Surgery In Athletes Research Articles

Double and Single Bundle in Athletes: A Comparison in Medium and Long-Term Rates to Return to Sport and Re-Injury.

Compare, retrospectively, the medium- and long-term of return to sport rates and re-injury of the anterior cruciate ligament (ACL) in patients submitted to single-bundle (SB) compared to double-bundle (DB) technique reconstruction. Athletes operated by SB or DB ACL reconstruction, with at least five years of follow-up at a single center, were included. The following data were collected: demographic data; competitive sports practice before the injury; previous surgery; injury/surgery to the contralateral knee; return to sports and level of the return; re-injury (time of the re-injury after the first surgery; mechanism of trauma for the re-injury; necessity of operative treatment); signs and complaints related to the knee the last clinical consultation. Seventy-six athletes (27 SB and 49 DB) were included. The return to sport rate (98%) was the same for both groups, and the return to the previous level rate showed an improvement in the DB group but without statistical significance (63% vs. 79%; P = 0.173). However, other outcomes showed higher results for the DB group: lower re-injury rate throughout the follow-up period (41% vs. 18%; P = 0.034) and during the first year of follow-up (22% vs. 4%; P = 0.021), and less stiffness (0% vs. 22%, P = 0.001). While in primary reconstruction cases, there was not a higher re-injury rate using SB (P = 0.744), in the revision cases, SB was correlated with more re-injuries than DB (P = 0.002). The overall re-injury in the medium- and long-term and the return to practice sports at the same level as before surgery in athletes submitted to DB reconstruction were slightly better than those submitted to SB reconstruction, especially in the cases that were asecond time lesion ( revisioned knees).

Return to Play After Thumb Ulnar Collateral Ligament Injuries Managed Surgically in Athletes—A Systematic Review

The purpose of this systematic review was to summarize the available data on how surgical management of injuries to the thumb ulnar collateral ligament (UCL) complex affects athletes and their return-to-play (RTP) and postinjury performance metrics in addition to evaluating rehabilitation guidelines. A systematic search was performed on PubMed and Embase databases for articles on outcomes of surgical treatment of thumb UCL injuries in athletes. Articles with expert recommendations on postoperative management and RTP guidelines were also included separately. Study characteristics were recorded, including sport, RTP rates, and data on performance. Recommendations were summarized by sport. The Methodological Index for Non-Randomized Studies (MINORS) criteria was used to assess methodological quality. The authors also present their recommended return-to-sport algorithm. Twenty-three articles were included, including 11 with reports on patients and 12 expert opinions on guiding RTP. The mean MINORS score for the applicable studies was 9.4. In the 311 patients included, RTP was 98.1% in aggregate. No performance detriments were noted in athletes after surgery. Thirty-two (10.3%) patients had postoperative complications. The recommendations on timing to RTP vary by sport and author, but all recommended initial thumb protection when returning to sport. Newer techniques, such as suture tape augmentation, suggest the permission for earlier motion. Return-to-play rates after surgical treatment of thumb UCL injuries are high, with reassuring return to preinjury level of play with few complications. Recommendations for surgical technique have trended toward suture anchors and, now, suture tape augmentation with earlier motion protocols, although rehabilitation guidelines vary by sport and author. Current information on thumb UCL surgery in athletes is limited by the low quality of evidence and expert recommendations. Prognostic IV.

Low-dose prophylaxis protocol for heterotopic ossification after hip preservation surgery in a sport participants cohort.

Heterotopic ossification (HO) is a well-known complication of arthroscopic and open surgical treatment of femoroacetabular impingement (FAI). Incidence of heterotopic ossification has been reported in the literature between 0% and 44% after hip arthroscopy and between 18.2% and 25% after anterior mini-open surgery. Currently, pharmacological prophylaxis with NSAIDs and selective COX-2 inhibitors are commonly used and their effectiveness is well documented in literature. We hypothesized that the low-dose prophylaxis protocol with selective cox-2 inhibitors decreases the risk of heterotopic ossification in open or arthroscopic hip preservation surgery in athletes. This study is an analysis of prospectively gathered data on 98 sport participant patients who underwent arthroscopic or anterior mini-open treatment for FAI between April 2008 and April 2018. All the patients received postoperative oral prophylaxis with 60mg etoricoxib once daily for two weeks. Post-operative X-rays were performed at 1, 3, and 12 months after surgery and reviewed by two orthopedic surgeons blinded to the type and side of surgery. HO were graded according to the Brooker classification. Descriptive statistics was used to analyze demographic data. Bivariate analysis was performed to analyze the association of HO with each of the following variables: type of surgery, physical activity, time of evolution of symptoms, age at surgery, and sex. Finally, a regression model analysis was performed to determine the presence of confounding effects between variables. The study cohort was composed of 54 patients in the arthroscopic treatment group and 44 patients in the anterior mini-open group. HO was identified in 6 (13.6%) patients in the mini-open group. No HO was identified in the arthroscopic group. In the bivariate analysis, "type of surgery" was the only variable that showed a statistically significant association with HO (p=0.007). Results of this study suggest that anterior mini-open treatment was characterized by a higher risk of HO development compared to hip arthroscopy for femoroacetabular impingement treatment regardless of pharmacological prophylaxis. The treatment regimen of 60 mg etoricoxib daily for two weeks was an effective prophylaxis for HO formation in sport participant patients compared with data available in the literature.

Return-to-Sport Criteria After Upper Extremity Surgery in Athletes-A Scoping Review, Part 1: Rotator Cuff and Shoulder Stabilization Procedures.

Background:Standardized criteria are lacking to guide patient return to sport (RTS) after rotator cuff surgery (RCS) or shoulder stabilization surgery (SSS).Purpose:To describe RTS criteria used after RCS and SSS in athletic populations.Study Design:Scoping review; Level of evidence, 4.Methods:This scoping review was based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Scoping Review) guidelines. A total of 5 electronic databases (MEDLINE, Scopus, SPORTDiscus, Embase, Google Scholar Advanced search) and the gray literature were searched for English-language studies that reported at least 1 RTS criterion in athletes after shoulder surgery. Studies were assigned to the RCS or SSS subgroup based on the primary procedure performed. Data were extracted and summarized as frequencies or arithmetic mean and standard deviation.Results:Included were 52 studies and 2706 athletes (2206 male, 500 female, with a mean age of 28.8 ± 1.8 years). The RCS group consisted of 14 studies and the SSS group consisted of 38 studies. Time from surgery was the most common RTS criterion reported overall (37/52 studies; 71%) as well as within the RCS (93%) and SSS (63%) subgroups. Muscle strength (25/52 studies; 48%) and range of motion (23/52; 44%) were used by almost half of the included articles. RTS criteria reported less often were absence of pain, successful completion of sport-specific or position-specific test, proprioception, radiographic evaluation, patient-surgeon agreement, minimum time required to participate in pain-free throwing, and satisfactory scapulothoracic mechanics. All studies used 1 to 3 of the above RTS criteria; however, the definition of each criterion differed among the included articles.Conclusion:Time from surgery was the most commonly reported RTS criterion after RCS or SSS in athletes, whereas muscle strength and range of motion were used by almost half of the articles. There was high heterogeneity in the definition of each RTS criterion used among the included studies, which also used different combinations of 1 to 3 RTS criteria. These results suggest the need to better define quantitative and qualitative RTS criteria in athletes undergoing rotator cuff and shoulder stabilization procedures in order to safely return athletes to sport.

Return-to-Sport Criteria After Upper Extremity Surgery in Athletes-A Scoping Review, Part 2: Ulnar Collateral Ligament of the Elbow Procedures.

Background:There is a lack of consensus to guide patient return to sport (RTS) after elbow ulnar collateral ligament surgery (eUCLS).Purpose:To describe the reported RTS criteria after eUCLS in the athletic population.Study Design:Scoping review; Level of evidence, 4.Methods:This scoping review was performed by adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Scoping Review) guidelines. We searched 5 electronic databases (MEDLINE, Scopus, SPORTDiscus, Embase, Google Scholar Advanced) and the gray literature for English-language studies that reported at least 1 RTS criterion in athletes after eUCLS. Data were extracted and summarized as frequencies or arithmetic mean and standard deviation.Results:Included were 14 studies and 1335 athletes with a mean age of 21.4 ± 1.1 years. Time from surgery (range, 6-16 months) was the most common RTS criterion used, and it was reported by all 14 of the included articles. RTS criteria reported less often were pain (3/14; 21%), successful completion of a throwing program (3/14; 21%), muscle strength of the forearm muscles (1/14; 7%), and “normal” range of motion and muscle strength of the elbow and shoulder joints on the operated upper extremity (1/14; 7%). All studies used 1 to 5 of the above RTS criteria.Conclusion:Only 14 studies reported 1 or more RTS criteria after eUCLS in athletes, and time was the most common RTS criterion used. Our results highlight the need for a coordinated effort among surgeons, physical therapists, and athletic trainers in order to establish evidence-based RTS criteria after eUCLS in athletes so athletes can safely to sport and prolong their athletic careers.

Positive reframing: An important but underutilized coping strategy in youth athletes undergoing sports-related knee surgery.

It is unknown how specific coping strategies are associated with the short-term outcomes among athletes following knee surgery. 1) To determine whether specific coping strategies are associated with satisfaction, return to sport, self-reported knee function, or kinesiophobia following sports-related knee surgery. 2) To determine whether these associations vary by age, sex, or surgical procedure. Case series. Athletes (n=184 total; n=104 men, n=80 women; n=38 age <20 years, n=35 age 20-25, n=36 age 26-31, n=36 age 32-40, n=39 age >40) who underwent outpatient knee surgery were enrolled from a single center. Utilization of specific coping strategies (self-distraction, use of emotional or instrumental support, venting, positive reframing, and acceptance) was assessed pre-operatively with the Brief-COPE inventory. Relationship between coping strategies and post-operative satisfaction, return to sport, International Knee Documentation Committee-subjective (IKDC-S) and Tampa Scale for Kinesiophobia scores at median 10.7 months follow-up were determined with consideration for age, sex, and surgical procedure. Return to prior level of sport was 72%, and satisfaction was 86%. Most coping strategies had age-specific utilization rates; positive reframing was utilized least frequently in ages <20 years. Satisfaction increased with greater positive reframing among ages <20 years and decreased with greater self-distraction among men. Return to sport was higher with greater positive reframing in ages <32 years. No coping strategies predicted IKDC-S scores. Greater positive reframing correlated with lower kinesiophobia in ages <20 years. Greater instrumental support correlated with lower kinesiophobia in ages >40 years. No other coping strategies were associated with outcomes. Surgical procedure was not related to association between coping strategies and outcomes. Coping strategies have age-specific associations with outcomes after knee surgery in athletes. Positive reframing is infrequently utilized in younger athletes. Greater use of positive reframing in this group may improve satisfaction, return to sport, and lower fear of re-injury.

Tears of biceps femoris, semimembranosus, and semitendinosus are not equal-a new individual muscle-tendon concept in athletes.

Objectives:Hamstring injuries are common and can now be accurately diagnosed. In addition, novel surgical indications have been introduced. However, evidence-based guidelines on the hamstring injuries in management of top-level athletes are missing.Methods:The management methods and outcomes of treatment are classically based on relatively small case series. We discuss a novel concept based on the fact that each tendon of the hamstrings muscle should be managed in an individual fashion. Furthermore, suitable indications for hamstring surgery in athletes are introduced.Results:The present study introduces modern treatment principles for hamstring injury management. Typical clinical and imagining findings as well as surgical treatment are presented based on a critical review of the available literature and personal experience.Conclusions:Hamstring injuries should not be considered to be all equal given the complexity of this anatomical region: The three separate tendons are different, and this impacts greatly on the decision-making process and outcomes in athletes.

Return to sports activity in the revision of anterior cruciate ligament reconstruction: A 2–6 Year follow-up study

Introductionand Objective: The risk of an anterior cruciate ligament (ACL) injury in young patients and those with sports activity is increasing. Regarding the need of athletes with ACL re-rupture to return to sports, ACL revision surgery has received great importance. This study was conducted to evaluate the outcome of ACL reconstruction revision surgery in athletes. MethodIn general, 62 patients with primary surgery and 62 patients with revision ACL surgery were investigated in this study. The study subjects were matched in terms of age, gender, involved leg, injury mechanism, sports group, time of surgery, and the degree of cartilage injury and ankle meniscus rupture. The studied variables included age, gender, body mass index (BMI), sports group, infection, meniscus injuries, chondral lesion, time to return to sports, quality of return to sports, range of motion, Lachman’s test, and knee injury and osteoarthritis outcome score (KOOS), International Knee Documentation Committee score, Lysholm, and Marx scores. They were obtained through the information in the patients’ medical records and the questionnaire filled out by the participants and the examiner’s physician through the follow-ups. Then, the collected data were imported into the SPSS software and underwent analysis. ResultsThe mean follow-up of patients was 49 months (in the range of 2–6 years). None of the patients had a chronic infection. The mean time to return to sports was 29.2 ± 3.2 and 35.3 ± 4.3 weeks in the primary surgery and revision surgery groups, respectively. In addition, 34 (54.8%) and 25 (40.3%) patients of the primary surgery and the revision surgery groups returned to the same level before injury, respectively. On the latest follow-up, the results of the Lachman test showed no significant difference between the two groups (P = 0.222) whereas Lysholm, IKDC, MARX, and KOOS scores on the latest follow-up in primary surgery were significantly higher than those of revision surgery (P < 0.001). ConclusionThe rate of return to sports in revision surgery was 14.5% lower than that of primary surgery, and the average time of return to sports was six weeks. The rate of return to sports, similar to before the injury, was significantly lower in the revision group, females, the age group of over 25 years, and contact sports activity, and patients with a chondral lesion. All knee performance scores were also poorer in the revision surgery.

Endoscopic Spine Surgery in Athletes: Case Series and Review of Literature

Degenerative spine disease is common in athletes and can progress to requiring surgical intervention. Traditional open surgical techniques necessitate prolonged recovery time and time away from play. Newly developed endoscopic surgical techniques may promote faster healing and recovery, and increased return to play. The goal of this paper is to summarize the current evidence in return to play after spine surgery and to present our series of 3 athletes who underwent endoscopic spine surgery. A complete search of all PubMed indexed articles pertaining to spine surgery in athletes was conducted. This was supplemented by a 3-patient case series of our own endoscopic spine experience in athletes. There are no current widely accepted guidelines for return to play after spinal surgery. The best evidence available cites a return to play of 81% at 5.2-8.7 months after traditional open and minimally invasive surgery, and endoscopic surgery produces an average 88% return to play rate at 3 months. Although return to play can vary widely, case-based evidence as well as biomechanical principles support endoscopic spine surgery as a viable surgical modality for the treatment of spinal pathologies in athletes.

Similar Results in Return to Sports, Recurrences, and Healing Rates Between the Classic and Congruent-Arc Latarjet for Athletes With Recurrent Glenohumeral Instability and a Failed Stabilization

To compare the return-to-sport rate, functional outcomes, and complications of the "classic Latarjet" surgery with those of the "congruent arc Latarjet" surgery in athletes with recurrent glenohumeral instability and failed previous stabilization procedures. All the included patients were operated between May 2009 and April 2017. The inclusion criteria were athletes with recurrent anterior glenohumeral instability, a glenoid bone defect greater than 20%, at least 1 previous failed stabilization surgery operated with the classic or the congruent-arc Latarjet procedures, and a minimum 2 years of follow-up. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale for pain, and the Athletic Shoulder Outcome Scoring System score were used to assess functional outcomes. Complications were also evaluated. A total of 135 athletes were included in the study (55 patients were operated with the classic technique and 80 with the congruent arc technique). The mean follow-up was 40.3 months (range, 24-88 months) and the mean age was 26.5 years (range, 18-45 years). Overall, 87% were able to return to sports and 92% returned at the same level. No significant difference regarding return to sports was found between the groups. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, visual analog scale, and Athletic Shoulder Outcome Scoring System scores showed statistical improvement after operation (P < .001). No significant difference in shoulder ROM and functional scores was found between patients operated with the classic and congruent arc procedures. There were 6 recurrences (4%). There was no significant difference in the recurrence rate between groups. The bone block healed in 92% of the cases. In athletes with recurrent anterior glenohumeral instability and a failed previous operative repair, the Latarjet procedure produced excellent functional outcomes and most athletes returned to sport at their preinjury level with a very low rate of recurrences, regardless of whether the Latarjet was performed with the classic or with the congruent arc technique. Retrospective comparative study; Level of evidence,3.

Pain perception and coping strategies influence early outcomes following knee surgery in athletes

ObjectivesTo determine whether pain perceptions and coping strategies are predictive of the following outcomes after knee surgery in athletes: (1) return to similar level of sport, (2) improvement in symptoms, and (3) improvement in kinesiophobia. DesignProspective cohort study. Methods101 athletes (52 men, 49 women; mean age 32.7years) at mean 12.1months follow-up were included. Independent relationships between patient outcomes and pre-operative measures were determined: short form McGill Pain questionnaire (SF-MPQ), Pain Catastrophizing Scale (PCS), Pain Coping Measure (PCM), and the brief COPE subscales of acceptance, denial, positive reframing, and use of instrumental support. Adjustment was performed for length of follow-up, symptom duration, surgical history, age, activity level, and surgical procedure. ResultsRate of return to similar level of sport was 73%; severe pain catastrophizers (PCS >36 points) had increased odds of not returning to similar level of sport (OR 11.3 CI 1.51, 236; p=0.02) whereas COPE-use of instrumental support was protective (per point increase: 0.72 CI 0.54, 0.94; p=0.02). Problem-focused coping positively correlated with improvement in IKDC-S scores (beta 0.032 SE 0.010; p=0.001). Improvement in kinesiophobia after surgery was less likely with higher pre-operative perceived pain frequency (OR 0.23 CI 0.06, 0.71; p=0.009) and higher COPE-denial scores (OR 0.43 CI 0.21, 0.88; p=0.02). ConclusionsAmong athletes undergoing knee surgery, severe pain catastrophizing is negatively associated with return to similar level of sport. Instrumental support and problem-focused coping strategies are associated with improved outcomes. High preoperative pain scores are negatively associated with improvement in kinesiophobia after rehabilitation.

Elbow Surgery in Athletes.

Injuries and disorders of the elbow in athletes are common especially among throwing athletes. Common injuries encountered in the throwing athlete include ulnar collateral ligament injuries, ulnar neuritis, capitellar osteochondritis dissecans, valgus extension overload with posterior olecranon impingement, olecranon stress fracture, and loose bodies. A thorough knowledge of both the functional anatomy as well as throwing biomechanics are required to properly diagnosis and treat these problems. Nonoperative and surgical techniques have continued to advance over the last 25 years allowing for improved prognosis and return to play for athletes affected with elbow pathology.

Chronic lateral ankle instability increases the likelihood for surgery in athletes with os trigonum syndrome

PurposeThe etiology and incidence of os trigonum syndrome in professional athletes is highly variable. There is a paucity of data to ascertain why some athletes evolve towards surgery whilst others remain asymptomatic. We hypothesized that a lateral ligament ankle injury would increase the likelihood for surgery in those athletes with os trigonum syndrome.MethodsEighty professional athletes with clinical and radiological signs of os trigonum syndrome were identified to ascertain the incidence of injury to the lateral ligamentous ankle complex (acute and chronic) by magnetic resonance imaging (MRI). This cohort was subdivided into 2 groups; a surgical (n = 40) and a non-surgical (n = 40) cohort. Surgical division was decided if (1) the clinical hyper-plantar flexion test was positive, (2) a positive diagnostic ultrasound-guided injection and (3) no improvement was observed after 6 weeks of conservative rehabilitation.ResultsFrom the surgical cohort, 37 players (94.1%) had a chronic lateral ankle ligament injury on MRI, whilst 3 players (5.9%) had an acute lateral ankle ligament injury. Binary logistic linear modelling revealed that having a chronic lateral ligament injury increases the likelihood of os trigonum syndrome surgery by ten times compared to those with an acute lateral ligament injury.ConclusionProfessional athletes with chronic lateral ligament ankle injury have an approximate ten times greater risk for os trigonum syndrome surgery compared to athletes with acute lateral ligament ankle injury.Level of evidenceIV.

Endoscopic surgery in athletes with a symptomatic calcaneal lipoma.

This study shows that endoscopy is an effective treatment modality for athletes with a symptomatic calcaneal lipoma. Between 2013 and 2016, five professional athletes with symptomatic calcaneal lipoma underwent endoscopic-assisted curettage and bone graft treatment. Lipoma size was measured by magnetic resonance imaging (MRI) and rated using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS). All athletes were followed up for 12 months postoperatively and monitored on return to previous activity level. The mean ankle-hindfoot scale score improved from a preoperative 71.3 +/-3.9 points (median 67-81) to a postoperative 97.8 +/-3.4 points (median 89-100). Radiological assessment revealed no recurrence or pathologic fracture, with adequate bone fill-up in all 5 cases. All athletes returned to their previous level of activity within 8 weeks of surgery (mean period 7.2 weeks, median 5-8 weeks). Endoscopic surgery can be used as a valid treatment tool for athletes with a calcaneal lipoma. It allows for a safe and early return to sports activities and minimises risk for recurrence and pathological fracture after initial return to play. IV.

Qualifications of Safe Return to Play Criteria

Anterior cruciate ligament (ACL) injury has various negative implications for thigh muscle function, including reduction of muscle strength and instability of torque. Conservative treatment and / or surgical procedures may be preferred by considering patient’s age, activity level, additional injury and the patient’s expectations. Aim of ACL surgery in athletes is to allow a safe return to preoperative activity level. Literatures have shown different criterias about returning to sports. Some of these criterias are time after surgery, negative Lachman and Pivot shift tests, range of motion, extension/flexion muscle strength of the knee, functional knee tests and lower limb symmetry indexes. Although these criteria provide, second-injury risks are high within 2 years of primary ACL reconstruction. The risk of re-injury rates for the ACL vary between 0 and 19% for the ipsilateral side and between 7 and 24% for the uninjured contralateral knee. The purpose of this study was to investigate value of knee function between the return to normal knee function following ACL reconstruction (ipsilateral and uninjured contralateral side) and the healthy knees, and present recommendation for reduce the risk of rerupture. Totally 14 healthy male and 15 male patients who had unilateral ACL reconstruction, followed knee rehabilitation programme regularly and returned to normal knee function following after minimum 8th month the operation participated in the study. We applied Tegner activity level, Lysholm knee score, operated, intact and healthy knee range of motion, one leg hop test, flamingo balance test, isokinetic muscle strength test and proprioception test in the study. No statistically significant differences were found in the demographic data, activity level, and knee score between groups (p>0,05). The test that assesses passive joint position sense at 30˚ showed statistically significant differences between operated and intact non-operated knee (p<0,05). This data was better at operated knee. There were statistically significant differences in functional tests, isokinetic hamstring muscle test at operated knee and proprioception test between patients and control groups (p<0,05). Arthrogenic muscle inhibition occurs bilaterally after unilateral ACL ruptures. Thus, normal lower limb symmetry determined by tests. On the other hand; muscle strength, motor coordination, proprioception and knee function may be insufficient compared to healthy control groups. For this reason, we should consider that it is important to improve bilateral lower extremity functions at ACL rehabilitation program. Datas of operated and non-operated knee and control groupOperated sideNon-operated sideControl groupFlexion ROM (˚)130131,67130,5Extension ROM (˚)1,2700Flamingo balance test EV1,531,332,5One leg hop test (cm)108,22123142,67Prop active 30˚ AEV5,735,81,45Prop active 45˚ AEV5,276,132,18Prop active 75˚ AEV5,274,22,3Prop passive 30˚ AEV2,276,131,79Prop passive 45˚ AEV4,333,81,33Prop passive 75˚ AEV3,073,61,51Extension PT (Nm)168,9193,2179,07Extension PT/BW (%)222,27253,87250,93Extension IPT (Nm)99,21112,8108,57Extension TWD (Nm)1437,291575,41526,86Flexion PT (Nm)91,87100,6111Flexion PT/BW (%)118,13129,47157,5Flexion IPT (Nm)61,8668,2772,14Flexion TWD (Nm)797,93818,67885,86ROM: Range of motions, cm:centimeter, EV: Error value, Prop: Proprioception, AEV: Absolute error value, PT: Peak torque, PT/BW: Peak torque/body weight, IPT: Initial peak torque, TWD: Total work done, Nm: Newtonmeter

Pectoralis Major Tendon Repair

Objectives:Systematic reviews of the literature have identified 365 reported cases of Pectoralis Major Tendon (PMT) injuries. While surgical treatment has demonstrated improved outcomes compared to non-operative treatment, there is still relatively limited data on the functional outcome, return to sport and need for 2nd surgery in athletes following PMT repair. This study comprises the largest series of athletes following PMT repair reported to date. The Objective is to report on the functional outcomes, return to sport and need for 2nd surgery in a consecutive series of PMT tears.Methods:From 2009, 81 patients with PMT tears were enrolled in this prospective series. Baseline evaluation included patient demographics, mechanism of injury, physical examination and PMT specific MRI for confirmation of the diagnosis and analysis of the extent of injury. Each patient underwent surgical repair by the senior author utilizing a previously published surgical technique. Patients were then followed at 2 weeks, 6 weeks, 3 months and 6 months and further follow-up was conducted annually thereafter with functional outcome scores and adduction strength testing. The return to sport and incidence of 2nd surgery data were recorded. This study includes the first 40 athletes to reach the 2-year post-operative period.Results:All athletes were male, with an average age of 34.4 years (range 23-59). The patient cohort consisted of 4 professional NFL players and 36 recreational athletes. Average follow-up duration was 2.5 years (range 2 - 6.0 years). The most common mechanisms of injury occurred during the bench press (n=26) and contact sport participation (n=14). Sixteen injuries were complete avulsions involving both the clavicular and sternocostal heads, while 24 were isolated sternocostal head avulsions. Average pre-injury bench press of 396 lbs (range 170-500 lbs) was restored to 241 lbs post-operatively (range 140-550 lbs). Single Assessment Numeric Evaluation (SANE) scores averaged 93.6 (range 62-100) with an average overall patient satisfaction rated at 9.6 out of 10 (range 6-10). All athletes returned to their pre-injury level of activity at average 5.5 months post-op (range 4.5-6.5 months). Isokinetic evaluation assessing adduction strength revealed an average decrease of <11% (avg. 9.9%, range -18 - 41%) compared with the contralateral extremity. Application of the Bak criteria revealed 50% of athletes scored as excellent, 35% as good and 15% as fair. One athlete developed a pulmonary embolus 10 days post-op. Two athletes required a 2nd surgery (5%), both were re-injured within 3 weeks of surgery.Conclusion:As demonstrated in this consecutive series, which represents the largest cohort of PMT repairs reported to date, surgical repair resulted in 96% patient satisfaction, with 85% good to excellent restoration of function and adduction strength. The athletes returned to sport on average at 5.5 months post-operatively and the incidence of 2nd surgery was 5%.

Athletic groin pain: a systematic review of surgical diagnoses, investigations and treatment.

Athletic groin pain requiring surgery remains a diagnostic and therapeutic challenge. This systematic review aims to identify the most common causes of groin pain in athletes requiring surgery. Additionally, it aims to further characterise their susceptible athlete profiles, common physical examination and imaging techniques, and surgical procedures performed. This will enable the orthopaedic sports medicine clinician/surgeon to best treat these patients. The electronic databases MEDLINE, PubMed and EMBASE were searched from database inception to 13 August 2014 for studies in the English language that addressed athletic groin pain necessitating surgery. The search was updated on 4 August 2015 to find any articles published after the original search. The studies were systematically screened and data were abstracted in duplicate, with descriptive data presented. A total of 73 articles were included within our study, with data from 4655 patients abstracted. Overall, intra-articular and extra-articular causes of groin pain in athletes requiring surgery were equal. The top five causes for pain were: femoroacetabular impingement (FAI) (32%), athletic pubalgia (24%), adductor-related pathology (12%), inguinal pathology (10%) and labral pathology (5%), with 35% of this labral pathology specifically attributed to FAI. Given the complex anatomy, equal intra-articular and extra-articular contribution, and potential for overlap of clinical entities causing groin pain leading to surgery in athletes, further studies are required to ascertain the finer details regarding specific exam manoeuvres, imaging views and surgical outcomes to best treat this patient population.

Current Rehabilitation Concepts for Anterior Cruciate Ligament Surgery in Athletes.

The anterior cruciate ligament is the most commonly disrupted ligament in the knee in high-performance athletes. Most recently, advancements in surgical technique and graft fixation have enabled athletes to participate in early postoperative rehabilitation, focusing on range of motion and progressing to patellar mobilization, strengthening, and neuromuscular control. Several rehabilitation protocols exist with variations in specific exercises, progression through phases, and key components. The ultimate goal of rehabilitation is to return the athlete to preinjury performance level, including motion and strength, without injuring or elongating the graft. Each athlete is unique; thus, safe return to play should be individualized rather than follow a particular postoperative month or time line. This article provides an overview of the application and the scientific basis for formulating a rehabilitation protocol prior to and following anterior cruciate ligament surgery.

Sports Participation 2 Years After Anterior Cruciate Ligament Reconstruction in Athletes Who Had Not Returned to Sport at 1 Year

Background: A return to their preinjury level of sport is frequently expected within 1 year after anterior cruciate ligament (ACL) reconstruction, yet up to two-thirds of athletes may not have achieved this milestone. The subsequent sports participation outcomes of athletes who have not returned to their preinjury level sport by 1 year after surgery have not previously been investigated. Purpose: To investigate return-to-sport rates at 2 years after surgery in athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: A consecutive cohort of competitive- and recreational-level athletes was recruited prospectively before undergoing ACL reconstruction at a private orthopaedic clinic. Participants were followed up at 1 and 2 years after surgery with a sports activity questionnaire that collected information regarding returning to sport, sports participation, and psychological responses. An independent physical therapist evaluated physical function at 1 year using hop tests and the International Knee Documentation Committee knee examination form and subjective knee evaluation. Results: A group of 122 competitive- and recreational-level athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction participated. Ninety-one percent of the athletes returned to some form of sport after surgery. At 2 years after surgery, 66% were playing sport, with 41% playing their preinjury level of sport and 25% playing a lower level of sport. Having a previous ACL reconstruction to either knee, poorer hop-test symmetry and subjective knee function, and more negative psychological responses were associated with not playing the preinjury level sport at 2 years. Conclusion: Most athletes who were not playing sport at 1 year had returned to some form of sport within 2 years after ACL reconstruction, which may suggest that athletes can take longer than the clinically expected time of 1 year to return to sport. However, only 2 of every 5 athletes were playing their preinjury level of sport at 2 years after surgery. When the results of the current study were combined with the results of athletes who had returned to sport at 1 year, the overall rate of return to the preinjury level sport at 2 years was 60%. Demographics, physical function, and psychological factors were related to playing the preinjury level sport at 2 years after surgery, supporting the notion that returning to sport after surgery is multifactorial.

Timing of Surgery for Complete Proximal Hamstring Avulsion Injuries

Background: Avulsion of the proximal hamstring origin is well documented, and surgical treatment is advocated for complete avulsions. Purpose: To compare the return to preinjury level of sport and the complexity of surgery in athletes undergoing surgical intervention for complete proximal hamstring avulsions within 6 weeks, 6 months, and after 6 months of injury. Study Design: Case series; Level of evidence, 4. Methods: This was the largest case series from a tertiary referral center reported in the literature. A total of 112 athletes were included, with complete proximal avulsion injuries confirmed on MRI scans; 63 patients (56.3%) were high-level athletes. Patients were divided into subgroups depending on the timing of surgical intervention: “early” was defined within 6 weeks, “delayed” within 6 weeks to 6 months, and “late” after 6 months. All patients were surgically explored and repaired with the aim of comparing the timing between each group and the return to preinjury sport. All patients underwent an individualized rehabilitation protocol. There was no loss to follow-up. The primary outcome measure was the return to preinjury level sports activity. Results: A total of 108 patients (96.4%) returned to sport. In the early intervention group, the average time of return to play was 16 weeks, 9 weeks faster than the delayed group and 13 weeks faster than the late group. There were 2 partial reruptures in those with delayed intervention—both athletes retired from competitive sport but were recreationally active. Two other athletes recovered well but retired from playing at all levels. Twelve athletes (2 in the early intervention group, 5 in the delayed, 5 in the late) were delayed by local nerve symptoms. Only 2 cases required further exploration. Conclusion: Early surgical intervention was associated with good clinical outcomes and a quicker return to sport; however, delaying the diagnosis can lead to prolonged morbidity and an increased likelihood of complications.