Anterior glenohumeral capsular ligament reconstruction with hamstring autograft for internal impingement with anterior instability of the shoulder in baseball players: preliminary surgical outcomes.

BACKGROUND: Shoulder pain and dysfunction are common in baseball players, and although "internal impingement" is recognized as one of the most common pathologies of shoulder dysfunction, the optimal surgical treatment for internal impingement with anterior instability of the shoulder remains controversial. This study evaluated baseball players' preliminary outcomes following anterior glenohumeral capsular ligament reconstruction for internal impingement with anterior instability of the shoulder. METHODS: Twelve baseball players (all male; mean age, 20.5 ± 2.2 years) with internal impingement and anterior instability managed via anterior glenohumeral capsular ligament reconstruction were examined. The mean follow-up period was 25.3 ± 4.6 months. Anterior glenohumeral capsular ligament reconstruction was performed with a knee hamstring autograft for balanced stability and laxity with two major targets: to prevent hyperangulation and translation in horizontal abduction and to mimic the individual arm cocking position at the final decision of tension. Preoperative and final follow-up evaluations were performed using Jobe's postoperative grading system; the Kerlan-Jobe Orthopaedic Clinic Overhead Athletes Shoulder and Elbow Score; Disabilities of the Arm, Shoulder and Hand sports module; plain radiographs; and magnetic resonance imaging. RESULTS: Jobe's postoperative grading system score, the Kerlan-Jobe Orthopaedic Clinic Overhead Athletes Shoulder and Elbow Score, and the Disabilities of the Arm, Shoulder and Hand sports module score improved significantly from 20.4 ± 12.2, 28.4 ± 8.3, and 80.2 ± 11.1 points preoperatively to 88.8 ± 13.6, 80.8 ± 7.7, and 22.4 ± 18.7 points postoperatively, respectively (P < .001, .0025, <0.001, respectively). Both clinical and imaging evaluations revealed improved internal impingement with anterior instability after anterior glenohumeral capsular ligament reconstruction. The mean external rotation at abduction significantly decreased from 113° preoperatively to 104° postoperatively. At follow-up, 10 of the 12 athletes (83.3%) returned to their prior competitive level. Plain radiographs and magnetic resonance imaging revealed no obvious loosening of the graft or screws. CONCLUSIONS: Anterior glenohumeral capsular ligament reconstruction resulted in preferable clinical outcomes for young baseball players who experienced pain during the throwing motion. Stabilization of the glenohumeral joint with autografting of the knee hamstring may thus represent a solution for internal impingement with anterior instability in overhead throwing athletes.

Physical functions, to be or not to be a risk factor for osteochondritis dissecans of the humeral capitellum?

Background: Physical risk factors for osteochondritis dissecans (OCD) of the humeral capitellum in young baseball players have not been fully elucidated. We aimed to identify the risk factors for capitellar OCD in baseball players aged 8-14 years. Methods: Between December 2018 and December 2019, young baseball players were recruited from 8 regional baseball leagues. Ultrasonography and physical assessments were performed preseason and at the end of the study period. Bilateral passive ranges of motion (ROM) of horizontal adduction of the shoulders, internal rotation (IR) of the hips, and the thoracic kyphosis angle were measured. 1-year follow-ups were scheduled to determine the occurrence of OCD. Players with OCD were categorized into an OCD group; those without OCD and any elbow pain for one year were categorized into a non-injured group. The players' baseline data (age, sex, position in baseball, and Rohrer's Index) were analyzed using univariate analyses. Their physical parameters were analyzed using two-way analysis of variance with repeated measures to investigate OCD-related risk factors. Results: In total, 3651 baseball players attended the 1-year follow-up. Of these, 71 (1.9%) players had OCD of the humeral capitellum. In the OCD group, a significant association was found at baseline and at the end of the study period between a higher Rohrer index at the baseline and a smaller hip IR ROM on the nondominant side. Conclusions: Loss of hip IR ROM on the nondominant side is a newly discovered risk factor related to physical function in the development of OCD.

7. Usefulness of Low-Intensity Pulsed Ultrasound (LIPUS) for the Treatment of Osteochondritis Dissecans (OCD) of the Humeral Capitellum.

OBJECTIVES: LIPUS has been reported to promote bone union in pseudoarthrosis and delayed fracture union as well as to have a beneficial effect in shortening the duration of bone healing in fresh fractures. The purpose of this study was to examine whether LIPUS has an accelerating effect on healing OCD. SUBJECTS AND METHODS: From 2008 to 2012, cases with advanced-stage OCD were randomized, and the study was conducted on 51 patients (LIPUS group) who enabled us to decide the treatment efficacy, and gave consent after receiving an explanation on the benefit of LIPUS. LIPUS was performed for 20 minutes every day by treating the elbow in 2 directions, namely on the external and internal sides. The patients were told to stop pitching and batting. Plain radiography was performed once every 6 weeks and computed tomography (CT) scans were performed approximately once every 3 months. Image repair criteria were that the outside localized type was repaired completely, and the central localized or extensive type had lesion occupancy of less than 20%. Twenty-nine of 51 who did not recover and received surgical operation were excluded in the study, and 22 patients who were healed with LIPUS were compared with 21 patients who received conservative therapy only. RESULTS AND DISCUSSION: The image repair period for the LIPUS group was an average of 4.5 ± 1.9 months, while for the non-LIPUS group it was 6.8 ± 3.8 months. LIPUS treatment for OCD significantly shortened the image repair period (P = 0.037). It is necessary to increase the number of cases, and clarify the utility of LIPUS.