Impact of Quadriceps Tendon Graft Thickness on Electromechanical Delay and Neuromuscular Performance After ACL Reconstruction.

Background: Both partial- and full-thickness quadriceps tendon (QT) graft harvests are used for anterior cruciate ligament reconstruction (ACLR). Purpose: To evaluate the impact of QT graft harvest depth (full or partial thickness) on electromechanical delay (EMD), peak torque (PT), and rate of torque development (RTD) after ACLR. Study Design: Controlled laboratory study. Methods: A total of 26 patients who underwent either partial-thickness (n = 14) or full-thickness (n = 12) autograft QT ACLR were recruited between June and November 2021 (>1 year before participation). Patients performed isokinetic knee extension testing with surface electromyography of the quadriceps muscles. Mixed repeated-measures analysis of variance with least significant difference post hoc testing was used to determine significant differences (mean difference [MD] ± SE) or interactions for all variables. Results: A significant speed×depth interaction was seen for the vastus medialis (P = .005). Pairwise analyses showed significantly longer EMD for the partial-thickness graft than the full-thickness graft (MD ± SE, 19.92 ± 6.33 ms; P = .006). In the partial-thickness graft, the EMD was significantly longer at 90 deg/s versus 180 deg/s (MD ± SE, 19.11 ± 3.95 ms; P < .001) and 300 deg/s (MD ± SE, 16.43 ± 5.30 ms; P = .006). For PT, the full-thickness graft had a significantly lower PT on the operated versus nonoperated side at all speeds (MD ± SE: 90 deg/s, -57.0 ± 10.5 N·m, P < .001; 180 deg/s, -26.0 ± 10.2 N·m, P = .020; 300 deg/s, -20.3 ± 8.9 N·m, P = .034). For RTD, the full-thickness graft showed significantly Slower RTD for the operated versus nonoperated side at all time points (MD ± SD: RTD0-25 (0-25% of the range of motion), -131.3 ± 50.9 N·m/s, P = .018; RTD25-50, -197.0 ± 72.5 N·m/s, P = .014; RTD50-75, -113.3 ± 39.8 N·m/s, P = .013; RTD75-100, -149.4 ± 35.9 N·m/s, P < .001). Conclusion: Compared with partial-thickness QT, full-thickness QT showed a shorter vastus medialis EMD at higher loading, and therefore greater stiffness, as well as slower RTD and lower PT across all testing speeds. Clinical Relevance: The impact of full-thickness QT autograft on EMD and neuromuscular performance should be considered for ACLR.

The Associations Between Quadriceps Tendon Graft Thickness and Isokinetic Performance.

BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) using the quadriceps tendon is an increasingly popular technique. Both partial-thickness quadriceps tendon (PT-Q) and full-thickness quadriceps tendon (FT-Q) graft depths are employed. HYPOTHESIS/PURPOSE: This study was designed to assess isokinetic peak torque, average power, and total work during knee extension in patients with FT-Q or PT-Q grafts for ACLR. We hypothesized that both groups would show lower isokinetic values for the operated side, with greater deficits in the FT-Q group than in the PT-Q group. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 26 patients who underwent ACLR with either an FT-Q or PT-Q graft were recruited between June 2021 and November 2021. Patients underwent isokinetic knee extension testing at > 1 year after surgery. Mixed repeated-measures analysis of covariance with least square difference post hoc testing was used to determine significant differences or interactions for all variables. RESULTS: Peak torque was significantly lower for the operated limb than the nonoperated limb in the FT-Q group (mean difference [MD] ± standard error [SE], -38.6 ± 8.3 Ncm [95% CI, -55.7 to -21.5 Ncm]; P < .001; d = 0.90) but not in the PT-Q group (MD ± SE, -7.3 ± 7.7 Ncm [95% CI, -23.2 to 8.5 Ncm]; P = .348; d = 0.20). Similarly, average power for the operated limb was lower than that for the nonoperated limb in the FT-Q group (MD ± SE, -53.6 ± 13.4 W [95% CI, -81.3 to -26.9 W]; P < .001; d = 0.88) but not in the PT-Q group (MD ± SE, -4.1 ± 12.4 W [95% CI, -29.8 to 21.5 W]; P = .742; d = 0.07), and total work was lower for the operated limb compared with the nonoperated limb in the FT-Q group (MD ± SE, -118.2 ± 27.1 J [95% CI, -174.3 to -62.2 J]; P < .001; d = 0.96) but not in the PT-Q group (MD ± SE, -18.3 ± 25.1 J [95% CI, -70.2 to 33.6 J]; P = .472; d = 0.15). CONCLUSION: The FT-Q group showed significant deficits in the operated limb compared with the nonoperated limb for all isokinetic variables. In contrast, no significant differences were found between the nonoperated and operated limbs for the PT-Q group.

The 50 Most Cited Articles in Knee Medial Collateral Ligament Injury Research.

Background: Medial collateral ligament (MCL) injury is a common orthopaedic knee injury with a plethora of published articles regarding evaluation, treatment, and outcome. Purpose: To perform a comprehensive bibliometric analysis of the 50 most cited articles in MCL research. Study Design: Cross-sectional study. Methods: We performed a keyword search of the Institute for Scientific Information's Web of Knowledge database for the identification of articles published before September 2021 encompassing the MCL. The conducted search yielded 9534 articles. The results were then filtered using predetermined guidelines and criteria, and the 50 most cited articles were selected for analysis. Extracted data included title, authors, citation count, year of publication, topic, journal, article type, country of origin, and level of evidence. Results: The selected 50 articles ranged from 1976 to 2013. The largest proportion was classified as having level 4 evidence (n = 12; 24%). The majority of the articles were published in the decade from 2000 to 2009 (n = 17; 34%), followed by 1990 to 1999 (n = 16; 32%). The mean raw citation score per article was 133 (range, 74-422). The most popular topic discussed was surgical technique and outcome (n = 14; 28%), followed by anatomy and biomechanics (n = 13; 26%). Conclusion: This study provides a comprehensive and objective measure of the most cited articles on MCL research. Knowledge of the characteristics of these most influential articles improves the understanding of MCL injury and can guide discussion for future research.

Imaging Findings of Complications After Lateral Extra-Articular Tenodesis of the Knee: A Current Concepts Review.

Background: Despite successful anterior cruciate ligament (ACL) reconstruction, many patients continue to experience persistent anterolateral rotatory instability. Lateral extra-articular tenodesis (LET) is used to address this instability by harvesting a portion of the iliotibial band, passing it underneath the fibular collateral ligament, and attaching it just proximal and posterior to the lateral femoral epicondyle. Based on the most recent clinical evidence, the addition of LET to ACL reconstruction improves clinical outcomes, which has led to an increase in the use of this technique. Purpose: To provide an overview of the postoperative complications of the LET procedure and their associated imaging findings, with a focus on magnetic resonance imaging (MRI). Study Design: Narrative review. Methods: In this scoping review, the authors reviewed available radiographic, computed tomography, and MRI scans of patients who experienced postoperative complications after ACL reconstruction with LET, in which the complication was determined to be from the LET procedure. Images were reviewed and subsequently described by an on-staff musculoskeletal radiologist. Results: The authors found 9 different complications associated with LET: graft failure, hematoma, infection, chronic pain, tunnel convergence, fixation device migration, muscular hernia, peroneal nerve palsy, and knee stiffness. They supplemented these findings with radiographic evidence from 6 patients. Conclusion: As extra-articular reconstruction techniques including LET become more popular among orthopaedic surgeons, it is important that radiologists and surgeons be adept at recognizing the normal imaging findings of LET and associated complications.

Word of Mouth and Online Reviews Are More Influential Than Social Media for Patients When Selecting a Sports Medicine Physician.

Purpose: To (1) identify the percentage of patients seen in an orthopaedic sports medicine practice who use social media and (2) identify the role that social media has in physician selection as compared with other factors. Methods: After institutional review board approval was received, new patients aged 18 years or older who attended a single orthopaedic sports medicine office from February 2020 to May 2021 were identified for inclusion. Sociodemographic information was recorded, and each patient was asked to fill out a questionnaire that assessed social media usage and online resources used to choose and formulate opinions regarding the patient's provider. Results: Two hundred patients met the inclusion criteria and completed the questionnaire. Of these, 96.5% reported social media use. The most common online method of searching for and identifying a physician was Google (50.5%). Social media outlets such as Facebook, Instagram, or LinkedIn were only used 15.5% of the time to search for and select a physician. Older patients were more likely to use recommendations from friends and family in their consideration when selecting a physician. Conclusions: Despite almost all participants stating that they use social media, only 15.5% of patients reported that they used social media to search for and potentially select their physician. Our study suggests that although social media can be a helpful tool for patient education, other factors such as physician education and physician reputation through word-of-mouth referrals, online reviews, and online ratings seem to play a larger role in the patient's selection of his or her physician. Clinical Relevance: This information may be of value to orthopaedic surgeons looking for ways to build their patient base, online reputation, or other aspects of their practice on the Internet.

A Comparison of Two-Year Anterior Cruciate Ligament Reconstruction Clinical Outcomes Using All-Soft Tissue Quadriceps Tendon Autograft With Femoral/Tibial Cortical Suspensory Fixation Versus Tibial Interference Screw Fixation.

PURPOSE: To contribute to future quadriceps tendon harvest and fixation guidelines in the setting of anterior cruciate ligament reconstruction by comparing 2-year patient-reported subjective knee outcome scores and incidence of graft-related complications between the shorter harvest all-inside tibial-femoral suspensory fixation (TFSF) approach versus the longer harvest standard tibial interference screw fixation technique. METHODS: Patients who underwent primary anterior cruciate ligament reconstruction with all soft tissue quadriceps tendon autograft from January 2017 to May 2019 were identified for inclusion. Patients were matched into 2 cohorts of 62 based on reconstruction technique. All patients completed baseline and minimum 2-year International Knee Documentation Committee, Tegner Activity Level, and Lysholm questionnaires and were queried regarding subsequent procedures and complications to the operative knee. RESULTS: Average graft length for the all-inside TFSF was 69.55 (95% confidence interval 68.99-70.19) mm versus 79.27 (95% confidence interval 77.21-81.34) mm in the tibial screw fixation cohort (P = .00001). Two-year Lysholm scores were greater in the TFSF cohort (P = .04) but were not clinically significant. There was no difference in 2-year International Knee Documentation Committee (P = .09) or Tegner (P = .69) scores between cohorts, but more patients in the TFSF cohort returned to or exceeded their baseline activity level compared with the tibial screw fixation cohort (73% vs 61%, P = .25). Seven patients in the TFSF cohort versus 13 in the tibial screw fixation cohort reported anterior knee pain or kneeling difficulty (P = .22). There were no differences in reported complications. CONCLUSIONS: All-inside soft-tissue quadriceps tendon autograft with TFSF resulted in clinically comparable subjective outcome scores at 2 years to tibial screw fixation. There were also no differences in complications or reports of anterior knee pain or kneeling difficulty. All-inside TFSF can be a viable alternative to tibial screw fixation for all-soft tissue quadriceps autograft. LEVEL OF EVIDENCE: III, comparative therapeutic trial.

Effect of Passing Plays on Injury Rates in the National Football League.

ABSTRACT: Burke, J, Geller, JS, Perez, JR, Naik, K, Vidal, AF, Baraga, MG, and Kaplan, LD. The effect of passing plays on injury rates in the national football league. J Strength Cond Res 35(12S): S1-S4, 2021-The National Football League (NFL) has one of the highest all-cause injury rates in sports, yet our understanding of extrinsic injury risk factors is limited. The objective of this study was to assess the effect of play type on injury incidence in the NFL. We obtained data for every regular season game played during the 2013-2016 seasons from the official NFL game books. There were 2,721 in-game injuries during the 4 seasons examined, with an overall rate of 1.33 injuries per team per game. For statistical analysis, p < 0.05 was considered significant. Passing plays conferred significantly higher odds of injury than running plays (odds ratio [OR] 1.4, 95% confidence interval [CI]: 1.3-1.5, p < 0.0001). This primarily stems from increased risks in quarterbacks (OR 6.9, 95% CI: 3.6-13.3, p < 0.0001), receivers (OR 5.0, 95% CI: 3.7-6.6, p < 0.0001), and defensive backs (OR 2.3, 95% CI: 1.9-2.7, p < 0.0001). Our study suggests that passing plays confer a greater risk of overall injuries in the NFL when compared with running plays, specifically regarding concussions and core or trunk injuries.

Association Between Neuromuscular Variables and Graft Harvest in Soft Tissue Quadriceps Tendon Versus Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Autografts.

BACKGROUND: Quadriceps tendon (QT) autografts are increasingly popular for anterior cruciate ligament reconstruction (ACLR). However, no study has compared QT autografts with bone-patellar tendon-bone (BTB) autografts regarding the electromechanical delay (EMD), the peak torque (PT), and the rate of force development (RFD) in the superficial quadriceps muscles (rectus femoris [RF], vastus medialis [VM], and vastus lateralis [VL]). HYPOTHESES: We hypothesized (1) there would be a significantly lower PT, lower RFD, and longer quadriceps EMD of the operative limb for the QT versus the BTB autograft; (2) the PT, the RFD, and the quadriceps EMD of the operative limb would be significantly depressed compared with those of the nonoperative limb, regardless of the surgical technique; and (3) there would be greater increases in the RF EMD than in the VM or the VL EMD. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 34 patients (age, 18-40 years), who had undergone ACLR (QT, n = 17; BTB, n = 17) at least 1 year before testing and performed 3 perceived maximal effort isometric tests, which were time synchronized with surface electromyography (EMG) on their operative and nonoperative limbs, were included in this study. EMD, PT, and RFD data were analyzed using a 2 (limb) × 2 (graft) × 3 (repetition) mixed repeated-measures analysis of variance. RESULTS: The EMD, the PT, and the RFD were not significantly affected by graft choice. For the VL, a significant repetition × graft × limb interaction was detected for the VL EMD (P = .027; ηp = 0.075), with repetition 3 having longer EMD than repetition 2 (mean difference [MD], 16 milliseconds; P = .039). For the RF EMD, there was a significant repetition × limb interaction (P = .027; ηp = 0.074), with repetition 3 being significantly longer on the operative versus the nonoperative limb (MD, 24 milliseconds; P = .004). Further, the operative limb EMD was significantly longer for repetition 3 versus repetition 2 (MD, 17 milliseconds; P = .042). For the PT, there was a significant effect for repetition (P = .003; ηp = 0.114), with repetition 1 being significantly higher than both repetitions 2 (MD, 8.52 N·m; P = .001) and 3 (MD, 7.79 N·m; P = .031). For the RFD, significant limb (P = .034; ηp = 0.092) and repetition (P = .010; ηp = 0.093) effects were seen, with the nonoperative limb being significantly faster than the operative limb (MD, 23.7 N·m/s; P = .034) and repetition 1 being significantly slower than repetitions 2 (MD, -20.46 N·m/s; P = .039) or 3 (MD, -29.85 N·m/s; P = .002). CONCLUSION: The EMD, the PT, and the RFD were not significantly affected by graft type when comparing QT and BTB autografts for ACLR; however, all neuromuscular variables were affected regardless of the QT or the BTB harvest.

Rehabilitation Protocols for Superior Capsular Reconstruction Are Variable: A Systematic Review.

PURPOSE: To screen manuscripts that discuss rehabilitation protocols for patients who underwent superior capsular reconstruction (SCR) to elucidate whether a standard rehabilitation algorithm exists for SCR. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (i.e., PRISMA) guidelines. PubMed (MEDLINE) and Embase were searched using pertinent Boolean operation terms "superior capsular reconstruction" and "rotator cuff repair rehabilitation," and articles that included rehabilitation protocols following superior capsular reconstruction surgery were reviewed. Two independent reviewers performed the search and quality assessment. RESULTS: A total of 549 articles were yielded after our database search. Fourteen studies fulfilled our inclusion criteria and were included in the review. Study designs included 9 editorials, 3 case series, and 2 case reports. Each study included in this review used a unique rehabilitation algorithm that posed significant variability between the protocols. Four phases were identified to summarize each protocol and were used as a basis of discussion-sling versus brace time (3-6 weeks for comfort/removal vs complete immobilization), passive range of motion (immediately after surgery to initiation at 6 weeks), active range of motion (4-8 weeks), and strengthening/return to full activity (12-52 weeks). Initiation of rehabilitation, length of time spent in each phase, types of exercises, and overarching goals for return to function were significantly variable and were decided upon by the surgeon based on current massive rotator cuff repair protocols. Presently, there is no standard rehabilitation protocol for SCR. CONCLUSIONS: SCR is a relatively new procedure that is gaining rapid popularity with promising outcomes. Based on our review, there is no standard rehabilitation protocol in place; thus, it is not possible to recommend an evidence-based rehabilitation protocol following SCR at this time. LEVEL OF EVIDENCE: Level V, systematic review of Level IV and V studies.

The 50 Most Cited Articles in Meniscal Injury Research.

BACKGROUND: Meniscal injuries are among the most common orthopaedic injuries, with a significant volume of published literature. PURPOSE: To perform a comprehensive bibliometric analysis that appropriately evaluates the 50 most cited articles in meniscal research. STUDY DESIGN: Cross-sectional study. METHODS: We performed a keyword search of the ISI Web of Knowledge database and then pared the results down to the 50 most cited articles using specific inclusion and exclusion criteria. Data extracted included title, first author, citation count, year of publication, topic, journal, article type, country of origin, and level of evidence. Correlation coefficients were calculated between publication date and citation density and between publication date and raw citation count. RESULTS: The 50 most cited articles were published from 1975 to 2013. The mean number of citations was 258.24 (range, 163-926; median, 225). The majority of articles were published in The American Journal of Sports Medicine (19%), the Journal of Bone and Joint Surgery (12%), and Arthritis & Rheumatology (14%). Most articles focused on either the anatomy and biomechanics of meniscal injury or on prevention and physical rehabilitation (12 papers each). CONCLUSION: The most popular fields of meniscal research involved anatomy/biomechanics and prevention/rehabilitation, and both are areas that will likely increase the probability of an article's being highly cited in the future. This study provided a quality selection of the most cited articles on meniscal injury and may provide a foundation for both beginner and senior clinician readers for further discussion and research.

Current Measurement Strategies of Coronal Tibiofemoral Subluxation: A Systematic Review of Literature.

OBJECTIVE. Coronal tibiofemoral (TF) subluxation has generated interest in the last several years due to newfound clinical implications of its presence. However, controversy within the literature concerning how to measure and calculate coronal TF subluxation on radiographic imaging remains. The purpose of this study was to describe how coronal TF subluxation is being measured and calculated in the literature with the goal of describing a reproducible and validated technique for clinical adoption. MATERIALS AND METHODS. A PubMed literature search was performed in March 2020 according to PRISMA guidelines. The terms "tibiofemoral subluxation" and "tibial femoral subluxation" were included in the search. Criteria of interest included radiographic view and evaluation, anatomic landmarks used, and measurement validity. RESULTS. Review of relevant literature resulted in 744 articles, 16 of which met our inclusion criteria. A wide range of measuring techniques, anatomic landmarks, and radiographic views were used with varying validity. Full-limb radiographic views were the most common. Six studies measured the translation of the mechanical axes of the tibia and femur. Eight studies measured the translation of either femoral condyle in reference to the tibial plateau. Coordinate-based software with the iterative closest point algorithm was used in two studies. Whether coronal TF subluxation should be divided by tibial plateau width to account for knee size was controversial. CONCLUSION. A variety of approaches exist for diagnosing and quantifying coronal TF subluxation because of the lack of clear anatomic landmarks within the TF joint that can be used to measure coronal TF subluxation in the horizontal plane. Even when using the same anatomic landmarks, studies varied on how to measure coronal TF subluxation radiographically and whether knee size should be accounted for. Further studies are necessary to standardize (via inter- and intraobserver validation with a control group) an easy, reproducible, and minimally biased approach to measuring coronal TF subluxation on radiographic imaging. We believe our systematic review succinctly provides the necessary information to either develop such a tool or encourage future studies to compare existing techniques to find the most reliable and clinically useful approach for evaluating coronal TF subluxation.

The Fifty Most-Cited Articles Regarding SLAP Lesions.

PURPOSE: To identify and evaluate the top 50 most-cited articles pertaining to SLAP tears. METHODS: The ISI Web of Knowledge database was used to conduct a query for articles pertaining to SLAP tears. Our query was conducted in April 2020 with multiple Boolean operative combinations performed by 2 independent reviewers. Articles on the final list were further reviewed to extract the following data: manuscript title, first author, total citation count, year of publication, citation density since publication, current citation rate since 2013, journal, country of origin, and level of evidence. RESULTS: Our initial search yielded 2,597 articles. Within this cohort, the top 50 publications pertaining to SLAP tears were identified that met our search criteria. The top article was cited 802 times while the 50th ranked article was cited 46 times. The average number of citations per publication was 131, whereas the average citation density since year of publication was 7.3. No strong correlations were found between citation density and year published. Twelve journals published articles pertaining to SLAP tears, with Arthroscopy accounting for the greatest number (15 articles, 30%). Most articles were graded with a level of evidence (LOE) of IV (n = 24, 48%), followed by review articles without LOE (n = 8, 16%). Only 2 articles achieved an LOE of I (4%). Articles typically addressed the arthroscopic management (n = 11, 22%), whereas anatomy/classification (n =10, 20%), and outcomes (n = 9, 18%) also were reported. CONCLUSIONS: This review provides a quantitative analysis of the most-referenced literature pertaining to SLAP tears. This body of knowledge helps surgeons search for literature regarding these injuries and identify trends regarding SLAP tear research. CLINICAL RELEVANCE: This research provides practitioners with an easily accessible and comprehensive collection of the major contributions regarding SLAP tears and offers insight into future areas for research.

Telehealth in an Orthopedic Sports Medicine Clinic: The First 100 Patients.

Background: Orthopedic specialties have begun to embrace telehealth as an alternative to in-person visits. We have not found studies assessing telehealth in sports medicine. Our goal is to evaluate patient perception of telehealth in an orthopedic sports medicine practice. Methods: Institutional review board (IRB) approval was obtained. The first 100 patients 18 years and older who had their initial videoconference telehealth appointment with our sports medicine providers from March to April 2020 were contacted at the conclusion of their visit. Surveys assessed satisfaction with telehealth, the provider, and whether attire played a role in their perception of the quality of the telehealth visit. Results: Patients on average stated excellent satisfaction with their visit (4.76 out of 5) and their provider (4.98 out of 5). Patients slightly disagreed with the notion that telehealth is equivalent to in-person provider visits (2.95 out of 5). This did not affect their perception to telehealth itself. It did not discourage patients from recommending telehealth or their provider to future patients. Patients overall felt that attire of the provider does not influence their opinion as to the standard of care they received. Returning patients versus new patient visits were more likely to recommend telehealth to others (4.83 vs. 4.56, p = 0.04). The responses from both groups were overwhelmingly positive. Conclusion: Telehealth is a viable clinic option in an orthopedic sports medicine clinic. Patients who have seen providers in-person previously are more likely to recommend telehealth versus new patients. New patients were satisfied with their telehealth experience. Level of Evidence:IV.

Is it necessary to tie the medial row in rotator cuff repair double-row constructs when using suture tape?

PURPOSE: To evaluate the selected biomechanical differences of a double-row trans-osseous equivalent rotator cuff repair with a knotless versus knot-tying medial row using suture tape in regard to repair displacement, stiffness, and ultimate load to failure. METHODS: In 16 fresh-frozen human shoulders (8 matched pairs), double-row rotator cuff repairs were performed with medial-row mattress knots (MK) on one side, the other without (NK). Two DVRT (Differential Variable Reluctance Transducer) sensors were attached between the humerus and 3 mm above the repair site and were used to measure the displacement across the repair during cycling. The biomechanical parameters measured were repair displacement, stiffness, and ultimate load to failure. The supraspinatus was loaded in a similar fashion to previously described protocol using cyclic loading and load to failure testing.1. RESULTS: All data from paired specimens were compared using paired Student t tests. No statistically significant difference (SSD) in displacement across the repair over the 200 cycles of the test was noted between the two groups (MK = 0.591 ± 0.501 mm; NK = 0.439 ± 0.417 mm, p = 0.618). No SSD in stiffness was noted between the two groups (MK = 32.87 ± 6.31 N/mm; NK = 27.98 ± 9.69 N/mm, p = 0.120). No SSD in ultimate load to failure was noted between the two groups (MK = 501.2 ± 126.1 N; NK = 416.8 ± 120.0 N, p = 0.116). CONCLUSION: There was no statistically significant different between knotless versus knotted medial row double row rotator cuff repair constructs using suture tape in regard to displacement across the repair site, stiffness and ultimate load to failure. Despite previous evidence suggesting inferiority of knotless medial row technique using suture constructs, this evidence may support the biomechanical equivalency of knotless medial row technique using suture tape.

The Effect of Thursday Night Games on In-Game Injury Rates in the National Football League.

BACKGROUND: Although claims of increased injury rates with Thursday night National Football League (NFL) games exist, a paucity of data exist substantiating these claims. PURPOSE: To evaluate the effect of rest between games on in-game injury rates as it pertains to overall injury incidence, location, and player position. STUDY DESIGN: Descriptive epidemiologic study. METHODS: Data were obtained from official NFL game books for regular season games from all 32 teams for the 2013-2016 seasons. All in-game injuries recorded in official game books were included. Rest periods between games were classified as short (4 days), regular (6-8 days), or long (≥10 days). Overall observed injury rates per team-game were analyzed in relation to different rest periods using negative binomial regression. For results with significant overall findings, pairwise comparisons were tested using the Wald chi-square test. Exploratory secondary analyses were performed in a similar fashion to assess differences in injury rates for the different rest periods when stratified by anatomic location and player position. RESULTS: A total of 2846 injuries were identified throughout the 4 seasons. There was an overall significant difference in injuries per team-game between short, regular, and long rest (P = .01). With short rest, an observed mean of 1.26 injuries per game (95% CI, 1.06-1.49) was significantly different from the 1.53 observed injuries per game with regular rest (95% CI, 1.46-1.60; P = .03), but not compared with the 1.34 observed injuries per game with long rest (P = .56). For player position, only the tight end, linebacker, and fullback group demonstrated significant differences between the injury rates for different rest categories. Quarterback was the only position with more injuries during games played on Thursday compared with both regular and long rest. This specific analysis was underpowered and the difference was not significant (P = .08). No differences were found regarding injury rates in correlation with differences in rest periods with different injury locations. CONCLUSION: A short rest period between games is not associated with increased rates of observed injuries reported in NFL game books; rather, our data suggest there are significantly fewer injuries for Thursday night games compared with games played on regular rest. Future research correlating rest and quarterback injury rates is warranted.

Supplement Use in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review.

PURPOSE: To assess whether a standardized dietary supplementation can help to decrease postoperative muscle atrophy and/or improve rehabilitation outcomes in patients who underwent anterior cruciate ligament reconstruction (ACLR). METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). MEDLINE, Scopus, and Cochrane Library databases were searched, and articles that examined protein or amino acid, vitamin, or any other type of supplementation in ACLR were reviewed. Two independent reviewers conducted the search using pertinent Boolean operations. RESULTS: A total of 1818 articles were found after our database search. Ten studies fulfilled our inclusion criteria and only assessed patients undergoing ACLR. Four studies assessed protein-based supplementation. One study assessed creatine as a supplement. Four studies assessed vitamin-based supplementation. One study assessed testosterone supplementation. Protein and amino acid supplementation showed potential benefits; multiple authors demonstrated a combination of improved achievement of rehabilitation benchmarks, graft maturation, muscular hypertrophic response, and peak dynamic muscle strength. When we examined creatine, vitamin, or hormone-based protocols, none demonstrated results, suggesting these factors may attenuate muscle atrophy after surgery. Vitamin C and E demonstrated potentially increased local inflammation in skeletal muscle, which runs contrary to the belief that antioxidant vitamin-based supplementation may decrease the inflammatory response that plays a role in the post injury/operative period. CONCLUSIONS: Protein-based supplementation may play a role in mitigating muscle atrophy associated with ACLR, as multiple authors demonstrated a combination of improved achievement of rehabilitation benchmarks, thigh hypertrophic response, and peak dynamic muscle strength. However, based on current literature, it is not possible to recommend a specific protein-based supplementation protocol at this time for patients undergoing ACLR. Limited evidence suggests no benefit for creatine, vitamin, or hormone-based protocols. LEVEL OF EVIDENCE: II, a systematic review of level I-II studies.

MRI of Superior Capsular Reconstruction.

Massive irreparable rotator cuff tears can be a challenging problem for arthroscopists in the perioperative setting because the typical treatment, reverse total shoulder arthroplasty, may not be the best option for all patients. Superior capsular reconstruction (SCR) is an advancing treatment option for patients with rotator cuff tears that are neither amenable to primary repair nor ideal for arthroplasty. Patient selection, which is strongly dependent on preoperative imaging findings, is an important step in obtaining favorable surgical outcomes. The tissue quality and tear type are particularly important when considering SCR for a patient. When unsuccessful SCR is suspected, postoperative MRI of the shoulder offers the surgeon and radiologist a means of evaluating the integrity and fixation of the graft. Fluid-sensitive MRI sequences are best for examining the final SCR construct, with high-signal-intensity fluid interruptions within the graft and the presence or worsening of shoulder arthropathy indicating graft failure. The indications for SCR are discussed, and the normal postoperative MRI findings after SCR are described in this review. In addition, the common types of SCR graft failure and associated imaging findings are described and illustrated. ©RSNA, 2020.

MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation.

BACKGROUND: Meniscal ramp lesions have been defined as longitudinal vertical peripheral tears of the medial meniscus involving the posterior meniscocapsular ligament, meniscotibial ligament, and/or the red-red zone of the posterior horn. They are heavily associated with anterior cruciate ligament injuries, and because of their potentially important biomechanical role in knee stabilization, injuries to this region may require surgical repair. However, due to their location and lack of general knowledge regarding their different types and associated appearances on magnetic resonance imaging, ramp lesions are routinely underreported. This is compounded by the fact that ramp lesions are also often overlooked during conventional anterior portal arthroscopy when direct visualization is not achieved. PURPOSE: To demonstrate MRI appearances and arthroscopic findings of the different types of meniscal ramp lesions, in the hopes of improving their detection on pre-operative imaging.

Magnetic resonance imaging of the quadriceps tendon autograft in anterior cruciate ligament reconstruction.

BACKGROUND: Quadriceps tendon (QT) autograft is emerging as a popular technique for primary anterior cruciate ligament (ACL) reconstruction. Studies have shown that it has comparable outcomes to bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts while mitigating post-operative complications associated with these grafts. PURPOSE: To provide a literature summary of the important pre- and post-operative magnetic resonance imaging (MRI) findings of the quadriceps tendon and pertinent postoperative complications associated with the QT harvest. Radiologists should be familiar with MR findings after autologous graft harvest of the quadriceps tendon for reconstruction of the ACL. LEVEL OF EVIDENCE: Level IV.