Contact Athletes Research Articles

Are Patients Who Undergo the Latarjet Procedure Ready to Return to Play at 6 Months? A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group Cohort Study

Background: The Latarjet procedure is growing in popularity for treating athletes with recurrent anterior shoulder instability, largely because of the high recurrence rate of arthroscopic stabilization, particularly among contact athletes with bone loss. Purpose: (1) To evaluate return of strength and range of motion (ROM) 6 months after the Latarjet procedure and (2) to determine risk factors for failure to achieve return-to-play (RTP) criteria at 6 months. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 65 athletes (83% contact sports, 37% overhead sports; mean ± SD age, 24.5 ± 8.2 years; 59 male, 6 female) who enrolled in a prospective multicenter study underwent the Latarjet procedure for anterior instability (29% as primary procedure for instability, 71% for failed prior stabilization procedure). Strength and ROM were assessed preoperatively and 6 months after surgery. RTP criteria were defined as return to baseline strength and <20° side-to-side ROM deficits in all planes. The independent likelihood of achieving strength and motion RTP criteria at 6 months was assessed through multivariate logistic regression modeling with adjustment as needed for age, sex, subscapularis split versus tenotomy, preoperative strength/motion, percentage bone loss, number of prior dislocations, preoperative subjective shoulder function (American Shoulder and Elbow Surgeons and Western Ontario Shoulder Instability Index percentage), and participation in contact versus overhead sports. Results: Of the patients, 55% failed to meet ≥1 RTP criteria: 6% failed for persistent weakness and 51% for ≥20° side-to-side loss of motion. There was no difference in failure to achieve RTP criteria at 6 months between subscapularis split (57%) versus tenotomy (47%) (P = .49). Independent risk factors for failure to achieve either strength or ROM criteria were preoperative American Shoulder and Elbow Surgeons scores (per 10-point decrease: adjusted odds ratio [aOR], 1.61; 95% CI, 1.14-2.43; P = .006), Western Ontario Shoulder Instability Index percentage (per 10% decrease: aOR, 0.61; 95% CI, 0.38-0.92; P = .01), and a preoperative side-to-side ROM deficit ≥20° in any plane (aOR, 5.01; 95% CI, 1.42-21.5; P = .01) or deficits in external rotation at 90° of abduction (per 10° increased deficit: aOR, 1.64; 95% CI, 1.06-2.88; P = .02). Conclusion: A large percentage of athletes fail to achieve full strength and ROM 6 months after the Latarjet procedure. Greater preoperative stiffness and subjective disability are risk factors for failure to meet ROM or strength RTP criteria.

Epidemiology of Injuries Sustained in Boys' High School Contact and Collision Sports, 2008-2009 Through 2012-2013.

Background:Injury epidemiology for boys’ high school contact and collision sport has been described in several overlapping but fragmented studies. Comprehensive comparisons of injuries sustained in boys’ soccer, wrestling, football, ice hockey, and lacrosse are lacking.Purpose:To describe patterns of injury by severity, body site, and diagnosis among high school boys’ contact and collision sports in the United States.Study Design:Descriptive epidemiology study.Methods:Injury rates and rate ratios (RRs) were calculated for injuries sustained in boys’ high school soccer, wrestling, football, ice hockey, and lacrosse through use of the High School RIO (Reporting Information Online) surveillance data from 2008-2009 through 2012-2013. Injury patterns were described by site, diagnosis, time loss, and severity. Severe injury was defined as an injury that resulted in 21 days or more of time loss from sport participation. Risk of sustaining a concussion was compared between sports.Results:The risk of sustaining an injury was higher in competition compared with practice overall (RR, 4.01; 95% CI, 3.90-4.12); the same pattern was true for severe injuries (RR, 4.61; 95% CI, 4.34-4.90). Football players experienced the highest injury rate (3.87 per 1000 athlete-exposures [AEs]) and the highest severe injury rate (0.80 per 1000 AEs). Overall, the most commonly injured body site was the head/face (22.5%), and the most prevalent injury diagnosis was ligament sprain not requiring surgery (23.5%). The most frequently injured body site from severe injury was the knee (24.6%), and fracture or avulsion was the most prevalent severe injury diagnosis (37.0%). Football players had a significantly higher risk of sustaining a concussion compared with other contact or collision sport athletes (P < .05).Conclusion:Injuries rates were higher in competition than those in practice for boys’ high school contact and collision athletes. Football players sustained the highest injury rate, the highest severe injury rate, and the highest concussion rate among the sports included in this analysis. Understanding these patterns of injury can generate policy and rule changes to make sports safer and maintain high levels of participation.

Incidence of injuries and illnesses among Sabah athletes during SUKMA XIX 2018

This is a study on the prevalence of injuries and illnesses among Sabah SUKMA athletes 2018. This is a retrospective study on injuries and illnesses seen among Sabah athlete who participating in SUKMA 2018 using standardized data registry. Incidence of injury and illness is 16.27 and 16.74 per 100 athletes respectively. Combat sports showed the highest incidence of injuries (45%) mainly involving head and neck region in martial arts event (Muay Thai). Commonly occurring injuries involved were muscle strains and ligament sprains. Concussion rate was 1.85 per 100 full contact athletes. Time loss percentage was 1.4%. The only important illness reported was an isolated case of mumps. There was a high number of injuries in combat sports. There were no report of severe injuries or severe concussions. This could be due to the strict implementation of protective gear during competition. Concussion rate was lower compared to many international studies. Muscle strains was seen more in high speed sprinting and kicking athletes. Contact tracing was activated and no reported Mumps outbreaks in Sabah. There is a need for athlete to learn prevention strategies in combat sports and screening of athlete for infectious diseases prior to participation in national or international sporting event.

Revision Arthroscopic Posterior Shoulder Capsulolabral Repair in Contact Athletes: Risk Factors and Outcomes

To determine risk factors and outcomes of revision arthroscopic posterior capsulolabral repair in contact athletes. Contact athletes with unidirectional posterior instability who underwent arthroscopic posterior capsulolabral repair from 2000 to 2014 with minimum 4-year follow-up were reviewed. Revision rate was determined and those who required revision surgery were compared with those who did not. Age, gender, labral and/or capsular injury, level of sport, and return to sport were compared. Pre- and postoperative American Shoulder and Elbow Surgeons, pain, function, stability, range of motion, strength, and satisfaction were also compared. Magnetic resonance imaging measurements of glenoid bone width, glenoid version, labral width, labral version, and cartilage version were also compared. A total of 149 contact athletes' shoulders met inclusion criteria. Eight shoulders required revision surgery (5.4%) at 13.0-year follow-up with 2.6 years between primary surgery and revision. Preoperative stability was significantly worse in those that required revision (0.008). Postoperative American Shoulder and Elbow Surgeons score was significantly worse in the revision group (75.1 vs 87.8, P= .03). The only significant risk factor for requiring revision surgery was decreased glenoid bone width (26.4 mm vs 29.1 mm, P= .005). Cartilage version, labral version, and bone version were not significantly different, nor was labral width. Sex, labral injury, capsule injury, both capsule and labrum injury, and level of sport were not risk factors. Both return to sport at the same level (revision= 16.7% vs nonrevision= 72.1%, P < .001) and overall return to sport (revision= 50.0% vs nonrevision=93.7%, P < .001) were significantly worse in the revision group. Contact athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 5.4% at minimum 4-year and average 13.0-year follow-up. The only significant risk factors for requiring revision surgery was smaller glenoid bone width and higher preoperative instability. Return to play after their subsequent surgery was significantly worse. Level III, comparative study.

Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair in Contact Athletes

Risk factors and outcomes of revision arthroscopic posterior capsulolabral repair are currently not well defined in contact athletes.

Return to Play and Failure Rates in Arthroscopic Bankart Repair in Contact Athletes

Return to Play and Failure Rates in Arthroscopic Bankart Repair in Contact Athletes

Scapula Fractures in Elite Soccer and Rugby Players

Background:Scapula fractures are uncommon in sports and are poorly understood in this patient group.Purpose:To report on scapula fractures in contact and collision athletes and assess the injury patterns of different mechanisms of injury.Study Design:Case series; Level of evidence, 4.Methods:A retrospective case series was performed of all sports-related scapula fractures treated at a single institution between 2007 and 2015. The mechanisms of injury were divided into direct lateral impact, fall onto an outstretched arm, or abduction/external rotation.Results:A total of 11 patients were identified: 9 professional rugby players, 1 professional soccer player, and 1 amateur soccer player. The mean age was 28 years (range, 18-35 years). The mean return to play was 127 days in those treated nonoperatively and 163 days in those treated operatively. A direct impact mechanism occurred in 7 patients, all of whom sustained glenoid neck and body fractures and were treated nonoperatively. Two rugby players had a concomitant suprascapular nerve injury. An outstretched arm mechanism occurred in 2 cases, leading to posterior and inferior glenoid fractures. Both patients were treated operatively. An abduction/external rotation mechanism occurred in 2 cases, resulting in an anteroinferior and an anterior glenoid rim fracture. One case was treated operatively and the other was treated nonoperatively. Of those with glenoid fractures, 75% were not visible on plain radiographs and required further imaging.Conclusion:Scapula fractures acquired in sports are a serious injury with a prolonged recovery period. The mechanism of injury can help predict the injury pattern and highlight the need for further imaging. There is a high association with suprascapular nerve injuries.

Influence sur l’activité quotidienne d’une perte de substance glénoïdienne modérée dans l’instabilité antérieure d’épaule

BackgroundIt has been biomechanically demonstrated that 20 to 25% is a critical glenoid bone loss. Recently, there are several reports describing that a bone loss less than 20 to 25% needed to be treated because patients may have decreased quality of life without recurrent instability events. The purpose of this study was to clarify the presence of subcritical bone loss that would affect postoperative instability or quality of life. MethodsSubjects were 43 patients aged≤40 years with less than 25% glenoid bone loss who had undergone arthroscopic Bankart repair. These patients were assessed at a mean follow-up of 32 months. The Western Ontario Shoulder Instability (WOSI) and Rowe scores were used for the clinical evaluation. Patients were divided in 3 groups based on the percentage of bone loss: group 1: <8%; group 2: 8% to 17%; and group 3: >17%. ResultsThe recurrence rate was 7% (3/43 shoulders). A weak negative correlation was seen between bone loss and Sports/Recreation/Work domain of the WOSI score (r=−0.304, p=0.0191). The WOSI for group 3 was significantly lower than that for groups 1 and 2 (p=0.0009). The male WOSI scores were significantly lower than the female ones (p=0.0471). The WOSI scores of the contact athletes were significantly lower than those of noncontact athletes (p=0.0275). All the patients in Group 3 were males and participated in contact sports. ConclusionGlenoid bone loss between 17 and 25% is considered to be a “subcritical bone loss” in our series, especially in male patients who are involved in sports or high-level activities. Level of evidenceIII, retrospective study.

Evaluación Neuropsicológica de Conmoción Cerebral: estudio de caso de un jugador de fútbol americano

La conmoción cerebral (CC) es la principal causa de lesión cerebral en deportistas de contacto siendo el fútbol americano (FA) uno de los más populares. La CC produce una amplia gama de síntomas físicos, cognitivos y emocionales que hasta el 36.1% de los jugadores desconocen. Los cambios cognitivos ocurren en la atención, memoria, flexibilidad mental, fluidez verbal, planeación, memoria de trabajo, inhibición y velocidad de procesamiento. El objetivo fue evaluar el rendimiento cognitivo de un jugador defensivo de FA categoría mayor, de 23 años de edad y 15 años de escolaridad, antes y después de presentar una CC. Se aplicaron los siguientes instrumentos: Cuestionario de Datos Generales, test de MoCA, Dígitos y Cubos en regresión, Detección Visual, Fluidez Verbal Semántica, test de Stroop, Torre de Hanoi y Wisconsin. Se estableció su perfil cognitivo basal en pretemporada y se reevaluó durante la temporada una semana posterior a una CC. En la evaluación pretemporada el jugador presentó un perfil cognitivo dentro de los rangos esperados para su edad y escolaridad. En la fase aguda de la CC, el jugador disminuyó su rendimiento en tareas de velocidad de procesamiento (pre: 26 seg; post:120 seg), atención sostenida (pre:7 puntos; post:6 puntos), inhibición (pre: 84 aciertos; post: 82 aciertos) y planeación (pre: 15 movimientos; post: 20 movimientos). La EN ha demostrado ser una herramienta sensible y confiable para la detección de los síntomas cognitivos en fase aguda y posterior a la CC.&#x0D; Palabras claves: neuropsicología, fútbol, cognición Cerebral Concussion (CC) is the main cause of brain injury in contact athletes, with American football (AF) being one of the most popular. The CC produces a wide range of physical, cognitive and emotional symptoms that most of the players (36,1%) do not know. Cognitive changes are observed in attention and memory processes, mental flexibility, verbal fluency, planning, working memory, inhibition and speed of processing. The Neuropsychological Assessment (NA) is fundamental for the detection and management of CC in the acute phase and its sequelae. The objective was to evaluate the cognitive performance of a defensive player of american football, major category, of 23 years of age and 15 years of schooling, before and after presenting a CC. Instruments were: General Data Questionnaire, MoCA test, Digits and Cubes in regression, Visual Detection, Semantic Verbal Fluency, Stroop test, Tower of Hanoi and Wisconsin Sorting Cards. Baseline cognitive profile was established and reevaluated during the season one week after a CC. In the pre-season evaluation the player presented a cognitive profile within the ranges expected. In the acute phase of CC, the player decreased his performance in processing speed tasks (pre: 26 sec, post: 120 sec), sustained attention (pre: 7 points, post: 6 points), inhibition (pre: 84) hits, post: 82 hits) and planning (pre: 15 movements, post: 20 movements). The NA has proven to be a sensitive and reliable tool for the detection of cognitive symptoms in the acute and post-CC phase.&#x0D; Key words: neuropsychology, football, cognition. A concussão (CC) é a principal causa de lesão cerebral em atletas de contato, sendo o futebol americano (AF) um dos mais populares. O CC produz uma ampla gama de sintomas físicos, cognitivos e emocionais que até 36,1% dos jogadores não conhecem. Mudanças cognitivas ocorrem na atenção, memória, flexibilidade mental, fluência verbal, planejamento, memória de trabalho, inibição e velocidade de processamento. Objetivou-se avaliar o desempenho cognitivo de um jogador defensivo da categoria sênior de AF, 23 anos de idade e 15 anos de escolaridade, antes e depois de apresentar um CC. Foram aplicados os seguintes instrumentos: Questionário de dados gerais, teste MoCA, Dígitos e regressão cubos, detecção visual, Fluência Verbal Semântica, teste Stroop, Torre de Hanói e Wisconsin. Seu perfil cognitivo basal foi estabelecido na pré-temporada e reavaliado durante a estação uma semana após o CC. Na avaliação neuropsicológica pré-temporada o jogador apresentou um perfil cognitivo dentro das faixas esperadas para sua idade e escolaridade. Na fase aguda da CC, o jogador diminuição do desempenho em tarefas velocidade de processamento (pré: 26 seg; coloca-120 seg), atenção sustentada (pré: 7 pontos; pós 6 pontos), a inibição (pré: 84 hits, post: 82 hits) e planejamento (pré: 15 movimentos, post: 20 movimentos). Na avaliação neuropsicológica provou ser uma ferramenta sensível e confiável para a detecção de sintomas cognitivos em fase aguda e subsequente CC.&#x0D; Palavras-chave: neuropsicologia, futebol, cognição.

Effect of Routine Sport Participation on Short-Term Clinical Neurological Outcomes: A Comparison of Non-Contact, Contact, and Collision Sport Athletes.

To compare pre-season to post-season changes on a battery of clinical neurological outcome measures between non-contact, contact, and collision sport athletes over multiple seasons of play. 244 high school and collegiate athletes participating in multiple non-contact, contact, and collision sports completed standardized annual pre-season and post-season assessments over 1-4years. Pre/post-season changes in 10 outcome measures assessing concussion symptoms, neurocognitive performance, and balance were compared between the groups using linear mixed models. Small, but statistically significant overall pre/post-season change differences were present between the groups for Axon computerized neurocognitive test processing speed, attention, and working memory speed scores (Axon-PS, Axon-Att, Axon-WMS), as well as Balance Error Scoring System (BESS) total score. Small seasonal declines not exceeding reliable-change thresholds were observed in the collision sport group relative to the contact and non-contact groups for Axon-PS and Axon-Att scores. The collision and contact sport groups demonstrated less pre-/post-season improvement than the non-contact sport group for Axon-WMA and BESS, with less BESS improvement also observed in the collision sport group relative to the contact sport group. Overall, longitudinal performance on all 10 outcome measures remained stable in all 3 groups over 4years. Our findings do not necessarily support the notion that participation in sports associated with exposure to repetitive head impacts has clinically meaningful cumulative effects over the course of a season, nor over four consecutive seasons in high school and collegiate athletes.

Effect of subcritical glenoid bone loss on activities of daily living in patients with anterior shoulder instability

BackgroundIt has been biomechanically demonstrated that 20% to 25% is a critical glenoid bone loss. Recently, there are several reports describing that a bone loss less than 20% to 25% needed to be treated because patients may have decreased quality of life without recurrent instability events. The purpose of this study was to clarify the presence of subcritical bone loss that would affect postoperative instability or quality of life. MethodsSubjects were 43 patients aged≤40years with less than 25% glenoid bone loss who had undergone arthroscopic Bankart repair. These patients were assessed at a mean follow-up of 32months. The Western Ontario Shoulder Instability (WOSI) and Rowe scores were used for the clinical evaluation. Patients were divided in 3 groups based on the percentage of bone loss: group 1: <8%; group 2: 8% to 17%; and group 3: >17%. ResultsThe recurrence rate was 7% (3/43 shoulders). A weak negative correlation was seen between bone loss and sports/recreation/work domain of the WOSI score (r=−0.304, p=0.0191). The WOSI for group 3 was significantly lower than that for group 1 and 2 (p=0.0009). The male WOSI scores were significantly lower than the female ones (p=0.0471). The WOSI scores of the contact athletes were significantly lower than those of non-contact athletes (p=0.0275). All the patients in Group 3 were males and participated in contact sports. ConclusionGlenoid bone loss between 17% and 25% is considered to be a “subcritical bone loss” in our series, especially in male patients who are involved in sports or high-level activities. Level of evidenceIII, retrospective study.

Prevalence of MRI Shoulder Abnormalities in Asymptomatic Professional and Collegiate Ice Hockey Athletes.

Background:The literature demonstrates a high prevalence of asymptomatic knee and hip findings on magnetic resonance imaging (MRI) in athletes. Baseball pitchers are shown to have a high prevalence of asymptomatic shoulder MRI findings, but the incidence of asymptomatic shoulder MRI findings has not been systematically evaluated in nonthrowing contact athletes.Purpose/Hypothesis:The purpose of this study was to determine the prevalence of shoulder abnormalities in asymptomatic professional and collegiate hockey players. We hypothesized that, similar to overhead throwing athletes, ice hockey players will have a high prevalence of asymptomatic MRI findings, including labral, acromioclavicular (AC), and rotator cuff pathology on MRI.Study Design:Cross-sectional study; Level of evidence, 4.Methods:A total of 25 asymptomatic collegiate and professional hockey players (50 shoulders) with no history of missed games or practice because of shoulder injury, pain, or dysfunction underwent bilateral shoulder noncontrast 3.0-T MRI. MRIs were read blinded by 2 board-certified radiologists at 2 separate time points, 3 months apart, to determine the prevalence of abnormalities of the joint fluid, bone marrow, rotator cuff tendon, biceps tendon, labrum, AC joint, and glenohumeral joint. Interrater and intrareader reliability was determined, and regression analysis was performed to identify the prevalence and relationship to stick-hand dominance.Results:Labral abnormalities were seen in 25% of the shoulders. AC joint abnormalities and rotator cuff findings were noted in 8% and 6% of shoulders, respectively. One shoulder was noted to have a biceps tendon abnormality, and 1 shoulder demonstrated glenohumeral joint chondral findings. Interrater reliability coefficients were 0.619 for labral abnormalities. Intrareader reliability kappa coefficients were 0.493 and 0.718 for both readers, respectively, for labral abnormalities. Regression analysis was performed and revealed that the overall shoulder pathology was more common in the nondominant stick hand (top stick hand) (coefficient –0.731; P = .021).Conclusion:Professional and collegiate ice hockey players had an overall prevalence of labral abnormalities in 25% of their shoulders, with findings more often found in the nondominant stick hand. Rotator cuff abnormalities were uncommon in ice hockey players. These findings differ significantly from published reports examining professional baseball players and other overhead sports athletes.

Traumatic Brachial Plexopathy in Athletes: Current Concepts for Diagnosis and Management of Stingers.

Traumatic upper trunk brachial plexopathy, also known as a stinger or burner, is the most common upper extremity neurologic injury among athletes and most commonly involves the upper trunk. Recent studies have shown the incidence of both acute and recurrent injuries to be higher in patients with certain anatomic changes in the cervical spine. In addition, despite modern awareness, tackling techniques, and protective equipment, some think the incidence to be slowly on the rise in contact athletes. The severity of neurologic injury varies widely but usually does not result in significant loss of playing time or permanent neurologic deficits if appropriate management is undertaken. Timely diagnosis allows implementation of means to minimize the risk of recurrent injury. It is important for treating physicians to understand the pathogenesis, evaluation, and acute and long-term management of stingers to improve recovery and minimize chronic sequela.

Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair in Contact Athletes

Objectives: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repairare currently not well defined in contact athletes.Evaluation of risk factors for contact athletes who require revision arthroscopic posterior unidirectional capsulolabral repair is needed. Methods: A total of 186 contact athletes’ shoulders that underwent arthroscopic posterior capsulolabral repair at minimum 2 year follow-up were reviewed. Those who required revision surgery were compared with those who did not. Parameters assessed included age, gender, labral and/or capsular injury, level of sport, and return to sport. Glenoid bone width, bone version, labral width, and labral version were also compared. Results: Eleven shoulders required revision surgery (5.9%) at mean 12.0 year follow-up. The only significant risk factor was glenoid bone width (revision=26.4 mm vs. non-revision=29.1 mm, p=0.005). Cartilage version (p=0.676), labral version (p=0.539), and bone version (p=0.791) were not significantly different between groups, nor was labral width (p=0.751). Gender (p=0.326), labral injury (p=0.349), capsule injury (p=0.683), and level of sport (p=0.381) were not significant factors for requiring revision surgery. Both return to sport at the same level (revision=16.7% vs. non-revision=72.1%, p&lt;0.001) and overall return to sport (revision=50% vs. non-revision=93.7%, p&lt;0.001) was significantly worse in the revision group. Of those who had revision surgery, 33.3% stated their original surgery was not worthwhile, which was significantly higher than the 4.5% in the non-revision group (p=0.041). Conclusion: Contact athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 5.9% at 12 year follow-up. The only significant risk factor for requiring revision surgery was smaller glenoid bone width. Return to play was significantly worse in those who required revision surgery. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder capsulolabral repair in contact athletes that require revision has not previously been evaluated.

Is Return To Play At 6 Months After Latarjet Safe? A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group Cohort Study

Objectives: The Latarjet procedure is the becoming increasingly popular for the treatment of young athletes with recurrent instability. Earlier return to play protocols have been trialed with the thought that one is primarily waiting on bone healing. However, the impact of post-operative range of motion (ROM) and strength must be considered as well. Return to play has traditionally been accepted at 6 months post-operatively, but it is unknown what percentage of athletes achieve full strength and range of motion at that point. The purpose of this study was to 1) To evaluate rates of return of full strength and range of motion at 6 months after Latarjet, and 2) determine whether rates of results vary by percent bone loss, subscapularis split versus tenotomy, or athlete status (contact or overhead). Methods: Ten participating sites throughout the United States enrolled patients in a multicenter prospective cohort study. Sixty-five athletes met inclusion criteria (mean age 24.5 SD 8.2; 59 male, 6 female) and underwent Latarjet procedure for anterior instability (19/65 (29%) primary operation, 46/65 (71%) had a prior failed anterior stabilization). All participated in either contact sports (83%) and/or overhead sports (37%). Regarding anterior glenoid bone loss, 10% had &lt;10% bone loss, 55% had 11-20%, and 35% had 21-30%. The Latarjet procedure was performed with either subscapularis tenotomy (64%) or split (36%). Strength and range of motion were assessed pre-operatively and at 6 months after surgery. Return to play (RTP) criteria were defined as full strength as well as less than 20 degrees side-to-side ROM deficits in all planes. The independent likelihood of strength and motion RTP criteria at 6 months for percent bone loss as well as subscapularis tenotomy vs split was assessed with multivariate logistic regression modeling with adjustment as needed for age, sex, preoperative strength/motion, number of prior dislocations, and participation in contact versus overhead sports. Results: 45% of patients failed to meet one or more return to play criteria: 9% failed for persistent weakness and 39% for ≥ 20 degree side to side loss of motion. All patients with loss of motion had ≥ 20 degree external rotation (ER) deficits either with elbow at side (88%) or at 90 degrees abduction (44%). There was no difference in achieving RTP criteria at 6 months between subscapularis split versus tenotomy either for strength (p=0.89) or range of motion (p=0.53). Contact athletes had a 53% RTP rate while overhead athletes had a 67% passage rate (p=0.17). Pre-operative weakness was not significantly predictive of post-operative weakness (p=0.13), and pre-operative external rotation was not predictive of post-operative ER deficits (p=0.16). Percent bone loss was not predictive of side-to side post-operative ROM deficits or weakness (p&gt;0.20 all planes of motion). No other predictors for failure to meet RTP criteria at 6 months were identified. Conclusion: A large percentage of athletes do not have full return of strength and range of motion at 6 months following Latarjet procedure. Further consideration may be warranted prior to releasing these athletes to contact sports.

Comparison of Knotless Versus Traditional Glenoid Anchors in Early Outcomes Following Arthroscopic Shoulder Stabilization

Objectives: To compare knotless versus traditional glenoid anchors as well as use of all-suture versus non-all suture anchor material in early outcomes after arthroscopic shoulder stabilization. We hypothesize there is no difference in outcomes between anchor type or material. Methods: Patients who were prospectively enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group instability database completed a series of patient reported outcomes (PROs) pre and post-operatively at 2 years. At the time of surgery, physicians documented technique utilized and materials employed. The incidence of subsequent shoulder surgeries, re-dislocations or subluxations, and return to sport (RTS) were obtained. Patients were stratified by anchor type (knotless [KL] versus knotted [KT]) and then by anchor material (all-suture [AS] versus non-all suture [NS]). Bivariate analyses were performed to compare outcomes between groups, including the Wilcoxon signed-rank test and chi-square test. Results: A total of 447 patients who underwent primary arthroscopic shoulder stabilization were evaluated, with 112 patients in the KL group (90.2% male) and 335 in the KT group (82.4% male; p &gt; .05). Then there were 70 patients in the AS group (74.3% male) and 377 in the NS group (86.2% male; p = .01). The KT group (24.6 ± 8.9 years) was significantly older than the KL group (21.3 ±7.8 years; p = .0003) while the AS group (26.8 ±9.1 years) was significantly older than the NS group (23.2 ±8.6 years; p = .003). Significantly more patients in the KL group (87.5%) underwent surgery in the beach chair (BC) position than the KT group (45.4%; p &lt; .0001) and significantly more patients in the NS group (59.9%) underwent surgery in the BC position than the AS group (34.3%; p &lt; .0001). The primary direction of instability was anterior, with 78.6% in the KL group, 71.3% in the KT group, 82.9% in the AS group and 71.4% in the NS group. The number of contact athletes was similar in each group, with 75.0% in the KL group, 66.0% in the KT group, 70.0% in the AS group, and 67.9% in the NS group. Significantly more anchors were used in the KL group (4.2 ± 1.6) compared to the KT group (3.9 ± 1.8; p = .003) and significantly more anchors were used in the AS group (5.3 ± 2.4) compared to the NS group (3.7 ± 1.4; p &lt; .0001). Significantly more patients had a redislocation in the KL group (11.6%) compared to the KT group (5.7%; p = .03), and significantly more patients had a redislocation in the NS group (8.2%) compared to the AS group (1.4%; p = .04). There were no significant differences in improvement of any PROs, incidence of RTS, subsequent shoulder surgeries or subluxations between anchor type or material groups. Conclusion: Compared to traditional knotted glenoid anchors, patients undergoing arthroscopic shoulder stabilization with knotless anchors can expect to experience similar clinical outcomes. However, use of knotless anchors may be a significant risk factor for subsequent dislocation 2 years after arthroscopic shoulder stabilization surgery, which may be related to patients’ age. Moreover, use of all-suture based anchors may be associated with lower rates of subsequent dislocation which may be attributed to the size of their footprint and the apparent inclination of surgeons using these to utilize more anchors per labral repair, thus increasing points of labral fixation. Continued investigation of potential confounding variables is necessary to identify the direct effect of anchor type and material on patient outcomes.

The Effect of School Socioeconomic Status and Sport on Adolescent Athletes’ Baseline Concussion Assessment

PURPOSE:The purpose is to examine the effect of school socioeconomic status (SES) and sport on the baseline performance of adolescent athletes on the King-Devick test (KD), modified Balance Error Scoring System (mBESS), and Post Concussive Symptom Inventory (PCSI). METHODS:A retrospective cohort study was conducted on athletes’ baseline concussion assessments completed as part of a concussion surveillance program. Testing included a history and risk factor questionnaire, KD, mBESS, and PCSI. Schools and sports clubs were classified as high SES (private or <50% free/reduced lunches) vs. low SES (public, > 75% free/reduced lunches). Sports were categorized as collision, contact, and non-contact. An ANCOVA was performed for each outcome while controlling for age RESULTS:Analysis was conducted on 377 athletes (63% M), average age 15.9+1.5 years (range 12.1-19.2). Two schools and 1 club were classified as high SES (n=162); 5 schools (n=215) were classified as low SES. For KD score, only a significant school × sport interaction was observed (p=0.01), with age as a significant co-variate (p=0.01). Only a significant main effect of school was observed for the mBESS (p=0.02), while a significant main effect of school (p=0.001) and school × sport interaction (p=0.02) was observed for PCSI. Age was not significant for either mBESS or PCSI (p>0.47). CONCLUSIONS: This study examines the influence of school SES and sport on baseline KD, mBESS, and PCSI. KD scores were slower in contact and non-contact athletes of high SES schools compared to low SES school athletes. Additionly, low SES school contact and non-contact athletes reported higher baseline PCSI scores compared to their high SES school counterparts. These findings have implications for how baseline scores are considered as comparisons for concussion surveillance; however, more studies are necessary to examine other confounding factors and the utility of these measures in managing injury recovery.

Summer Adaptive Sports Technology, Equipment, and Injuries.

As adaptive sports grow in popularity, it is increasingly important to understand the injuries for which their athletes are at risk. This population is challenging to study given its small size and diversity of its participants; accordingly, research is mostly low quality because of limited sample sizes and study durations. Summer adaptive sports account for 22 of 28 Paralympic sports, with the most frequently studied being wheelchair basketball, rugby, tennis, athletics, swimming, and soccer. Injuries vary by sport because of differences in contact level, limbs utilized, and athlete impairments. Equipment changes and technological advances, especially within wheelchair and amputee sports, have increased the level of competition and reduced injury rates. Fortunately, the majority of injuries across adaptive sports are minor and do not result in significant time off from sport. Still, even minor injuries can negatively impact these athletes' mobility and activities of daily living compared to the nondisabled population.

Prevalence of Staphylococcus aureus carriage and pattern of antibiotic resistance, including methicillin resistance, among contact sport athletes in Italy.

Background and purpose: Athletes participating in contact or collision sports have a great chance of acquiring Staphylococcus aureus infections. The risk factors for colonization and infections include frequent antibiotic use, close contact situations, skin trauma, sharing of sports equipment, and poor hygiene. Therefore, our specific goals were to determine (1) prevalence of S. aureus among different types of contact sport athletes which were barely studied in the European region, (2) antimicrobial resistance of S. aureus isolates, and (3) association of carriage with particular risk factors of spor t practices.Patients and methods: A cross-sectional study was conducted among contact or collision sport athletes in Italy. A questionnaire was used to gather information about sociodemographic characteristics, specific sport activities, and participants’ health conditions. Swabs were collected from the nares, oropharynx, and fingers and tested for S. aureus isolation and antimicrobial susceptibility.Results: S. aureus was carried by 42% of 238 enrolled athletes. Colonization was associated with number of weekly training days, sharing of sports equipment, not taking a shower immediately after training, and a previous history of pharyngitis or sinusitis and skin manifestations. Isolates were resistant to clindamycin (24.8%) and erythromycin (15.8%). Of all athletes, 1.3% carried methicillin-resistant S. aureus (MRSA); MRSA were 3% of all S. aureus isolates. No strains were resistant to sulfamethoxazole/trimethoprim.Conclusion: Our results have shown a high prevalence of S. aureus carriage and a relevant resistance to antimicrobials used for the treatment of S. aureus infections. Prevention efforts aimed at reducing S. aureus colonization, and thus potentially reducing infections, should be improved.

Hip Injuries in the Contact Athlete

Despite being relatively uncommon when compared to injuries to the ankle and knee, hip injuries in the contact athlete account for 5%-6% of all athletic-related injuries with increasing prevalence over the last decade. Athletic hip injuries represent a spectrum of often overlapping intra- and extra-articular disorders with the potential to cause significant disability and time lost from sport. Advancements in imaging modalities, arthroscopic instrumentation, and surgical techniques have improved diagnostic capabilities and treatment outcomes of athletic hip injuries. Furthermore, increased screening and better recognition of the role of femoroacetabular impingement on the development of intra-articular hip pathology and instability has provided physicians with a treatable risk factor deterring further hip disorders. This chapter provides physicians with a brief overview of commonly encounter hip injuries in the contact athlete, namely: muscle strains, contusion, labral injuries, and hip instability secondary to dislocation or subluxation in the setting of femoroacetabular impingement, as well as the previously described “sports hip triad.”