Prior Acromioplasty Provides Similar Outcomes and Rate of Postoperative Complications Including Acromial Fracture After Reverse Total Shoulder Arthroplasty: A Retrospective Matched-Cohort Analysis.

Purpose: To compare outcomes of reverse total shoulder arthroplasty (RTSA) in patients with prior arthroscopic acromioplasty versus a control group of patients with no history of acromioplasty. Methods: We performed a retrospective matched-cohort study of patients from a single institution who underwent RTSA with a history of acromioplasty from 2009 to 2017 with a minimum 2-year follow-up period. Patients' clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons shoulder score and Simple Shoulder Test, visual analog scale, and Single Assessment Numeric Evaluation surveys. Postoperative radiographs and patient charts were reviewed to determine whether patients sustained a postoperative acromial fracture. Charts were reviewed to determine range of motion and postoperative complications. Patients were matched on a 1:1 basis to a cohort of patients who underwent RTSA without a history of acromioplasty, and comparisons were performed using t and χ2 tests. Results: Forty-five patients who underwent RTSA with a history of acromioplasty met the inclusion criteria and completed the outcome surveys. There were no significant differences between cases and controls in post-RTSA American Shoulder and Elbow Surgeons, visual analog scale, Simple Shoulder Test, or Single Assessment Numeric Evaluation outcome scores. There was no difference in the postoperative acromial fracture rate between cases and controls (P = .577). Overall, more complications occurred in the study group (n = 6, 13.3%) compared with the control group (n = 4, 8.9%); however, this difference was not statistically significant (P = .737). Conclusions: After RTSA, patients who have undergone a prior acromioplasty have similar functional outcomes without a significant difference in the rate of postoperative complications compared with patients with no history of acromioplasty. Furthermore, previous acromioplasty does not increase the risk of acromial fracture after RTSA. Level of Evidence: Level III, retrospective comparative study.

The impact of elective surgery restrictions during the COVID-19 (coronavirus disease 2019) pandemic on shoulder and elbow surgery: patient perceptions.

BACKGROUND: In late 2019 and early 2020, a novel coronavirus, COVID-19 (coronavirus disease 2019), spread across the world, creating a global pandemic. In the state of Pennsylvania, non-emergent, elective operations were temporarily delayed from proceeding with the normal standard of care. The primary purpose of this study was to determine the proportion of patients who required prescription pain medication during the surgical delay. Secondarily, we sought to determine the proportion of patients who perceived their surgical procedure as non-elective and to evaluate how symptoms were managed during the delay. MATERIALS AND METHODS: A single institutional database was used to retrospectively identify all shoulder and elbow surgical procedures scheduled between March 13 and May 6, 2020. Charts were manually reviewed. Patients who underwent non-shoulder and elbow-related procedures and patients treated by surgeons outside of Pennsylvania were excluded. Patients whose surgical procedures were postponed or canceled were administered a survey evaluating how symptoms were managed and perceptions regarding the delay. Preoperative functional scores were collected. Statistical analysis was performed to determine associations between procedure status, preoperative functional scores, perception of surgery, and requirement for prescription pain medication. RESULTS: A total of 338 patients were scheduled to undergo shoulder and elbow surgery in our practice in Pennsylvania. Surgery was performed as initially scheduled in 89 of these patients (26.3%), whereas surgery was postponed in 179 (71.9%) and canceled in 70 (28.1%). The average delay in surgery was 86.7 days (range, 13-299 days). Responses to the survey were received from 176 patients (70.7%) in whom surgery was postponed or canceled. During the delay, 39 patients (22.2%) required prescription pain medication. The surgical procedure was considered elective in nature by 73 patients (41%). One hundred thirty-seven patients (78%) would have moved forward with surgery if performed safely under appropriate medical guidelines. Lower preoperative American Shoulder and Elbow Surgeons scores (r = -0.36, P < .001) and Single Assessment Numeric Evaluation scores (r = -0.26, P = .016) and higher preoperative visual analog scale scores (r = 0.28, P = .009) were correlated with requiring prescription pain medication. Higher preoperative American Shoulder and Elbow Surgeons scores were positively correlated with perception of surgery as elective (r = 0.4, P < .001). CONCLUSION: Patients undergoing elective shoulder and elbow surgical procedures during the COVID-19 (coronavirus disease 2019) pandemic experienced a delay of nearly 3 months on average. Fewer than half of patients perceived their surgical procedures as elective procedures. Nearly one-quarter of patients surveyed required extra prescription pain medicine during the delay. This study elucidates the fact that although orthopedic shoulder and elbow surgery is generally considered "elective," it is more important to a majority of patients. These findings may also be applicable to future potential mandated surgical care delays by other third-party organizations.

Articular Cartilage Damage Worsens from First-time to Recurrent Patellar Dislocation-A Longitudinal Magnetic Resonance Imaging Study.

Purpose: To compare the frequency and severity of articular cartilage injury on longitudinal magnetic resonance imaging (MRI) in patients after their initial dislocation and subsequent recurrent dislocations for those undergoing patellar stabilization surgery. Methods: Between January 2012 and December 2017, patients undergoing patellar stabilization surgery were retrospectively reviewed. Only patients with an MRI after both the initial dislocation and subsequent dislocation events were included. The MRI scans were blindly examined to assess the Outerbridge classification grade of articular cartilage injury following each dislocation. Comparison was performed of each MRI for grade of articular cartilage damage and location. Results: Thirty-five patients undergoing patellar stabilization surgery with recurrent instability were eligible. The incidence of articular cartilage injury following initial dislocation was 45.7%. Following a second dislocation, the incidence of articular cartilage injury increased to 62.9%, a statistically significant increase of 17.2% (P = .031). Furthermore, of the 16 patients with articular cartilage injury following their initial dislocation, 56.2% of patients (9) had an increase in grade of articular cartilage injury following the second dislocation, whereas 43.8% (7) of patients had no progression in their articular cartilage injury. Six (17.1%) patients had no articular cartilage injury following their initial dislocation but did have articular cartilage injury following their second dislocation. Conclusions: Articular cartilage injury following patellar dislocation is common, and delayed surgical treatment may lead to an increase in articular cartilage damage. The incidence of articular cartilage injury following recurrent patellar dislocation was high (62.9%), and the majority of patients experienced an increase in their articular cartilage injury grade between their initial and recurrent dislocation on MRI evaluation. Level of Evidence: Level IV, retrospective case series.

Knotted Versus Knotless Medial-Row Transosseous-Equivalent Double-Row Rotator Cuff Repairs Have Similar Clinical and Functional Outcomes.

Purpose: To retrospectively investigate the clinical and functional outcomes of patients who underwent knotted medial-row rotator cuff repair (KT-RCR) compared with patients who underwent knotless medial-row rotator cuff repair (KL-RCR). Methods: A retrospective chart review of patients who underwent double-row transosseous-equivalent rotator cuff repair in 2016 was performed at a single institution with 2-year follow-up. Information regarding demographic characteristics, preoperative tear size (magnetic resonance imaging), surgical variables (including method of suture stabilization), preoperative and postoperative American Shoulder and Elbow Surgeons (ASES) scores, and all complications (e.g., cuff failure, adhesive capsulitis, and persistent pain) was compiled. Results: A total of 189 patients met the inclusion criteria: 72 in the KL-RCR group and 117 in the KT-RCR group. No significant difference in preoperative ASES scores was found between the KL-RCR and KT-RCR groups (48.3 vs 45.4, P = .327). Postoperative ASES scores did not differ between the groups (82.4 for KL-RCR vs 78.8 for KT-RCR, P = .579). We found no significant difference in cuff failure rates after 2 years, determined by magnetic resonance imaging (5.6% for KL-RCR vs 6.1% for KT-RCR, P > .999), or complication rates (11.1% for KL-RCR vs 8.6% for KT-RCR, P = .743). Conclusions: The knotted approach and knotless approach to double-row rotator cuff repair showed similar outcome scores, cuff failure rates, and complication rates at minimum 2-year follow-up. Level of Evidence: Level III, retrospective therapeutic comparative trial.

Safer Return to Play After Anterior Cruciate Ligament Reconstruction: Evaluation of a Return-to-Play Checklist.

Background: Questions remain regarding the traditional protocols used in rehabilitation and clearance for return to sports after anterior cruciate ligament reconstruction (ACLR). Purpose/Hypothesis: To investigate the impact on injury rates after return to sports by developing and validating a Safer Return to Play Following ACL Reconstruction Checklist consisting of subjective and objective functional tests that can be quickly and easily implemented into a sports medicine practice. It was hypothesized that patients who successfully passed the checklist before returning to sports would experience lower rates of ipsilateral and contralateral knee injuries at a 2-year follow-up as compared with patients who returned to play before completing the checklist. Study Design: Cohort study; Level of evidence, 2. Methods: First, a systematic review was performed to generate a list of the most common outcome measures used to assess return to play after ACLR. To refine our checklist, we conducted a survey with an expert panel of 10 medical professionals utilizing the Delphi technique. After the creation of the checklist, validation was performed by prospectively evaluating patients who had undergone ACLR for injury of the ipsilateral or contralateral knee, with a minimum 2-year follow-up. Results: After our systematic review of 60 studies, 7 criteria were included in the final checklist. During the period studied, October 2014 to December 2017, a total of 222 patients met the inclusion criteria and were enrolled in the study. At a minimum 2 years of follow-up, there were 146 patients who successfully passed the checklist and 38 who did not. Overall, 24 (16.4%) patients who had passed the checklist sustained an injury to either knee, as compared with 10 (26.3%) from the group that did not pass the checklist (P = .162). Of the group that passed the checklist, 8 (5.5%) patients sustained an injury to the ipsilateral knee, as compared with 7 (18.4%) in the group that did not pass (P = .017). Conclusion: Prospective validation of our checklist demonstrated that patients who successfully passed the checklist before returning to play experienced a significantly lower incidence of ipsilateral anterior cruciate ligament injury as compared with patients who did not pass the checklist.

Evaluation of Rotator Cuff Repair With and Without Concomitant Biceps Intervention: A Retrospective Review of Patient Outcomes.

BACKGROUND: Biceps tendon pathology is common in patients with rotator cuff tears. Leaving biceps pathology untreated in rotator cuff repairs (RCRs) may lead to suboptimal outcomes. PURPOSE/HYPOTHESIS: The purpose was to compare clinical outcomes between patients who underwent isolated RCR versus patients who underwent RCR with concomitant biceps treatment. It was hypothesized that there would be no difference in clinical outcomes between groups. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 244 patients who underwent RCR in 2016 were included. Patient characteristics, presence of concomitant biceps pathology, pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores, rotator cuff failure, revision surgery, and complications were recorded. RESULTS: There were no significant differences between patients who underwent isolated RCR (n = 143) and those who underwent RCR with biceps treatment (n = 101) at 2 years postoperatively in ASES scores (RCR, 81.5; RCR+biceps treatment, 79.5; P = .532), cuff failure rate (5.6% vs 4.0%; P = .760), revision RCR rate (3.5% vs 2.0%; P = .703), or complication rate (11.9% vs 5.0%; P = .102). Furthermore, when comparing concomitant biceps tenotomy (n = 30) versus concomitant biceps tenodesis (n = 71), there were no differences in ASES scores (P = .149), cuff failure rate (P > .999), revision RCR rate (P > .999), or complication rate (P > .999) postoperatively. Finally, when comparing arthroscopic biceps tenodesis (n = 50) versus subpectoral biceps tenodesis (n = 21), there were no differences in ASES scores (P > .592), cuff failure rate (P > .999), revision RCR rate (P = .507), or complication rate (P > .999) 2 years postoperatively. CONCLUSION: Addressing biceps pathology when performing RCR resulted in similar rates of cuff failure, revision RCR, and complications, as well as a similar improvement in patient-reported outcomes when compared with isolated RCR at 2 years postoperatively. Furthermore, when comparing tenotomy versus tenodesis and arthroscopic versus subpectoral tenodesis, comparable outcomes with regard to rate of rotator cuff repair failure, revision RCR, complications, and patient-reported outcomes were found.

Establishing maximal medical improvement following aseptic revision of shoulder arthroplasty.

BACKGROUND: Shoulder arthroplasty surgery volume continues to increase yearly. As the prevalence of shoulder replacement continues to rise, there will be a growing number of revision surgeries performed for a variety of indications. Understanding patient outcomes and recovery time following these procedures is critical, particularly as it relates to revision surgery, which generally has worse outcomes and longevity than primary arthroplasty. The point at which the peak of potential improvement is reached can be defined as the point of maximal medical improvement (MMI). The timing to MMI has previously been reported in the literature following both primary anatomic and reverse total shoulder arthroplasty. However, to our knowledge, timing to MMI following revision shoulder arthroplasty has not been defined. The purpose of the present study, therefore, is to establish the time to MMI following aseptic revision shoulder arthroplasty using validated patient-reported outcome measures. MATERIALS AND METHODS: A retrospective cohort study was conducted following patients who underwent aseptic revision shoulder arthroplasty over a defined 3-year period. Multiple fellowship-trained shoulder and elbow surgeons from a single institution performed all operations. Those with at least 24 months of follow-up and multiple time points of postoperative patient-reported outcome scores were included in the analysis. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores and Single Assessment Numeric Evaluation (SANE) scores were prospectively recorded and followed over time. Exclusion criteria included revision surgeries done for infection, staged procedures following infection, and revision for periprosthetic fracture. RESULTS: Twenty-two patients met inclusion criteria. The mean preoperative ASES and SANE scores were 41.8 and 30.5, respectively. There was a trend toward improvement in both the ASES and SANE scores through the 6-9-month postoperative follow-up point, at which point clinically significant improvement was achieved, with mean values of, respectively, 76.9 and 81.2. No further improvement was achieved 9 months after surgery, although scores were generally maintained through an average final follow-up of 30 months, with final ASES and SANE scores of 70.1 and 67.8, respectively. CONCLUSIONS: Following aseptic revision shoulder arthroplasty, clinically significant improvements in patient-reported outcome scores are seen up to 9 months postoperatively, the point at which MMI is achieved. These findings serve to guide clinicians in counseling patients regarding their expected postoperative recovery following revision shoulder arthroplasty.

Outcomes of instability after reverse shoulder arthroplasty: reoperation and persistent instability are common.

HYPOTHESIS: Although risk factors for instability after reverse shoulder arthroplasty (RSA) have been extensively studied, the outcomes of patients who experience instability are unknown. The purpose of this study was to evaluate functional outcomes in patients with instability after RSA. METHODS: We retrospectively identified patients with instability after RSA with a minimum of 2 years' follow-up from an institutional database. Baseline data were recorded, and all patients we contacted to obtain clinical outcome scores. Patients who required revision surgery and those treated successfully with closed reduction were compared. RESULTS: Fifty patients were included. Of these patients, 40 (80%) required revision surgery whereas 10 (20%) were treated successfully with closed reduction. At an average follow-up of 63.7 months (range, 24-123 months), outcome scores did not differ between groups. Patients who required revision surgery were more likely to have undergone previous shoulder surgery, prior to their index arthroplasty (P = .031). Seventeen patients (42.5%) reported recurrent instability following revision surgery, and 14 (35.0%) required additional revision surgery. Ultimately, stability was never achieved in 7 of 50 patients (14%) after their index instability event. CONCLUSION: Although instability after RSA can commonly be corrected with reasonable functional results, multiple procedures may be needed and some patients may experience persistent instability.

Ulnar collateral ligament reconstruction in javelin throwers: an analysis of return to play rates and patient outcomes.

BACKGROUND: Although results after ulnar collateral ligament reconstruction (UCLR) in baseball players have been well documented, the literature is replete regarding the outcomes after UCLR in javelin throwers. PURPOSE: To report outcomes after UCLR in javelin throwers. HYPOTHESIS: UCLR in javelin throwers will result in a high rate of return to play similar to that of previously published studies from athletes of other sports. METHODS: All patients who were identified preoperatively as javelin throwers and underwent UCLR between 2011 and 2017 with a minimum 2-year follow-up were eligible for inclusion. Patients were assessed with the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score, Timmerman-Andrews Elbow score, Conway-Jobe score, patient satisfaction, return to sport rate questionnaire, and the occurrence of any postoperative complications. RESULTS: Eighteen patients met the inclusion criteria. Complete follow-up was available in 16 (88.9%) patients. The average age at surgery was 21.2 ± 2.0 (range, 18.6-24.9) years. At the final follow-up, the average Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score and Timmerman-Andrews Elbow score were 77.3 (range, 18.7-98.4) and 91.8 (range, 70.0-100.0), respectively. Outcomes on the Conway-Jobe scale were as follows: excellent (n = 6; 37.5%), good (n = 4; 25%), fair (n = 6; 37.5%). Ten (62.5%) patients returned to play at an average of 12.2 ± 3.6 (range, 6.0-18.0) months after surgery. Two (12.5%) patients sustained a shoulder injury postoperatively; however, neither required surgery. CONCLUSION: UCLR in javelin throwers results in good outcomes with a low rate of reinjury/reoperation. However, the return to play rate (62.5%) and good/excellent outcomes per the Conway-Jobe scale (68.8%) are lower than what has been previously reported in baseball players and javelin throwers. Further investigation regarding outcomes in javelin throwers after UCLR is warranted.

Combined MPFL reconstruction and tibial tubercle osteotomy for patellar instability: A retrospective review of 23 patients.

The primary objective of this retrospective study is to compare patient outcomes following a combined approach (MPFL reconstruction and TTT) to outcomes reported in the literature by patients who required either only an isolated TTT procedure to treat pathologic lateral patellar instability or isolated MPFL reconstruction to treat patellar dislocation due to MPFL insufficiency. Twenty-three patients (74%) were available for follow-up and are included in our analysis. MPFL reconstruction combined with TTT has a high rate of success for patients presenting with patellar instability and extensor mechanism mal-alignment. The risk of recurrence with this technique was low (4.3%).

Snapping Hamstring Tendons Case Report: Tenotomy and Tendon Transposition.

CASE: A 14-year-old girl with a hypermobility syndrome presented with bilateral snapping semimembranosus (SM) and semitendinosus (ST) tendons. After failure of conservative treatment, she was treated with tenotomy of SM and later tendon transposition of her ST to her gracilis. CONCLUSIONS: Surgical treatment of snapping hamstring tendons has historically consisted of the release of the tendon insertions (tenotomy) or tendon harvest. This new surgical technique describes an alternative technique for definitive management with tenotomy and tendon transposition where the snapping ST is transposed to the gracilis tendon to maintain hamstring muscle length, strength, and function.

Ultrasonographic Technique, Appearance, and Diagnostic Accuracy for Common Shoulder Sports Injuries: A Narrative Review.

¼: Ultrasonography (US) is valued for its availability, tolerability, low cost, and utility in real-time dynamic evaluation. Its use in diagnosing upper-extremity shoulder injury has expanded, but several features require definition before more widespread adoption can be realized. ¼: In particular, the evaluation of rotator cuff tears (RCTs) with US has been extensively studied, and authors generally agree that US is comparable with magnetic resonance imaging for the detection of full-thickness RCTs, whereas partial-thickness RCTs are more difficult to accurately identify with US. Dynamic evaluation is particularly useful for pathologies such as subacromial impingement and glenohumeral instability. ¼: US has shown particular usefulness for the assessment of athletes, where there is additional motivation to delay more invasive techniques. US has demonstrated promising results as a diagnostic modality for common shoulder injuries in athletes, and it is an important imaging tool that complements a thorough history and physical examination.

Do Relaxation Exercises Decrease Pain After Arthroscopic Rotator Cuff Repair? A Randomized Controlled Trial.

BACKGROUND: Pain after rotator cuff repair is commonly managed with opioid medications; however, these medications are associated with serious adverse effects. Relaxation exercises represent a potential nonpharmacologic method of pain management that can be easily implemented without substantial adverse effects; however, the effects of relaxation exercises have not been studied in a practical, reproducible protocol after arthroscopic rotator cuff repair. QUESTIONS/PURPOSES: (1) Does performing relaxation exercises after arthroscopic rotator cuff repair (ARCR) decrease pain compared with standard pain management medication? (2) Does performing relaxation exercises after ARCR decrease opioid consumption? (3) What proportion of patients who used the relaxation techniques believed they decreased their pain level, and what proportion continued using these techniques at 2 weeks? (4) Does performing relaxation exercises after ARCR affect shoulder function? METHODS: During the study period, 563 patients were eligible for inclusion; however, only 146 were enrolled, randomized, and postoperatively followed (relaxation group: 74, control group: 72); 68% (384 of 563) of patients were not contacted due to patient and research staff availability. Thirty-three patients were unenrolled preoperatively or immediately postoperatively due to change in operative procedure (such as, only debridement) or patient request; no postoperative data were collected from these patients. Follow-up proportions were similar between the relaxation and control groups (relaxation: 80%, control: 81%; p = 0.90). The relaxation group received and reviewed educational materials consisting of a 5-minute video and an educational pamphlet explaining relaxation breathing techniques, while the control group did not receive relaxation education materials. Patients recorded their pain levels and opioid consumption during the 5 days after ARCR. Patients also completed the American Shoulder and Elbow Surgeons shoulder score preoperatively and 2, 6, 13, 18, and 26 weeks postoperatively. Linear mixed models were created to analyze postoperative pain, opioid consumption measured in morphine milligram equivalents (MMEs), and shoulder function outcomes. A per-protocol approach was used to correct for patients who were enrolled but subsequently underwent other procedures. RESULTS: There was no difference in pain scores between the relaxation and control groups during the first 5 days postoperatively. There was no difference in pain scores at 2 weeks postoperatively between the relaxation and control groups (3.3 ± 3 versus 3.5 ± 2, mean difference -0.22 [95% CI -1.06 to 0.62]; p = 0.60). There was no difference in opioid consumption during the first 5 days postoperatively between the relaxation and control groups. The use of relaxation exercises resulted in lower 2-week narcotics consumption in the relaxation group than in the control group (309 ± 241 MMEs versus 442 ± 307 MMEs, mean difference -133 [95% CI -225 to -42]; p < 0.01). Sixty-two percent (41 of 66) of patients in the relaxation group believed the relaxation exercises decreased their pain levels. Fifty-two percent (34 of 66) were still performing the exercises at 2 weeks postoperatively. During the 6-month follow-up period, there was no difference in shoulder function between the relaxation and control groups. CONCLUSION: The preoperative administration of quick, basic relaxation exercises allowed patients to use appreciably lower opioid analgesic doses over the first 2 weeks after ARCR, without any worsening of pain scores. We consider this result promising but preliminary; it is possible that a more intense mindfulness intervention-the one we studied here was disseminated using only a 5-minute video-would deliver reductions in pain and further reductions in opioid usage. LEVEL OF EVIDENCE: Level II, therapeutic study.

Does Velocity Increase From Flat-Ground to Mound Work During a Lighter Baseball Training Program?

INTRODUCTION: There has been recent interest in throwing from flat-ground versus the mound regarding stress on the elbow. Typical throwing progression programs begin with flat-ground work and progress to mound work. METHODS: All baseball pitchers of ages 10 to 17 years who completed a 15-week pitching mechanics and velocity-training program were included. Players' pitch velocity was tested at four time points during training. Average velocity and maximum velocity of pitches from flat-ground were compared with those of mound, and change in velocity between testing sessions was also compared. RESULTS: Thirty-six male pitchers (average age: 14.4 ± 1.6 years) were included. Fastball velocity increased by an average of 5.2 mph (95% confidence intervals 2.0 to 8.8 mph) at the end of the training program. When change in average and maximum velocity was compared between the four testing sessions, the most notable increase in velocity occurred between the third and fourth testing sessions. Both sessions were thrown from the mound. CONCLUSION: The 15-week baseball pitcher-training program markedly improved pitching velocity. Throwing from a mound compared with flat-ground resulted in the largest velocity increase. Therefore, when attempting to increase a pitcher's velocity, throwing from the mound should be an integral part of any velocity program.

Return to play rates after ulnar nerve transposition and decompression surgery: a retrospective analysis.

BACKGROUND: Medial elbow pain is a common complaint in overhead throwing athletes. The throwing motion places repetitive tensile and compressive forces on the elbow resulting in significant stress across the ulnohumeral joint. This stress can result in soft-tissue, ligamentous, and ulnar nerve injury. The purpose of this study was to retrospectively investigate the clinical findings and outcomes, including return to play rates, of patients who underwent ulnar nerve transposition surgery for isolated ulnar neuritis. METHODS: Throwing athletes who underwent isolated, primary ulnar nerve transposition surgery over an eight-year period, 2009 to 2017, were identified and included in our analysis. Nonthrowing athletes, those who underwent revision ulnar nerve transposition surgery, and those who underwent concomitant ulnar collateral ligament reconstruction or repair were excluded. Patients were contacted to complete the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score as well as a return to play rate questionnaire. The minimum follow-up was 2 years. RESULTS: Fifteen patients met the inclusion criteria: 13 (86.7%) men and 2 (13.3%) women. The average age at the time of surgery was 19.2 years old (range, 15.6-28.0). Preoperatively, 13 (86.7%) patients played baseball and 2 (13.3%) patients played softball. Two patients (13.3%) underwent a previous ulnar collateral ligament reconstruction. There were no complications. The average final follow-up was 65.26 (range, 24.44-113.29) months with an average Kerlan-Jobe Orthopaedic Clinic Score of 64.51 (range, 28.60-100.00). Thirteen (86.7%) patients were able to return to their preinjury sport, 2 to a higher level of competition, 8 to the same level, and 3 to a lower level. Seven of the 13 (53.8%) patients sustained a postoperative ipsilateral shoulder or elbow injury at an average of 19.57 (range, 7.00-36.00) months postoperatively. All patients reported sustaining the injury as a result of throwing. CONCLUSION: The results of our study indicate that ulnar nerve transposition surgery in throwing athletes allows athletes to return to throwing with low reoperation rates. However, more than half of the athletes in our analysis sustained a subsequent ipsilateral shoulder or elbow injury. Further investigation regarding outcomes in throwing athletes after ulnar nerve transposition surgery is warranted.

Ulnar Collateral Ligament Reconstruction in Adolescents: A Systematic Review.

BACKGROUND: Ulnar collateral ligament (UCL) reconstruction is an established surgical technique to restore UCL deficiency, especially in the overhead throwing athlete. Over the past decade, the number of patients requiring UCL reconstruction has increased significantly, particularly in the adolescent patient population. Return-to-play rates after UCL reconstruction reported in the literature have ranged from 33% to 92%, and a recent systematic review noted a return-to-play rate of 89.40% in all high school athletes. PURPOSE: To evaluate the outcomes, particularly return-to-play rates and subjective outcome scores, of UCL reconstruction of the elbow in adolescent throwing athletes. STUDY DESIGN: Systematic review. METHODS: A systematic review of the literature was conducted via the electronic databases Embase, PubMed, and Cochrane. Studies that reported on outcomes, particularly return-to-play rates, in adolescent throwing athletes met the inclusion criteria and were included in our analysis. Studies that did not report on adolescent throwing athletes and studies that reported on adolescent throwing athletes but did not specify the return-to-play outcomes for these athletes were excluded from our analysis. RESULTS: Nine studies met the inclusion criteria and were included in this review. There were 404 baseball players and 10 javelin throwers included in our analysis. A total of 349 of the 414 patients (84.30%) were successfully able to return to play at the same level of competition or higher. Successful rates of return to prior performance ranged from 66.67% to 91.49% in our analysis. Javelin throwers had a mean 80.00% rate of return to prior performance, while baseball players had a mean return-to-play rate of 84.40%. Complications were evaluated for 8 (88.9%) studies and 283 (68.4%) patients. There were 11 (3.9%) reported complications and 5 (1.8%) reoperations. CONCLUSION: The findings of this systematic review revealed that adolescent patients are generally able to return to their preinjury level of performance or higher with limited complications. Further investigation is necessary to determine long-term outcomes for return to play after UCL reconstruction of the elbow in adolescent throwing athletes.

Knee Arthroplasty with Prior Ligamentous Knee Surgery: A Matched Case-Control Study.

We aimed to evaluate the timing, operative details, and outcomes of total knee arthroplasty (TKA) in patients with prior ligamentous knee surgery (LKS). All consecutive patients undergoing TKA with prior LKS at a single institution were identified from a large prospectively collected database. Patients were matched on a 2:1 basis according to age, sex, and body mass index to a group of patients without previous LKS undergoing primary TKA. A total of 39 patients with prior LKS and a mean age of 55.6 years (range: 42.8-76.4) were identified and matched with 78 patients without LKS with a mean age of 57.6 years (range: 44.0-79.4) undergoing primary TKA (p = 0.24). Significantly more posterior stabilized implants were used in patients with LKS compared with control patients (29 [74.3%] vs. 27 [34.6%], p < 0.001). In the LKS group, 15 patients (38.4%) required hardware removal. Postoperative complications and rate of further surgery were greater in the LCS group, but the difference was not significant (10.6 vs. 6.4%, p = 0.25). Mean difference in pre- to postoperative knee flexion and clinical outcome scores (12-item Short Form Survey, International Knee Documentation Committee, and Oxford Knee Score) were similar between the two groups, with no cases of loosening or osteolysis. TKA with prior LKS often warranted hardware removal and generally more constrained implants. Those patients with prior LKS undergoing subsequent TKA have higher complication rates and an increased rate of subsequent surgery related to post-TKA stiffness.

Return to Play After Isolated Meniscal Repairs in Athletes: A Systematic Review.

BACKGROUND: Meniscal tears are a common knee injury. Isolated meniscal tears are less common; however, unaddressed tears can be troublesome, particularly for athletes. There is currently a lack of data in the literature on athletes returning to play after isolated meniscal repair. PURPOSE: To evaluate the return to play rate and time to return to play for athletes with isolated meniscal injuries. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A search of the PubMed, EMBASE, and Cochrane electronic databases was conducted to identify studies that reported the time and the rate of return to play in athletes after repair of isolated meniscal tears. Studies were excluded if there was a concomitant anterior cruciate ligament reconstruction, if there was a meniscectomy instead of a meniscal repair, or if the study was a systematic review. Quality assessment and data extraction were performed by 2 examiners. RESULTS: Overall, 21 studies were included in this review. There were 355 athletes (358 knees) with a mean age of 22.5 years (range, 9-68 years). A sex breakdown was noted in 16 of the 21 (76.2%) studies with 224 men and 71 women. The specific repair technique was described in 259 (72.3%) knees. Of the total knees, 109 (30.4%) had an open repair, 128 (35.8%) had an inside-out arthroscopic technique repair, and 22 (6.1%) had an all-inside arthroscopic technique repair. Complications were addressed in 11 studies, with 13 out of 155 (8.4%) patients across the 11 articles having a postoperative complication. Of the total 355 patients, 295 (83.1%) returned to play, and 17 of these 21 (81.0%) articles reported the time it took for athletes to return to play, with a mean return of 8.7 months. CONCLUSION: The study results indicate that return to play rates after isolated meniscal repair are high, with an overall return to play rate of 83.1% and a mean return to play time of 8.7 months. However, the limited number of studies, particularly ones with larger patient numbers, highlights the need for further investigation regarding isolated meniscal repair in athletes.

Ultrasonographic Technique, Appearance, and Diagnostic Accuracy for Common Elbow Sports Injuries.

Ultrasonography is a valuable diagnostic imaging tool because of its availability, tolerability, low cost, and utility in real-time dynamic evaluation. Its use in diagnosing elbow injuries has expanded recently and continues to do so. In particular, stress ultrasonography represents a unique imaging technique that directly visualizes the ulnar collateral ligament (UCL) and allows the assessment of ligament laxity, offering an advantage over magnetic resonance imaging and magnetic resonance arthrography in this patient population. Furthermore, ultrasonography has shown particular usefulness in instances where invasive techniques might be less desirable. This is particularly important in athletes since more invasive procedures potentially result in lost time from their sport. Ultrasonography is an important imaging tool that complements a thorough history and physical examination in the evaluation of elbow injuries in athletes. The use of ultrasonography in orthopaedic sports medicine has been investigated previously; however, to our knowledge, there has been no comprehensive review regarding the utility of ultrasonography for common elbow injuries in athletes. The current study provides a comprehensive, detailed review of the utility and indications for the use of ultrasonography for common elbow injuries in athletes.

Robotic-Assisted versus Manually Implanted Total Hip Arthroplasty: A Clinical and Radiographic Comparison.

INTRODUCTION: Component positioning during THA is one of the more critical surgeon-controlled factors as malposition has been associated with higher rates of hip dislocations, poor biomechanics, accelerated wear rates, leg length discrepancies (LLDs), and revision surgeries. In order to reduce the rates of component malposition and improve surgical accuracy, robotic-assisted THA has developed increased interest. The primary objective of this study was to compare patient outcomes following THA using the Mako Stryker robotic system (Stryker Orthopaedics, Mahwah, New Jersey) to outcomes in patients who underwent conventional instrumented THA. MATERIALS AND METHODS: Consecutive patients undergoing THA with a direct-lateral surgical approach from a single surgeon were reviewed. Patients were treated with either a robotic-arm assisted total hip arthroplasty (RTHA) or a conventional-instrumented total hip arthroplasty (CTHA). Minimum follow up was 16 months. RESULTS: Robotic-assisted THA significantly improved patient outcomes compared to conventional THA. No significant differences were observed in postoperative radiographic outcomes between the RTHA and CTHA cohorts. In our analysis, patients in the RTHA cohort compared to the CTHA cohort had significantly higher Western Ontario and McMaster Universities Arthritis Index (WOMAC) (P<0.001) and Harris Hip Scores (P<0.05) at final follow up. There were no significant differences between the RTHA cohort and CTHA cohorts in regard to cup inclination (°) (P=0.10), hip length difference (mm) (P=0.80), hip length discrepancy (mm) (P=0.10), and global offset difference (mm) (P=0.20). CONCLUSION: Further studies, particularly prospective randomized studies, are necessary to investigate the short- and long-term clinical outcomes, possible long-term complications, and cost-effectiveness of robotic-assisted THA in regard to improving outcomes and accuracy.