Preinjury Level Of Performance Research Articles

Ulnar collateral ligament repair in professional baseball players

Background: While initial reports of surgical repair of ulnar collateral ligament tears are promising, studies detailing post-repair outcomes are lacking. This study explores the effectiveness of ulnar collateral ligament (UCL) repair in returning professional baseball players to their pre-injury level of play. Our hypothesis is that professional baseball players undergoing UCL repair will have successful outcomes and high return to sport rates after surgery.Methods: Publicly available databases were utilized to search for data on professional baseball players who underwent UCL repair from 2016 to 2021. Players undergoing primary UCL repair with an internal brace were included. Amateur players were excluded as were those undergoing revision UCL repair or UCL reconstruction. Results: Of the 11 pitchers who underwent UCL repair, minor league baseball (MiLB) pitchers returned to the sport at an average of 17.5 months. MiLB pitchers had similar earned run averages (ERAs), games played, innings pitched, and walks plus hits per inning pitched ratios (WHIPs) before and after surgery. Four major league baseball (MLB) pitchers (80%) returned to the sport at 9.55 months. MLB pitchers played fewer games and pitched fewer innings than before the surgery, but their ERAs and WHIPs were similar before and after surgery. Pitch velocity and spin rates after surgery varied based on pitch type. The seven positional players who underwent UCL repair showed no differences in batting or fielding performance before and after surgery.Conclusions: UCL repair can successfully return both pitchers and positional players at both the MiLB and MLB levels to play at pre-injury performance levels. Repair can be considered as an option for qualifying injuries in players hoping to maximize performance after surgery with minimal recovery time.Level of Evidence: IV.

Return to play and Athletic Performance in division I female volleyball players following anterior cruciate ligament injury

ABSTRACT Objectives The purpose of this study is to examine NCAA Division I volleyball players’ return to play rates and performance statistics compared to pre-injury levels following ACL injury. Methods Female volleyball players that sustained ACL injuries from 2008-2020 and competed in one of seven collegiate conferences (n = 99) were identified via an internet search algorithm. Players were categorized by position, academic year, and playing time pre- and post-injury. Post-injury performance statistics were gathered for a subset of outside hitters and middle blockers that played in ≥ 35 sets in a single season for up to 3 years following injury (mean 1.7 seasons). A control group (n = 512) was generated for demographic and statistical comparison. Mean pre-injury and post-injury statistics were compared for players that did not change positions and played ≥ 35 sets before and after injury. Results Volleyball attackers were 54.7% of the control population but sustained 78.8% of identified injuries. Following ACL injury, 6.1% of players registered no in-game statistics, 16.2% played in < 35 sets, 65.7% played in ≥ 35 sets, and 12.1% graduated. Mean performance statistics increased linearly the more years players were from ACL injury. Conclusions Female collegiate volleyball players return to play following ACL injury at high rates (93.1%) and maintain pre-injury performance levels. Volleyball attackers sustain ACL injuries more commonly than setters and libero/defensive specialists.

Return to Sport, Re-injury and Performance After the Anterior Cruciate Ligament Reconstruction: Evaluating the Role of International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) Scoring Systems.

Introduction Anterior cruciate ligament (ACL) tears are common injuries that can considerably impact an individual's quality of life and athletic performance. In these cases, surgical reconstruction of the ligament can be considered to restore stability to the knee. This study aims to investigate the time taken for individuals to return to sport post-ACL reconstruction, assess the rate of re-injuryand evaluate the reliability of the International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scoring systems in predicting a return to sport at the pre-injury level. Methods In this retrospective study, a total of 104 patients who underwent ACL reconstruction between January 2016 and December 2022 by one surgical team at Mater Dei Hospital, Malta were evaluated using a self-administered questionnaire. The questionnaire was based on different components including the sport practised at the time of injury, sport engagement classification, return to sport, the ability to return to pre-injury levels of performanceand re-injury. The participants then had to fill in IKDC and KOOS evaluation forms. Results In this study, 73% (n=76) of individuals successfully returned to sport after ACL reconstruction, with no significant difference being found between professional and recreational athletes (Chi-squared=0.00455, p=0.95). After reconstruction, 31.7% (n=33) of participants experienced an ipsilateral or contralateral ACL tear, with those returning to sport within six months showing a fivefold increase in re-injury risk compared to individuals who returned at eight or 12 months, suggesting a significant association between return duration and re-injury. The relationship between scoring systems and return to sport at the pre-injury level of performance was analysed using binary logistic regression, revealing that achieving scores of 85.6 or higher in IKDC or 89 or higher in KOOS meant having a 95% probability of returning to sport at the pre-injury level. Conclusions By considering these scoring systems with other post-operative criteria, clinicians can offer a more customised rehabilitation plan tailored to each patient who undergoes ACL reconstruction.

Sovateltide (ILR-1620) Improves Motor Function and Reduces Hyperalgesia in a Rat Model of Spinal Cord Injury.

Spinal cord injury (SCI) presents a major global health challenge, with rising incidence rates and substantial disability. Although progress has been made in understanding SCI's pathophysiology and early management, there is still a lack of effective treatments to mitigate long-term consequences. This study investigates the potential of sovateltide, a selective endothelin B receptor agonist, in improving clinical outcomes in an acute SCI rat model. Thirty male Sprague-Dawley rats underwent sham surgery (group A) or SCI and treated with vehicle (group B) or sovateltide (group C). Clinical tests, including Basso, Beattie, and Bresnahan scoring, inclined plane, and allodynia testing with von Frey hair, were performed at various time points. Statistical analyses assessed treatment effects. Sovateltide administration significantly improved motor function, reducing neurological deficits and enhancing locomotor recovery compared with vehicle-treated rats, starting from day 7 post injury. Additionally, the allodynic threshold improved, suggesting antinociceptive properties. Notably, the sovateltide group demonstrated sustained recovery, and even reached preinjury performance levels, whereas the vehicle group plateaued. This study suggests that sovateltide may offer neuroprotective effects, enhancing neurogenesis and angiogenesis. Furthermore, it may possess anti-inflammatory and antinociceptive properties. Future clinical trials are needed to validate these findings, but sovateltide shows promise as a potential therapeutic strategy to improve functional outcomes in SCI. Sovateltide, an endothelin B receptor agonist, exhibits neuroprotective properties, enhancing motor recovery and ameliorating hyperalgesia in a rat SCI model. These findings could pave the way for innovative pharmacological interventions for SCI in clinical settings.

Arthroscopic Posterior Capsular Release Improves Range of Motion and Outcomes for Flexion Contracture After Anterior Cruciate Ligament Reconstruction in Athletes

To assess outcomes of arthroscopic posterior capsular release among athletes for loss of terminal extension following anterior cruciate ligament (ACL) reconstruction. A retrospective review of prospectively collected data was performed for patients undergoing arthroscopic posterior capsular release for knee extension loss following ACL reconstruction between January 2014 and December 2019. Procedure indications included extension loss greater than 10° at least 3 months after ACL reconstruction that was refractory to physical therapy. Patients were included if they were involved in either high school or college athletics, had complete outcomes of interest, and had at least 2 years of follow-up. Prospectively collected outcomes included preoperative and postoperative measurement of knee extension, International Knee Documentation Committee score, Lysholm score, return to sport data, and complications. Eighteen athletes with minimum 2 years of follow-up who underwent posterior capsular release following ACL reconstruction performed by a single surgeon were included in the analysis. Patients underwent surgery at an average of 16 weeks after ACL reconstruction. Knee extension improved an average of 13.8° at 2 years' follow-up (prerelease mean extension deficit 15.1°, postrelease mean extension deficit 1.3°, P < .005). Improvements in the International Knee Documentation Committee score averaged 21.7 at 6 months and 35.0 at 24 months, both of which were statistically significant (P < .001). Similarly, differences in Lysholm included a significant improvement of 23.0 and 34.2 at 6 months and 2 years, respectively (P < .001). In total, 77.8% returned to sport at an average of 9.8 months from their primary ACL surgery and 6.5 months following posterior capsular release surgery. No infections or neurovascular complications were observed. One patient required secondary release to achieve adequate extension. For athletes with persistent knee extension loss after ACL reconstruction, knee extension was significantly improved at 2 years following arthroscopic posterior capsular release. Substantial improvements in patient-reported outcomes also were seen. In addition, subjects demonstrated a high rate of return to sport and return to preinjury performance levels. Level IV, therapeutic case series.

Performance-Based Outcomes after Revision Ulnar Collateral Ligament Surgery in Professional Pitchers.

To compare performance in baseball pitchers before and after revision ulnar collateral ligament (UCL) surgery using performance metrics. Case series. Public online database. Players who underwent revision UCL surgery between 2015 and 2021 were identified. Players were included if they were Minor League (MiLB) or Major League (Major League baseball [MLB]) pitchers. Players were excluded if they were not pitchers, if they underwent their revision surgery as an amateur, or if there is no record of their primary reconstruction surgery. Revision UCL surgery (repair or reconstruction). Return to sport (RTS) rate, RTS time, pitch velocity, and pitch spin rate. Sixty-five pitchers underwent revision UCL surgery. MiLB pitchers had a shorter RTS time after their primary surgery (15.62 vs 20.77 months, P < 0.01) compared with MLB pitchers but similar RTS times after their revision reconstruction (19.64 vs 18.48 months, P = 0.44). There was also no difference in return to play (RTP) rate overall after primary versus revision reconstruction (P = 1.00). Major League baseball pitchers also had decreased RTS time after primary compared with revision reconstruction (15.62 vs 19.64 months, P < 0.01) but similar RTP rates (P = 0.28). Finally, MLB pitchers had similar pitch breakdowns, velocities, and spin rates before and after their primary and revision repair or reconstruction. Both revision UCL repair and reconstruction can return pitchers to preinjury performance levels. Pitchers and teams should be properly counseled on realistic RTP times and postsurgery performance when discussing revision UCL surgeries.

Impact of ERAS compliance on the short-term outcomes for distal radius surgery: a single-center retrospective study

BackgroundDistal radius fractures (DRF) account for one in five bony injuries in both primary and secondary trauma care. Enhanced recovery after surgery (ERAS) has been adopted successfully to improve clinical outcomes in multiple surgical disciplines; however, no study has investigated the effect of different degrees of compliance with ERAS protocol on short-term outcomes following distal radius surgery. We aimed to analyze whether different degrees of compliance with the ERAS pathway are associated with clinical improvement following surgery for DRF.MethodsWe retrospectively analyzed all consecutive patients with ERAS who underwent surgery for DRF at our department between May 2019 and October 2022. Their pre-, peri-, and post-operative compliance with the 22 elements of the ERAS program were assessed. We compared parameters between low- (< 68.1%) and high-compliance (> 68.1%) groups, including patient complications, total length of hospitalization, discharge time after surgery, hospital costs, time taken to return to preinjury level performance level, number of visual analogue scale (VAS) pain scores > 3 points during hospitalization, disabilities of the arm, shoulder and hand (DASH) scores. We performed multiple linear regression analyses to assess the impact of ERAS compliance on the postoperative function level (DASH scores).ResultsNo significant differences were detected between the high- and low-compliance groups with respect to demographics, including sex, age, body mass index (BMI), and comorbidities (P > 0.05). We observed significant differences between the high- and low-compliance groups in terms of the DASH score (32.25 ± 9.97 vs. 40.50 ± 15.65, p < 0.05) at 6 months postoperatively, the discharge time after surgery (2.45 ± 1.46 vs. 3.14 ± 1.50, p < 0.05), and number of times when the VAS pain score was > 3 points during hospitalization (0.88, [0.44, 1.31], p < 0.05). Our study demonstrated a significant negative association between ERAS compliance and the function level of patients postoperatively (DASH scores) when adjusted for age, comorbidity, sex, and BMI.ConclusionsThis study provided a realistic evaluation and comparison of the ERAS protocol among patients with DRF and can guide clinical decision making. The ERAS protocol may improve outcomes after surgery, with high postoperative function levels and reduced pain and discharge time after surgery, without increased complication rates or hospital costs.

Dancers Show Significant Improvement in Outcomes and Favorable Return-to-Dance Rates After Primary Hip Arthroscopy With Femoral Head Cartilage Status Being a Predictor of Secondary Surgical Procedures at Mid-Term Follow-Up

To report minimum 5-year follow-up patient-reported outcome measurement scores (PROMS) and return to dance in dancers who underwent primary hip arthroscopy and to identify predictors for secondary surgeries. Prospectively collected data from May 2010 and June 2016 were retrospectively reviewed. Patients were included if they participated in dance one year prior to surgery at any level, had preoperative and minimum 5-year follow-up scores for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analog Scale for pain (VAS). Exclusion criteria were previous hip conditions, previous ipsilateral hip surgery, Tönnis grade > 1, or lateral center-edge angle < 18°. The minimal clinically important difference (MCID) was reported. Dancers that discontinued dance for reasons other than pain in their operated hip were excluded from the return to dance analysis. A logistic regression model was used to identify predictors of secondary surgeries. Fifty-one hips (48 female dancers) were included. The average age and follow-up were 29.8 ± 17.2 years and 79.1 ± 23.2 months, respectively. Improvement in all PROMS (P < 0.001) was reported. Achievement rates of MCID for the mHHS, NAHS and VAS were 83.3%, 85.7% and 85.7%, respectively. Five dancers (9.8%) underwent revision hip arthroscopy and four dancers (7.8%) converted to total hip arthroplasty. The rate to return to dance was 78.6%, with 57.6% returning to the pre-injury or higher performance level. Higher femoral head Outerbridge grade was identified as a predictor for secondary surgeries [P = 0.045, odds ratio 6.752, 95% CI (1.043 - 43.688)]. Dancers following primary hip arthroscopy experienced significant improvement in all PROMS collected and achieved a high rate of the MCID at a minimum 5-year follow-up. The rate to return to dance, in dancers that did not discontinue due to lifestyle transition, was 78.6% with 57.6% returning to the pre-injury or higher performance level. Higher femoral head Outerbridge grade was found to be a predictor for secondary surgeries.

Poster 117: Dancers Following Primary Hip Arthroscopy Demonstrate Favorable Outcomes and High Rate of Return to Dance at a Minimum 5-Year Follow-Up

Objectives: The purpose is to report minimum 5-year follow-up patient-reported outcome measurement scores (PROMS) and return to dance in dancers who underwent primary hip arthroscopy, and to identify predictors for secondary surgeries Methods: Prospectively collected data from May 2010 and June 2016 was retrospectively reviewed. Patients were included if they participated in dance one year prior to surgery at any level, had preoperative and minimum 5-year follow-up scores for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and Visual Analog Scale for pain (VAS). Exclusion criteria were previous hip conditions, previous ipsilateral hip surgery, Tönnis grade &gt; 1, or lateral center-edge angle &lt; 18°. The minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and the maximum outcome improvement (MOI) were reported. A logistic regression model was used to identify predictors of secondary surgeries. Results: Fifty-one hips (48 female dancers) were included. The average age and follow-up were 29.8 ± 17.2 years and 79.1 ± 23.2 months, respectively. Improvement in all PROMS (P &lt; 0.001) was reported. Achievement rates of MCID for the mHHS, NAHS and VAS were 83.3%, 85.7% and 85.7%, respectively. Achievement rates of PASS for the mHHS and the International Hip Outcome Tool–12 were 90.5% and 81%, respectively. The MOI was 73.8% for the mHHS, and 78.6% for the NAHS. Six dancers (14.3%) underwent revision hip arthroscopy and three dancers (5.8%) converted to total hip arthroplasty. The rate to return to dance was 79.1%. Femoral head Outerbridge grade was identified as a predictor for secondary surgeries [P = 0.045, odds ratio 6.752, 95% CI [1.043 – 43.688]). Conclusions: Dancers following primary hip arthroscopy experienced significant improvement in all PROMS and achieved high rates of the MCID, PASS, and MOI at a minimum 5-year follow-up. Further, 89.3% continued to dance with 68% returning to the pre-injury or higher performance level. Femoral head Outerbridge grade was found to be a predictor for secondary surgeries.

"Biofeedback-based return to sport": individualization through objective assessments.

Elite athletes are regularly exposed to high and repetitive mechanical stresses and impacts, resulting in high injury rates. The consequences of injury can range from time lost from training and competition to chronic physical and psychological burden, with no guarantee that the athlete will return to preinjury levels of sport activity and performance. Prominent predictors include load management and previous injury, highlighting the importance of the postinjury period for effective return to sport (RTS). Currently, there is conflicting information on how to choose and assess the best reentry strategy. Treating RTS as a continuum, with controlled progression of training load and complexity, seems to provide benefits in this process. Furthermore, objectivity has been identified as a critical factor in improving the effectiveness of RTS. We propose that assessments derived from biomechanical measurements in functional settings can provide the objectivity needed for regular biofeedback cycles. These cycles should aim to identify weaknesses, customize the load, and inform on the status of RTS progress. This approach emphasizes individualization as the primary determinant of RTS and provides a solid foundation for achieving it.

Tension band wiring of fracture distal end of clavicle: Favorable clinical outcome among the patients

Background: A fracture of the clavicle is common traumatic injury. It can be classified into middle third, medial third, and distal third fractures. Around 10–15% of clavicle fractures occur in the distal third. The ideal method of fixation in distal third clavicle fracture remains controversial till date. Aims and Objectives: The clinical outcome of the patients having fracture of the distal end clavicle using rigid fixation with tension band wiring (TBW) with Kirshner wires and SS wire to be assessed instead of other conventional procedures. Materials and Methods: Eight patients of Neer type II closed distal-third clavicle fracture of &lt;3 weeks of duration were included in our study. The fractures were reduced by open reduction and fixed with TBW with two K-wires and SS wire. Results: The mean average age of patients was 41.87 years. All fractures united clinically and radiologically. The mean average time of union was 12 weeks. There was two case of hardware prominence, no fracture related complications. One case of superficial infection was found in study. All of them regained near normal range of motion, and the mean average constant Murley score for distal clavicle fracture at the end of 1 year was 88. At the end of 1 year follow-up, all patients had reached their pre-injury performance levels. Conclusion: There was an encouraging result with TBW in distal third clavicle fracture in our study. This technique is simple with lesser need of expertise and is also cost effective.

Upper limb performance and neuromuscular asymmetries in Australian Rules Footballers following shoulder stabilisation surgery

Introduction: Shoulder dislocations are prevalent in Australian Rules Football (ARF) with many requiring shoulder stabilisation surgery. Following surgery, most athletes desire to return to sport (RTS) at their pre-injury level of performance. However, residual inter-limb deficits in strength and neuromuscular performance may delay RTS, and contribute to poor outcomes. The aim of this study was to investigate inter-limb deficits at the time of clearance to RTS during long-lever isometric tests in patients after stabilisation surgery, compared to an uninjured control group of ARF players.

Performance Is Regained Within 2 Seasons After Quadriceps Tendon Tears in National Basketball Association Players

To characterize quadriceps tendon injuries over 30 National Basketball Association (NBA) seasons and assess the effects on player performance upon return to play. Partial and complete quadriceps tendon tears in NBA players between the 1990-1991 and 2021-2022 seasons were queried from a publicly available database. The primary outcomes were changes in player performance statistics obtained from each player's preindex season and first 2 postindex seasons. These interseason changes were compared with the changes of a healthy control cohort. Each injured player was matched with 2 controls using position, career length and win shares by season. The secondary measure of this study was the rate of return to play. Nine quadriceps tendon tears (6 partial, 3 complete) were identified in NBA players. Seven (78%) of the players returned to play in NBA games, missing 50 ± 30 games and 214 ± 112 calendar days on average. Comparisons between these player's preindex and first postindex seasons revealed significant declines in games played (73.2 ± 6.6 vs 41.8 ± 10.8, P= .009) and minutes per game (27.2 ± 2.9 vs 23.0 ± 3.7, P= .042). When compared with controls, only the decrease in games played was significant (-31.3 ± 7.6 vs 1.4 ± 8.2, P= .004). These findings were consistent when comparing preindex and second postindex seasons (games played: 79.6 ± 1.9 vs -28.4 ± 5.4, P= .006; minutes per game: 29.3 ± 2.6 vs 51.2 ± 4.6, P= .003). All other player performance metrics including player efficiency rating returned to near-baseline levels in the first 2 seasons after injury. NBA players with quadriceps tendon tears return to play in 78% of cases. These athletes achieved preinjury levels of performance within 1 to 2 seasons, but with reduced games played per season. IV, therapeutic case series.

Using systemic serum amyloid A as a biomarker for synovial structure infections in horses with acute limb wounds.

In postoperative monitoring of synovial structure infection due to limb wounds, early recognition of a recurrence of synovial infection is indispensable to prevent further damage to the affected synovial structure. This study evaluated the role of serum amyloid A (SAA) as a systemic biomarker in disease monitoring and correlated this tool with clinical variables. In this prospective cohort study, 55 horses with acute limb wounds were divided into two groups: those with (group 1, n=26) or without (group 2, n=29) a diagnosis of synovial structure penetration. SAA, lameness and body temperature were evaluated repeatedly and compared between groups. Correlations were explored between SAA and body temperature as well as lameness. The long-term outcome was also analysed. In both groups, SAA levels followed the characteristic rise-and-fall pattern observed in previous studies, with a significant increase up to a peak concentration within 48hours, followed by a constant decline. Lameness and body temperature did not change significantly. SAA was not found to correlate with clinical variables at all time points. Three horses in group 1 had a recurrence of synovial sepsis with an associated increase in SAA. The long-term outcome was good. A total of 71% of the study population returned to pre-injury performance levels. Repeated measurements of SAA accurately reflected the course of synovial inflammation and thus provided a reliable and rapidly available tool to monitor the disease course and to adapt the treatment regimen. SAA should be routinely added to the postoperative management of such cases.

Marrow stimulation in football (soccer) players: a narrative review

IntroductionThe prevalence of focal cartilage defects in elite athletes is estimated to be as high as 36%, and treatment in professional football players poses a complex clinical challenge. Marrow stimulation is a common treatment option for athletes with symptomatic, contained, full-thickness chondral injuries. ObjectivesTo report the current indications for and efficacy of marrow stimulation in football players. MethodsPubMed, Scopus, and Embase were searched. All levels of evidence (I-IV) pertaining to marrow stimulation in football players were analyzed and presented in a narrative review. ResultsReported return to sport rates following microfracture range from 52% to 95%, with up to 67% of athletes returning to preinjury level of performance. Clinical outcomes improve shortly after microfracture but may decline by 2 years postoperatively. Augmented marrow stimulation techniques have since been developed in an effort to improve repair quality and clinical outcomes, though supporting data is limited. ConclusionIn professional football players, marrow stimulation is a viable treatment for the repair of small (<2 cm2), isolated cartilage injuries, though deterioration of mid- to long-term outcomes may hamper its widespread use. Multiple augmentation techniques have demonstrated the potential to generate a mechanically and biologically superior repair; however, more robust, high-level studies are needed to adequately assess efficacy.

Performance Outcomes and Return to Sport Following Metacarpal Fractures in Major League Baseball Players.

Major League Baseball (MLB) players are at risk for metacarpal fractures; however, little is known regarding the impact of these injuries on future performance. The purpose of this study was to determine whether MLB players who sustain metacarpal fractures demonstrate decreased performance on return to competition in comparison to the performance of control-matched peers. Data for MLB position players with metacarpal fractures incurred over 17 seasons were obtained from injury reports, press releases, and player profiles. Age, position, career experience, body mass index (BMI), injury mechanism, handedness, and treatment were recorded. Individual season statistics for the 2 seasons immediately before injury and the 2 seasons after injury were obtained. Controls matched by player position, age, BMI, career experience, and performance statistics were identified. A performance comparison of the cohorts was performed. Overall, 24 players met inclusion criteria. Eleven players with metacarpal fractures were treated with surgery (46%) and 13 (54%) were treated nonoperatively. Players treated nonoperatively missed significantly fewer games following injury compared with those treated operatively (35.5 vs 52.6 games, P = .04). There was no significant difference in postinjury performance when compared with preinjury performance among the fracture cohorts. Players with metacarpal fractures treated nonoperatively had a significant decline in their Wins Above Replacement (WAR) 2 seasons postinjury (1.37 point decline) in comparison to matched controls (0.84 point increase) (P = .02). There was no significant difference in WAR 1 or 2 seasons postinjury for players with metacarpal fractures treated operatively in comparison to the control cohort. Major League Baseball players sustaining metacarpal fractures can expect to return to their preinjury performance levels following both nonoperative and operative treatment. However, players treated nonoperatively may witness a decline in their performance compared with peers over the long term. Orthopedic surgeons treating professional athletes with metacarpal fractures should consider these outcomes when counseling their patients and making treatment recommendations.

Psychological and Social Components of Recovery Following Anterior Cruciate Ligament Reconstruction in Young Athletes: A Narrative Review.

Anterior cruciate ligament (ACL) rupture is a common injury in young athletes. To restore knee stability and function, patients often undergo ACL reconstruction (ACLR). Historically, there has been a focus in this population on the epidemiology of ACL injury, the technical aspects of ACL reconstruction, and post-operative functional outcomes. Although increasingly recognized as an important aspect in recovery, there remains limited literature examining the psychological aspects of post-operative rehabilitation and return to play following youth ACL reconstruction. Despite technical surgical successes and well-designed rehabilitation programs, many athletes never reach their preinjury athletic performance level and some may never return to their primary sport. This suggests that other factors may influence recovery, and indeed this has been documented in the adult literature. In addition to restoration of functional strength and stability, psychological and social factors play an important role in the recovery and overall outcome of ACL injuries in the pediatric population. Factors such as psychological readiness to return-to-play (RTP), motivation, mood disturbance, locus of control, recovery expectations, fear of reinjury, and self-esteem are correlated to the RTP potential of the young athlete. A better understanding of these concepts may help to maximize young patients’ outcomes after ACL reconstruction. The purpose of this article is to perform a narrative review of the current literature addressing psychosocial factors associated with recovery after ACL injury and subsequent reconstruction in young athletes. Our goal is to provide a resource for clinicians treating youth ACL injuries to help identify patients with maladaptive psychological responses after injury and encourage a multidisciplinary approach when treating young athletes with an ACL rupture.

Scaphoid Fracture Reconstruction with Rib Autograft: Case Report and Literature Review

Objective. To evaluate the results of scaphoid bone proximal pole reconstruction with rib osteochondral autograft due to comminuted scaphoid fracture. Material and methods. We present a clinical case of fragmented scaphoid bone proximal pole fracture reconstruction by rib osteochondral autograft. The modified wrist function score of Green and O’Brien and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measuring scales were used for clinical evaluation before and 6 months after the reconstruction. Additio­nally, a literature review was conducted for case reports and previous literature reviews describing scaphoid bone proximal pole fracture surgical treatment. Medline (PubMed), ScienceDirect and UpToDate databases were used. Results. Conventional treatment methods for the treatment of comminuted proximal pole scaphoid bone fractures are often inappropriate due to technical issues or potential adverse outcomes. In these cases, reconstruction with rib autograft is possible. The study patient’s modified wrist function score of Green and O’Brien increased from 75 to 95 points out of 100 at 6 months postoperatively, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score decreased from 13.64 to 4.55 points. The results of this technique have been investigated in several studies (Sandow, 1998, 2001; Veitch et al., 2007). All subjects (22, 47 and 14 patients, respectively), except one, experienced improvement of wrist function – enhanced wrist movement, grip strength, reduced pain and restored wrist function to the pre-injury performance level. Conclusions. Scaphoid bone proximal pole fragmented fracture reconstruction with osteochondrial rib autograft achieves favorable recovery of wrist function and avoids complications or unfavorable functional consequences of alternative surgical procedures.

Effect of Anterior Cruciate Ligament Rupture on Physical Activity, Sports Participation, Patient-Reported Health Outcomes, and Physical Function in Young Female Athletes

Background: Return to sports (RTS) is frequently considered an indicator of successful recovery after anterior cruciate ligament reconstruction (ACLR). However, despite the well-recognized health benefits of physical activity (PA), little is known about objectively measured PA in the 1 to 2 years after ACLR. Given that young female athletes have a high prevalence of ACLR and lower RTS rates as compared with their male counterparts, an in-depth examination of PA in this subgroup is warranted. Hypothesis: We hypothesized that female youth and young adults who have had ACLR in the previous 1 to 2 years would have less moderate or vigorous PA (MVPA) compared with healthy matched controls. We also hypothesized that the ACLR group would report lower levels of sports participation, patient-reported health outcomes, and physical function. Study Design: Cohort study; Level of evidence, 3. Methods: Participants included 51 female athletes with primary unilateral ACLR for a sports-related injury in the previous 1 to 2 years and 51 age- and sports-matched controls. Outcomes included objectively measured PA (GT3X accelerometers), previous and current sports participation and RTS, body mass index, Knee injury and Osteoarthritis Outcome Score (KOOS), triple single-leg hop, and one-leg rise. Mean within-pair differences with 95% CIs were used to assess differences between groups across all outcomes. Multivariable linear regression (clustered by pair) was used to examine whether the ACLR group had less MVPA than did the age- and sports-matched control group, adjusting for total wear time, age, time since injury, and body mass index. Results: Median age was 17.8 years (range, 14.6-22.6 years). There was no significant difference between groups in MVPA. However, the injury group had fewer mean minutes per day of vigorous PA (–1.22; 95% CI, −2.40 to −0.04), poorer KOOS values on all subscales, and shorter triple single-leg hop distance. In the injury group, 28 (55%) returned to sports, including 14 (27.5%) who returned at preinjury performance level. Across both groups, over one-third changed their most important sport, shifting toward an individual-based sport. Conclusion: At 1 to 2 years after ACLR, female athletes demonstrated no differences in combined MVPA and only a very small reduction in vigorous PA, yet they had higher levels of self-reported knee pain and symptoms, reduced knee function in sports, lower quality of life, and poorer objective knee function compared with matched controls.

Professional Athlete Return to Play and Performance After Shoulder Arthroscopy Varies by Sport

PurposeTo determine whether differences in return-to-play (RTP) rate and performance-based outcomes exist following shoulder arthroscopy in athletes from the National Football League (NFL), National Basketball League (NBA), Major League Baseball (MLB), and National Hockey League (NHL).MethodsProfessional athletes from the NFL, NBA, MLB, and NHL who underwent shoulder arthroscopy between January 1998 and December 2016 were identified through an established review of injury reports and public archives. Sport-specific statistics were collected before and after shoulder arthroscopy for each athlete, providing a performance score. RTP was defined as the first game played postsurgery.ResultsOf the 208 professional athletes who met the inclusion criteria, 167 (80.3%) returned to play following shoulder arthroscopy, with MLB players returning at a significantly lower rate than those of other sports (P < .0001). NBA players had significantly shorter recovery times (201 days; P < .01) and MLB players had significantly longer recovery times (413 days; P < .001) when compared with athletes in other sports. The mean number of seasons played after shoulder arthroscopy was 3.7, 4.7, 4.8, and 5.8 for MLB, NFL, NHL, and NBA, respectively. NBA players performed worse in their first season postoperative compared with their preoperative performance (P = .0017), but their postoperative season 2 performance returned to their preoperative performance level (P = .1893). Similarly, NHL players performed worse in their postoperative season 1 compared with preoperative performance (P = .0274), but their postoperative season 2 performance improved upon their preinjury performance level (P = .0861).ConclusionsThere is a modest RTP rate among professional athletes following shoulder arthroscopy. MLB players have the longest average time to RTP and the shortest postinjury careers following shoulder arthroscopy. However, they demonstrate no significant decline in performance following their injury. Conversely, NBA players had the shortest average time to RTP and the longest post-injury career. Both NBA and NHL athletes experienced a decrease in performance in post-operative season one.Level of EvidenceLevel III, retrospective comparative study.