Publications by authors named "Brandon J Erickson"

131 Publications

Analysis of Injuries and Pitching Performance Between Major League Baseball and Nippon Professional Baseball: A 2-Team Comparison Between 2015 to 2019.

Orthop J Sports Med 2021 May 18;9(5):23259671211008810. Epub 2021 May 18.

Hiroshima Toyo Carp, Hiroshima, Japan.

Background: There has been minimal research investigating injury and pitching performance differences between Major League Baseball (MLB) and other professional leagues.

Purpose/hypothesis: This 2-team comparison between MLB and Japan's Nippon Professional Baseball (NPB) involved affiliated players over 5 years. We hypothesized that teams would differ in the injury incidence, mechanism of injury, pitch velocity, and pitch type usage.

Study Design: Descriptive epidemiology study.

Methods: Between 2015 and 2019, pitching data as well as injury statistics for the highest level and minor league affiliates of the Los Angeles Angels (MLB) and the Hiroshima Toyo Carp (NPB) were reviewed for significant differences in the injury prevalence, injury type, mechanism of injury, and days missed. In total, 3781 MLB and 371 NPB injuries were studied.

Results: MLB-affiliated players were significantly younger, taller, and heavier ( < .001) than were NPB-affiliated players. MLB-affiliated pitchers threw faster than did their NPB counterparts ( = .026). MLB minor league pitchers threw more curveballs than did NPB minor league pitchers ( = .004), and MLB minor league relief pitchers threw more sliders than did NPB minor league relief pitchers ( = .02). The MLB team had a 3.7-fold higher incidence of injuries versus the NPB team (0.030 vs 0.008 injuries per player-game, respectively) as well as more repeat injuries, with fewer days missed per injury (15.8 ± 54.7 vs 36.2 ± 55.1 days, respectively; < .001). The MLB team also had a higher percentage of injuries that were throwing related ( < .001), were contact related ( < .001), and occurred outside of competition ( < .001) compared with the NPB team.

Conclusion: This is the first empirical study examining injury trends and pitching characteristics between MLB and NPB athletes. MLB-affiliated pitchers threw faster and relied more on breaking pitches in comparison with NPB-affiliated pitchers. From injury data, MLB players were younger, taller, and heavier with a higher percentage of throwing-related injuries, contact injuries, and injuries sustained outside of competition. Overall, the MLB team indicated a 3.7-fold higher rate of reported injuries with fewer days missed per injury than did the NPB team. Competitive conditions are distinctly different between MLB and NPB, and thus, more extensive research collaborations in the future can identify best practices to advance health and performance for both leagues.
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http://dx.doi.org/10.1177/23259671211008810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135222PMC
May 2021

Does Velocity Increase From Flat-Ground to Mound Work During a Lighter Baseball Training Program?

J Am Acad Orthop Surg 2021 Apr 7. Epub 2021 Apr 7.

From the Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, New York, NY (Hadley, Bassora, Bishop, Erickson), Teels Baseball, Wyckoff, NJ (Atlee), the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Chalmers), and Dupage Medical Group, Dupage, IL (Romeo).

Introduction: There has been recent interest in throwing from flat-ground versus the mound regarding stress on the elbow. Typical throwing progression programs begin with flat-ground work and progress to mound work.

Methods: All baseball pitchers of ages 10 to 17 years who completed a 15-week pitching mechanics and velocity-training program were included. Players' pitch velocity was tested at four time points during training. Average velocity and maximum velocity of pitches from flat-ground were compared with those of mound, and change in velocity between testing sessions was also compared.

Results: Thirty-six male pitchers (average age: 14.4 ± 1.6 years) were included. Fastball velocity increased by an average of 5.2 mph (95% confidence intervals 2.0 to 8.8 mph) at the end of the training program. When change in average and maximum velocity was compared between the four testing sessions, the most notable increase in velocity occurred between the third and fourth testing sessions. Both sessions were thrown from the mound.

Conclusion: The 15-week baseball pitcher-training program markedly improved pitching velocity. Throwing from a mound compared with flat-ground resulted in the largest velocity increase. Therefore, when attempting to increase a pitcher's velocity, throwing from the mound should be an integral part of any velocity program.
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http://dx.doi.org/10.5435/JAAOS-D-19-00876DOI Listing
April 2021

Clinical and radiographic outcomes after Latarjet using suture-button fixation.

JSES Int 2021 Mar 7;5(2):175-180. Epub 2020 Dec 7.

Cleveland Shoulder Institute, Beachwood, OH, USA.

Background: Latarjet has become a common treatment option for patients with shoulder instability in the setting of bone loss. The coracoid is commonly secured with screws.

Methods: All patients who underwent Latarjet with suture-button fixation with minimum 1-year follow-up were eligible for inclusion. Preoperative demographic and clinical outcome data including American Shoulder and Elbow Surgeons (ASES), Single Assessment Numerical Evaluation (SANE), and Visual Analog Scale (VAS) were recorded and compared with postoperative scores. Radiographs were reviewed for signs of nonunion. Complications were recorded.

Results: Overall 21 patients (76% male, average age: 30.4 ± 11.3 years) underwent Latarjet with suture-button fixation. Significant improvements at 1 year were seen in ASES ( < 0.001), SANE ( < 0.001), and VAS ( = 0.011) scores compared with preoperative scores. Of the 21 patients who had reached 1-year follow-up, 17 (81%) reached 2-year follow-up. For the 17 patients who reached 2-year follow-up, there were significant improvements in ASES ( = 0.001), SANE ( = 0.001), and VAS ( = 0.005) scores from preoperative values. When isolating the 17 patients with 2-year follow-up, there were no significant differences between their 1-year and 2-year ASES ( = 0.73), SANE ( = 0.17), and VAS ( = 0.37) scores. Overall, 3 patients (14%) sustained a complication (one redislocation, one with coracoid migration and a fibrous union, and one superior labral tear requiring biceps tenodesis and superior labral repair).

Conclusion: Suture-button fixation of the coracoid during the Latarjet provides encouraging clinical and radiographic outcomes at 1 and 2 years.
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http://dx.doi.org/10.1016/j.jseint.2020.10.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910742PMC
March 2021

Outpatient versus inpatient anatomic total shoulder arthroplasty: outcomes and complications.

JSES Int 2020 Dec 29;4(4):919-922. Epub 2020 Jul 29.

Cleveland Shoulder Institute, Beachwood, OH, USA.

Background: Total shoulder arthroplasty (TSA) is an effective treatment option for glenohumeral arthritis. Historically, this surgical procedure was performed on an inpatient basis. There has been a recent trend in performing TSA on an outpatient basis in the proper candidates.

Methods: All patients who underwent outpatient TSA performed by a single surgeon between 2015 and 2017 were included. Demographic information and clinical outcome scores, as well as data on complications, readmissions, and revision surgical procedures, were recorded. This group of patients was then compared with a matched cohort of patients who underwent inpatient TSA over the same period.

Results: Overall, 94 patients (average age, 60.4 years; 67.0% male patients) underwent outpatient TSA and were included. Patients who underwent outpatient TSA showed significant improvement in all clinical outcome scores at both 1 and 2 years postoperatively. The control group consisted of 77 patients who underwent inpatient TSA (average age, 62.6 years; 53.2% male patients). No significant differences in complications or improvements in clinical outcome scores were found between the inpatient and outpatient groups.

Conclusion: TSA performed in an outpatient setting is a safe and reliable procedure that provides significant improvement in clinical outcome scores and no difference in complication rates compared with inpatient TSA.
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http://dx.doi.org/10.1016/j.jseint.2020.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738588PMC
December 2020

First Report of a Humeral Fracture From Pitching After Latissimus Repair.

Orthop J Sports Med 2020 Nov 4;8(11):2325967120964482. Epub 2020 Nov 4.

Dupage Medical Group, Elmhurst, Illinois, USA.

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http://dx.doi.org/10.1177/2325967120964482DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645764PMC
November 2020

Does Having a Rotator Cuff Repair Before Total Shoulder Arthroplasty Influence Outcomes?

Orthop J Sports Med 2020 Aug 25;8(8):2325967120942773. Epub 2020 Aug 25.

Division of Sports and Shoulder, Hospital for Special Surgery, New York, New York, USA.

Background: The number of rotator cuff repairs (RCRs) is increasing each year. Total shoulder arthroplasty (TSA) is a successful treatment option for patients with glenohumeral osteoarthritis with a functioning rotator cuff.

Purpose/hypothesis: The purposes of this study were to report the outcomes of TSA in patients with ipsilateral RCR and determine whether patients with a history of ipsilateral RCR who subsequently underwent TSA had differences in outcomes compared with matched controls who underwent TSA with no history of RCR. We hypothesized that patients with prior RCR will have significant improvements in clinical outcome scores, with no difference in outcomes after TSA compared with those with no prior RCR.

Study Design: Cohort study; Level of evidence, 3.

Methods: Patients eligible for inclusion were those with a history of prior RCR who underwent TSA at a single institution with a minimum 2-year follow-up between 2000 and 2015. Outcomes for this group, including American Shoulder and Elbow Surgeons (ASES) scores, were reported and then compared with a matched control group of patients who underwent TSA with no history of prior RCR. Controls were matched based on age, sex, and preoperative ASES score.

Results: Overall, 14 patients (64% males; mean ± SD age, 65.1 ± 11.1 years) underwent prior ipsilateral RCR before TSA. ASES scores significantly improved from 42.9 to 78.5 at 2 years and to 86.6 at 5 years. When compared with 42 matched control patients (matched 1:3) who underwent TSA with no history of RCR, there was no significant difference in ASES scores at 2 years (78.5 vs 85.3; = .19) and 5 years (86.6 vs 90.9; = .72) between the prior RCR and no RCR groups.

Conclusion: TSA in patients with a history of prior ipsilateral RCR led to significant improvements in clinical outcomes. No difference in clinical outcomes at 2 or 5 years after TSA was found between patients with and without a history of prior ipsilateral RCR.
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http://dx.doi.org/10.1177/2325967120942773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450454PMC
August 2020

Performance and Return to Sport After Excision of the Fractured Hook of the Hamate in Professional Baseball Players.

Am J Sports Med 2020 10 24;48(12):3066-3071. Epub 2020 Aug 24.

Hospital for Special Surgery, New York, New York, USA.

Background: A fracture of the hook of the hamate is a common injury affecting professional baseball players. The treatment for these fractures ranges from nonoperative immobilization to excision of the fragment.

Purpose/hypothesis: The purpose was to report the results of surgical treatment of hook of hamate fractures in professional baseball players and determine which factors are associated with return to sport (RTS) and time to RTS. The hypothesis was that there is a high rate of RTS in professional baseball players after surgical treatment of the hook of the hamate fracture with no significant decline in performance after RTS.

Study Design: Descriptive epidemiology study.

Methods: All professional baseball players who underwent excision of the hook of the hamate between 2010 and 2017 were included. Player characteristic and performance data (before and after surgery) were recorded. Performance metrics were then compared before and after surgery.

Results: Overall, 261 players were included. Of total injuries, 96% were due to hitting, 86% occurred on the nondominant hitting side, and 89% were acute fractures (11% were nonunion cases). Most (95%) injuries occurred at the Minor League level and 96.2% of procedures were performed by hand fellowship-trained surgeons. Eight percent of players underwent concomitant procedures. The average tourniquet time was 31 ± 13 minutes. In total, 81% of players returned to sport at the same or higher level; 3% returned to sport at a lower level. The median time to RTS after surgery was 48 days (range, 16-246 days). The tourniquet time and number of days to RTS were significantly associated with one another ( = .001; Spearman ρ = 0.290; N = 130). Player utilization significantly increased after surgery. While player efficiency, including batting average (BA), on-base percentage (OBP), and on-base plus slugging percentage (OPS), significantly decreased, these changes were numerically small (BA: 0.26 ± 0.04 preoperatively vs 0.25 ± 0.04 postoperatively; OBP: 0.34 ± 0.04 preoperatively vs 0.32 ± 0.04 postoperatively; OPS: 0.73 ± 0.12 preoperatively vs 0.70 ± 0.11 postoperatively) ( < .001). There were no significant differences between rates of RTS to the same or higher level of play among acute fractures (81%) and nonunion cases (76%) ( = .837).

Conclusion: After surgical excision for hook of hamate fractures in professional baseball players, 84% were able to RTS, with 81% returning to the same or higher level. The median time for players to RTS after surgery was 48 days. Player usage increased after surgery, while hitting efficiency slightly declined.
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http://dx.doi.org/10.1177/0363546520949204DOI Listing
October 2020

Ulnar Collateral Ligament Tear Location May Affect Return-to-Sports Rate but Not Performance Upon Return to Sports After Ulnar Collateral Ligament Reconstruction Surgery in Professional Baseball Players.

Am J Sports Med 2020 09 18;48(11):2608-2612. Epub 2020 Aug 18.

Hospital for Special Surgery, New York, New York, USA.

Background: The number of ulnar collateral ligament (UCL) tears in professional baseball players is increasing. UCL reconstruction (UCLR) is the treatment of choice in players with failed nonoperative treatment who wish to return to sports (RTS). It is unknown if UCL tear location influences the ability of players to RTS or affects their performance upon RTS.

Purpose/hypothesis: The purpose was to compare the RTS rate and performance upon RTS in professional baseball players who underwent UCLR based on UCL tear location (proximal vs distal). It was hypothesized that no difference in RTS rate or performance upon RTS will exist between players with proximal or distal UCL tears.

Study Design: Cohort study; Level of evidence, 3.

Methods: All professional baseball players who underwent primary UCLR by a single surgeon between 2016 and 2018 were eligible for inclusion. Players with purely midsubstance tears or revision UCLR were excluded. Tear location was determined based on preoperative magnetic resonance imaging (MRI) and intraoperative findings. RTS rate and performance were compared between players with proximal versus distal UCL tears.

Results: Overall, 25 pitchers (15 proximal and 10 distal tears) and 5 position players (2 proximal and 3 distal) underwent primary UCLR between 2016 and 2018. Of the 25 pitchers, 84% were able to RTS. Of the 5 position players, 80% were able to RTS. Among the total cohort of pitchers and position players, 12 out of 17 (71%) players with proximal tears were able to RTS, while of the 13 distal tears, 13 out of 13 (100%) players were able to RTS ( = .05). With regard to performance data, pitchers with distal tears had higher utilization postoperatively and, as such, allowed statistically more hits ( = .03), runs ( = .015), and walks ( = .021) postoperatively. However, the WHIP ([walks + hits]/innings pitched) was not different between players with proximal or distal tears, indicating that efficacy in games was not significantly different between groups.

Conclusion: Professional baseball players who sustain a distal UCL tear and undergo UCLR may be more likely to RTS than those who sustain a proximal UCL tear and undergo UCLR. Players with distal UCL tears who underwent UCLR saw higher utilization postoperatively than those with proximal UCL tears. Further work is needed in this area to confirm this result.
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http://dx.doi.org/10.1177/0363546520947090DOI Listing
September 2020

Eclipse stemless shoulder prosthesis vs. Univers II shoulder prosthesis: a multicenter, prospective randomized controlled trial.

J Shoulder Elbow Surg 2020 Nov 21;29(11):2200-2212. Epub 2020 Jul 21.

Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA.

Background: Total shoulder arthroplasty is an accepted treatment for glenohumeral osteoarthritis. The Arthrex Eclipse shoulder prosthesis is a stemless, canal-sparing humeral prosthesis with bone ingrowth capacity on the trunnion, as well as through the fenestrated hollow screw, that provides both diaphyseal and metaphyseal load sharing and fixation.

Methods: Between 2013 and 2018, 16 sites in the United States enrolled 327 patients (Eclipse in 237 and Arthrex Univers II in 90). All patients had glenohumeral arthritis refractory to nonsurgical care. Strict exclusion criteria were applied to avoid confounding factors such as severe patient comorbidities, arthritis not consistent with osteoarthritis, and medical or prior surgical treatments that may have affected outcomes. Patients were randomized to the Eclipse or Univers II group via block randomization.

Results: In total, 149 Eclipse and 76 Univers II patients reached 2-year follow-up (139 Eclipse patients [93.3%] and 68 Univers II patients [89.5%] had complete data). The success rate using the Composite Clinical Success score was 95% in the Eclipse group vs. 89.7% in the Univers II group. No patient exhibited radiographic evidence of substantial humeral radiolucency, humeral migration, or subsidence at any point. Reoperations were performed in 7 patients (3.2%) in the Eclipse group and 3 (3.8%) in the Univers II group.

Conclusion: The Arthrex Eclipse shoulder prosthesis is a safe and effective humeral implant for patients with glenohumeral arthritis at 2-year follow-up, with no differences in outcomes compared with the Univers II shoulder prosthesis.
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http://dx.doi.org/10.1016/j.jse.2020.07.004DOI Listing
November 2020

Interaction Between Age and Change in Velocity During a Baseball Training Program.

Orthop J Sports Med 2020 Jun 17;8(6):2325967120927939. Epub 2020 Jun 17.

Rothman Orthopaedic Institute, New York, New York, USA.

Background: Pitching velocity is one of the most important metrics used to evaluate a baseball pitcher's effectiveness. The relationship between age and pitching velocity after a lighter ball baseball training program has not been determined.

Purpose/hypothesis: The purpose of this study was to examine the relationship between age and pitching velocity after a lighter ball baseball training program. We hypothesized that pitching velocity would significantly increase in all adolescent age groups after a lighter baseball training program, without a significant difference in magnitude of increase based on age.

Study Design: Cohort study; Level of evidence, 2.

Methods: Baseball pitchers aged 10 to 17 years who completed a 15-week training program focused on pitching mechanics and velocity improvement were included in this study. Pitchers were split into 3 groups based on age (group 1, 10-12 years; group 2, 13-14 years; group 3, 15-17 years), and each group trained independently. Pitch velocity was assessed at 4 time points (sessions 3, 10, 17, and 25). Mean, maximum, and mean change in pitch velocity between sessions were compared by age group.

Results: A total of 32 male baseball pitchers were included in the analysis. Mean/maximum velocity increased in all 3 age groups: 3.4/4.8 mph in group 1, 5.3/5.5 mph in group 2, and 5.3/5.2 mph in group 3. While mean percentage change in pitch velocity increased in all 3 age groups (group 1, 6.5%; group 2, 8.3%; group 3, 7.6%), the magnitude of change was not significantly different among age groups. Program session number had a significant effect on mean and maximum velocity, with higher mean and maximum velocity seen at later sessions in the training program ( = .018). There was no interaction between age and program session within either mean or maximum velocity ( = .316 and .572, respectively).

Conclusion: Age had no significant effect on the magnitude of increase in maximum or mean baseball pitch velocity during a velocity and mechanics training program in adolescent males.
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http://dx.doi.org/10.1177/2325967120927939DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301661PMC
June 2020

Does commercially available shoulder arthroplasty preoperative planning software agree with surgeon measurements of version, inclination, and subluxation?

J Shoulder Elbow Surg 2021 Feb 13;30(2):413-420. Epub 2020 Jun 13.

Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, New York, NY, USA.

Background: Preoperative planning with commercially available imaging software in shoulder arthroplasty may allow for improved decision-making and more accurate placement of the glenoid component.

Methods: A total of 81 consecutive shoulder computed tomography scans obtained for preoperative planning purposes for shoulder arthroplasty were analyzed by commercially available software from 4 companies (Blueprint: Wright Medical, Memphis, TN, USA; GPS: Exactech, Gainesville, FL, USA; Materialise: DJO, Vista, CA, USA; and VIP: Arthrex, Naples, FL, USA) and by 5 fellowship-trained sports medicine/shoulder surgeons. Inclination, version, and subluxation of the humerus were measured in a blinded fashion on axial and coronal sequences at the mid-glenoid. Surgeon measurements were analyzed for agreement and were compared with the 4 commercial programs.

Results: Surgeon reliability was acceptable for version (intraclass correlation coefficient [ICC]: 0.876), inclination (ICC: 0.84), and subluxation (ICC: 0.523). Significant differences were found between surgeon and commercial software measurements in version (P = .03), inclination (P = .023), and subluxation (P < .001). Software measurements tended to be more superiorly inclined (average -2° to 2° greater), more retroverted (average 2°-5° greater), and more posteriorly subluxed (average 7°-10° greater) than surgeon measurements. In comparing imaging software measurements, only Blueprint was found to produce significantly different version measurements than surgeon measurements (P = .02).

Conclusion: Preoperative planning software for shoulder arthroplasty has limited agreement in measures of version, inclination, and subluxation measurements, whereas surgeons have high inter-reliability. Surgeons should be cautious when using commercial software planning systems and when comparing publications that use different planning systems to determine preoperative glenoid deformity measurements.
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http://dx.doi.org/10.1016/j.jse.2020.05.027DOI Listing
February 2021

Complications and Readmissions After Reverse and Anatomic Total Shoulder Arthroplasty With Same-day Discharge.

J Am Acad Orthop Surg 2021 Feb;29(3):116-122

From the Rothman Orthopaedic Institute (Antonacci, Dr. Erickson, and Dr. Alberta), Philadelphia, PA, the Department of Orthopaedic Surgery (Cu, Dr. Vazquez, and Dr. Alberta), Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, and the Hackensack University Medical Center (Dr. Vazquez and Dr. Alberta), Hackensack, NJ.

Background: Recent studies have demonstrated the safety of anatomic total shoulder arthroplasty (TSA) in an outpatient setting. No clinical studies, to date, have specifically analyzed complication and readmission rates after reverse total shoulder arthroplasty (RTSA) with same-day discharge. The purpose of this study was to compare the 90-day complication and readmission rates of patients undergoing TSA and RTSA with same-day discharge.

Methods: Ninety-eight consecutive patients who underwent 104 shoulder arthroplasties with same-day discharge (52 TSA and 52 RTSA) between 2016 and 2019 were analyzed. Suitability for same-day discharge was determined preoperatively using the standardized criteria. Demographic variables, operative time, 90-day readmission, and complication rates were recorded and compared between groups. Differences between the patients undergoing TSA versus RTSA were evaluated with Student t-test, Mann-Whitney test, or Chi square tests as statistically appropriate and reported as P values.

Results: Average age in the TSA cohort was significantly lower (60.1 ± 7.4 versus 67.5 ± 7.5, respectively; P < 0.001). Total operating room time was significantly shorter in the RTSA cohort (153 ± 30.1 minutes versus 171 ± 20.9). Three minor postoperative complications (5.8%) were observed in the TSA cohort (three seromas) within the 90-day postoperative period. There were four postoperative complications (7.7%) in the RTSA cohort (two postoperative seromas, one periprosthetic fracture, and one dislocation). None of the TSA patients required readmission and 1 RTSA (periprosthetic fracture) patient required readmission within 90 days.

Discussion: RTSA with same-day discharge is a safe option for appropriately selected patients despite significantly increased age. 90-day readmission and complication rates between outpatient TSA and RTSA are similar.

Data Availability: Yes.

Trial Registration Numbers: NA.

Level Of Evidence: III (case-control).
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http://dx.doi.org/10.5435/JAAOS-D-20-00245DOI Listing
February 2021

The Utilization of Physician Cell Phone Numbers by Patients in an Orthopaedic Surgery Practice.

Cureus 2020 Apr 17;12(4):e7712. Epub 2020 Apr 17.

Orthopaedic Surgery, Rothman Orthopaedic Institute, New York, USA.

Introduction Orthopaedic surgeons choose to manage communication with their patients outside of official visits and interactions in a variety of ways, with some choosing to provide their personal cell phone number in order to provide patients with direct accessibility. The objective of this prospective study is to explore to what extent patients utilize the cell phone numbers of orthopaedic surgeons in the immediate period after it is provided to them. Methods Seven fellowship-trained orthopaedic surgeons from five different subspecialties in a single private, multi-site group each provided his/her personal cell phone number to 30 consecutive patients. The surgeon's phone number was written down on a business card, and the surgeons themselves provided the card to the patient. Phone calls and voice mail messages received in the 30 days following the patient receiving the phone number were recorded, and the reasons for these calls were categorized as being "appropriate" (e.g. acute postoperative issues, unclear instructions) or "inappropriate" (e.g. administrative issues, medication refills, advanced imaging-related inquires). Results Two-hundred seven patients with an average age of 51.5 years were provided cell phone numbers. During the 30 days following administration of cell phone numbers to each patient, 21 patients (10.1%) made calls to their surgeons, for an average of 0.15 calls per patient. Six patients (2.9%) called their surgeons more than once. Seventeen calls (54.8%) were deemed appropriate, while 14 calls (45.2%) were inappropriate. Logistic regression analysis did not reveal patient age, sex, type of visit, or surgeon subspecialty to be independently associated with calling. Conclusion Our study has demonstrated a low rate of patient utilization of surgeon cell phone number when provided to them. If surgeons choose to provide their cell phone number to patients, we recommend specifying appropriate reasons to call in order to maximize the effectiveness of this communication method.
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http://dx.doi.org/10.7759/cureus.7712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233492PMC
April 2020

Superior Labral Anterior Posterior Repair and Biceps Tenodesis Surgery: Trends of the American Board of Orthopaedic Surgery Database.

Am J Sports Med 2020 06 16;48(7):1583-1589. Epub 2020 Apr 16.

Rothman Orthopaedic Institute, New York, New York, USA.

Background: Recent evidence has specified indications for performing superior labral anterior posterior (SLAP) repair and biceps tenodesis (BT) for the treatment of bicipital-labral lesions in the shoulder. Trends in performance of these procedures are expected to reflect the growing body of research regarding this topic.

Purpose: To report practice trends for the surgical treatment of SLAP lesions utilizing the American Board of Orthopaedic Surgery (ABOS) database, particularly in older patients.

Study Design: Cohort study; Level of evidence, 3.

Methods: The ABOS database was retrospectively queried between 2012 and 2017 by Current Procedural Terminology (CPT) codes for SLAP repair (29807), open BT (23430), and arthroscopic BT (29828). The patient population was excluded if any concomitant open shoulder procedure was performed. Trends over time were evaluated with respect to case volume, patient age, surgeon subspecialty, and whether a concomitant arthroscopic rotator cuff repair (RCR) was performed (CPT 29827).

Results: A total of 9908 cases met inclusion/exclusion criteria: 4632 performed with RCR and 5276 performed without. The mean age of patients without RCR was 40.8 ± 13.8 years, while for those receiving RCR it was 55.0 ± 9.9 years ( < .001). In patients without RCR, there was a significant decline in rate of SLAP repairs performed over this period ( < .001). A significantly greater proportion of patients receiving open and arthroscopic BT were older than 35 years of age, compared with those receiving SLAP repair ( < .001). Within the RCR cohort, there was also a significant decline in concomitant SLAP repairs performed ( < .001) over the study period. With respect to BT, open BT was performed more frequently in the cohort without RCR (74.5%) than in the cohort with RCR (52.1%) ( < .001). Similarly, arthroscopic BT was performed more commonly in the cohort with RCR (47.9%) than in the cohort without RCR (25.5%) ( < .001).

Conclusion: The ABOS database revealed significantly reduced rates of SLAP repairs performed in recent times. Trends with age remained consistent over time, in that SLAP repairs were predominantly performed in younger patients. Open BT was performed more frequently overall, but with an increased proportion of arthroscopic BT occurring with RCR. Arthroscopic BT was performed much more frequently with RCR than without.
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http://dx.doi.org/10.1177/0363546520913538DOI Listing
June 2020

Adhesive Capsulitis: Demographics and Predictive Factors for Success Following Steroid Injections and Surgical Intervention.

Arthrosc Sports Med Rehabil 2019 Nov 26;1(1):e35-e40. Epub 2019 Sep 26.

Cleveland Shoulder Institute, Beachwood, Ohio, U.S.A.

Purpose: Examine demographic factors of all patients treated for adhesive capsulitis by a single surgeon, report the treatments and outcomes of these patients, and determine the effectiveness of various treatments, including corticosteroid injections and operative intervention in relation to risk factors for adhesive capsulitis.

Methods: All patients treated for adhesive capsulitis by a single surgeon between 2008 to 2014 with minimum 2 years' follow-up were identified via charts and operative reports and were eligible for inclusion. Demographic information including sex and medical comorbidities was documented. Preintervention and postintervention shoulder range of motion was recorded. Specific treatment information (number of corticosteroid injections, etc) was collected. Treatment outcomes were then compared as an aggregate and among varying comorbidities.

Results: Overall, 1377 patients were treated for adhesive capsulitis (946 women vs 431 men [ = .001]). For patients with adhesive capsulitis: a higher percentage of men than women had diabetes (24.8% vs 17.3% [ = .001]); nondiabetic patients had better forward flexion at initial presentation than patients with diabetes (114° vs 108° [ = .015]); more patients with diabetes required capsular release than nondiabetic patients (13% vs 7.3% [ = .003]); more nondiabetic patients resolved adhesive capsulitis without corticosteroid or surgical intervention than patients with diabetes (83.6% vs 61.7% [ = .001]); more nondiabetic patients resolved adhesive capsulitis after single corticosteroid injection than did patients with diabetes (95.9% vs 86.7% [ = .001]). Multiple intraarticular corticosteroid injections provided no added benefit over a single injection in resolving adhesive capsulitis in patients with diabetes and nondiabetic patients.

Conclusion: In shoulder adhesive capsulitis, women and patients with diabetes are more commonly affected, patients with diabetes respond less favorably to physical therapy in isolation and physical therapy plus corticosteroid injections than nondiabetic patients. No benefit from multiple intraarticular corticosteroid injections was seen compared with a single intraarticular corticosteroid injection in patients with diabetes and nondiabetic patients. Patients with diabetes and nondiabetic patients have functional improvement after capsular release and manipulation if conservative treatment for adhesive capsulitis fails.

Level Of Evidence: III, case control.
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http://dx.doi.org/10.1016/j.asmr.2019.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120833PMC
November 2019

Training With Lighter Baseballs Increases Velocity Without Increasing the Injury Risk.

Orthop J Sports Med 2020 Mar 26;8(3):2325967120910503. Epub 2020 Mar 26.

Rothman Orthopaedic Institute, New York, New York, USA.

Background: Pitch velocity has become an increasingly popular metric by which pitchers are graded and compared. Training programs that utilize weighted balls have been effective in increasing velocity but at the cost of an increased injury risk. No studies have evaluated training with lighter baseballs with regard to increasing pitch velocity and the injury risk.

Purpose/hypothesis: The purpose of this study was to determine whether a training program utilizing lighter baseballs could increase fastball velocity without increasing the injury risk to participants. We hypothesized that a training program with lighter baseballs would increase fastball velocity but not increase the injury risk.

Study Design: Case series; Level of evidence, 4.

Methods: All baseball pitchers who participated in a 15-week program at a single location, with the same coaches, and aimed to improve pitching mechanics and increase velocity were included. The training program was broken down into 3 phases, and each participant went through the same program. Lighter baseballs (3 and 4 oz) and standard baseballs (5 oz) were utilized as part of the training program. Weighted (heavier) balls were not used. Velocity was measured at 4 time points throughout the program with the pitcher throwing 5 fastballs using a standard 5-oz ball at maximum velocity (sessions 3, 10, 17, and 25). Injuries for all players were recorded throughout the entire program.

Results: A total of 44 male pitchers aged 10 to 17 years (mean age, 14.7 ± 1.8 years) completed the training program and were available for analysis. No pitcher sustained a shoulder or elbow injury during the course of the training program. Fastball velocity increased by a mean of 4.8 mph (95% CI, 4.0-5.6 mph) ( < .001). Overall, 43 of 44 players (98%) had an increase in fastball velocity over the course of the program.

Conclusion: A 15-week pitching training program with lighter baseballs significantly improved pitching velocity without causing any injuries, specifically to the shoulder or elbow. Lighter baseballs should be considered as an alternative to weighted baseballs when attempting to increase a pitcher's velocity.
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http://dx.doi.org/10.1177/2325967120910503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103592PMC
March 2020

The Biology of Sex and Sport.

JBJS Rev 2020 03;8(3):e0140

Rothman Orthopaedic Institute, New York, NY.

Sex and gender are not the same. Sex is defined by the human genotype and pertains to biologic differences between males and females. Gender is a fluid concept molded by self-perception, social constructs, and culturally laden attitudes and expectations of men and women. In general, males have longer limb levers, stronger bones, greater muscle mass and strength, and greater aerobic capacity. Females exhibit less muscle fatigability and faster recovery during endurance exercise. Physiologic sex-based differences have led to an average performance gap of 10% that has remained stable since the 1980s. The performance disparity is lowest for swimming and highest for track and field events. The International Olympic Committee currently mandates that female athletes with differences of sex development, or intersex traits, and transgender female athletes must limit their blood testosterone to <10 nmol/L for 12 months to be eligible for competition in the female classification.
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http://dx.doi.org/10.2106/JBJS.RVW.19.00140DOI Listing
March 2020

Timing of Return to Batting Milestones After Ulnar Collateral Ligament Reconstruction in Professional Baseball Players.

Am J Sports Med 2020 May 30;48(6):1465-1470. Epub 2020 Mar 30.

Rothman Orthopaedic Institute, New York, New York, USA.

Background: Ulnar collateral ligament reconstruction (UCLR) is a common procedure in professional baseball position players. Timing of return to hitting after UCLR is unknown.

Purpose/hypothesis: The purpose was to determine the time to return to batting milestones after UCLR as well as the effect of UCLR upon batting performance in professional baseball players. The hypothesis was that position players would return to batting in an in-season game before fielding in an in-season game, and hitting performance would remain unchanged after UCLR.

Study Design: Cohort study; Level of evidence, 3.

Methods: All professional position players who underwent UCLR between 2010 and 2018 were included. Time to batting milestones after UCLR was analyzed. Batting performance before and after UCLR was compared and analyzed.

Results: Overall, 141 UCLRs (96% performed on the dominant arm) in 137 position players were included (86% Minor League players). Four players underwent revision, all within 1 year of the primary UCLR. With regard to position, catchers and shortstops were overrepresented. With regard to batting side, 57% batted from the right and 12% batted as switch-hitters. Of the surgeries, 76% were on the trail/back arm. While 91% of players returned to some form of throwing, there was a progressive gradual decline as the rehabilitation process progressed, as only 77% were able to return to hitting in a real game and 75% were able to return to fielding in a real game. The first dry swing occurred at 150 ± 49 days after surgery, the first batting practice occurred at 195 ± 58 days after surgery, the first hitting in a real game occurred at 323 ± 92 days after surgery, and the first fielding in a real game occurred at 343 ± 98 days after surgery. However, players generally saw a decrease in their utilization, with fewer at bats ( < .001) translating into fewer hits ( < .001) and runs ( < .001).

Conclusion: Professional position players begin swinging at 150 days (approximately 5 months) after UCLR, while they do not hit in batting practice until 195 days (approximately 6.5 months) and do not hit in a real game until 323 days (approximately 10.7 months) after UCLR. Players see a decrease in hitting utilization after UCLR. On average, players hit in a real game 20 days before fielding in a real game.
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http://dx.doi.org/10.1177/0363546520910417DOI Listing
May 2020

Subscapularis Repair During Reverse Total Shoulder Arthroplasty Using a Stem-Based Double-Row Repair: Sonographic and Clinical Outcomes.

Orthop J Sports Med 2020 Mar 9;8(3):2325967120906806. Epub 2020 Mar 9.

Cleveland Shoulder Institute, Beachwood, Ohio, USA.

Background: Treatment of the subscapularis in reverse total shoulder arthroplasty (RTSA) is a controversial topic, with conflicting evidence regarding outcomes after repair.

Purpose/hypothesis: The purpose of this study was to report clinical and sonographic outcomes of a through-implant double-row suture technique for subscapularis repair in RTSA and to compare clinical outcomes and range of motion (ROM) between patients with an intact subscapularis tendon repair versus those whose tendon repair was not intact. The authors hypothesized that the novel repair technique would find more than 80% of tendons intact on ultrasound, with significant improvement in clinical outcome scores and ROM. The authors also hypothesized that patients with an intact subscapularis tendon repair would have better clinical outcomes compared with those with a nonintact tendon repair.

Study Design: Case series; Level of evidence, 4.

Methods: The study included all patients who underwent RTSA by 1 of 2 surgeons between August 2016 and March 2017 with the through-implant double-row suture technique for subscapularis repair. Subscapularis tendon integrity was assessed postoperatively via ultrasound at minimum 1-year follow-up. American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and pain visual analog scale (VAS) scores were recorded at the final follow-up visit in addition to ROM measures.

Results: A total of 48 patients (31 males, 17 females; mean age, 68.9 ± 7.4 years; mean follow-up, 13.8 ± 2.1 months) were included. On ultrasound, the subscapularis was intact in 83.3% of patients. Regarding preoperative versus postoperative outcome scores, the ASES score (mean ± SD) significantly improved from 38.3 ± 14.7 to 81.9 ± 13.6, the SANE score significantly improved from 29.8 ± 24.2 to 75.5 ± 21.0, and the VAS pain score significantly improved from 5.9 ± 2.1 to 1.2 ± 1.6 ( < .001 for all). Forward flexion and external rotation significantly improved. No significant difference existed in clinical outcome scores or ROM between patients with intact versus torn subscapularis tendons based on ultrasound.

Conclusion: Subscapularis repair using a stem-based double-row repair technique during RTSA demonstrated an overall healing rate of 83.3%, as evidenced by ultrasound examination at short-term follow-up. Integrity of subscapularis repair did not affect clinical outcome or ROM.
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http://dx.doi.org/10.1177/2325967120906806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065284PMC
March 2020

Tuberosity Repair in Reverse Total Shoulder Arthroplasty for Fracture Using a Stem-based Double-row Repair: A Cadaveric Biomechanical Study.

J Am Acad Orthop Surg 2020 Dec;28(23):e1059-e1065

From the Rothman Orthopaedic Institute, New York, NY (Dr. Erickson, Dr. Bishop, and Dr. Romeo), Banner Sports Medicine, University of Arizona College of Medicine, Phoenix, AZ (Dr. Shishani and Dr. Lederman), and Cleveland Shoulder Institute (Dr. Gobezie), Beachwood, OH.

Introduction: The optimal tuberosity repair method in reverse total shoulder arthroplasty for fracture is unknown.

Methods: Eight matched pairs of cadaver shoulders were randomly assigned to a stem-based tuberosity repair technique or a nonstem-based repair (Boileau technique) and mechanically tested with a 10 kN load cell. Cyclic loading was performed between 10 and 100 N for 500 cycles at 1 Hz, followed by static pull to failure at 33 mm/s. Ultimate load was determined from the maximum load reached during the pull to failure. A paired Student t-test was used to compare the means of the ultimate load and average cyclic displacement of the two sample groups.

Results: The ultimate load to failure for the stem-based tuberosity repair technique was significantly higher than the nonstem-based technique (668 ± 164 N versus 483 ± 67 N; P = 0.032). The average cyclic displacement for the stem-based tuberosity repair technique was significantly less than the nonstem-based technique 0 (0.83 ± 0.67 mm versus 3.36 ± 2.36 mm; P = 0.017).

Conclusion: The stem-based tuberosity repair technique afforded higher ultimate load to failure with less average cyclic displacement than the nonstem-based technique. Consideration to the stem-based technique should be given when performing a tuberosity repair in the setting of reverse total shoulder arthroplasty for fracture.

Level Of Evidence: Level III.
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http://dx.doi.org/10.5435/JAAOS-D-19-00667DOI Listing
December 2020

Current state of short-stem implants in total shoulder arthroplasty: a systematic review of the literature.

JSES Int 2020 Mar 28;4(1):114-119. Epub 2020 Jan 28.

University of Arizona College of Medicine, Phoenix, AZ, USA.

Background: Humeral stem length in anatomic total shoulder arthroplasty (TSA) continues to decrease in an attempt to preserve bone. Outcomes following short-stem TSA are not well documented. The purpose was to systematically review and report the outcomes and revisions following short-stem humeral implants for TSA.

Methods: A systematic review was registered with PROSPERO and performed with PRISMA guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting TSA outcomes of short-stem implants with levels of evidence I-IV were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and described.

Results: Thirteen studies were included (average follow-up: 33 months, range 24-84 months; 8 studies [62%] were multicenter and 6 [46%] were from Europe). All studies were published in the last 8 years, and almost all (12/13, 92%) reported results of uncemented components. Most of the studies (9/13, 70%) reported results from the Aequalis Ascend or Ascend Flex Stem (Tornier). Improvements were seen in all measured range of motion planes and patient-reported outcome scores. Complications were infrequent, with a 2% humeral loosening rate, a 3% overall revision rate, and a 1% rate of revision for aseptic humeral loosening. Radiographic results showed a 13% rate of radiolucent lines, a 16% rate of condensation lines, and a 22% rate of calcar osteolysis.

Conclusion: Short-stem TSA humeral implants provide excellent results, with low revision rates in the short term. Long-term follow-up will be necessary to understand the clinical impact of radiographic calcar osteolysis.
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http://dx.doi.org/10.1016/j.jses.2019.10.112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075780PMC
March 2020

Outpatient vs. inpatient reverse total shoulder arthroplasty: outcomes and complications.

J Shoulder Elbow Surg 2020 Jun 5;29(6):1115-1120. Epub 2020 Feb 5.

Cleveland Shoulder Institute, Beachwood, OH, USA.

Background: Reverse total shoulder arthroplasty (RTSA) is an effective treatment option for many shoulder conditions. Historically, this surgical procedure was performed on an inpatient basis. There has been a recent trend to perform RTSA on an outpatient basis in proper candidates.

Methods: All patients who underwent outpatient RTSA performed by a single surgeon between 2015 and 2017 were included. Demographic information and clinical outcome scores (American Shoulder and Elbow Surgeons, visual analog scale, and Single Assessment Numeric Evaluation scores), as well as data on complications, readmission, and revision surgery, were recorded. This group of patients was then compared with a cohort of patients who underwent RTSA in the inpatient setting during the same period.

Results: Overall, 241 patients (average age, 68.9 years; 52.3% female patients) underwent outpatient RTSA and were included. Patients who underwent outpatient RTSA showed significant improvements in all clinical outcome scores at both 1 and 2 year postoperatively (all P < .0001). The control group of patients who underwent RTSA as inpatients consisted of 373 patients (average age, 72 years; 66% female patients). Significantly more controls had diabetes (P = .007), and controls had a higher body mass index (P = .022). No significant differences existed in improvements in clinical outcome scores between the inpatient and outpatient groups. Complication rates were significantly lower for outpatient cases than for inpatient controls (7.0% vs. 12.7%, P = .023).

Conclusion: RTSA performed in an outpatient setting is a safe and reliable procedure that provides significant improvements in clinical outcome scores with fewer complications compared with inpatient RTSA.
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http://dx.doi.org/10.1016/j.jse.2019.10.023DOI Listing
June 2020

Upper Extremity and Hip Range of Motion Changes Throughout a Season in Professional Baseball Players.

Am J Sports Med 2020 02 31;48(2):481-487. Epub 2019 Dec 31.

Division of Sports and Shoulder, Hospital for Special Surgery, New York, New York, USA.

Background: Loss of upper and lower extremity range of motion (ROM) is a significant risk factor for injuries in professional baseball players.

Purpose/hypothesis: The purpose was to determine changes in ROM in professional baseball players over the course of a single season and their careers. We hypothesized that pitchers and position players would lose ROM, specifically total shoulder motion (total ROM [TROM]) and hip internal rotation (IR), over the course of a season and their careers.

Study Design: Case series; Level of evidence, 4.

Methods: Upper and lower extremity ROM measurements were recorded during pre-, mid-, and postseason on all professional baseball players for a single organization between 2011 and 2018. ROM measurements were compared for pitchers and position players over the course of the season and their careers. Also, ROM measurements over the pre-, mid-, and postseason were compared between pitchers and position players.

Results: A total of 166 professional baseball players (98 pitchers, 68 position players) were included. Pitcher hip external rotation (ER; .001), IR ( .010), and TROM ( .001) for lead and trail legs decreased over the course of the season. Pitcher shoulder ER ( = .005), TROM ( .042), and horizontal adduction ( .001) significantly increased over the course of the season. Position player shoulder flexion ( .046), hip ER ( .001, lead leg; .001, trail leg), and hip TROM ( .001; .002) decreased over the course of the season. Position player shoulder ER ( .031) and humeral adduction ( .001) significantly increased over the course of the season. Over the course of pitchers' careers, there was decreased shoulder IR ( .014), increased shoulder horizontal adduction ( .001), and hip IR ( .042) and hip TROM ( .027) for the lead leg. Position players experienced loss of hip TROM ( .010, lead leg; .018, trail leg) over the course of their careers. Pitchers started with and maintained more shoulder ER and gained more shoulder TROM over a season as compared with position players.

Conclusion: Pitchers and position players saw overall decreases in hip ROM but increases in shoulder ROM over the course of the season and career.
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http://dx.doi.org/10.1177/0363546519894567DOI Listing
February 2020

The biomechanics of subscapularis repair in reverse shoulder arthroplasty: The effect of lateralization and insertion site.

J Orthop Res 2020 04 27;38(4):888-894. Epub 2019 Nov 27.

Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York, 10021.

Functional outcomes of subscapularis (SSc) repair following reverse shoulder arthroplasty (RSA) remains controversial. SSc repair in combination with glenosphere lateralization was reported to yield worse clinical outcomes compared with the non-lateralized glenosphere. The aim of this biomechanical study was to investigate how glenosphere lateralization and different re-insertion sites can affect the biomechanics of the SSc after RSA. Nine patient-specific RSA shoulder models were created from patients' computed tomography scans. Moment arms and SSc length were calculated for abduction, forward flexion, and internal rotation in 20° and 90° abduction for three configurations of glenosphere lateralization (standard/+0, +5, and +10 mm) and three SSc repair sites (native, superior, and inferior) and compared with the native shoulder. When compared with the native shoulder, RSA resulted in large adducting SSc moment arms that were antagonistic to the deltoid. Glenosphere lateralization had no effect on SSc moment arms in any motion. However, lateralization increased SSc tension beyond its anatomic length for +5 and +10 mm of lateralization when attached to its native insertion. A superior SSc repair site created the least adductive moment arm as well as the least amount of SSc lengthening. Increased glenosphere lateralization showed a significant increase in the SSc length, which in combination with its adductive moment arm can be antagonistic to deltoid function. However, a superior SSc repair site may help reduce the adductive SSc moment arm and allow for reduced tension on the repair as its length in that location is less than that of the native SSc. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:888-894, 2020.
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http://dx.doi.org/10.1002/jor.24531DOI Listing
April 2020

Performance and Return to Sport After Anterior Cruciate Ligament Reconstruction in Professional Baseball Players.

Orthop J Sports Med 2019 Oct 30;7(10):2325967119878431. Epub 2019 Oct 30.

Department of Orthopedic Surgery, Columbia University, New York, New York, USA.

Background: Anterior cruciate ligament reconstruction (ACLR) is the gold standard treatment for ACL tears to allow baseball players to return to sport (RTS). The optimal graft type and femoral tunnel drilling technique are currently unknown.

Hypothesis: There is a high rate of RTS in professional baseball players after ACLR, with no significant difference in RTS rates or performance between cases and controls or between graft types or femoral drilling techniques.

Study Design: Cohort study; Level of evidence, 3.

Methods: All professional baseball players who underwent ACLR between 2010 and 2015 were included. Demographic and performance data (pre- and postoperative) for each player were recorded. Performance metrics were then compared between cases and matched controls.

Results: A total of 124 players (mean age, 23.7 ± 4.1 years; 83% minor league players) underwent ACLR. Of these, 80% returned to sport (73% to the same or higher level) at a mean 310 ± 109 days overall and 333 ± 126 days at the same or higher level. The most common graft type was an ipsilateral bone-patellar tendon-bone (BTB) autograft (n = 87; 70%). A total of 91 players underwent concomitant meniscal debridement or repair. No significant difference in any of the primary performance metrics existed from before to after ACLR. Compared with matched controls, no significant difference existed in RTS rates or any performance metrics after ACLR. No significant difference existed in RTS rates or primary performance outcome measures between graft types or femoral drilling techniques.

Conclusion: The RTS rate for professional baseball players after ACLR was 80%. No significant difference in performance metrics existed between BTB and hamstring autografts or between femoral drilling techniques. Furthermore, no significant difference in performance or RTS rates existed between cases and matched controls. Femoral drilling technique and graft type did not affect performance and RTS rates in professional baseball players after ACLR.
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http://dx.doi.org/10.1177/2325967119878431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822199PMC
October 2019

Nonoperative Treatment of Elbow Ulnar Collateral Ligament Injuries With and Without Platelet-Rich Plasma in Professional Baseball Players: A Comparative and Matched Cohort Analysis.

Am J Sports Med 2019 11 7;47(13):3107-3119. Epub 2019 Oct 7.

Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA.

Background: Recent studies evaluating nonoperative treatment of elbow ulnar collateral ligament (UCL) injuries augmented with platelet-rich plasma (PRP) have shown promising results. To date, no comparative studies have been performed on professional baseball players who have undergone nonoperative treatment with or without PRP injections for UCL injuries.

Hypothesis: Players who received PRP injections would have better outcomes than those who did not receive PRP.

Study Design: Cohort study; Level of evidence, 3.

Methods: The Major League Baseball (MLB) Health and Injury Tracking System identified 544 professional baseball players who were treated nonoperatively for elbow UCL injuries between 2011 and 2015. Of these, 133 received PRP injections (PRP group) before starting their nonoperative treatment program, and 411 did not (no-PRP group). Player outcomes and a Kaplan-Meier survival analysis were compared between groups. In addition, to reduce selection bias, a 1:1 matched comparison of the PRP group versus the no-PRP group was performed. Players were matched by age, position, throwing side, and league status: major (MLB) and minor (Minor League Baseball [MiLB]). A single radiologist with extensive experience in magnetic resonance imaging (MRI) interpretation of elbow injuries in elite athletes analyzed 243 MRI scans for which images were accessible for tear location and grade interpretation.

Results: Nonoperative treatment of UCL injuries resulted in an overall 54% rate of return to play (RTP). Players who received PRP had a significantly longer delay in return to throwing ( < .001) and RTP ( = .012). The matched cohort analysis showed that MLB and MiLB pitchers in the no-PRP group had a significantly faster return to throwing ( < .05) and the MiLB pitchers in the no-PRP group had a significantly faster RTP ( = .045). The survival analysis did not reveal significant differences between groups over time. The use of PRP, MRI grade, and tear location were not statistically significant predictors for RTP or progression to surgery.

Conclusion: In this retrospective matched comparison of MLB and MiLB pitchers and position players treated nonoperatively for a UCL tear, PRP did not improve RTP outcomes or ligament survivorship, although there was variability with respect to PRP preparations, injection protocols, time from injury to injection, and rehabilitation programs. MRI grade and tear location also did not significantly affect RTP outcomes or progression to surgery.
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http://dx.doi.org/10.1177/0363546519876305DOI Listing
November 2019

Do Professional Baseball Players With a Higher Valgus Carrying Angle Have an Increased Risk of Shoulder and Elbow Injuries?

Orthop J Sports Med 2019 Aug 27;7(8):2325967119866734. Epub 2019 Aug 27.

Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.

Background: There are many risk factors for shoulder and elbow injuries in professional baseball pitchers. The elbow carrying angle has not been studied as a potential risk factor.

Purpose/hypothesis: The aim of this study was to determine whether elbow carrying angle is a risk factor for shoulder or elbow injuries in professional baseball pitchers. We hypothesized that pitchers with a higher elbow carrying angle would be less likely to sustain an injury during the season than pitchers with a lower elbow carrying angle.

Study Design: Cohort study; Level of evidence, 2.

Methods: All professional pitchers for a single baseball club during the 2018 season had the carrying angle of both elbows measured at spring training by a single examiner. The pitchers were followed prospectively throughout the season. Shoulder and elbow injuries were recorded prospectively.

Results: A total of 52 pitchers (21 [40%] Major League Baseball and 31 [60%] Minor League Baseball) were included. During the season, 23 (44%) pitchers became injured. The mean carrying angle in the throwing arm was 12.5° ± 4.2° versus 9.9° ± 2.8° in the nonthrowing arm ( < .001). Comparing the injured and noninjured groups, there were no differences in level of play ( = .870), throwing hand dominance ( = .683), batting hand dominance ( = .554), throwing-side carrying angle ( = .373), nonthrowing-side carrying angle ( = .773), or side-to-side difference in carrying angle ( = .481).

Conclusion: The elbow carrying angle was not associated with an injury risk during a single season in professional baseball pitchers.
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http://dx.doi.org/10.1177/2325967119866734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712761PMC
August 2019

Magnetic Resonance Imaging Grading System for Tears of the Latissimus Dorsi and Teres Major.

Orthop J Sports Med 2019 Mar 4;7(3):2325967119826548. Epub 2019 Mar 4.

Hospital for Special Surgery, New York, New York, USA.

Background: Recent awareness of latissimus dorsi/teres major (LD/TM) injuries has led to an increase in diagnoses. No magnetic resonance imaging (MRI) classification system specific to the LD/TM exists, nor has tear severity been correlated with ability to return to sport (RTS).

Purpose/hypothesis: The purpose of this study was to report a novel MRI classification system for LD/TM tears as well as to correlate tear grade with performance and RTS. We hypothesized that the new MRI classification system would have high intra- and interobserver reliabilities and that players with higher grade tears would require operative management.

Study Design: Cohort study (diagnosis); Level of evidence, 3.

Methods: All patients with LD/TM tears diagnosed by MRI who were under the care of 2 orthopaedic surgeons were included. On 2 occasions 60 days apart, MRIs were reviewed and graded by 2 authors using a new classification system. Intra- and interobserver reliabilities were calculated. Timing from injury to RTS was recorded, and performance upon RTS was analyzed.

Results: The proposed grading system had excellent intra- and interrater reliabilities (Cohen kappa >0.850). A total of 20 male patients (mean ± SD age, 26 ± 9.3 years) with LD/TM tears were included (80% were baseball pitchers). Of the 16 players treated operatively, 5 were initially treated nonoperatively by an outside physician but could not RTS (all professional baseball pitchers); 2 of these players had grade IIIA tears and 3 of the players had grade IVA tears. Regardless of initial treatment, ultimately 100% of the professional baseball players were able to RTS at a mean of 8.7 ± 3.3 months, although the initial nonoperative management failed for some of these players and they needed surgical intervention. No statistically significant differences were found between pre- versus postoperative performance in those professional players who were treated surgically.

Conclusion: The proposed MRI-based grading system for LD/TM tears had excellent reliability. This system may allow physicians to better advise patients and all involved health care providers. Consideration should be given to acutely treat grade III and IV tears with operative repair.
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http://dx.doi.org/10.1177/2325967119826548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6700928PMC
March 2019

Performance and return to sport following rotator cuff surgery in professional baseball players.

J Shoulder Elbow Surg 2019 Dec 13;28(12):2326-2333. Epub 2019 Jul 13.

Rothman Orthopaedic Institute, New York, NY, USA.

Background: While many injuries to the rotator cuff in professional baseball players can be managed nonoperatively, recovery fails to occur with nonoperative treatment in some players and surgery on the rotator cuff is performed in an attempt to return to sport (RTS).

Methods: All professional baseball players who underwent rotator cuff surgery between 2010 and 2016 were included by use of the Major League Baseball injury database. Demographic and performance data (before and after surgery) for each player were recorded. Preoperative and postoperative performance metrics were then compared.

Results: Overall, 151 professional baseball players underwent rotator cuff débridement (n = 130) or rotator cuff repair (n = 21). In the rotator cuff repair group, 6 (28.6%) underwent single-row repair, 5 (23.8%) underwent double-row repair, and 10 (47.6%) underwent side-to-side repair. Among the 11 players who underwent either single- or double-row repair, the average number of anchors used per repair was 2.09 ± 1.1 (range, 1-4). Most performance metrics declined following rotator cuff débridement. For players who underwent débridement, the RTS rate was 50.8% (42.3% at the same level or a higher level and 8.5% at a lower level). For players who underwent repair, the RTS rate was 33.3% (14.3% at the same level or a higher level and 19% at a lower level). Most players underwent at least 1 concomitant procedure at the time of rotator cuff surgery.

Conclusion: Rotator cuff débridement is significantly more common than repair in professional baseball players, with 86% of all rotator cuff surgical procedures reported as débridement. RTS rates following débridement and repair are disappointing, at 50.8% and 33.3%, respectively. For players who do return, performance declines after surgery.
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http://dx.doi.org/10.1016/j.jse.2019.01.029DOI Listing
December 2019

Lytic Lesion in the Proximal Humerus After a Flu Shot: A Case Report.

JBJS Case Connect 2019 Jul-Sep;9(3):e0248

Division of Sports and Shoulder, Hospital for Special Surgery, New York, New York.

Case: There has been a recent campaign to vaccinate patients in an effort to prevent widespread flu pandemic. Although the complication rate after vaccine is low, there have been reports of Guillain-Barré syndrome and shoulder injury related to vaccine administration (SIRVA). In this case presentation, we discuss a patient who developed a large lytic lesion in the proximal humerus after a deeply administered flu shot.

Conclusions: SIRVA is a rare cause of shoulder pain after injections, but one that progresses and often necessitates operative management. Clinicians should be wary of persistent shoulder pain after a flu shot.
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http://dx.doi.org/10.2106/JBJS.CC.18.00248DOI Listing
June 2020