National Football League athletes' return to play after surgical reattachment of complete proximal hamstring ruptures.

Although hamstring strains are common among professional football players, proximal tendon avulsions are relatively rare. Surgical repair is recommended, but there is no evidence on professional football players return to play (RTP). We hypothesized that surgical reattachment of complete proximal hamstring ruptures in these athletes would enable successful RTP. Ten proximal hamstring avulsions were identified in 10 National Football League (NFL) players between 1990 and 2008. Participating team physicians retrospectively reviewed each player's training room and clinical records, operative notes, and imaging studies. The ruptures were identified and confirmed with magnetic resonance imaging. Of the 10 injuries, 9 had palpable defects. Each of the ruptures was managed with surgical fixation within 10 days of injury. All of the players reported full return of strength and attempted to resume play at the beginning of the following season, with 9 of the 10 actually returning to play. However, despite having no limitations related to the surgical repair, only 5 of the 10 athletes played in more than 1 game. Most NFL players who undergo acute surgical repair of complete proximal hamstring ruptures are able to RTP, but results are mixed regarding long-term participation. This finding may indicate that this injury is a marker for elite-level physical deterioration.

The timing of rotator cuff repair for the restoration of function.

INTRODUCTION: This study was developed to test the hypothesis that there is a period in which a painful, traumatic rotator cuff tear, with associated weakness and the inability to abduct above shoulder level, should be repaired to allow for improvement in function. METHODS: Forty-two consecutive, prospectively followed patients met the criteria for entrance into this study. Of those, 36 patients were available for a minimum 9 months follow-up (average, 31 months; range, 9-71) by office visit. Patient outcomes were measured using the UCLA End-Result and ASES scoring systems. Patient variables, including time from injury to repair, tear size, degree of preoperative fat infiltration, patient satisfaction, and improvement in pain, were evaluated for their association with surgical outcome using independent t testing. Time to repair was evaluated at 0-2 months, 2-4 months, and greater than 4 months. RESULTS: Pain scores improved from 7 to 1.4 (P < .01) and active elevation improved from 55° to 133° (P < .01). UCLA/ASES scores improved from 8/30 to 26/79, respectively (P < .01, P < .01). All but 2 of the 36 patients were satisfied with their result. Preoperative fatty atrophy did not correlate with postoperative function. Rotator cuff tear size had no influence on patient outcome if repaired before 4 months. Massive tears repaired after 4 months had the worst outcome. CONCLUSION: Our results emphasize that the treatment outcome for traumatic rotator cuff tears of all sizes, with associated weakness, is not compromised up to 4 months after their injury.

Patients' perceptions of hip resurfacing arthroplasty.

The purpose of this study was to understand patients' perceptions regarding hip resurfacing arthroplasty relative to conventional total hip arthroplasty (THA). A consecutive group of 139 patients being evaluated for hip symptoms were asked to complete a survey regarding hip resurfacing arthroplasty. Forty-one percent were aware of hip resurfacing arthroplasty, and 82% felt hip resurfacing arthroplasty was a safer procedure than THA. Seventy-nine percent felt there was less soft tissue damage associated with hip resurfacing arthroplasty, and 80% felt they would return to their activities more quickly. Eighty percent felt that their overall range of motion would be better following hip resurfacing arthroplasty. Patients' perceptions of hip resurfacing arthroplasty are inconsistent with the known published advantages and disadvantages of the procedure when compared to conventional THA. Most of the patients received their information from sources other than an orthopedic surgeon.