Traumatic Primary Anterior Glenohumeral Joint Dislocation in Sports: A Systematic Review of Operative versus Nonoperative Management.

Anterior shoulder (glenohumeral joint [GHJ]) dislocations are relatively common injuries in sports. Previous studies have evaluated clinical outcomes of operative and nonoperative management for primary traumatic anterior GHJ dislocations. The purpose of this study was to systematically review the literature in an effort to provide a thorough analysis of patients after undergoing closed reduction of a traumatic anterior GHJ dislocation, particularly among the athletic population. Two independent reviewers performed a comprehensive search of PubMed and the Cochrane Library through February 23, 2020. Unfortunately, the quantity and quality of published articles on this subject is very limited. In many studies, younger age (between 21 and 30 years) was associated with greater risk for recurrence of GHJ dislocations. Twelve studies (total N = 753) directly compared outcomes of operative versus nonoperative management. It seems that operative management significantly reduces recurrence rates with patients treated operatively among the young and active population. Operative management should be considered as a treatment option for young and athletic patients presenting with a first-time anterior GHJ dislocation.

Demographics and Clinical Outcomes of Patients Undergoing Anterior Cruciate Ligament Reconstruction with a Planned or Unplanned Hybrid Graft.

The purpose of this study was to report the demographics and clinical outcomes of patients at our institution following anterior cruciate ligament reconstruction (ACLR) with a planned or unplanned hybrid autograft-allograft. At a minimum 2-year follow-up, patients at our institution who had undergone primary ACLR with a planned (P) or unplanned (U) hybrid graft using fresh-frozen allografts were contacted to complete a survey containing the Knee Injury and Osteoarthritis Outcome Score, Subjective International Knee Documentation Committee score, Single Assessment Numeric Evaluation, 12-Item Short Form Health Survey, and visual analog scale for activity level. Demographics were compared between groups. Patient-reported outcomes (PROs) and a revision rate were reported for each group. Mean follow-up among all patients was 3.3 years. Revision rate at follow-up was 0.8 and 6.3% in the P and U groups, respectively (p = 0.03). Among patients reached for follow-up (90 P, 30 U), a lower proportion of males was found in the unplanned hybrid graft group (P: 52%, U: 23%, p < 0.01). Unplanned hybrid graft patients were significantly younger at the time of surgery (P: 41.0 years, U: 31.0 years, p < 0.0001). Graft size did not differ between groups (P: 9.1 mm, U: 8.9 mm, p = 0.11). Patients in both groups achieved moderate to high PROs. Demographics differ between patients undergoing ACLR with a planned or unplanned hybrid graft. Patients with a planned hybrid graft are at a significantly reduced risk of postoperative graft failure, likely due to the older age of this group.

Nonarthroplasty Surgical Treatment Options for Massive, Irreparable Rotator Cuff Tears.

Massive, irreparable rotator cuff tears (MIRCTs) provide a significant dilemma for orthopaedic surgeons. One treatment option for MIRCTs is reverse total shoulder arthroplasty. However, other methods of treating these massive tears have been developed. A search of the current literature on nonoperative management, arthroscopic debridement, partial repair, superior capsular reconstruction (SCR), graft interposition, balloon spacer arthroplasty, trapezius transfer, and latissimus dorsi transfer for MIRCTs was performed. Studies that described each surgical technique and reported on clinical outcomes were included in this review. Arthroscopic debridement may provide pain relief by removing damaged rotator cuff tissue, but no functional repair is performed. Partial repair has been suggested as a technique to restore shoulder functionality by repairing as much of the rotator cuff tendon as possible. This technique has demonstrated improved clinical outcomes but also fails at a significantly high rate. SCR has recently gained interest as a method to prohibit superior humeral head translation and has been met with encouraging early clinical outcomes. Graft interposition bridges the gap between the retracted tendon and humerus. Balloon spacer arthroplasty has also been recently proposed and acts to prohibit humeral head migration by placing a biodegradable saline-filled spacer between the humeral head and acromion; it has been shown to provide good clinical outcomes. Both trapezius and latissimus dorsi transfer techniques involve transferring the tendon of these respective muscles to the greater tuberosity of the humerus; these 2 techniques have shown promising restoration in shoulder function, especially in a younger, active population. Arthroscopic debridement, partial repair, SCR, graft interposition, balloon spacer arthroplasty, trapezius transfer, and latissimus dorsi transfer have all been shown to improve clinical outcomes for patients presenting with MIRCTs. Randomized controlled trials are necessary for confirming the efficacy of these procedures and to determine when each is indicated based on specific patient and anatomic factors.

Manuscript Submission Patterns of Authors Publishing in Orthopaedic Sports Medicine Journals.

BACKGROUND: Previous studies have examined the most cited articles in orthopaedic sports medicine research and the journals in which they were published. PURPOSE: To analyze the manuscript submission patterns of authors who published manuscripts in various orthopaedic sports medicine journals. STUDY DESIGN: Cross-sectional study. METHODS: All articles published in the March 2017 and April 2017 issues of Arthroscopy, the American Journal of Sports Medicine (AJSM), Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA), and the Orthopaedic Journal of Sports Medicine (OJSM) were searched. In addition, the past 50 sports medicine-related articles published in the Journal of Bone and Joint Surgery (JBJS) dating back from April 2017 to May 2015 were searched. The corresponding author of each article was asked whether the publishing journal was the first journal of submission. If the article was previously submitted elsewhere, authors were asked which other journals, the dates of submission, and the order of submission. The proportion of articles that were initially submitted to each journal, the mean number of submissions prior to publication, and the mean duration from initial submission to date of publication were calculated for each journal. RESULTS: A total of 298 articles were included in this study, and 221 (74%) corresponding authors responded to the survey. The mean number of submissions before acceptance was 1.05 for AJSM, 1.18 for JBJS, 1.20 for KSSTA, 1.38 for Arthroscopy, and 2.19 for OJSM. The percentage of articles that were submitted to their accepting journal first (ie, not previously submitted elsewhere) was 95% for AJSM, 85% for JBJS, 82% for KSSTA, 68% for Arthroscopy, and 13% for OJSM. CONCLUSION: Among the orthopaedic sports medicine journals included in this study, articles published in AJSM have the highest percentage of first submissions.

Is Delayed Weightbearing After Matrix-Associated Autologous Chondrocyte Implantation in the Knee Associated With Better Outcomes? A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Proper rehabilitation after matrix-associated autologous chondrocyte implantation (MACI) is essential to restore a patient's normal function without overloading the repair site. PURPOSE: To evaluate the current literature to assess clinical outcomes of MACI in the knee based on postoperative rehabilitation protocols, namely, the time to return to full weightbearing (WB). STUDY DESIGN: Systematic review; Level of evidence, 1. METHODS: A systematic review was performed to locate studies of level 1 evidence comparing the outcomes of patients who underwent MACI with a 6-week, 8-week, or 10/11-week time period to return to full WB. Patient-reported outcomes assessed included the Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity scale, Short Form Health Survey-36 (SF-36), and visual analog scale (VAS) for pain frequency and severity. RESULTS: Seven studies met the inclusion criteria, including a total of 136 patients (138 lesions) who underwent MACI. Treatment failure had occurred in 0.0% of patients in the 6-week group, 7.5% in the 8-week group, and 8.3% in the 10/11-week group at a mean follow-up of 2.5 years (P = .46). KOOS, SF-36, and VAS scores in each group improved significantly from preoperatively to follow-up (P < .001). CONCLUSION: Patients undergoing MACI in the knee can be expected to experience improvement in clinical outcomes with the rehabilitation protocols outlined in this work. No significant differences were seen in failure rates based on the time to return to full WB.

Evolving Treatment Patterns of NFL Players by Orthopaedic Team Physicians Over the Past Decade, 2008-2016.

BACKGROUND: Previous studies have analyzed the treatment patterns used to manage injuries in National Football League (NFL) players. HYPOTHESIS: Treatment patterns for injuries in NFL players will have changed over the study period. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 5. METHODS: The head orthopaedic team physicians for all 32 NFL teams were asked to complete a survey containing questions regarding experience as team physician, medical coverage of the team, and treatment preferences for some of the most common injuries occurring in football players. Responses from the current survey were compared with responses from the same survey sent to NFL team physicians in 2008. RESULTS: Responses were received from 31 (31/32, 97%) NFL team physicians in 2008 and 29 (29/32, 91%) NFL team physicians between April 2016 and May 2017. The proportion of physicians preferring patellar tendon autograft in anterior cruciate ligament (ACL) reconstruction increased from 87% in 2008 to 97% in 2016 ( P = 0.054). In 2008, 49% of physicians allowed return to contact after ACL reconstruction at 6 months or less as compared with only 14% of physicians in 2016 ( P = 0.033). In 2008, 93% of physicians used Toradol injections prior to a game to help with nagging injuries. Toradol injection utilization decreased to 48% of physicians in 2016 ( P < 0.001). Seventy-nine percent of physicians would administer 5 or more Toradol injections prior to a game in 2008, as compared with 28% of physicians in 2016 ( P < 0.0001). CONCLUSION: Orthopaedic physicians have changed their injury treatment preferences for professional football players. In particular, physicians have become more cautious with allowing players to return to play after ACL reconstruction and with the use of pregame Toradol injections. CLINICAL RELEVANCE: Expert opinions can help guide treatment decisions and lead to better care of all athletes.

The Evolving Treatment Patterns of NCAA Division I Football Players by Orthopaedic Team Physicians Over the Past Decade, 2008-2016.

BACKGROUND: Previous studies have analyzed the treatment patterns used to manage injuries in National Collegiate Athletic Association (NCAA) Division I football players. HYPOTHESIS: Treatment patterns used to manage injuries in NCAA Division I football players will have changed over the study period. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 5. METHODS: The head orthopaedic team physicians for all 128 NCAA Division I football teams were asked to complete a survey containing questions regarding experience as team physician, medical coverage of the team, reimbursement issues, and treatment preferences for some of the most common injuries occurring in football players. Responses from the current survey were compared with responses from the same survey sent to NCAA Division I team physicians in 2008. RESULTS: Responses were received from 111 (111/119, 93%) NCAA Division I orthopaedic team physicians in 2008 and 115 (115/128, 90%) orthopaedic team physicians between April 2016 and April 2017. The proportion of team physicians who prefer a patellar tendon autograft for primary anterior cruciate ligament reconstruction (ACLR) increased from 67% in 2008 to 83% in 2016 ( P < 0.001). The proportion of team physicians who perform anterior shoulder stabilization arthroscopically increased from 69% in 2008 to 93% in 2016 ( P < 0.0001). Of team physicians who perform surgery for grade III posterior cruciate ligament (PCL) injuries, the proportion who use the arthroscopic single-bundle technique increased from 49% in 2008 to 83% in 2016 ( P < 0.0001). The proportion of team physicians who use Toradol injections prior to a game to help with nagging injuries decreased from 62% in 2008 to 26% in 2016 ( P < 0.0001). CONCLUSION: Orthopaedic physicians changed their injury treatment preferences for NCAA Division I football players over the study period. In particular, physicians have changed their preferred techniques for ACLR, anterior shoulder stabilization, and PCL reconstruction. Physicians have also become more conservative with pregame Toradol injections. CLINICAL RELEVANCE: These opinions may help guide treatment decisions and lead to better care of all athletes.

Knee Osteoarthritis After Anterior Cruciate Ligament Reconstruction With Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autograft: A Systematic Review of Randomized Controlled Trials.

PURPOSE: The primary purpose of this study was to systematically review high-quality studies in the literature to compare the postoperative radiographic incidence of knee osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) versus hamstring tendon (HT) autograft. The secondary purpose of this study was to compare other symptoms of postoperative knee OA between these 2 groups through patient-reported outcome scores and knee range of motion. METHODS: A systematic review was performed by searching PubMed, Embase, and Cochrane Library to locate randomized controlled trials that compared postoperative progression of knee OA in patients who had undergone ACLR with BPTB versus HT autograft. Search terms used were "anterior cruciate ligament reconstruction," "patellar tendon," "hamstring," "randomized," and "osteoarthritis." Patients were assessed based on radiographic evaluation (Kellgren-Lawrence, Ahlbäck, Fairbank, and the Objective International Knee Documentation Committee scales), patient-reported outcome scores (Knee Injury and Osteoarthritis Outcome Score and visual analog scale scores), graft failure, and active knee flexion and extension deficit. RESULTS: Eight studies (6 Level I, 2 Level II) were identified that met inclusion criteria, including a total of 237 and 268 nonoverlapping patients who had undergone ACLR with BPTB and HT autograft, respectively, with a mean follow-up of 11.5 years (range, 3-16 years). Graft failure was experienced by 7.0% of patients in each group (P = .99). A Kellgren-Lawrence grade ≥2 was found in 52.0% and 51.0% of BPTB and HT autograft patients, respectively (P = .85). An Ahlbäck and Fairbank grade ≥2 was found in 5.0% and 8.4% of BPTB and HT autograft patients, respectively (P = .36). There were no significant differences in any patient-reported outcomes between groups within any study. CONCLUSIONS: Patients undergoing ACLR with BPTB autograft or HT autograft can be expected to experience a similar incidence of postoperative knee OA at long-term follow-up. LEVEL OF EVIDENCE: Level II, systematic review of Level I and II studies.

What is the Value of a National Football League Draft Pick? An Analysis Based on Changes Made in the Collective Bargaining Agreement.

Kraeutler, MJ, Carver, TJ, Belk, JW, and McCarty, EC. What is the value of a National Football League draft pick? An analysis based on changes made in the collective bargaining agreement. J Strength Cond Res 32(6): 1656-1661, 2018-The purpose of this study was to analyze and compare the value of players drafted in early rounds of the National Football League (NFL) Draft since the new collective bargaining agreement began in 2011. The NFL's player statistics database and database of player contract details were searched for players drafted in the first 3 rounds of the 2011 to 2013 NFL Drafts. Performance outcomes specific to each position were divided by each player's salary to calculate a value statistic. Various demographics, NFL Combine results, and total number of games missed because of injury were also recorded for each player. These statistics were compared within each position between players selected in the first round of the NFL Draft (group A) vs. those drafted in the second or third round (group B). A total of 147 players were included (group A 35, group B 112). Overall, players in group A were significantly taller (p ≤ 0.01) and heavier (p = 0.037) than players in group B. Group B demonstrated significantly greater value statistics than group A for quarterbacks (p = 0.028), wide receivers (p ≤ 0.001), defensive tackles (p = 0.019), and cornerbacks (p ≤ 0.001). No significant differences were found between groups with regard to number of games missed because of injury. Players drafted in the second or third rounds of the NFL Draft often carry more value than those drafted in the first round. NFL teams may wish to more frequently trade down in the Draft rather than trading up.

An Analysis of Duplicate Presentations at the 2014 Through 2016 AOSSM and AANA Annual Meetings.

BACKGROUND: Previous studies have shown a high incidence of duplicate presentations at research conferences within different medical disciplines. PURPOSE: To determine the rate and analyze characteristics of duplicate presentations at the American Orthopaedic Society for Sports Medicine (AOSSM) and Arthroscopy Association of North America (AANA) Annual Meetings. STUDY DESIGN: Cross-sectional study. METHODS: Meeting programs for the 2014 to 2016 AOSSM and AANA Annual Meetings were searched. All podium presentation abstracts from each AOSSM meeting were cross-referenced with podium presentation abstracts from AANA meetings from all 3 years of the study period to locate all duplicate presentations. Duplicate presentations were then analyzed for changes in abstract title, author order, and addition or removal of authors. RESULTS: A total of 192 and 213 abstracts were accepted for podium presentations at the AOSSM and AANA Annual Meetings, respectively, during the study period. This included 65 presentations at the 2014 AOSSM Annual Meeting, 72 in 2015, and 55 in 2016. Overall, 28 AOSSM presentations (15%) were also presented at an AANA Annual Meeting, including 9 (14%) from the 2014 AOSSM meeting, 15 (21%) from the 2015 meeting, and 4 (7%) from the 2016 meeting. Of the 28 duplicate presentations, authors often altered their abstracts in several ways, including changing the abstract title (14; 50%), changing the author order (17; 61%), and adding or removing authors (10; 36%). Duplication rates were not significantly different between the years (P = .10). CONCLUSION: A moderate proportion of abstracts presented at the AOSSM and AANA Annual Meetings are duplicates. Meeting committees may want to consider stricter guidelines to ensure only original work is presented at these meetings.