Kerlan-Jobe Orthopaedic Clinic Research Articles

Reproducibility and Validity of the Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Score (Japanese Version).

The Kerlan-Jobe Orthopedic Clinic (KJOC) questionnaire is a self-reported performance and functional assessment tool with good reliability and validity for overhead athletes with shoulder and elbow injuries. This study aimed to develop a Japanese version of the KJOC (J-KJOC) to clarify its reproducibility and validity for use by Japanese university baseball players. The J-KJOC was translated according to the guidelines for cross-cultural adaptation. A total of 88 university baseball players completed the J-KJOC and the Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaires. Thirty players completed the J-KJOC two times after a median interval of two weeks. We assessed the absolute reliability, construct validity, internal consistency, and test-retest reliability. Cronbach's alpha coefficients ranged from 0.88 and the intraclass correlation coefficient for the total score was 0.91. A fixed bias was absent in the J-KJOC scores (mean difference: -2.2, 95% CI: -4.8 to 0.5). Furthermore, the J-KJOC score was correlated with the Q-DASH-disability/symptom (r = -0.60, p<0.01) and Q-DASH-sports/music (r = -0.63, p<0.01) scores but not correlated with the Q-DASH-work score (r = -0.11, p = 0.316). The J-KJOC questionnaire demonstrated good reproducibility and validity for assessing upper arm performance in Japanese university baseball players. The results of this study support the use of the J-KJOC for Japanese-speaking baseball players. Further research using this instrument on other types of overhead athletes is needed to determine its wider utility in sports medicine applications.

Translation, Adaptation and Validation of the Greek Version of the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score in Greek Overhead Athletes.

Athletes engaging in overhead activities often face injury risks, emphasising the need for reliable assessment tools. This study focused on the translation and psychometric evaluation of the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score into Greek (Gr-KJOC) for assessing upper limb function in Greek-speaking overhead athletes. The Gr-KJOC underwent meticulous translation and adaptation processes, ensuring linguistic equivalence and cultural relevance. A sample of 60 athletes participated in the psychometric evaluation, including assessments of internal consistency, test-retest reliability, construct validity, and structural validity. The Gr-KJOC demonstrated excellent internal consistency (Cronbach's alpha = 0.95), indicating consistent measurement of the underlying construct. Test-retest reliability was excellent (ICC = 0.95), with low measurement errors. Construct validity was confirmed through correlations with the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. Structural validity revealed a unidimensional structure with high explained variance (75%). No floor or ceiling effects were observed, and the questionnaire proved feasible, with an average completion time of 6 min. The Gr-KJOC emerges as a reliable, valid, and feasible tool for evaluating upper limb function in Greek-speaking overhead athletes. Its psychometric properties support its utility in clinical and research contexts, contributing to the effective assessment and management of shoulder and elbow conditions in the realm of overhead sports in Greece.

Arm Health in Elite Collegiate Summer League Baseball Players Assessed by the Kerlan-Jobe Orthopaedic Clinic Score.

Collegiate baseball players with professional aspirations often participate in summer leagues; foremost among them is the Cape Cod Baseball League (CCBL). Injuries acquired during the collegiate baseball season can be carried into the CCBL season and vice versa. To assess the history of throwing arm injury and current functionality in midseason CCBL players. Cross-sectional study. Online questionnaire. A total of 123 CCBL players participated. Qualifying athletes were ≥18 years old and were rostered CCBL players with remaining collegiate eligibility. After collecting background information, we used the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow questionnaire to assess the history of throwing arm injury and current functionality. The maximum KJOC score is 100.0; higher scores correspond with greater functionality. The mean KJOC score was 86.6 ± 14.5 (n = 92); 24.5% (23/94) of players reported a prior diagnosis of throwing arm injury other than a strain or sprain. A total of 49 (49/96, 51.0%) players had undergone rehabilitation for a throwing arm injury, and 7 (7/96, 7.3%) had experienced a medical procedure. Players with no previous treatment (n = 41, mean KJOC score = 88.9 ± 19.0) more frequently demonstrated KJOC scores of ≥90 than players with such treatment (n = 55, 80.9 ± 17.1; P < .001). The 18 players with time-loss arm injury in the last year had lower mean KJOC scores (71.3 ± 20.0) than players with no injury or time loss (90.3 ± 9.8; P < .001). Similarly, players who reported current arm trouble (n = 15) had lower KJOC scores (71.6 ± 17.5) than players with healthy arms (89.5 ± 11.9; P < .001). The average KJOC score of the CCBL players was <90, with particularly low scores in athletes with prior arm injury and treatment.

Spanish Cross-Cultural Adaptation and Validation of the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score.

There are no available questionnaires in Spanish that assess the function and performance of shoulder and elbow in overhead sports. The Kerlan-Jobe Orthopaedic Clinic (KJOC) score is a reference tool for this purpose. We aimed to cross-culturally adapt and investigate its measurement properties in Spanish overhead athletes. Cross-cultural adaptation followed the steps of direct translation, back translation, comprehensibility analysis, and review by the Committee of Experts. Then, symptomatic and asymptomatic overhead athletes were invited to complete an electronic version of the Spanish adaptation (KJOC-Sp). The structural validity was evaluated through an exploratory factor analysis with principal axis factoring. Hypotheses were tested for known-groups and convergent validity, studying the correlation with the Shoulder Pain and Disability Index and the Disabilities of the Arm, Shoulder, and Hand Sports Module questionnaires in symptomatic athletes. Cronbach alpha was calculated for internal consistency and intraclass correlation coefficient (ICC)2,1 for test-retest reliability. Floor and ceiling effects and time to completion were also calculated. The KJOC-Sp maintained the content of the original version and was adapted to the new population. One hundred participants (41 females and 59 males) with a mean age of 22.4 (5.9)years participated in the study of measurement properties. The factor analysis revealed a 1-factor solution. Symptomatic participants scored significantly lower than asymptomatic, with a large effect size (P < .001; r = .67). Correlations were of -.60 (P < .05) with the Shoulder and Pain Disability Index questionnaire and -0.66 (P < .05) with the Disabilities of the Arm, Shoulder, and Hand Sports Module questionnaire. Cronbach alpha was .98 (95% confidence interval, .97-.98) and the ICC2,1 was .96 (95% confidence interval .93-.98). No floor or ceiling effects were observed among the symptomatic athletes, while mean time to completion was 121seconds. The KJOC-Sp is equivalent to the original score, aside from valid and reliable, without floor or ceiling effects in symptomatic athletes and with a low time consumption.

THE MUSCULOSKELETAL PROFILE OF FEMALE ADOLESCENT ELITE WATER POLO PLAYERS AND THE FACTORS AFFECTING THROWING PERFORMANCE

The musculoskeletal (MSK) profiles of water polo players and other overhead athletes has been shown to relate to injury and throwing performance (TP). There have been no robust studies conducted on the MSK profiles and the variables affecting TP amongst female, adolescent, elite water polo players.A prospective quantitative cohort design was conducted amongst eighty-three female adolescent, elite water polo players (range 14–19 years). All participants filled out the Kerlan-Jobe Orthopaedic Clinic questionnaire, followed by a battery of screening tests aimed to identify possible MSK factors affecting TP. Pain provocation tests, range of motion (ROM), upward scapula rotation (USR), strength and pectoralis minor length measurements were all included. Participants also performed throwing speed (TS) and throwing accuracy (TA) tests.All the data collected were grouped together and analysed using SPSS 28.0. The condition for statistical significance was set as p &lt;0.05. Multi-collinearity was tested for among variables to find out inter-variable correlations. Finally, a multiple regression analysis was performed.The mean KJOC score was 82.55 ± 14.96. 26.5% tested positive for at least one of the impingement tests. The MSK profile revealed decreased internal rotation ROM, increased external rotation ROM, a downwardly rotated scapula, weak external rotators, weak serratus anterior strength, strong lower trapezius and gluteus medius strength and a shorter pectoralis minor length all on the dominant side.Age, pectoralis minor length, upper trapezius and serratus anterior strength as well as upward scapula rotation were all positively correlated with TS, while sitting height, upper trapezius and serratus anterior strength and glenohumeral internal rotation ROM were positively correlated with TA.Multiple MSK parameters were found to be related to TS and TA in elite, adolescent water polo players.

Similar return to sport between double cortical button and docking techniques for ulnar collateral ligament reconstruction in baseball players

A double cortical button technique for ulnar collateral ligament reconstruction (UCLR) has advantages including significant control over graft tensioning, less concern about graft length and minimized risk of bone tunnel fracture compared to traditional UCLR techniques. This double cortical button technique was recently found to be non-inferior in mechanical performance compared to the traditional docking technique regarding joint strength, joint stiffness, and graft strain. However, clinical outcomes have not been compared between these UCLR techniques. Therefore, the purpose of this study was to determine whether baseball players who underwent UCLR with a double cortical button (double button) technique have similar return to sport (RTS) outcomes compared to baseball players who underwent UCLR with the traditional docking (docking) technique. Baseball players that underwent primary UCLR from 2011-2020 across two institutions were identified. Included patients were contacted to complete a follow-up survey evaluating reoperations, RTS, and functional outcome scores. Functional outcome surveys include the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway-Jobe score, Andrews-Timmerman (AT) elbow score, and the Single Assessment Numeric Evaluation (SANE) score. Overall, 78 male baseball players (age: 18.9±2.4 years) with an average follow-up of 3.1±2.4 years were evaluated, with 73 of the players being baseball pitchers. Players in the double button group more frequently received palmaris longus autografts (78% vs. 30%) and less frequently received gracilis autografts (22% vs. 58%) compared to players in the docking group (p=0.001); however, all other demographic factors were similar between groups. All players in the double button group were able to RTS in 11.1±2.6 months, while 96% of players in the docking group were able to RTS in 13.5±3.4 months (p>0.05). All post-operative outcomes and patient-reported outcomes were statistically similar between groups, and remained similar after isolating pitchers only and after separating partial-thickness from full-thickness UCL tears (all p>0.05). Return to sport and other post-operative outcomes may be similar between baseball players who underwent UCLR with the double button technique and the docking technique. While future research may be necessary to strengthen clinical recommendations, these findings provide the first clinical outcomes in light of a recent cadaveric study finding similar elbow strength, joint stiffness, and graft strain compared to the docking technique.

Midterm Clinical Outcomes After Arthroscopic Rotator Cuff Repair in Olympic Volleyball Players: Return to Sports and Return to Performance.

The decision-making process and predicting the time to return to sport (RTS) and return to performance (RTP) after arthroscopic rotator cuff repair (ARCR) in elite volleyball players are difficult issues to address, even among experienced shoulder surgeons. The purpose of the study was to evaluate the results in Olympic-level volleyball players treated with arthroscopic supraspinatus repair and to report the RTS and the RTP. It was hypothesized that these athletes had higher RTS and faster RTP. Case series; Level of evidence, 4. This study included 17 elite volleyball athletes (11 male, 6 female; mean age, 26.2 years) who underwent ARCR for partial- and full-thickness supraspinatus tears that did not improve despite nonoperative treatment. The clinical results were evaluated at 12 months postoperatively. The authors compared the athletes' preoperative, 6-month, and 12-month Kerlan-Jobe Orthopaedic Clinic (KJOC) scores and the visual analog scale (VAS) for pain after competition and conducted 6- and 12-month isometric strength analyses. The athletes' RTS and RTP times were recorded. All tears were on the dominant side (15 right, 2 left), and 82% were partial tears (14 partial thickness, 3 full thickness). The mean time from the onset of symptoms to surgery was 11.3 ± 6.7 months. While the mean Kerlan-Jobe Orthopaedic Clinic score was 31 preoperatively, it was 89 after 6 months (P < .001 vs preoperative) and 96 after 12 months (P = .003 vs 6 months). The mean VAS for pain was 7.9 preoperatively, 0.4 at 6 months (P < .001 vs preoperative), and 0.1 at 12 months (P = .02 vs 6 months). All athletes were able to reach their preinjury level, with RTS at a mean of 6.9 months and RTP at a mean of 12.4 months. ARCR appears to be an effective option for Olympic-level volleyball players who do not benefit from nonoperative treatment. All athletes returned to their preinjury level of sports. The surgeon and athlete can plan surgical decision-making and timing based on the mean RTS time of 6.9 months and mean RTP time of 12.4 months.

Paper 18: A Prospective, Randomized Trial of the Modified Jobe vs. Modified Docking Techniques for Ulnar Collateral Ligament Reconstruction in the Elbow

Objectives: Overhead throwing athletes, notably pitchers, subject the elbow to tremendous valgus stress, and numerous studies have demonstrated an increasing incidence of ulnar collateral ligament of the elbow (UCL) injury. However, surgical reconstruction has transformed this injury from career-ending to career-interruptive. Two primary techniques exist for UCL reconstruction (UCLR): 1) the Modified Jobe and 2) the Modified Docking techniques. Prior biomechanical comparisons have reported equivalent ulnohumeral stability. Systematic reviews of clinical studies have suggested that the Docking technique may result in improved rates of return to play (RTP) and fewer complications, but these comparisons have been indirect and complicated by changes in technique. Our objective was to perform the first prospective, randomized comparison of UCLR utilizing the Modified Jobe or Modified Docking technique as measured by Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Andrews-Timmerman score, and Conway-Jobe score. As secondary outcomes, we sought to compare pre- and postoperative imaging characteristics, required tourniquet times, rate of complications, and RTP data. We hypothesized that no difference exists between the two techniques with regard to any of the above outcomes. Methods: This study was a single-surgeon, prospective, randomized trial comparing the Modified Jobe and Modified Docking techniques for primary UCLR. Patients were eligible if they had clinical and radiographic evidence of UCL injury and participated in overhead sports. Patients were excluded if they were not an overhead athlete, lacked clinical and radiographic evidence of a UCL tear, or had a history of previous elbow surgery. An a priori power analysis was performed utilizing historic data from both techniques to generate a sample size of 80 (40 in each group). All patients were randomized to one of the two techniques for UCLR using a standardized, contralateral gracilis autograft. All patients underwent the same postoperative rehabilitation protocol including throwing and batting progressions. Patient reported outcomes (PROs; KJOC score, Andrews-Timmerman score, and Conway-Jobe score) were obtained preoperatively and at 6 months, 1 year, 18 months, and 2 years postoperative. Pre- and post-operative imaging including both stress ultrasound (SUS) and magnetic resonance (MRI/MRA) were obtained. Additional information including demographics, intraoperative data, complications, and RTP data were collected. T-tests or Mann-Whitney U tests were used to calculate differences between continuous data. Chi-Square or Fisher’s Exact were used for categorical data. Results: There were 40 patients (38M/2F) enrolled in the Jobe group and 40 patients (39M/1F) enrolled in the Docking group. Demographics including sex ratio, age, time between injury and surgery, and sport and level of play were similar between groups. Detailed patient demographic data is given in Table 1. Six patients in the Jobe group and eight patients in the Docking group underwent concomitant anterior subcutaneous UNT (p=0.769). Gracilis autograft harvest and closure required similar mean tourniquet time in both groups (28.7 minutes in Jobe group vs 28.3 minutes in Docking group; p=0.721). However, UCLR required significantly longer upper extremity tourniquet time in the Jobe group (101.0 minutes vs. 92.0 minutes; p=0.008). Preoperatively, patients reported similar levels of function via all PROs. Postoperatively at 6 months, 1 year and 18 months, both groups reported similar PROs. At two years, patients reported similar scores in terms of Andrews Timmerman and Conway Jobe scores, however the Docking group reported significantly higher mean KJOC scores (75.0 vs 85.0; p=0.025). Following surgery, both groups took a similar mean time to swing a bat, to begin tossing, and to begin a mound program. Of the patients that returned for two year follow up in clinic, 28/32 in the Jobe group returned to play at a mean of 13.4 months, compared to 27/27 in the Docking group who returned to play at 14.3 months (p=0.166). Detailed patient outcome data is given in Table 2. All grafts were intact and showed progressive healing on MR and SUS at final radiographic follow-up. There were no significant differences in the rate of complications. One patient in the Docking group required reoperation with revision ulnar nerve decompression with transposition for persistent ulnar nerve symptoms. No patient in the Jobe group required reoperation. Conclusions: This study is the first and only prospective, randomized trial evaluating the outcomes of the Modified Jobe and Modified Docking techniques for UCLR. The study identified high rates of good-to-excellent results with equivalent RTP rates and time to RTP for both techniques. Surgeons should continue to utilize the technique with which they are most comfortable, but the Docking technique demonstrated reduced tourniquet times and superior KJOC scores at 2 years. [Table: see text][Table: see text]

Cross-Cultural Adaptation and Validation of the Persian Version of the Functional Arm Scale for Throwers.

The Functional Arm Scale for Throwers (FAST) is a reliable and valid region-specific tool designed to evaluate health-related quality of life in throwing athletes with upper-extremity injuries. The purpose of this study was to adapt, translate, and evaluate the psychometric properties of the Persian version of the Functional Arm Scale (FAST-Persian) for use in throwing athletes. The study was conducted based on 5 steps of cross-cultural adaptation including forward translation, synthesis, backward translation, expert committee review, and pretesting. The final Persian questionnaire, along with Persian versions of Disabilities of the Arm, Shoulder, and Hand and Kerlan-Jobe Orthopedic Clinic questionnaires, was completed by 177 throwing athletes for validity analysis. After 7 to 14days, the FAST-Persian was reanswered by 80 throwers, who had no changes in this time interval. Internal consistency and test retest reliability were used to evaluate reliability of the questionnaire. Standard error of measurement and smallest detectable changes were also calculated. Construct validity was determined by correlational analysis with Disabilities of the Arm, Shoulder, and Hand and Kerlan-Jobe Orthopedic Clinic questionnaires. Dimensionality was evaluated with factor analysis. Cronbachs alpha was .99, and the interclass correlation coefficient levels for total score and 5 subscales of the FAST-Persian ranged between .98 and .99. The standard error of measurement and smallest detectable changes were 3.17 and 8.80, respectively. The FAST-Persian had a high correlation with Disabilities of the Arm, Shoulder, and Hand (r = .98, P < .0001) and Kerlan-Jobe Orthopedic Clinic (r = .98, P < .0001) scores. Factor analysis revealed one factor with a total variance of 75.23%. The FAST-Persian is a reliable and valid measurement tool that can be used to evaluate health-related quality of life in overhead athletes and throwers.

Paper 21: Functional Outcomes of Primary Ulnar Collateral Ligament Repair with Internal Bracing in Athletes

Objectives: The ulnar collateral ligament (UCL) is the primary restraint to valgus stress in the elbow. Injury to this ligament can occur in the setting of acute trauma as well as chronic overuse as seen in baseball players and other overhead athletes. Injury to the UCL continues to be a major source of morbidity in overhead-throwing athletes, with the incidence of UCL tears increasing dramatically over the past 15 years. UCL reconstruction using palmaris longus or hamstring autograft (also known as Tommy John surgery) has been considered the gold standard for the surgical treatment of symptomatic UCL injuries in overhead athletes for decades. Recently, there has been a renewed interest in UCL repair. In 2016, Dugas et al described the novel use of a collagen-dipped internal brace to augment UCL repair with encouraging biomechanical results from a cadaveric study. To date, only two studies have reported outcomes for this novel approach to UCL repair with internal brace (IB) augmentation, both with encouraging results. It is thought that the main advantages of UCL repair with IB augmentation compared to UCL reconstruction are comparable return to sport rates with a more rapid postoperative recovery, as well as restoration of normal anatomy that eliminates the need for an autograft and the associated complications of graft harvesting. Given the paucity of data examining this new surgical approach, this study seeks to add clinical outcome data for UCL repair to the scientific literature. The goal of this project is to evaluate functional outcomes following primary ulnar collateral ligament repair using internal brace augmentation and to describe new advancements in the surgical technique for this procedure. Methods: Approval was obtained from the Columbia University Irving Medical Center Institutional Review Board. A retrospective review of the electronic medical records of all consecutive patients who underwent medial UCL repair with internal brace augmentation between 2016 and 2022 was performed. All procedures were performed at a single tertiary institution and all patients were under the direct medical care of the senior author. Only patients with a focal UCL injury, such as a distal or proximal avulsion tear, were selected for UCL repair with internal brace augmentation. Evidence of chronic attritional disease, including calcification on MRI, or extensive ligamentous injury were contraindications to UCL repair. Additionally, only patients undergoing primary UCL repair with internal brace augmentation were included; those with prior UCL reconstructions or repairs were excluded as were patients with insufficient clinical follow-up data. Included in the chart review were patient demographics, level of sport, injury characteristics, preoperative imaging findings, operative data, and postoperative clinical outcomes including complications and reoperations. Patient reported outcomes were collected from the Pitch Registry, a national database maintained by Major League Baseball (MLB). Primary outcomes for this study include the ability to return to play (RTP) at the same previous level or higher, the time to return to competition, complications, and reoperations. Results: A total of 56 patients were included in this study (mean age at surgery was 19.5 ± 4.5 years; 55 men and 1 woman). The majority were baseball players (n=52) of which 43 were pitchers, while the remaining athletes played football, wrestled, or competed in Jujitsu. Twenty-eight were high school athletes, 23 played at the collegiate level, 4 played recreationally, and 1 played professionally. Symptoms of UCL injury preceded surgery by an average of 7.5 ± 15.0 months. The UCL was partially torn in 39 patients and fully torn in the remaining 17 patients, and it was torn proximally in 18, distally in 37, and mid-substance in 1 patient. The mean preoperative Kerlan-Jobe Orthopaedic Clinic (KJOC) score was 61.5 ± 15.3, the mean preoperative American Shoulder and Elbow Surgeons (ASES) score was 71.6 ± 14.9, and the mean preoperative Youth Throwing Score (YTS) was 40 ± 14. A concomitant arthroscopic osteophyte debridement and synovectomy was performed in 10 cases and a concomitant ulnar nerve transposition was performed in 4 cases. There were no intra-operative complications. The mean length of follow-up was 12.1 ± 7.1 months. Of the total cohort, 51 (91.0%) patients were able to return to play at an average of 7.8 ± 2.4 months. There were 4 reoperations (7.1%) including a single revision UCL reconstruction, 2 ulnar nerve transpositions, and 1 arthroscopic osteophyte debridement. Conclusions: Primary UCL repair with internal brace augmentation is a viable alternative to UCL reconstruction as supported by a rapid return to play and a low complication rate. There remains a paucity of data examining this encouraging and novel surgical approach. Additional data and analysis examining functional outcomes and optimal patient selection will be critical to address the rising epidemic of UCL injuries in young athletes.

Paper 20: Similar Clinical Outcomes Between Double Cortical Button and Docking Techniques for Ulnar Collateral Ligament Reconstruction in Baseball Players

Objectives: A double button technique using a cortical button on both the humeral and ulnar sides of the UCLR for fixation has recently been proposed, with advantages including greater control over graft tensioning and decreased risk of bone tunnel fracture. This double cortical button technique was recently evaluated biomechanically and found to be non-inferior to the traditional docking technique regarding strength, joint stiffness, and graft strain. However, clinical outcomes have not been compared between the double cortical button technique and standard UCLR techniques such as the docking technique. Therefore, the purpose of this study was to determine whether baseball players who underwent UCLR with a double cortical button (double button) technique have similar return to sport (RTS) rates, time to RTS, and subjective outcomes compared to baseball players who underwent UCLR with the traditional docking (Docking) technique. Methods: Competitive baseball players that underwent primary UCLR from 2011-2020 at across two institutions were identified using the CPT code 24346. Patients were excluded if they were not baseball players or if they did not undergo UCLR with the double button or docking technique. Included patients were contacted via RedCap to complete a follow-up survey evaluating reoperations, RTS, functional outcome scores, and patient satisfaction. Functional outcome surveys include the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway-Jobe score, Andrews-Timmerman (AT) elbow score, and the Single Assessment Numeric Evaluation (SANE) score. Results: Overall, 78 male baseball players (age: 18.9 ± 2.4 years) with an average follow-up of 3.1±2.4 years were evaluated, with 73 of the players being baseball pitchers and 55 (71%) of players completing the functional outcome surveys. Players in the double button group more frequently received palmaris longus autografts (78% vs. 30%) and less frequently received both gracilis autografts (22% vs. 58%) and allografts (0% vs. 13%) compared to players in the docking group (p=0.001); however, all other demographic factors were similar between groups (Table 1). All post-operative and patient-reported outcomes were also similar between groups. All players in the double button group (100%) were able to RTS in 11.1±2.6 months, while 96% of players in the docking group were able to RTS in 13.5±3.4 months (p&gt;0.05). All other post-operative outcomes and patient-reported outcomes were statistically similar between groups, and remained similar after isolating pitchers only and after separating partial-thickness from full-thickness UCL tears (all p&gt;0.05) (Tables 1-3). Two complications were observed in the docking group, with one player experiencing pain at elbow extension due to nerve neurolysis and another player developing an elbow stress fracture during rehabilitation, while no double button players experienced a complication. Conclusions: Post-operative outcomes were similar between baseball players who underwent UCLR with the double button technique and the docking technique. These findings provide the first clinical outcomes in support of a recent cadaveric study which showed the double button technique to provide similar elbow strength, joint stiffness, and graft strain compared to the docking technique. Larger comparative studies are necessary before a clear clinical recommendation can be made regarding the utilization of double button UCLR for baseball players. [Table: see text][Table: see text][Table: see text][Table: see text]

Clinical Outcomes of Osteochondritis Dissecans Lesions of the Capitellum Treated with Arthroscopy with a Mean Follow-Up of 8.3 Years.

While numerous studies exist evaluating the short-term clinical outcomes for patients who have undergone elbow arthroscopy for osteochondritis dissecans (OCD) of the capitellum, the literature on minimum 2-year clinical outcomes for a large cohort of patients is limited. /Hypothesis: We hypothesized that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved postoperative subjective functional and pain scores, and with acceptable return to play for these patients. A retrospective analysis from a prospectively collected surgical database was performed to identify all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Inclusion criteria for this study included the diagnosis of OCD of the capitellum treated arthroscopically with minimum 2-year follow-up. Exclusion criteria included any prior surgical treatment on the ipsilateral elbow, missing operative reports, and patients with any portions of the surgical procedure performed open. Follow-up was performed by telephone using multiple patient-reported outcome questionnaires: American Shoulder and Elbow Surgeons - Elbow (ASES-e), Andrews/Carson, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), and our institution-specific return-to-play questionnaire. After the inclusion and exclusion criteria were applied to our surgical database, 107 eligible patients were identified. Of these, 90 were successfully contacted for a follow-up rate of 84%. The mean age was 15.2 years and mean follow-up time was 8.3 years. Eleven patients had a subsequent revision procedure for a 12% failure rate in these patients. ASES-e pain was an average of 4.0 out of a max pain scale of 100, ASES-e function was an average of 34.5 out of a maximum of 36, and surgical satisfaction was an average of 9.1 out of 10. The average Andrews/Carson score was 87.1 out of 100 and the average KJOC score for overhead athletes was 83.5 out of 100. Additionally, out of the 87 patients evaluated who played sports at the time of their arthroscopy, 81 (93%) returned to play. This study demonstrated an excellent return-to-play rate and satisfactory subjective questionnaire scores with a 12% failure rate following arthroscopy for OCD of the capitellum with a minimum 2-year follow-up.

Posteromedial Osteophyte Resection in Baseball Players Undergoing Ulnar Collateral Ligament Reconstruction Has no Effect on Return to Play but Decreases Patient-Reported Satisfaction and Throwing Control

PurposeThe purpose of this study was to compare patient-reported outcomes and return to play (RTP) rates following ulnar collateral ligament reconstruction (UCLR) in patients with and without posteromedial elbow impingement (PI) treated with concomitant arthroscopic posteromedial osteophyte resection.MethodsBaseball players who underwent UCLR performed by the senior surgeon with minimum follow-up of 2 years were surveyed in this retrospective cohort study. Primary outcomes included Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC) score, Andrews-Timmerman score, and RTP rate. Secondary outcomes included patient satisfaction scores.Results35 baseball players were included. Eighteen had no preoperative impingement (mean age: 19.06 ± 3.28 years), while 17 had PI treated with concomitant arthroscopic osteophyte resection (mean age: 20.06 ± 2.68 years). Following surgery, there was no difference in mean Andrews-Timmerman score (no impingement = 91.67 ± 8.04 vs PI = 92.06 ± 7.92, P = .89) nor KJOC score (no impingement = 83.36 ± 11.72 vs PI = 79.88 ± 12.35, P = .40), but there was a decreased mean KJOC throwing control sub-score in the PI group (7.65 ± 2.40 vs 9.11 ± 1.32, P = .04). There was no difference in RTP rate between the groups (no impingement = 72.22%, PI = 94.12%, χ2 = 1.28; P = .26). There was significantly higher mean satisfaction score in the no impingement group (96.67 ± 4.58 vs 90.12 ± 11.91; P = .04), and those patients were also more likely to pursue surgical treatment again (94.44% vs 52.94%, χ2 = 7.88; P = .005).ConclusionsThere was no difference in RTP rate following ulnar collateral ligament reconstruction in baseball players with and without posteromedial impingement treated with arthroscopic resection. Outcomes on the KJOC and Andrews-Timmerman scores were good to excellent in both groups. Players in the posteromedial impingement group were less satisfied with their outcome, however, and less likely to elect for surgery if they were to sustain the injury again. Additionally, players in the posteromedial impingement group were found to have decreased throwing control on the KJOC questionnaire, which may suggest that the presence of posteromedial osteophytes represent adaptive changes to stabilize the elbow while throwing.Level of EvidenceLevel III, retrospective cohort study. The purpose of this study was to compare patient-reported outcomes and return to play (RTP) rates following ulnar collateral ligament reconstruction (UCLR) in patients with and without posteromedial elbow impingement (PI) treated with concomitant arthroscopic posteromedial osteophyte resection. Baseball players who underwent UCLR performed by the senior surgeon with minimum follow-up of 2 years were surveyed in this retrospective cohort study. Primary outcomes included Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC) score, Andrews-Timmerman score, and RTP rate. Secondary outcomes included patient satisfaction scores. 35 baseball players were included. Eighteen had no preoperative impingement (mean age: 19.06 ± 3.28 years), while 17 had PI treated with concomitant arthroscopic osteophyte resection (mean age: 20.06 ± 2.68 years). Following surgery, there was no difference in mean Andrews-Timmerman score (no impingement = 91.67 ± 8.04 vs PI = 92.06 ± 7.92, P = .89) nor KJOC score (no impingement = 83.36 ± 11.72 vs PI = 79.88 ± 12.35, P = .40), but there was a decreased mean KJOC throwing control sub-score in the PI group (7.65 ± 2.40 vs 9.11 ± 1.32, P = .04). There was no difference in RTP rate between the groups (no impingement = 72.22%, PI = 94.12%, χ2 = 1.28; P = .26). There was significantly higher mean satisfaction score in the no impingement group (96.67 ± 4.58 vs 90.12 ± 11.91; P = .04), and those patients were also more likely to pursue surgical treatment again (94.44% vs 52.94%, χ2 = 7.88; P = .005). There was no difference in RTP rate following ulnar collateral ligament reconstruction in baseball players with and without posteromedial impingement treated with arthroscopic resection. Outcomes on the KJOC and Andrews-Timmerman scores were good to excellent in both groups. Players in the posteromedial impingement group were less satisfied with their outcome, however, and less likely to elect for surgery if they were to sustain the injury again. Additionally, players in the posteromedial impingement group were found to have decreased throwing control on the KJOC questionnaire, which may suggest that the presence of posteromedial osteophytes represent adaptive changes to stabilize the elbow while throwing.

Cross-cultural adaptation and validation of the Greek version of the Kerlan-Jobe orthopaedic clinic shoulder and elbow score in Greek overhead athletes

Background: Overhead athletes frequently perform rapid and powerful throwing overhead strokes in positions at the extreme range of motion, increasing the risk of upper limb injury. The Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score has shown to be a valid and reliable questionnaire that can be used for the assessment of the functional status of the upper limb of patients involved in highly demanding overhead sports. The KJOC has been translated into several other languages however, a Greek version of the KJOC is not available yet. Methods: The KJOC will be cross-culturally adapted into Greek following international guidelines. At least 100 overhead athletes with or without shoulder or elbow complaints will be recruited and asked to fill in the Greek version of the KJOC twice and the Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) once. The internal consistency and the test-retest reliability will be examined using Cronbach’s alpha and the intraclass correlation coefficient (ICC), respectively. The standard error of measurement (SEM) and the minimum detectable change (MDC) will be calculated and possible ground or ceiling effects will be also examined. Convergent validity will be evaluated with the Greek DASH using Pearson’s correlation. Results: The results of this study will be presented in an article to be published later. Conclusions: This report describes the process of translation and cross cultural adaptation of the Greek version of the KJOC. We believe a study protocol will assist researchers in the field to improve the reporting of similar studies and as a result improve the quality of their studies.

Return to Preinjury-Level Sports After Arthroscopic Latarjet for Recurrent Anterior Shoulder Instability in Professional Athletes.

The Latarjet procedure is recommended to treat recurrent anterior shoulder instability with glenoid bone loss. Longer return-to-sport (RTS) times have been reported after the open Latarjet when compared with the arthroscopic Latarjet. To assess the clinical outcomes and RTS in athletes who underwent an arthroscopic Latarjet. Case series; Level of evidence, 4. This study included 46 professional athletes with recurrent anterior shoulder instability who underwent an arthroscopic Latarjet between 2010 and 2016. Patients were divided by type of sport: noncollision and nonoverhead (n = 22), collision and martial arts (n = 13), and overhead (n = 11). Sport activity was evaluated with the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Subjective Patient Outcome for Return to Sports score, and RTS time. Clinical results were evaluated by Constant-Murley score, Walch-Duplay score, and range of external and internal rotation. Complication rates, recurrence of shoulder instability, and number of revision procedures were recorded. Correlation tests were used to assess the relationship between measured parameters. The mean ± SD patient age was 27.1 ± 7.3 years, and the mean follow-up was 50.7 ± 18 months. Overall, 44 patients (95.7%) returned to their previously practiced sports, and 40 (87%) returned to their preinjury levels. The RTS time was 5 ± 1.4 months, with no significant difference among sport types. KJOC and Subjective Patient Outcome for Return to Sports scores were 95.2 ± 5.6 and 9.5 ± 1, respectively. Significant pre- to postoperative improvement was seen on the Constant-Murley score (from 54.3 ± 9.4 to 87.9 ± 8.2; P = .001) and Walch-Duplay score (from 53.7 ± 7.3 to 88.1 ± 10.7; P = .001). Mean postoperative external and internal rotation was 72.8° ± 18.6° and 81.3° ± 11.3°. Procedure-related complications occurred in 10 patients (21.7%); recurrence of shoulder instability was observed in 4 (8.7%); and 4 (8.7%) underwent revision surgery. A worse Walch-Duplay score was significantly associated with longer RTS time (r = -0.39; P = .019) and lower KJOC score (r = 0.29; P = .03). There was a 95.7% RTS rate after the arthroscopic Latarjet procedure, although the procedure was not free from complications.

Arthroscopic Posterior Capsulolabral Repair With Suture-First Versus Anchor-First Technique in Patients With Posterior Shoulder Instability (Type B2): Clinical Midterm Follow-up.

Isolated soft tissue injuries of the posterior capsulolabral complex can be addressed arthroscopically, with various anchor systems available for repair. To evaluate clinical and patient-reported outcomes after arthroscopic capsulolabral repair in patients with posterior shoulder instability (PSI) and to compare differences in outcomes between patients treated with a suture-first technique (PushLock anchor) and an anchor-first technique (FiberTak all-suture anchor). Cohort study; Level of evidence, 3. Included were 32 patients with dynamic structural PSI (type B2 according to the ABC classification) treated with an arthroscopic posterior capsulolabral repair. After a mean follow-up time of 4.8 ± 3.4 years (range, 2-11) patients were evaluated clinically, and standardized outcome scores were obtained for the Subjective Shoulder Value (SSV), the Western Ontario Shoulder Instability Index (WOSI), Rowe, Kerlan-Jobe Orthopaedic Clinic (KJOC), patient satisfaction (0-5 [best]), and pain on a visual analog scale (VAS; 0-10 [worst]). The overall satisfaction level with the outcome of the surgery was 4.6 ± 0.5 (range, 4-5). No patient suffered from instability events. The mean VAS level for pain was 0.4 ± 0.9 (range, 0-4) at rest and 1.9 ± 2.0 (range, 0-6) during motion. The mean SSV was 80 ± 17 (range, 30-100), the mean postoperative WOSI score 75% ± 19% (range, 18-98), the mean Rowe score 78 ± 20 (range, 10-100), and the mean KJOC score was 81 ± 18 (range, 40-100) for the entire cohort. There was no significant difference between the techniques with regard to range of motion, strength, or clinical outcome scores. Arthroscopic posterior capsulolabral repair was a satisfactory method to treat structural PSI type B2 with regard to stability, pain relief, and functional restoration. The majority of patients had good outcomes. No differences in outcomes were observed between the anchor-first and suture-first techniques.

Clinical outcomes and return to play in softball players following SLAP repair or biceps tenodesis.

Shoulder pain due to labral tears and biceps tendonitis is commonly found in softball players. Surgical options include labral repair and biceps tenodesis. Although past studies are limited by heterogeneous study groups from multiple sports, this is the first study that assesses clinical outcomes and return to play rates for fast-pitch softball players. The purpose of this study was to evaluate the clinical outcomes and return to play for fast-pitch softball players treated for a superior labrum anterior posterior (SLAP) tear and recalcitrant biceps tendonitis with a biceps tenodesis compared with a traditional SLAP repair. We hypothesized that the biceps tenodesis would have comparable outcomes with a faster return to play compared with SLAP repair. We performed a retrospective analysis on fast-pitch softball players treated surgically for SLAP tear, recalcitrant biceps tendonitis, or a combination between 2001 and 2019 at our institution. Inclusion criteria were fast-pitch softball players who underwent biceps tenodesis or a SLAP repair with greater than 2-year follow-up. Exclusion criteria involved slow-pitch softball players, patients with less than 2-year follow-up, and patients who had undergone concomitant procedures on the ipsilateral shoulder at the time of SLAP repair or biceps tenodesis. Follow-up was either self-reported through OBERD, a patient-reported outcomes (PRO)-managing software, or achieved over the phone. Follow-up data included American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Andrews Carson Score, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score, Numeric Rating Scale for Pain, and our institution-specific return-to-play questionnaire. We statistically compared players who underwent biceps tenodesis or a SLAP repair, and compared pitchers with position players using Student t tests and Fisher exact test with statistical significance determined to be P<.05. From 60 eligible patients identified, follow-up outcome data were successfully captured for 47 (78%). Of the 18 SLAP repair patients, 17 (94%) returned to full competition at an average of 7.9 months. Of the 29 patients who underwent biceps tenodesis, 27 (93%) returned to full competition at an average of 7.1 months. Statistical analysis of PRO scores for each group found no significant differences between any of the measures used to evaluate patient outcomes, including no statistical difference in pitchers compared with position players. In conclusion, this study demonstrated comparable outcomes between SLAP repairs and biceps tenodesis procedures among our study group of fast-pitch softball players. There was no significant difference between RTP times between the 2 groups.

Minimum 10-Year Clinical Outcomes After Arthroscopic Capsulolabral Repair for Isolated Posterior Shoulder Instability

Background: Arthroscopic capsulolabral repair for posterior shoulder instability has been shown to improve patient-reported outcomes and return to sport at short-term and midterm follow-up, but long-term outcomes are unknown. Purpose: To determine the objective and subjective clinical outcomes of shoulder function after arthroscopic posterior shoulder stabilization at a minimum 10-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A total of 53 patients (55 shoulders) with unidirectional recurrent posterior shoulder instability who underwent arthroscopic capsulolabral repair were evaluated at a mean follow-up of 15.4 years. Outcomes such as the American Shoulder and Elbow Surgeons (ASES) shoulder score, Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score, and subjective strength, stability, range of motion, and pain were evaluated preoperatively and postoperatively at a minimum 10-year follow-up. Outcomes from the same patient cohort were previously collected at 3.0-year follow-up and were evaluated for longitudinal analysis. Subgroup analyses for sport type (contact vs noncontact), position (thrower vs nonthrower), and revision versus nonrevision were performed. Risk factors for revision surgery based on magnetic resonance imaging findings, patient characteristics, and surgical findings were investigated. Results: Arthroscopic capsulolabral repair for posterior shoulder instability led to a statistically significant improvement on all outcome measures, with similar values at short-term (3.0-year) and long-term (15.4-year) follow-up. Across the total population, patients with 19 of 55 shoulders (35%) returned to sport at the same preinjury level, and patients with 33 of 55 shoulders (60%) returned to sport at some level. At long-term follow-up, patients with only 22% of shoulders were involved in the primary sport in which the injury was sustained, with patients with 28% of shoulders discontinuing sporting participation because of ongoing shoulder issues. Throwers trended toward lower Kerlan-Jobe Orthopaedic Clinic scores than nonthrowers both preoperatively (36.5 ± 22.8 vs 48.7 ± 22.9, respectively; P = .10) and postoperatively (57.4 ± 27.0 vs 73.5 ± 26.8, respectively; P = .09) but had similar improvements. Contact and noncontact athletes had similar preoperative and postoperative values, with equal improvements after surgery. With failure defined as revision surgery, an ASES score <60, or a stability value >5, 19 of 55 shoulders (35%) met failure criteria at final follow-up. Overall, 7 of 55 shoulders (13%) underwent revision surgery. At long-term follow-up, patients who underwent revision surgery had worse outcomes than those who did not undergo revision (ASES score: 53.1 ± 25.9 vs 81.8 ± 19.4, respectively; P < .001). An acute injury in the postoperative period (P < .001) and a smaller glenoid bone width on magnetic resonance imaging (P = .02) were the only identified risk factors for revision surgery. Conclusion: Arthroscopic capsulolabral repair for posterior shoulder instability was a durable treatment option that improved long-term shoulder pain and function and facilitated return to sport in the majority of patients at a mean follow-up of 15.4 years, although a notable proportion of patients met various criteria for failure.

Does Prehabilitation Before Surgery Affect Return to Sport in Baseball Pitchers With Partial Ulnar Collateral Ligament Tears?

Purposeful rehabilitation before surgery (prehabilitation) has been researched and implemented in the treatment of anterior cruciate ligament tears. However, it is unclear whether prehabilitation would affect outcomes for baseball pitchers with partial ulnar collateral ligament (UCL) tears. The purpose of this study was to determine whether baseball pitchers with partial UCL tears who completed ≥4 weeks of prehabilitation (prehab group) have different return to play (RTP) outcomes than pitchers with 0 to 3 weeks of preoperative physical therapy (no prehab group). We hypothesized that pitchers in the prehab group would have similar RTP rates compared with pitchers in the no prehab group. Cohort study; Level of evidence, 3. Baseball pitchers of all competitive levels who underwent primary UCL reconstruction (UCLR) or UCL repair between 2010 and 2019 were included. Physician chart notes, magnetic resonance images, and operative notes were screened to confirm primary UCLR or UCL repair of a partial UCL tear and to identify whether the nonoperative treatment had been attempted. Patients were contacted via RedCap for postoperative complications, reoperations, RTP, and patient-reported outcomes (Kerlan-Jobe Orthopaedic Clinic score, Andrews-Timmerman score, Conway-Jobe score, and satisfaction). Overall, 105 baseball pitchers (n = 55 prehab group; n = 50 no prehab group) were included and evaluated at 3.4 ± 2.5 years postoperatively. Six pitchers underwent UCL repair, and 99 pitchers underwent UCLR. All demographic characteristics were similar between groups except the prehab group received a gracilis graft more frequently (76.5% vs 51.2%; P = .038). The RTP rate (prehab [88.1%] vs no prehab [93.8%]; P = .465) was similar between groups. All other postoperative outcomes were also similar between groups, including revision rates and patient-reported outcomes. Postoperative and patient-reported outcomes did not differ significantly between pitchers with partial UCL tears who performed rehabilitation before UCL surgery and pitchers who did not attempt a significant period of rehabilitation before UCL surgery. Clinicians should feel comfortable recommending rehabilitation for patients with partial UCL tears who wish to attempt a period of nonoperative treatment, as postoperative outcomes are not affected if UCL surgery is later needed.

Paper 23: Outcomes Following Arthroscopic Removal of A Posteromedial Osteophyte and Risk of Future Ulnar Collateral Ligament Reconstruction

Objectives: Despite successful return to sport (RTS) outcomes after posteromedial osteophyte resection, one possible consequence of removing this osteophyte is increased stress on the ulnar collateral ligament (UCL), leading to a UCL injury. It is currently unknown how often overhead athletes who have an isolated posteromedial osteophyte resection progress to require UCL reconstruction (UCLR). Therefore, the purpose of this study was to report outcomes following arthroscopic resection of posteromedial osteophyte in overhead athletes and determine if baseball pitchers who underwent arthroscopic posteromedial osteophyte resection for posteromedial impingement went on to require UCL surgery. Methods: All patients who underwent elbow arthroscopy from 2010-2020 were reviewed. Patients were included if they underwent isolated arthroscopic posteromedial osteophyte resection without concomitant UCL surgery, were overhead athletes at the onset of posteromedial impingement symptoms and had no history of prior elbow surgery. Primary outcomes included RTS rate, complications, subsequent shoulder and elbow injury/surgery and several patient-reported outcome measures (Kerlan-Jobe Orthopaedic Clinic score, Timmerman-Andrews Elbow score, Conway-Jobe score). Results: Overall, 36 overhead athletes were evaluated at 5.1 years post-operatively, including 28 baseball pitchers, 3 baseball catchers, 3 softball players, 1 tennis player, and 1 volleyball player. 77% of overhead athletes RTS and had a mean KJOC score of 70, with 89% of athletes having either an excellent (73%) or good (16%) Conway-Jobe score at long-term follow-up. Subsequent UCLR was required in 18% (n=5) of baseball pitchers at a median of 13 months post-op. Three of the five UCLR were performed shortly after posteromedial osteophyte resection (6, 7, and 13 months post-op), while the other two UCLRs were performed at 6.2 and 7.5 years post-op. Conclusions: Following arthroscopic posteromedial osteophyte resection, 77% of athletes were able to RTS. Baseball pitchers who undergo arthroscopic posteromedial osteophyte resection have an 18% risk of subsequent UCLR.