstruction. Pitchers who had partial tears had worse performance before injury and after reconstruction, and those with chronic tears saw a significant improvement in ERA with reconstruction.

Posterior capsule injection of local anesthetic for post-operative pain control after ACL reconstruction: a prospective, randomized trial.

PURPOSE: Alternative modalities to optimize pain control after anterior cruciate ligament reconstruction (ACLR) are continually being explored. The purpose of this study was to compare femoral nerve block (FNB) only vs FNB with posterior capsule injection (PCI) of the knee for pain control in patients undergoing ACLR. METHODS: Patients undergoing primary ACLR were randomized to receive either FNB only or FNB with PCI. Following surgery, patient's pain was evaluated in the postoperative care unit (PACU) and at home for 4 days. Pain levels were measured via visual analog scale (VAS) and calculating opioid consumption. Outcomes of interest included postoperative pain levels and opioid consumption. RESULTS: A total of 42 patients were evaluated, with 21 patients randomized to each study arm. Outcomes showed significant pain reduction in both anterior and posterior knee VAS scores in the PACU in those that received PCI (anterior VAS: 39.6 vs 21.3 (SD = 12.9), p < 0.01; posterior VAS: 25.4 vs 15.3 (SD = 8.05), p = 0.01). Moreover, the PCI group also showed significantly less opioid consumption compared to FNB only (23.5 vs 17.4 pills, p = 0.03). There were no differences found in pain scores between groups in home VAS sores. CONCLUSIONS: These finding suggest the use of arthroscopically assisted injection of local anesthetic to the posterior capsule of the knee significantly reduces early post-operative pain and dramatically reduces the number of opoid medication taken after ACLR. LEVEL OF EVIDENCE: Prospective, randomized, control trial, Level I.

Transmission imaging with a programmable detector in a scanning electron microscope.

A new type of angularly selective electron detector for use in a scanning electron microscope is presented. The detector leverages a digital micromirror device (DMD) to take advantage of the benefits of two-dimensional (2D) imaging detectors and high-bandwidth integrating detectors in a single optical system. The imaging detector provides direct access to the diffraction pattern, while the integrating detector can be synchronized to the microscope scan generator providing access to a real space image generated by integrating (pixel-by-pixel) a portion of the diffraction pattern as quantitatively defined by the DMD. The DMD, in effect, takes the place of the objective aperture in a transmission electron microscope (TEM) or an annular detector in a scanning transmission electron microscope (STEM), but has the distinct advantage that it can be programmed to take any shape in real time. Proof-of-principle data collected with the detector show diffraction contrast in samples ranging from a polycrystalline gold film to monolayer graphene.

Does Hospital Consumer Assessment of Healthcare Providers and Systems survey correlate with traditional metrics of patient satisfaction? The challenge of measuring patient pain control and satisfaction in total joint replacement.

BACKGROUND: Medicare reimbursements have been tied to patient satisfaction measures. Despite these measures' influence on reimbursements, the relationship between pain management and patient satisfaction remains unclear. This study aims to evaluate the relationship between traditional patient perception of pain control and their overall satisfaction after joint replacement. METHODS: This study is a retrospective review of consecutive primary total hip and total knee replacements. A total of 286 patients who underwent primary total hip (N = 106) and total knee (N = 196) replacements with completed Hospital Consumer Assessment of Healthcare Providers and Systems surveys were evaluated. Pain control, communication, and hospital satisfaction were stratified into satisfactory or unsatisfactory groups. These 2 groups were compared in terms of visual analog scale (VAS), opioid use in morphine equivalents, length of hospital stay, anesthesia type, and demographics. RESULTS: Average VAS and opioid use did not differ between patient groups for any of the questions evaluated. Those who responded "always" to pain domain questions had a statistically shorter length of stay compared to patients with other response. On average, those who endorsed "always" on communication question were younger. CONCLUSIONS: Patients who endorsed satisfactory pain control and communication with staff had shorter lengths of stay. There was no relationship between survey scores and traditional pain control measures such as VAS and opioid use. This questions the relevance of our primary pain measures in assessing patient perception of pain control. Length of stay may be a better surrogate marker for patient satisfaction of pain control.

Medial Elbow Pain During the Return-to-Throwing Period After Ulnar Collateral Ligament Reconstruction in Pitchers.

BACKGROUND: Ulnar collateral ligament reconstruction (UCLR) is common in the sport of baseball, particularly among pitchers. Postoperative return-to-sport protocols have many players beginning to throw at 4 to 5 months and returning to full competition between 12 and 16 months after surgery. Medial elbow pain during the return-to-throwing period often occurs and can be difficult to manage. PURPOSE: To evaluate the incidence of medial elbow pain and associations with outcomes and revision surgery during the return-to-throwing period after UCLR. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Between the years of 2002 and 2014, all pitchers who underwent UCLR at a single institution were identified. Charts were reviewed for incidence of medial elbow pain during return to throwing, return to sport, and subsequent operative interventions, including revision ulnar collateral ligament surgery. RESULTS: Of a total of 616 pitchers who underwent UCLR during the study period, 317 were included in this study. Medial elbow pain was experienced by 45.1% (143 of 317), with a mean time of complaint of 9.75 months after surgery. The groups with and without pain did not differ statistically with regard to age (pain, 20.6 years; no pain, 20.9 years) or level of competition. Of those who experienced medial elbow pain, 10.5% did not return to sport; 5.6% underwent revision UCLR; and 19.6% underwent other operative procedures at the elbow. Among those who did not experience medial elbow pain when returning to throw, 8.7% did not return to sport, with only 1.7% undergoing revision UCLR and 6.9% undergoing other operative elbow procedures. CONCLUSION: Of the pitchers evaluated in the study, approximately half reported pain during the return-to-throwing phase after UCLR. Those who experienced medial elbow pain had a higher rate of subsequent surgical intervention.

Pitching Performance After Ulnar Collateral Ligament Reconstruction at a Single Institution in Major League Baseball Pitchers.

BACKGROUND: Ulnar collateral ligament (UCL) reconstruction (UCLR) has shown reliable rates of return to play, with conflicting results on pitching performance after players' return. PURPOSE: To evaluate Major League Baseball (MLB) pitching performance before and after UCLR performed at a single institution. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: MLB pitchers (minor league players were excluded) who underwent UCLR at our institution between 2002 and 2016 were identified. Player information and return to play were determined including pitching level (MLB vs minor league) and total number of years played after surgery. Pitching performance statistics were evaluated for 3 years before surgery and for 3 years after returning to play including earned run average (ERA), walks plus hits per inning pitched (WHIP), innings pitched, wins above replacement, runs above replacement, and pitch velocity. RESULTS: A total of 54 MLB pitchers were identified, with 46 primary and 8 revision reconstructions. The mean time to return to play was 13.8 months (primary reconstruction: 13.7 months). The majority returned to play with a 94% return rate (primary reconstruction: 96%), and 80% returned to MLB play (primary reconstruction: 82%). Three primary reconstructions required revision surgery. Pitchers played a mean of 3.2 years in MLB and 4.6 years total after surgery (39% still playing). Pitching workload and performance were maintained or improved after surgery. The preoperative ERA was 4.63 versus 4.13 after returning to play ( P = .268). Fastball velocity ( P = .032), ERA ( P = .003), and WHIP ( P = .001) worsened the first year after surgery and then improved the second year (ERA: 4.63 to 4.06 [ P = .380]; WHIP: 1.35 to 1.32 [ P = .221]; fastball velocity: 91.3 to 91.9 mph [ P = .097]). Compared with a matched control group, pitchers who had UCLR showed improvements or maintained performance after reconstruction including improved ERA ( P = .007), WHIP ( P = .025), and fastball velocity ( P = .006). CONCLUSION: MLB players experienced a high rate of return to play and previous level of play after UCLR. Pitching workload was maintained after returning to play. Pitching performance initially decreased the first year after returning and then improved or reverted to previous levels after the first year from UCLR.