Evaluation and management of elbow injuries in the adolescent overhead athlete.

With an increased interest in youth sports, the burden of overhead throwing elbow injuries accompanying early single-sport focus has steadily risen. During the overhead throwing motion, valgus torque can reach and surpass Newton meters (N m) during the late cocking and early acceleration phases, which exceeds the tensile strength (22.7-33 N m) of the ulnar collateral ligament. While the ulnar collateral ligament serves as the primary valgus stabilizer between and degrees of elbow flexion, other structures about the elbow must contribute to stability during throwing. Depending on an athlete's stage of skeletal maturity, certain patterns of injury are observed with mechanical failures resulting from increased medial laxity, lateral-sided compression, and posterior extension shearing forces. Together, these injury patterns represent a wide range of conditions that arise from valgus extension overload. The purpose of this article is to review common pathologies observed in the adolescent overhead throwing athlete in the context of functional anatomy, osseous development, and throwing mechanics. Operative and non-operative management and their associated outcomes will be discussed for these injuries.

A comparison of postoperative pain between anterior cruciate ligament reconstruction and repair.

PURPOSE: To determine if patients who underwent ACL repair experienced less short-term postoperative pain versus patients who underwent ACL reconstruction. METHODS: Electronic charts were retrospectively reviewed of patients who underwent ACL surgery from November 2014 through April 2019 by a single surgeon. Patients were divided into two groups based on whether they underwent ACL repair or ACL reconstruction. A two-tailed equal variance t-test was used to evaluate visual analog scale (VAS) pain scores at the first postoperative visit. A chi-squared test of independence was used to evaluate narcotic prescription refills at the first postoperative visit. RESULTS: 36 ACL repair patients and 71 ACL reconstruction patients were included. The mean visual analog scale (VAS) pain score at the first postoperative visit (12.9 ± 3.7 days post-op) for ACL repair patients (2.81 ± 1.79) was significantly lower (p = .004) compared to ACL reconstruction patients (4.07 ± 2.26). The number of narcotic prescription refills at the first postoperative visit was significantly lower (p = .027, ARR = 21.4%, NNT = 4.67) in the ACL repair group (7 of 36, 19.4%) compared to the ACL reconstruction group (29 of 71, 40.8%). CONCLUSION: Patients who underwent ACL repair experienced less short-term postoperative pain and were prescribed fewer narcotics compared to patients who underwent ACL reconstruction.