Kerlan-Jobe Orthopaedic Clinic Score Research Articles

The Functional Arm Scale for Throwers (FAST)-Part II: Reliability and Validity of an Upper Extremity Region-Specific and Population-Specific Patient-Reported Outcome Scale for Throwing Athletes.

Background:The Functional Arm Scale for Throwers (FAST) is an upper extremity (UE) region-specific and population-specific patient-reported outcome (PRO) scale developed to measure health-related quality of life in throwers with UE injuries. Stages I and II, described in a companion paper, of FAST development produced a 22-item scale and a 9-item pitcher module. Stage III of scale development, establishing reliability and validity of the FAST, is reported herein.Purpose:To describe stage III of scale development: reliability and validity of the FAST.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:Data from throwing athletes collected over 5 studies were pooled to assess reliability and validity of the FAST. Reliability was estimated using FAST scores from 162 throwing athletes who were injured (n = 23) and uninjured (n = 139). Concurrent validity was estimated using FAST scores and Disabilities of the Arm, Shoulder, and Hand (DASH) and Kerlan-Jobe Orthopaedic Clinic (KJOC) scores from 106 healthy, uninjured throwing athletes. Known-groups validity was estimated using FAST scores from 557 throwing athletes who were injured (n = 142) and uninjured (n = 415). Reliability and validity were assessed using intraclass correlation coefficients (ICCs), and measurement error was assessed using standard error of measurement (SEM) and minimum detectable change (MDC). Receiver operating characteristic curves and sensitivity/specificity values were estimated for known-groups validity. Data from a separate group (n = 18) of postsurgical and nonoperative/conservative rehabilitation patients were analyzed to report responsiveness of the FAST.Results:The FAST total, subscales, and pitcher module scores demonstrated excellent test-retest reliability (ICC, 0.91-0.98). The SEM95 and MDC95 for the FAST total score were 3.8 and 10.5 points, respectively. The SEM95 and MDC95 for the pitcher module score were 5.7 and 15.7 points, respectively. The FAST scores showed acceptable correlation with DASH (ICC, 0.49-0.82) and KJOC (ICC, 0.62-0.81) scores. The FAST total score classified 85.1% of players into the correct injury group. For predicting UE injury status, a FAST total cutoff score of 10.0 out of 100.0 was 91% sensitive and 75% specific, and a pitcher module score of 10.0 out of 100.0 was 87% sensitive and 78% specific. The FAST total score demonstrated responsiveness on several indices between intake and discharge time points.Conclusion:The FAST is a reliable, valid, and responsive UE region-specific and population-specific PRO scale for measuring patient-reported health care outcomes in throwing athletes with injury.

Medium and long-term follow-up outcome after arthroscopic repair of type II SLAP lesions with two Loops

Objective To determine the medium-long term functional outcome of arthroscopic repair of type II SLAP lesions with two loops. Methods According to retrospective study, 29 cases patients with arthroscopic repairs of isolated type II SLAP lesions were collected from March 2011 to June 2013, the mean patient age at the time of surgery was 31.8 years(range17 to 47 years). All patients with ground anchor suture, and through double loop knot technology to fix SLAP injury.Visual analogue scale(VAS), Kerlan-Jobe Orthopaedic Clinic(KJOC), Roche Shouder function Score(ROWE) were used to determine the function of shoulder joint.The shoulderjoint range of motion before treatment and post treatment were recorded, shoulder joint mobility was recorded, satisfaction survey was done, compared the preoperative and postoperative data to evaluate its clinical effect. Results All patients were available for follow-up of 2.7-5.2 years.Overall, functional outcome was improved from baseline compared with final follow-up for VAS scores((4.3±1.2) points vs.(1.5±0.8) points, t=5.435, P<0.05), KJOC scores((72.1±4.9) points vs.(92.8±5.4) points, t=5.921, P<0.01), and ROWE scores((54.1±12.4) points vs.(84.3±10.2) points, t=7.326, P<0.01). Only a minority of patients feel pain when they did srenuous exercise.According to satisfaction investigation of patients, patient satisfaction was reported in 89.7%, 3 cases had not good results, they could not return to previous level of play, including 2 cases were athletes, 1 case was not athlete. Conclusion There is no more persistent pain and dysfunction after surgery, a good or excellent medium-long term functional outcome can be anticipated after arthroscopic repair of type II SLAP lesions with two loops. Key words: SLAP lesions; Shoulder joint; Arthroscope; Repair

Treatment for Ulnar Neuritis Around the Elbow in Adolescent Baseball Players: Factors Associated With Poor Outcome

Background: Ulnar neuritis around the elbow is one of the injuries seen in throwing athletes. Outcomes of nonsurgical treatment and factors associated with failure outcomes have not been reported. Purpose: To investigate the outcomes of treatments for ulnar neuritis in adolescent baseball players. Study Design: Case series; Level of evidence, 4. Methods: We assessed 40 male baseball players with a mean age of 15.0 years (range, 13-17 years) who presented with ulnar neuritis. There were 19 pitchers and 21 fielders whose throwing side was affected. All patients had elbow pain, and 13 patients had hand numbness on the ulnar side. The mean Kerlan-Jobe Orthopaedic Clinic (KJOC) overhead athlete shoulder and elbow score was 52.5 at the first follow-up visit (n = 36 patients). Thirteen patients were identified with ulnar nerve subluxation, and 23 patients had concomitant elbow ulnar collateral ligament (UCL) injury. All patients underwent nonsurgical treatment, which included rehabilitation exercises and prohibition of throwing. If the nonsurgical treatment failed, we recommended surgical treatment. We investigated the outcomes of the nonsurgical and surgical treatments. Return to sports was evaluated, combined with factors associated with return to sports in nonsurgical treatment by univariate and multivariate statistical analysis. Results: The mean follow-up period was 23.6 months (range, 6-39 months). After nonsurgical treatment, 24 patients (60%) returned to the previous competition level after a mean of 2.4 months. Two patients returned to a recreational level. One patient gave up playing baseball at 2 months. The remaining 13 patients underwent surgery and returned to sports after a mean of 2.0 months postoperatively, and 12 had no limitation of sports activities. Multivariate logistical regression analysis demonstrated that hand numbness, ulnar nerve subluxation, and UCL injury were associated with failure of nonsurgical treatment (P < .05). In addition, KJOC score of <45 at the first follow-up tended to be associated with poor outcomes of nonsurgical treatment (P = .06). Conclusion: Hand numbness on the ulnar side, ulnar nerve subluxation, and UCL injury are strong predictors of poor outcomes after nonsurgical treatment for ulnar neuritis, and surgery provides excellent results.

Ulnar Collateral Ligament Reconstruction; the Rush Experience

To report the patient demographics, surgical techniques, and outcomes of all UCLR performed at a single institution from 2004-2014 The surgical database of one institution was searched from January 1st 2004-December 31st 2014 for the current procedural terminology (CPT) code 24346 “Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)”. Charts were reviewed to determine patient age, gender, date of surgery, sport played, athletic level, surgical technique, graft type, and complications were recorded. Patients were contacted via phone calls to obtain the return to sport rate, Conway-Jobe score, Timmerman & Andrews score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score. One hundred eighty-nine patients underwent UCLR during the study period (92% male, average age 19.6 +/- 4.9 years, 77.8% were right elbows). There were 166 baseball players (87.8% of all patients), 156 of which were pitchers (82.5% of all patients). Ninety-eight (51.6%) were college athletes, 62 (36%) were high school athletes, and 25 (13.2%) were professional athletes at the time of surgery. The docking technique was used in 111 (58.7%) patients while the double docking technique was used in 78 (41.3%). An ipsilateral palmaris longus graft was used in 111 (58.7%) of patients while a hamstring autograft was used in 48 (25.4%) patients. The ulnar nerve was subcutaneously transposed in 79 (41.8%) patients. Overall 95.7% of patients were able to return to sport and had a Conway-Jobe score of good/excellent while 4.3% had a score of fair. The average KJOC score was 94.7 +/- 5.7 and average Timmerman-Andrews score was 93.7 +/- 7.7. Subsequent surgeries were performed in 5.8% of patients. Overall 95.7% of patients who underwent UCLR were able to return to sport with an average KJOC score of 94.7 and Timmerman Andrews Score of 93.7.

Ulnar Collateral Ligament Reconstruction; the Rush Experience

Objectives:Background: Ulnar collateral ligament reconstruction (UCLR) is now a common surgery performed in both professional, as well as high level athletes Purpose: To report the patient demographics, surgical techniques, and outcomes of all UCLR performed at a single institution from 2004-2014 Hypothesis: UCLR will be performed mostly in male pitchers and will have a complication rate of less than 5%.Methods:Methods: The surgical database of one institution was searched from January 1st 2004-December 31st 2014 for the current procedural terminology (CPT) code 24346 “Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)”. Charts were reviewed to determine patient age, gender, date of surgery, sport played, athletic level, surgical technique, graft type, and complications were recorded. Patients were contacted via phone calls to obtain the return to sport rate, Conway-Jobe score, Timmerman & Andrews score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score.Results:Results: One hundred eighty-nine patients underwent UCLR during the study period (92% male, average age 19.6 +/- 4.9 years, 77.8% were right elbows). There were 166 baseball players (87.8% of all patients), 156 of which were pitchers (82.5% of all patients). Ninety-eight (51.6%) were college athletes, 62 (36%) were high school athletes, and 25 (13.2%) were professional athletes at the time of surgery. The docking technique was used in 111 (58.7%) patients while the double docking technique was used in 78 (41.3%). An ipsilateral palmaris longus graft was used in 111 (58.7%) of patients while a hamstring autograft was used in 48 (25.4%) patients. The ulnar nerve was subcutaneously transposed in 79 (41.8%) patients. Overall 95.7% of patients were able to return to sport and had a Conway-Jobe score of good/excellent while 4.3% had a score of fair. The average KJOC score was 94.7 +/- 5.7 and average Timmerman-Andrews score was 93.7 +/- 7.7. Subsequent surgeries were performed in 5.8% of patients.Conclusion:Conclusion: Overall 95.7% of patients who underwent UCLR were able to return to sport with an average KJOC score of 94.7 and Timmerman Andrews Score of 93.7.

Ulnar Collateral Ligament Reconstruction: The Rush Experience.

Background:Ulnar collateral ligament reconstruction (UCLR) is a common surgery performed in professional, collegiate, and high school athletes.Purpose:To report patient demographics, surgical techniques, and outcomes of all UCLRs performed at a single institution from 2004 to 2014.Study Design:Case series; Level of evidence, 4.Methods:All patients who underwent UCLR from January 1, 2004, through December 31, 2014, at a single institution were identified. Charts were reviewed to determine patient age, sex, date of surgery, sport played, athletic level, surgical technique, graft type, and complications. Data were collected prospectively, and patients were contacted via phone calls to obtain the return-to-sport rate, Conway-Jobe score, Andrews-Timmerman score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score. Continuous variable data were reported as weighted means, and categorical variable data were reported as frequencies with percentages.Results:A total of 187 patients (188 elbows) underwent UCLR during the study period (92% male; mean age, 19.6 ± 4.7 years; 78.2% right elbows). There were 165 baseball players (87.8% of all patients), 155 of whom were pitchers (82.5% of all patients). Ninety-seven (51.6%) were college athletes, 68 (36.2%) high school athletes, and 7 (3.7%) professional athletes at the time of surgery. The docking technique was used in 110 (58.5%) patients while the double-docking technique was used in 78 (41.5%). An ipsilateral palmaris longus graft was used in 110 (58.5%) patients while a hamstring autograft was used in 48 (25.5%) patients. The ulnar nerve was subcutaneously transposed in 79 (42%) patients. Clinical follow-up data were available on 85 patients. Mean follow-up was 60 ± 30.8 months. Overall, 94.1% of patients were able to return to sport and had a Conway-Jobe score of good/excellent while 4.3% had a score of fair. The mean KJOC score was 90.4 ± 6.7 and mean Andrews-Timmerman score was 92.5 ± 7.1. Subsequent surgeries were performed in 5.3% of patients.Conclusion:UCLR was performed most commonly on collegiate athletes using an ipsilateral palmaris longus graft. Overall, 94.1% of patients who underwent UCLR were able to return to sport with a mean KJOC score of 90.4 and Andrews-Timmerman Score of 92.5.

Predictive Value Of Preseason Screening In Collegiate Baseball Pitchers

Objectives:High level baseball pitchers are prone to shoulder and elbow injuries, resulting in significant morbidity and missed time from sport. This is the first study to use both subjective and objective preseason evaluations of baseball pitchers to predict injuries that occur in-season. We hypothesize that athletes reporting unfavorable scores on subjective questionnaires, and athletes falling outside the established pre-season normative values for objective data are more likely to develop injuries in season.Methods:Over three collegiate baseball seasons from 2011 through 2013, a cohort of collegiate Division I baseball pitchers underwent both objective and subjective evaluation prior to the start of the fall collegiate season. Preseason analysis included range of motion (ROM) in 5 planes, upper extremity manual muscle testing (MMT), Functional Movement Screen (FMS) assessment, a Kerlan-Jobe Orthopaedic Clinic (KJOC) Overhead Athlete Shoulder and Elbow score, an Upper Extremity Patient History (UEPH) questionnaire, and a Modified American Shoulder Elbow Score (MASES) questionnaire. This cohort was monitored over the course of the subsequent season for the development of injury and missed game time. A descriptive analysis for each questionnaire and all objective variables was performed. Univariate and multivariate regression models were used to explore potential risk factors for upper extremity (UE) injuries. Scatter plots, Spearman's correlation coefficients, and corresponding p-values were used to examine the relationship between subjective responses, objective physical parameters, and injury days missed.Results:Forty-two athletes participated in the study over three consecutive collegiate baseball seasons. Our preseason normative values for ROM, MMT, and the KJOC questionnaire are shown in Tables 1, 2, and 3. The mean KJOC score for our cohort was 86.93/100 (SD 12.49), and the mean MASES score was 88.4/100 (SD 21.7). The mean FMS score in our cohort was 15/21 (SD 3). Injury data for our cohort are shown in Table 4. After three full seasons, a lower KJOC score significantly correlated with injury days missed (Spearman's rho = 0.63, P-value 0.0122). Through the first two seasons, pitchers with a 1% higher UE rating on the UEPH questionnaire had 9.5% lower odds of developing injury during the season (OR 0.9149, 95% CI 0.8525-0.9819, P Value 0.014). Pitchers reporting every 1 unit higher of subjective instability had 61.27% higher odds of developing an UE injury (OR 0.6127, 95% CI 1.1044-2.3549, P value 0.013). However, by the end of the third season, and after adjusting for the use of pain medication, these variables failed to reach significance in our multiple regression analysis. Dominant shoulder TAM, rotator cuff strength, and glenohumeral internal rotation deficit (GIRD) were not predictive of injury in our cohort; although having over 5 degrees of difference in TAM vs the non-dominant shoulder approached significance (P-value 0.0598).Conclusion:This is the first study to demonstrate predictive value of subjective questionnaires. The KJOC Overhead Athlete Shoulder and Elbow Score can be used as part of the standardized preseason athlete evaluation to target pitchers at risk for developing injuries in-season. Objective parameters - notably TAM, GIRD, and rotator cuff strength - were not predictive of injuries in our cohort, which contradicts prior reports. To our knowledge, normative FMS data has not yet been established in baseball pitchers.

Superior Labrum Anterior Posterior Lesions and Associated Injuries

Background:Superior labrum anterior posterior (SLAP) lesions often cause shoulder pain, dysfunction, and instability. Professional athletes require a high level of shoulder function for competition and overhead activities.Purpose:To evaluate elite athletes who had arthroscopic surgery for common shoulder pathologies and SLAP lesions with a follow-up of more than 3 years. The associated intra-articular pathologies and return to play were documented.Study Design:Case series; Level of evidence, 4.Methods:Thirty-five shoulders in 34 elite athletes (4 women and 30 men; mean age, 25 years [range, 18-32 years]) had arthroscopic repair of SLAP lesions and accompanying Bankart or rotator cuff tears between January 2008 and November 2011. The documentation included patient symptoms, physical examination, radiological analysis with radiographs, and magnetic resonance imaging. Shoulder function was evaluated preoperatively and at follow-up using American Shoulder and Elbow Surgeons (ASES) and Kerlan Jobe Orthopaedic Clinic (KJOC) scores. The mean follow-up was 52 months.Results:Isolated SLAP lesions were seen in 17.1% of patients, SLAP lesions and partial cuff tear occurred in 25.7%, associated Bankart lesions in 37.1%, full-thickness rotator cuff tears in 8.6%, Bankart and posterior labrum lesions in 8.6%, and Bankart and full-thickness rotator cuff tears in 2.9%. Return to play was a mean 6.4 ± 1.5 months. The mean postoperative ASES and KJOC scores were 89.6 ± 4.6 and 80.9 ± 6.8, respectively, compared with preoperative scores of 64.0 ± 7.2 and 50.5 ± 10.3 (t test, P < .01).Conclusion:The majority (88.2%) of professional athletes returned to their preinjury levels. SLAP lesions may frequently occur with Bankart lesions and rotator cuff tears. A high rate of return to sport at the same level of athletic performance can be achieved by anatomic repair and effective rehabilitation.

Outcomes evaluation of the athletic elbow.

The high-level athletic population poses difficulty when evaluating outcomes in orthopedic surgery, given generally good overall health and high function at baseline. Subtle differences in performance following injury or orthopedic surgery are hard to detect in high-performance athletes using standard outcome metrics; however, attaining these subtle improvements after injury or surgery are key to an athletes' livelihood. Outcome measures serve as the cornerstone for critical evaluation of clinical outcomes following orthopedic surgery or injury. In the age of "evidence-based medicine" and "pay-for-performance" accountability for surgical intervention, understanding clinically relevant outcome measures is essential for careful review of the published literature, as well as one's own critical review of surgical performance. The purpose of this manuscript is to evaluate clinical outcome measures in the context of the athletic elbow. An emphasis will be placed on evaluation of the 5 most clinically relevant outcome measures for sports-related elbow outcomes: (1) American Shoulder and Elbow Committee; (2) Mayo Elbow Performance Index; (3) Andrews-Timmerman [and its precursor the (4) Andrews-Carson]; and (5) Kerlan-Jobe Orthopaedic Clinic overhead athlete score. A final outcome measure that will be analyzed is "return to play" statistics, which has been published in various studies of athletes' recovery from elbow surgery, as well as, the outcomes metric known as the "Conway-Jobe scale." Although there is no perfect outcomes score for the athletic elbow, the Kerlan-Jobe Orthopaedic Clinic score is the only outcomes tool developed and validated for outcomes for elbow injuries in the overhead athlete, as compared with the Andrew-Timmerman and Conway-Jobe metrics, which were not validated outcome measures for the elbow in this patient population. Despite the Disabilities of Arm, Shoulder, Hand (DASH) (and DASH-Sport module) being validated in the general population, this upper extremity scale is not specific for elbow function.

Operative Management of Ulnar Collateral Ligament Insufficiency in Adolescent Athletes

Background: The incidence of ulnar collateral ligament (UCL) injuries of the elbow has increased in adolescents over the past decade because of widespread participation in athletics and heightened awareness among physicians. Hypothesis: Ulnar collateral ligament reconstruction using the docking technique would result in a successful return to athletic activity in this age group. Study Design: Case series; Level of evidence, 4. Methods: Study participants were 55 skeletally mature adolescent athletes (mean age, 17.6 years; range, 15-18 years) who underwent UCL reconstruction between 2008 and 2010. While the majority of patients were baseball players (n = 47), there were 3 gymnasts and 5 javelin throwers included in the study. Each patient underwent UCL reconstruction utilizing the docking technique after an adequate trial of nonoperative management (mean, 5.8 months). At the latest follow-up, patients were evaluated to determine their ability to return to athletic activity. Clinical outcomes were classified using the Conway scale, the Andrews-Timmerman score, and the Kerlan-Jobe Orthopaedic Clinic (KJOC) score. Results: At a minimum 2-year follow-up, 87% (48/55) of patients had excellent results using the Conway scale. Overall, there were only 2 poor results (3.6%) that were observed in patients with concomitant osteochondritis dissecans lesions of the capitellum. There were 4 postoperative complications in 4 patients (2 gymnasts and 2 javelin throwers) who developed ulnar neuritis after UCL reconstruction. The mean Andrews-Timmerman score was 83.6 ± 7.2 (range, 30-100), and the mean KJOC score was 88.0 ± 6.0 (range, 40-100). Conclusion: The docking technique results in favorable clinical outcomes in adolescent athletes with UCL insufficiency at a minimum of 2 years postoperatively. Patients with concomitant intra-articular lesions should be cautioned preoperatively that they might experience inferior clinical outcomes. Postoperatively, adolescent gymnasts and javelin throwers may be at an increased risk for transient paresthesia of the ulnar nerve caused by increased stress on the medial elbow.

The Utility of the KJOC Score in Professional Baseball in the United States

Background: The Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow questionnaire has been shown by previous studies to be more sensitive than other validated subjective measurement tools in the detection of upper extremity dysfunction in overhead-throwing athletes. Purpose: The primary objective was to establish normative data for KJOC scores in professional baseball players in the United States. The secondary objectives were to evaluate the effect of player age, playing position, professional competition level, history of injury, history of surgery, and time point of administration on the KJOC score. Study Design: Cross-sectional study; Level of evidence, 3. Methods: From 2011 to 2012, a total of 203 major league and minor league baseball players within the Houston Astros professional baseball organization completed the KJOC questionnaire. The questionnaire was administered at 3 time points: spring training 2011, end of season 2011, and spring training 2012. The KJOC scores were analyzed for significant differences based on player age, injury history, surgery history, fielding position, competition level, self-reported playing status, and time point of KJOC administration. Results: The average KJOC score among healthy players with no history of injury was 97.1 for major league players and 96.8 for minor league players. The time point of administration did not significantly affect the final KJOC score (P = .224), and KJOC outcomes did not vary with player age (r = −0.012; P = .867). Significantly lower average KJOC scores were reported by players with a history of upper extremity injury (86.7; P < .001) and upper extremity surgery (75.4; P < .0001). The KJOC results did vary with playing position (P = .0313), with the lowest average scores being reported by pitchers (90.9) and infielders (91.3). Conclusion: This study establishes a quantitative baseline for the future evaluation of professional baseball players with the KJOC score. Age and time of administration had no significant effect on the outcome of the KJOC score. Missed practices or games within the previous year because of injury were the most significant demographic predictors of lower KJOC scores. The KJOC score was shown to be a sensitive measurement tool for detecting subtle changes in the upper extremity performance of the professional baseball population studied.

Operative Management of Elbow UCL Insufficiency in Adolescent Athletes Age 18 Years and Younger

Objectives:The incidence of ulnar collateral ligament (UCL) insufficiency of the elbow has drastically increased in the adolescent population over the last decade due to widespread participation in overhead athletics. Previous reports suggest clinical outcomes in teenage athletes are inferior to results in higher-level adult athletes. We hypothesized that UCL reconstruction using the docking technique would result in improved outcomes in this age group.Methods:46 adolescent athletes (mean age 17 years, range 12-18 years) underwent UCL reconstruction using the docking technique. The majority of patients were baseball players; there were three gymnasts and three javelin throwers. Retrospective review revealed each patient had a history and physical exam consistent with UCL injury along with advanced imaging demonstrating corresponding UCL pathology (24 distal tears, 22 proximal tears). Patients were evaluated at a minimum of 2 years postoperatively based on their ability to return to athletic activity. Clinical outcomes were classified using the Conway Scale, the Andrews-Timmerman Score, and the Kerlan-Jobe Orthopaedic Clinic (KJOC) Score.Results:At most recent follow-up, 89% (41/46) of patients had excellent results using the Conway Scale. There was one good, two fair and two poor results. One fair result was noted in a revision case and the two poor results occurred in patients who had concomitant capitellar OCD lesions. UCL tear location did not affect clinical outcome. There were four postoperative complications in four patients (two gymnasts and two javelin throwers) who developed ulnar neuritis following reconstruction. The average Andrews-Timmerman Score was 86.7 and the mean KJOC score was 88.Conclusion:The docking technique results in favorable clinical outcomes in adolescent athletes with UCL insufficiency at a minimum of 2 years postoperatively. Overall, results were better than previously published reports in this age group and this may be attributed to technique specific factors. Patients with concomitant intraarticular pathology should be counseled preopreratively that they may experience inferior clinical outcomes. Additionally, gymnasts and javelin throwers may be at increased risk for postoperative complications due to increased stress on the medial elbow.

Arthroscopic Capsular Plication for Microtraumatic Anterior Shoulder Instability in Overhead Athletes

Background: Extreme loading conditions at the glenohumeral joint during overhead athletic activities can result in both soft tissue and osseous adaptative changes at the shoulder. Subtle alterations in the stabilizing structures may lead to anterior instability and debilitating shoulder pain with subsequent inability to participate in athletics. There is currently a paucity of data documenting clinical outcomes after arthroscopic capsular plication in overhead athletes who demonstrate objective findings of pain and anterior instability on physical examination. Purpose: To evaluate outcomes after arthroscopic capsular plication for anterior instability in overhead athletes with an emphasis on postoperative range of motion, postoperative shoulder function, and return to sport. Study Design: Case series; Level of evidence, 4. Methods: The authors identified 20 overhead athletes with debilitating shoulder pain and a failed trial of nonoperative management who underwent arthroscopic capsular plication (12 suture plication, 8 suture anchor plication) for anterior instability related to isolated capsular redundancy. Patients were evaluated with the Single Assessment Numerical Evaluation (SANE) and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, and they were interviewed to determine the rate of return to athletic activity. Failures of treatment included patients who demonstrated debilitating pain that precluded return to sport. Results: At a mean follow-up of 3.6 years (range, 2.0-5.5 years), 18 (90%) patients returned to overhead sports, with 17 (85%) at their preinjury level. The mean (SD) SANE score was 86 (17.5%; range, 30%-100%), and the mean (SD) KJOC score was 82 (18.2; range, 28-100). When compared with the contralateral extremity, there were no significant differences in glenohumeral range of motion. Two patients with associated rotator cuff injury experienced persistent pain with overhead activity and were unable to return to sport, representing a 10% failure rate. Conclusion: Arthroscopic capsular plication for anterior instability related to isolated capsular redundancy is an effective procedure that yields a high rate of patient satisfaction and return to overhead athletic activity with an acceptably low failure rate. Patients with associated rotator cuff injury may be at higher risk for treatment failure.

Kerlan-Jobe Orthopaedic Clinic overhead athlete scores in asymptomatic professional baseball pitchers

The Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score is a subjective questionnaire that has been validated and been shown to be more specific in overhead athletes than the American Shoulder and Elbow Surgeons scale. The purpose of this study was to determine a mean KJOC score and reasonable range of KJOC scores within which a healthy asymptomatic professional baseball pitcher will fall. It was hypothesized that healthy professional baseball pitchers would have very high KJOC scores. KJOC questionnaires were given to all healthy pitchers before the start of the season at all levels in 1 professional Minor League system. Pitchers were asked to complete the questionnaire upon reporting to their AAA, AA, or A affiliate team. Any pitcher starting the season on the disabled list was excluded from the study. KJOC scores were returned by 44 pitchers. The mean score for all pitchers was 94.82 (95% confidence interval, 92.94-96.70). The mean score for each question was greater than 9 of 10. The mean score for the AAA affiliate was significantly higher than that for the AA affiliate (P = .015). No other significant differences in scores were found between class levels or groups based on professional playing experience. Only 7 of 44 healthy asymptomatic pitchers (16%) had a KJOC score below 90. Therefore, we believe that the KJOC score is an accurate assessment for overhead athletes and normal values should be greater than 90. Anything below this value could be a potential cause for concern for team physicians. Basic Science, Survey Study, Healthy Subjects.

Outcome of Type II Superior Labral Anterior Posterior Repairs in Elite Overhead Athletes

Background: There are conflicting reports in the literature regarding the outcome of superior labral anterior posterior (SLAP) repairs in overhead athletes and a paucity of data demonstrating ability to return to prior level of competition. Hypothesis: Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score provides more accurate assessment of shoulder function and ability to return to previous level of athletic competition after SLAP lesion repair than does the conventional American Shoulder and Elbow Surgeons scoring system. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-three elite (collegiate or professional) overhead athletes who were more than 1-year status postarthroscopic repair of type II SLAP lesions were evaluated using both the Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score and American Shoulder and Elbow Surgeons score. P values were computed using the analysis of variance model. Postoperative American Shoulder and Elbow Surgeons and Kerlan-Jobe Orthopaedic Clinic scores from subjects were compared with control values obtained from a healthy athletic cohort; the relationship between the scores was investigated using the linear regression model and assessed using Pearson correlations. Results: At a mean 38-month follow-up, 13 athletes were playing pain free at the time of the questionnaire administration, 6 were playing with pain, and 4 were not playing because of pain. Regarding American Shoulder and Elbow Surgeons scores, 22 athletes (96%) had good-excellent scores, whereas 1 (4%) had a fair score. The Kerlan-Jobe Orthopaedic Clinic scores revealed 9 excellent (39%), 3 good (13%), 4 fair (17%), and 7 poor (30%) results for the same study group. Of the 23 patients, 13 (57%) had returned to their pain-free preinjury levels of competition at final follow-up. The inability to return to this level of competition correlated with the presence of a partial-thickness rotator cuff tear (P = .0059). The Kerlan-Jobe Orthopaedic Clinic demonstrated better overall accuracy (85%) than did the American Shoulder and Elbow Surgeons (70%) in evaluating return to pain-free preinjury levels. Conclusion: Return to preinjury level of competition for elite overhead athletes after type II SLAP lesion repairs was 57%, despite high American Shoulder and Elbow Surgeons scores. Return to play status correlated with the presence of a partial-thickness rotator cuff tear. The Kerlan-Jobe Orthopaedic Clinic score, designed specifically for the evaluation of the overhead athlete, was a more accurate assessment tool than was the American Shoulder and Elbow Surgeons in this population of elite overhead athletes with SLAP tears.