Publications by authors named "Brandon J Erickson"

152 Publications

Professional Baseball Pitchers Drafted at a Younger Age Pitch More Innings During Their Professional Baseball Careers Than Pitchers Drafted at an Older Age.

Arthrosc Sports Med Rehabil 2022 Jun 5;4(3):e969-e973. Epub 2022 Mar 5.

Rothman Orthopaedic Institute, Paramus, New Jersey, U.S.A.

Purpose: To evaluate and describe the differences in characteristics between the Major League Baseball (MLB) pitchers with greater workload and career longevity in terms of innings pitched (IP) and performance-matched controls who have not experienced similar length careers.

Methods: Using publicly available data, we identified the top 100 MLB pitchers in terms of career IP. Controls were matched to the top 100 pitchers by draft year and round. Pitchers with fewer than 400 IP were excluded. Demographic information, performance statistics, and injury history were reviewed. Logistic regression analysis and Mann-Whitney tests were used to compare data.

Results: Compared with controls, the top 100 pitchers in terms of IP were drafted at a younger age (19.35 vs 19.83, < .001) and in later rounds (6.16 vs 2.45, < .001). They made their MLB debut at a younger age (21.77 vs 23.12, < .001). They also pitched fewer innings before debut (470.59 vs 632.07,  = .007), were older at their first (30.72 vs 27.50 years, < .001) and second (32.42 vs 29.43 years, < .001) designations to the injured list (IL), and had a significantly longer time from debut to first (3063.50 vs 1565.59 days, < .001) and second (3712.10 vs 2202.03 days, < .001) IL trips. The top 100 pitchers were 7.45 times less likely to have made a trip to the IL within 8 seasons from their debut and were 4.04 times more likely to be younger than 24 years at their major league debut.

Conclusions: Pitchers with the greatest number of IP in their MLB careers were significantly younger when drafted and when they made their major league debut, although this age difference is likely clinically insignificant. Pitchers who were drafted or debuted at a later age accumulate more pre-debut innings and this may contribute to fewer total IP in the MLB. Similarly, later trips to the injured list and longer duration from debut to first or second trip to the IL, but not total IL trips, are predictive of longer careers compared to age and draft class matched controls.

Level Of Evidence: III, retrospective cohort study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.asmr.2022.01.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210370PMC
June 2022

Effect of COVID-19 on Injury Rates and Timing in the National Football League.

Orthop J Sports Med 2022 Jun 2;10(6):23259671221098749. Epub 2022 Jun 2.

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

Background: The coronavirus 2019 (COVID-19) pandemic resulted in the cancellation of the 2020 National Football League (NFL) preseason and a decreased preseason roster size. The effect of this disruption on athlete injury rates is unknown.

Purpose/hypothesis: The purpose was to quantify the rates of anterior cruciate ligament (ACL), Achilles tendon, and hamstring tendon injuries in NFL players before and after the COVID-19 pandemic. We hypothesized that injury rates in the 2020 season would be higher than those seen prepandemic.

Study Design: Descriptive epidemiology study. Level of evidence, 4.

Methods: An online search using publicly available data was carried out to identify all NFL players who sustained an ACL, Achilles tendon, or hamstring tendon injury between April 1, 2017, and March 31, 2021. Data collected included player characteristics as well as career and season of injury workloads.

Results: The number of Achilles tendon (27 vs 20; = .024) and hamstring tendon (186 vs 149; < .001) injuries, respectively, in the 2020 NFL season were significantly higher than the average of the 2017 to 2019 seasons. However, the number of ACL injuries sustained remained constant (43 vs 46; = .175). More than half (52.9%) of ACL injuries in the 2017 to 2019 seasons occurred in the preseason, while most of the injuries (34.9%) in the 2020 season occurred in weeks 1 to 4. There was no player characteristic or career workload variable collected that was significantly different for players who sustained an ACL, Achilles tendon, or hamstring tendon injury in the 2020 NFL season compared with the 2017 to 2019 seasons.

Conclusion: In the 2020 NFL season, the number of Achilles tendon and hamstring tendon injuries rose while the number of ACL injuries remained constant compared with the 2017 to 2019 seasons. Injuries that occurred during the first 4 games of the 2020 NFL season were consistent, with higher rates of injuries seen in the preseason in previous years.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/23259671221098749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9168859PMC
June 2022

Surgical Techniques and Clinical Outcomes for Medial Epicondylitis: A Systematic Review.

Am J Sports Med 2022 Jun 6:3635465221095565. Epub 2022 Jun 6.

Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.

Background: Medial epicondylitis (ME) is a pathological condition that arises in laborers and athletes secondary to repetitive wrist flexion and forearm pronation causing degeneration of the common flexor tendon. Although nonoperative management has demonstrated high rates of success, no standardized surgical technique has been established for situations when operative management is indicated.

Purpose/hypothesis: The purpose of this study was to perform a systematic review of the surgical treatment options for ME and evaluate the associated patient-reported outcomes (PROs). We hypothesized that surgical management of ME would vary across studies but no technique would prove to be superior.

Study Design: Systematic review; Level of evidence, 4.

Methods: Searches were conducted using PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature (CINAHL), SPORTDiscus, and Cochrane databases between 1980 and April 2020. All level 1 to 4 studies were identified that focused on surgical management and PROs in the setting of ME. Description of surgical technique and PROs were required for inclusion. Investigators independently dually abstracted and reviewed the studies for eligibility. Weighted means were calculated for demographic characteristics and available PROs.

Results: Overall, 851 studies were identified according to the search criteria. A total of 16 studies met the inclusion and exclusion criteria and therefore were evaluated. Three surgical techniques were found: open (13 studies), arthroscopic (2 studies), and percutaneous (1 study). Descriptions of the open technique were subdivided into those with (7 studies) and without (6 studies) common flexor tendon repair. Analysis included 479 elbows; patients were primarily male (58.3%) with a weighted mean age of 47.2 years. Weighted mean follow-up was 4.6 years. Tennis and manual laborer were the most common sport and occupation, respectively. Surgical success ranged from 63% to 100%, with a low complication rate of 4.3%. Success rates for return to sports and work were 81%-100% and 66.7%-100%, respectively, and only 1 study reported a return to work rate <90%.

Conclusion: This systematic review demonstrates that surgical intervention for refractory ME often has a high success rate. Regardless of surgical technique performed, patients generally demonstrated an improvement in PROs, and an encouraging number returned to work with limited complications. Further investigation is necessary to determine superiority among open, arthroscopic, and percutaneous techniques.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/03635465221095565DOI Listing
June 2022

Beach-Chair Versus Lateral Decubitus Positioning for Arthroscopic Posterior Shoulder Labral Repair: A Retrospective Comparison of Clinical and Patient-Reported Outcomes.

Am J Sports Med 2022 Jul 23;50(8):2211-2218. Epub 2022 May 23.

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

Background: Both beach-chair and lateral decubitus patient positioning are often utilized for shoulder arthroscopy, with each offering its unique advantages and disadvantages. The surgical position is often selected according to each surgeon's preference, with no clear superiority of one position over the other.

Purpose/hypothesis: The purpose was to compare clinical and patient-reported outcomes between patients who underwent arthroscopic posterior labral repair in the beach-chair versus the lateral decubitus position. We hypothesized that patient positioning would not affect clinical and patient-reported outcomes.

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

Methods: A list of all patients diagnosed with the Current Procedural Terminology codes 29806 and 29807 between 2015 and 2019 was obtained from the medical records. Patients were only included if arthroscopic posterior labral repair with or without concomitant superior labral anterior to posterior repair was confirmed. Data collected for eligible patients included the number of anchors used, perioperative and postoperative complications, redislocations, subjective instability, reoperation, and revision. Patients were also contacted to complete several patient-reported outcome surveys. Preoperative data, perioperative data, and postoperative outcomes were compared between patients who underwent surgery in the beach-chair versus lateral decubitus position.

Results: Overall, 126 patients were included-69 patients underwent surgery in the lateral decubitus position and 57 in the beach-chair position-with a mean follow-up of 2.6 ± 1.7 years. There were no significant pre- or perioperative differences between groups. Rates of postoperative dislocations, subjective instability, reoperations, revisions, all complications, and return to sports rates also did not differ between groups (all, > .05). Finally, there was no difference between groups regarding postoperative pain, function, and subjective instability scores (all, > .05). Results of the multivariate regression analysis showed that increased age was a weak independent risk factor for subjective recurrent posterior shoulder instability (odds ratio, 1.04; = .036).

Conclusion: Surgical positioning for arthroscopic posterior shoulder labral repair did not affect postoperative clinical and patient-reported outcomes. Both beach-chair and lateral decubitus position provided good outcomes for posterior shoulder labral repair, with an overall recurrence rate of 8.7%. Increased age was a weak independent risk factor for subjective recurrent instability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/03635465221095243DOI Listing
July 2022

Is Workload Associated With Hamstring and Calf Strains in Professional Baseball Players? An Analysis of Days of Rest, Innings Fielded, and Plate Appearances.

Sports Health 2022 May 19:19417381221093557. Epub 2022 May 19.

Rothman Orthopaedic Institute, New York, NY.

Background: The influence of player workload on hamstring and calf injuries in professional baseball players remains unknown.

Hypothesis: Increased workload would significantly increase hamstring and calf strain injury risk.

Study Design: Case-control.

Level Of Evidence: Level 3.

Methods: All professional baseball players who sustained a hamstring or calf injury between 2011 and 2017 were identified using the Major League Baseball (MLB) Health and Injury Tracking System (HITS). A separate player usage dataset was used to determine workload. We then compared these variables between player games 2, 6, 12, and >12 weeks before a documented calf strain to player games from a noncalf injury control group. In a paired analysis, we compared the acute workload (2, 6, and 12 weeks) before injury with the injured player's workload >12 weeks before injury.

Results: There were 175 unique calf strains (71% occurred in position players) and 1042 unique hamstring strains (97.8% occurred in position players) documented in the MLB HITS database from 2011 to 2017. In all time periods, position players with fewer days rest, more innings fielded, and more plate appearances were associated with a higher risk of subsequent hamstring and calf strains. Having only 1 day rest was associated with a 2.08-fold increase in percentage of players who sustained a subsequent calf strain compared with those with 4 days rest. Position players with >5 days of rest had a 4.03-fold decrease in percentage of players who sustained a hamstring strain compared with players with 1 day rest. Position players who fielded >9 innings per game had a 2.01-fold increase in percentage of players with a subsequent calf strain and a 3.68-fold increase in percentage of players who sustained a subsequent hamstring strain compared with players who only fielded 1 innings per game.

Conclusion: Position players with fewer days rest, more innings fielded, and more plate appearance per game had an increased risk of sustaining a hamstring or calf injury.

Clinical Relevance: Increased workload had a direct relationship with risk of hamstring and calf strains in professional baseball players. Teams should consider more days rest for position players to avoid calf injuries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/19417381221093557DOI Listing
May 2022

Biomechanical Comparison of Novel Ulnar Collateral Ligament Reconstruction with Internal Brace Augmentation Versus Modified Docking Technique.

J Shoulder Elbow Surg 2022 Apr 29. Epub 2022 Apr 29.

Arthrex Inc., Naples, FL, USA.

Background: Ulnar collateral ligament (UCL) reconstruction (UCLR) is a common surgery among baseball pitchers. UCL repair combined with augmentation using high strength tape, referred to as an internal brace, was developed as an alternative to UCLR in select patients with the benefit of allowing these athletes to return to sport (RTS) faster. A combined UCLR with an internal brace may allow players indicated for an UCLR to RTS more expeditiously.

Methods: 24 cadaveric elbows were divided into 3 groups: 12 specimens into the modified docking (MD) group, 6 into the double docking (DD) group and 6 into the double docking with internal brace augmentation (DDA) group. This allowed a 1:1 comparison of the MD to the DD and the MD to the DDA. Valgus cyclic testing of native and reconstructed specimens was executed at 90˚ elbow flexion. After preconditioning, all specimens were cycled between 2 Nm and 10 Nm for 250 cycles. Reconstructed specimens continued to a torque test to catastrophic failure step. Outcome data included intra-cyclic stiffness, maximum cyclic rotational displacement, gap formation, and failure torque.

Results: Cyclic stiffness of the constructs remained constant throughout the entirety of the torque-controlled cycling phase. DDA group resulted in a 38% increase in cyclic stiffness from native testing (not statistically significant), and a statistically significant 54% increase from the MD (p=0.002). The DDA mean cyclic stiffness was significantly greater than Native (p<0.001), DD (p=0.025), and MD (p<0.001) groups. Between reconstruction groups, mean gap formation was greatest amongst the MD group (2.51 deg ± 1.59 deg) and least for the DDA group (1.01 deg ± 0.57 deg) but did not reach statistical significance.

Conclusion: Tape augmentation to the modified UCLR (DDA group) improved cyclic stiffness and reduced gap formation compared to the modified docking (MD) group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jse.2022.03.020DOI Listing
April 2022

Knotted Versus Knotless Medial-Row Transosseous-Equivalent Double-Row Rotator Cuff Repairs Have Similar Clinical and Functional Outcomes.

Arthrosc Sports Med Rehabil 2022 Apr 27;4(2):e381-e386. Epub 2021 Nov 27.

Rothman Orthopaedic Institute, New York, New York, U.S.A.

Purpose: To retrospectively investigate the clinical and functional outcomes of patients who underwent knotted medial-row rotator cuff repair (KT-RCR) compared with patients who underwent knotless medial-row rotator cuff repair (KL-RCR).

Methods: A retrospective chart review of patients who underwent double-row transosseous-equivalent rotator cuff repair in 2016 was performed at a single institution with 2-year follow-up. Information regarding demographic characteristics, preoperative tear size (magnetic resonance imaging), surgical variables (including method of suture stabilization), preoperative and postoperative American Shoulder and Elbow Surgeons (ASES) scores, and all complications (e.g., cuff failure, adhesive capsulitis, and persistent pain) was compiled.

Results: A total of 189 patients met the inclusion criteria: 72 in the KL-RCR group and 117 in the KT-RCR group. No significant difference in preoperative ASES scores was found between the KL-RCR and KT-RCR groups (48.3 vs 45.4,  = .327). Postoperative ASES scores did not differ between the groups (82.4 for KL-RCR vs 78.8 for KT-RCR,  = .579). We found no significant difference in cuff failure rates after 2 years, determined by magnetic resonance imaging (5.6% for KL-RCR vs 6.1% for KT-RCR, > .999), or complication rates (11.1% for KL-RCR vs 8.6% for KT-RCR,  = .743).

Conclusions: The knotted approach and knotless approach to double-row rotator cuff repair showed similar outcome scores, cuff failure rates, and complication rates at minimum 2-year follow-up.

Level Of Evidence: Level III, retrospective therapeutic comparative trial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.asmr.2021.10.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9042748PMC
April 2022

Evaluation of Rotator Cuff Repair With and Without Concomitant Biceps Intervention: A Retrospective Review of Patient Outcomes.

Am J Sports Med 2022 05 6;50(6):1534-1540. Epub 2022 Apr 6.

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

Background: Biceps tendon pathology is common in patients with rotator cuff tears. Leaving biceps pathology untreated in rotator cuff repairs (RCRs) may lead to suboptimal outcomes.

Purpose/hypothesis: The purpose was to compare clinical outcomes between patients who underwent isolated RCR versus patients who underwent RCR with concomitant biceps treatment. It was hypothesized that there would be no difference in clinical outcomes between groups.

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

Methods: A total of 244 patients who underwent RCR in 2016 were included. Patient characteristics, presence of concomitant biceps pathology, pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores, rotator cuff failure, revision surgery, and complications were recorded.

Results: There were no significant differences between patients who underwent isolated RCR (n = 143) and those who underwent RCR with biceps treatment (n = 101) at 2 years postoperatively in ASES scores (RCR, 81.5; RCR+biceps treatment, 79.5; = .532), cuff failure rate (5.6% vs 4.0%; = .760), revision RCR rate (3.5% vs 2.0%; = .703), or complication rate (11.9% vs 5.0%; = .102). Furthermore, when comparing concomitant biceps tenotomy (n = 30) versus concomitant biceps tenodesis (n = 71), there were no differences in ASES scores ( = .149), cuff failure rate ( > .999), revision RCR rate ( > .999), or complication rate ( > .999) postoperatively. Finally, when comparing arthroscopic biceps tenodesis (n = 50) versus subpectoral biceps tenodesis (n = 21), there were no differences in ASES scores ( > .592), cuff failure rate ( > .999), revision RCR rate ( = .507), or complication rate ( > .999) 2 years postoperatively.

Conclusion: Addressing biceps pathology when performing RCR resulted in similar rates of cuff failure, revision RCR, and complications, as well as a similar improvement in patient-reported outcomes when compared with isolated RCR at 2 years postoperatively. Furthermore, when comparing tenotomy versus tenodesis and arthroscopic versus subpectoral tenodesis, comparable outcomes with regard to rate of rotator cuff repair failure, revision RCR, complications, and patient-reported outcomes were found.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/03635465221085661DOI Listing
May 2022

Initial and 1-Year Radiographic Comparison of Reverse Total Shoulder Arthroplasty With a Short Versus Standard Length Stem.

J Am Acad Orthop Surg 2022 Mar 15. Epub 2022 Mar 15.

From the Department of Orthopaedic Surgery, Sports Medicine and Shoulder, Rothman Orthopaedic Institute, New York, NY (Erickson), Southern Oregon Orthopedics, Medford, OR (Denard and Griffin), Jordan-Young Institute, Virginia Beach, VA, (Griffin) Cleveland Shoulder Institute, Beachwood, OH (Gobezie), University of Arizona College of Medicine-Phoenix, Phoenix, AZ (Lederman), and University of Virginia, Charlottesville, VA (Werner).

Introduction: In an effort to preserve bone, humeral stems in reverse total shoulder arthroplasty (RTSA) have gradually decreased in length. The purpose of this study was to compare the immediate postoperative radiographic appearance of short-length with standard-length RTSA stems.

Methods: Patients who underwent RTSA using a press-fit standard-length or short-length humeral implant with a consistent geometry (Univers Revers or Revers Apex) were evaluated in a multicenter retrospective review. Initial postoperative radiographs were used to assess initial alignment and filling ratios. In addition, radiographs were evaluated for early signs of stress shielding and/or loosening. Clinical outcome scores and range of motion were also evaluated.

Results: Overall, 137 short-length stems and 139 standard-length stems were analyzed. Initial radiographs demonstrated a significantly higher percentage of stems placed in neutral alignment in the short-stem group (95.6% vs 89.2%, P = 0.045). Similar metaphyseal filling ratios were seen between groups, but a significantly higher diaphyseal filling ratio was observed in the short-stem group (57% vs 34%, P < 0.001). Less calcar osteolysis (2.2% vs 12.9%; P = 0.001) and fewer overall number of radiographic changes (tuberosity resorption, lucencies, and subsidence) (0.7% vs 5.0%; P = 0.033) were seen with short stems compared with the standard-length stems.

Conclusion: RTSA with a short-stem humeral implant demonstrates excellent radiographic outcomes, including low rates of loosening and subsidence at 1 year, with less early calcar osteolysis compared with a standard-length stem.

Level Of Evidence: III (Case-control).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5435/JAAOS-D-21-01032DOI Listing
March 2022

Update on Performance and Return to Sport After Biceps Tenodesis in Professional Baseball Players.

Orthop J Sports Med 2022 Feb 10;10(2):23259671221074732. Epub 2022 Feb 10.

DuPage Medical Group, Westmont, Illinois, USA.

Background: Bicipital disorders are common among overhead athletes, especially professional baseball players. The ideal treatment for bicipital problems in professional baseball players is unknown.

Purpose/hypothesis: The purpose was to determine the return-to-sport (RTS) rate and performance after RTS in professional baseball players who underwent biceps tenodesis. It was hypothesized that there will be a high RTS rate in this population, with no difference between the biceps tenodesis and control groups in the RTS rate or performance.

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

Methods: All professional Major League Baseball players who underwent biceps tenodesis between 2014 and 2017 were included. Players with concomitant rotator cuff repair were excluded. Demographic and performance data (preoperative and postoperative) were recorded for each player. Performance metrics were then compared between players with biceps tenodesis and matched controls (no history of biceps tenodesis).

Results: Included were 14 players (mean age, 27 ± 4 years; 12 pitchers, 2 position outfielders). Most surgeries (79%) were open subpectoral tenodeses, 2 were arthroscopic biceps transfers, and 1 was an arthroscopic suprapectoral tenodesis. Fixation methods included cortical button (42%), interference screw (25%), suture anchor (25%), and drill holes (8%). Most players (79%) underwent concomitant procedures (43% underwent superior labral anterior-posterior repairs). While 86% (12/14) were able to RTS, 50% (7/14) returned at the same or a higher level, and 50% of the whole study were either unable to return or returned to a lower level. Among pitchers, 100% (12/12) were able to RTS, but only 50% (6/12) were able to return to the same or a higher level. For those players who did RTS, it took 245 ± 84 days, and their performance after RTS was unchanged and did not differ from that of matched controls.

Conclusion: Open subpectoral tenodesis was the most common tenodesis technique performed on professional baseball players. While 86% of players returned to sport after biceps tenodesis, only 50% returned to the same or higher level. No decline in performance was noted in players who returned successfully.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/23259671221074732DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8841927PMC
February 2022

Performance and Return to Sports After Meniscectomy in Professional Baseball Players.

Am J Sports Med 2022 03 11;50(4):1006-1012. Epub 2022 Feb 11.

Andrews Sports Medicine & Orthopaedic Center, Birmingham, Alabama, USA.

Background: Meniscal injuries are common in athletes across many sports. How professional baseball players respond to partial meniscectomy is not well documented.

Purpose/hypothesis: The purpose was to determine the performance and return-to-sports (RTS) rate in professional baseball players after arthroscopic partial knee meniscectomy and compare the results of partial medial meniscectomy versus partial lateral meniscectomy. The hypothesis was that there would be a high RTS rate in professional baseball players after partial meniscectomy with no difference in the RTS rate or timing of RTS between players who underwent partial medial meniscectomy versus partial lateral meniscectomy.

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

Methods: All professional baseball players who underwent arthroscopic partial meniscectomy between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Demographic and performance data (before and after injury) for each player were recorded. The RTS rate and timing of RTS were then compared between players who underwent partial medial meniscectomy versus partial lateral meniscectomy.

Results: A total of 168 knees (168 players) underwent arthroscopic partial meniscectomy (mean age, 25 ± 5 years; 46% medial meniscectomy, 45% lateral meniscectomy, and 9% both medial and lateral meniscectomy). The most common mechanism of injury was fielding in the infield on natural grass. Injuries were spread evenly across positions: 18% catchers, 24% infielders, 20% outfielders, and 38% pitchers. The overall RTS rate was 80% (76% returned to the same or a higher level, and 4% returned to a lower level). For performance, pitchers saw significant decreases in usage but significant improvements in performance using the advanced statistics of fielding independent pitching ( < .001) and wins above replacement ( = .011). Hitters saw significant decreases in usage but increases in efficiency as seen by improvements in wins above replacement ( = .003). Of the 79 athletes who returned during the same season, the median time to return to play was 42 days.

Conclusion: The RTS rate after meniscectomy in professional baseball players was 80%. Player efficiency improved after surgery in pitchers and position players. No difference in the RTS rate or timing of RTS existed between players who underwent partial medial meniscectomy versus partial lateral meniscectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/03635465221074021DOI Listing
March 2022

Effect of Weather and Game Factors on Injury Rates in Professional Baseball Players.

Am J Sports Med 2022 03 21;50(4):1130-1136. Epub 2022 Jan 21.

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

Background: Injury rates in baseball players of all ages are increasing. Identifying modifiable risk factors is paramount to implementing injury prevention programs.

Purpose/hypothesis: The purpose was to evaluate the influence of weather (temperature, humidity, atmospheric pressure, and heat index) and game factors (start time, duration, single vs doubleheader) on injury rates in professional baseball players. We hypothesized that colder temperatures would be associated with significantly more injuries per game.

Study Design: Case-control study; Level of evidence, 3.

Methods: This was a retrospective database study. Two data sets were combined: 1 containing all injuries in Major and Minor League Baseball between 2011 and 2017 and 1 containing all games played in Major and Minor League Baseball during the same period to determine the number of injuries per game. Temperature, humidity, atmospheric pressure, and heat index were determined for each game using the data from the US Environmental Protection Agency. Additional game variables included the level of play, the turf type (natural vs artificial grass), the stadium type (open vs dome vs retractable), the game start time, the game duration, and whether the game was a doubleheader. Then, a multivariate analysis was conducted to determine which factors were associated with the number of injuries per game.

Results: In total, our analysis included 33,587 injuries and 76,747 games. A total of 25,776 (33.6%) games contained an injury, and 41% of injuries occurred as multiples per game, with up to 9 injuries per game. The multivariate analysis identified significant associations between game duration and injuries per game ( < .001; effect size, 0.013) and the level of play and injuries per game ( < .001; effect size, 0.011). There were significant associations between the venue type ( < .001), the game start time ( < .001), humidity ( < .001), the turf type ( = .016), and barometric pressure ( = .031); however, the effect size for each was <0.001, suggesting that these factors are clinically unimportant. Our overall model produced an of 0.04, indicating that these variables only predicted 4% of the variance in injury risk.

Conclusion: In professional baseball, the weather is not associated with injury risk; however, game duration may contribute to injury risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/03635465211070287DOI Listing
March 2022

Strong Agreement Between Magnetic Resonance Imaging and Radiographs for Caton-Deschamps Index in Patients With Patellofemoral Instability.

Arthrosc Sports Med Rehabil 2021 Dec 2;3(6):e1621-e1628. Epub 2021 Sep 2.

Rothman Orthopaedic Institute, New York, New York, U.S.A.

Purpose: To compare the measurements of the Caton-Deschamps index on preoperative magnetic resonance imaging and radiographs of patients undergoing operative management of patellar instability.

Methods: Patients who underwent primary medial patellofemoral ligament reconstruction and/or tibial tubercle osteotomy between January 2015 and November 2019 were assessed. Caton-Deschamps indices were measured by 3 independent reviewers on both radiographs and magnetic resonance imaging. Intra- and interclass correlation coefficients and a Bland-Altman analysis were calculated to assess inter-rater reliability and measurement agreement between radiographic and magnetic resonance imaging.

Results: Seventy-two patients (73 knees) were identified. The average Caton-Deschamps index was 1.23 ± 0.18 on radiograph and 1.26 ± 0.18 on magnetic resonance imaging. Strong inter-rater reliability was observed between reviewers for both radiographic and magnetic resonance imaging Caton-Deschamps indices (intraclass correlation coefficients 0.700 and 0.715, respectively). Pooled observer measurements revealed a moderate agreement between radiographic and magnetic resonance imaging for patella to tibia distance, weak agreement for patellar articular cartilage distance, and strong agreement for the Caton-Deschamps index (intraclass correlation coefficients 0.687, 0.485, and 0.749, respectively). Bland-Altman analysis demonstrated a mean difference in Caton-Deschamps index of -0.03 ± 0.15 (95% limits of agreement: -0.29 to 0.23) between radiographic and magnetic resonance imaging, meaning that Caton-Deschamps indices were on average 0.03 lower on radiographic than on magnetic resonance imaging.

Conclusions: The Caton-Deschamps index has strong agreement between radiographic and magnetic resonance imaging in patients undergoing patellar stabilization surgery. Either modality can be reliably used to preoperatively assess patellar height.

Level Of Evidence: Level IV, diagnostic case series.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.asmr.2021.07.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689203PMC
December 2021

Is workload associated with latissimus dorsi and teres major tears in professional baseball pitchers? An analysis of days of rest, innings pitched, and batters faced.

J Shoulder Elbow Surg 2022 May 30;31(5):957-962. Epub 2021 Nov 30.

Rothman Orthopaedic Institute, New York, NY, USA. Electronic address:

Background: Latissimus dorsi (LD) and teres major (TM) tears have become increasingly recognized injuries in professional baseball pitchers. The purpose of this study was to determine whether workload, as measured by the number of days of rest between outings, number of innings pitched, number of batters faced, and being a starting pitcher, is associated with an increased risk of sustaining an LD-TM tear in professional baseball pitchers.

Methods: All professional baseball pitchers who sustained an LD-TM tear between 2011 and 2017 were identified using the Major League Baseball Health and Injury Tracking System. A separate player-usage data set was used to determine workload. We then compared workload variables between pitcher-games 2, 6, 12, and >12 weeks prior to a documented LD-TM tear and pitcher-games from a non-LD-TM tear control group. In a paired analysis, we compared the acute workload (2, 6, and 12 weeks) prior to injury and the injured pitchers' non-acute workload >12 weeks prior to injury.

Results: A total of 224 unique LD-TM tears were documented in the Major League Baseball Health and Injury Tracking System database. In most periods, player-games with more innings pitched and more batters faced were associated with a higher incidence of subsequent LD-TM tears. The number of days of rest was not a significant predictor of an LD-TM tear in the acute workload setting, but pitchers who sustained an LD-TM injury averaged fewer days of rest over the previous ≥12 weeks than controls (P < .001). Pitchers who faced >30 batters per game showed a 1.57-fold increase in the percentage of pitchers with a subsequent LD-TM tear as compared with pitchers who faced ≤5 batters per game. Significantly more starting pitchers were in the case group that sustained LD-TM tears over multiple time points than in the control group.

Conclusion: Having a greater pitcher workload and being a starting pitcher were associated with an increased risk of sustaining LD-TM tears in professional baseball players. The average number of days of rest was only a risk factor for LD-TM tears over a 3-month or longer period.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jse.2021.10.035DOI Listing
May 2022

Do Injury Rates in Position Players Who Convert to Pitchers in Professional Baseball Differ From Players Who Have Always Been Pitchers?

Orthop J Sports Med 2021 Oct 25;9(10):23259671211050963. Epub 2021 Oct 25.

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

Background: There are some professional baseball players who begin their career as a position player and later convert to a pitcher; injury rates in these players are unknown.

Purpose: To compare injury rates of professional baseball players who started their career as position players and converted to pitchers with a control group of pitchers who have been only pitchers throughout their professional career.

Hypothesis: Injury rates would be lower in the conversion players.

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

Methods: All players who began their professional baseball career as position players and converted to pitchers between 2011 and 2018 were included. All injuries that occurred after they converted to pitchers were included. The conversion players were matched 1 to 1 with a control group of pitchers who entered professional baseball as pitchers and never changed position. Injury rates were compared between groups. The performance between groups was also compared.

Results: Overall, 221 players were identified who converted from position players to pitchers. There were significantly more injuries per year in the control pitcher group (0.8 ± 0.9) than in the conversion pitcher group (0.7 ± 0.9; = .015). Injuries in the control group resulted in 61 ± 112 days missed per injury, while injuries in the conversion player group resulted in 54 ± 102 days missed per injury ( = .894). Injury characteristics differed between groups. However, in both groups, most of the injuries were related to pitching or throwing, were noncontact or gradual overuse injuries, and involved the upper extremity. Converted pitchers had lower pitcher usage, with fewer games and innings pitched ( < .001), with significantly worse statistics for walks plus hits per inning pitched ( = .018).

Conclusion: Professional baseball players who convert from position players to pitchers are injured at lower rates than control pitchers. Conversion pitchers have lower pitcher usage, which may contribute to their reduced injury rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/23259671211050963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549473PMC
October 2021

A comprehensive evaluation of the association of radiographic measures of lateralization on clinical outcomes following reverse total shoulder arthroplasty.

J Shoulder Elbow Surg 2022 May 29;31(5):963-970. Epub 2021 Oct 29.

Southern Oregon Orthopedics, Medford, OR, USA.

Background: Although reverse total shoulder arthroplasty (RTSA) has excellent reported outcomes and satisfaction, patients often have postoperative limitations in range of motion (ROM), specifically internal rotation. Increased lateralization is thought to improve ROM following RTSA. The purpose of this study was to evaluate the association between radiographic measurements of lateralization and postoperative ROM and clinical outcome scores following RTSA. The authors hypothesized that increased radiographic lateralization would be associated with improved postoperative ROM, specifically internal rotation, but have no significant association with clinical outcome scores.

Methods: Patients who underwent RTSA with a 135° neck-shaft angle prosthesis and minimum 2-year clinical and radiographic follow-up were included and retrospectively reviewed. Postoperative radiographs were evaluated for several lateralization measurements including the lateralization shoulder angle (LSA), distance from the lateral border of the acromion to the lateral portion of the glenosphere, distance from the glenoid to the most lateral aspect of the greater tuberosity, and the distance from the lateral aspect of the acromion to the most lateral aspect of the greater tuberosity. Linear regression analyses were used to evaluate the independent association of each radiographic measurement of lateralization on forward flexion, external rotation, internal rotation, and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) index score at 2 years postoperation. Receiver operating characteristic (ROC) curves were constructed to identify significant thresholds of each radiographic lateralization measurement.

Results: A total of 203 patients were included. For internal rotation, a greater LSA (P = .007), shorter acromion to glenosphere distance (meaning more glenoid lateralization) (P = .005), and a greater acromion to greater tuberosity distance (with the tuberosity more lateral to the acromion) (P = .021) were associated with improved internal rotation. Overall, ROC analysis demonstrated very little significant data, the most notable of which was the LSA, which had a significant cutoff of 82° (sensitivity 57%, specificity 68%, P = .012).

Conclusion: Of the numerous radiographic measures of lateralization after RTSA, the LSA is the most significantly associated with outcomes, including improved internal rotation and a decrease in forward flexion and ASES score. The clinical significance of these statistically significant findings requires further study, as the observed associations were for very small changes that may not represent clinical significance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jse.2021.10.010DOI Listing
May 2022

Ulnar collateral ligament reconstruction in javelin throwers: an analysis of return to play rates and patient outcomes.

J Shoulder Elbow Surg 2022 Mar 20;31(3):488-494. Epub 2021 Oct 20.

Shoulder, Elbow, Sports Surgery, Dupage Medical Group, Downers Grove, IL, USA.

Background: Although results after ulnar collateral ligament reconstruction (UCLR) in baseball players have been well documented, the literature is replete regarding the outcomes after UCLR in javelin throwers.

Purpose: To report outcomes after UCLR in javelin throwers.

Hypothesis: UCLR in javelin throwers will result in a high rate of return to play similar to that of previously published studies from athletes of other sports.

Methods: All patients who were identified preoperatively as javelin throwers and underwent UCLR between 2011 and 2017 with a minimum 2-year follow-up were eligible for inclusion. Patients were assessed with the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score, Timmerman-Andrews Elbow score, Conway-Jobe score, patient satisfaction, return to sport rate questionnaire, and the occurrence of any postoperative complications.

Results: Eighteen patients met the inclusion criteria. Complete follow-up was available in 16 (88.9%) patients. The average age at surgery was 21.2 ± 2.0 (range, 18.6-24.9) years. At the final follow-up, the average Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score and Timmerman-Andrews Elbow score were 77.3 (range, 18.7-98.4) and 91.8 (range, 70.0-100.0), respectively. Outcomes on the Conway-Jobe scale were as follows: excellent (n = 6; 37.5%), good (n = 4; 25%), fair (n = 6; 37.5%). Ten (62.5%) patients returned to play at an average of 12.2 ± 3.6 (range, 6.0-18.0) months after surgery. Two (12.5%) patients sustained a shoulder injury postoperatively; however, neither required surgery.

Conclusion: UCLR in javelin throwers results in good outcomes with a low rate of reinjury/reoperation. However, the return to play rate (62.5%) and good/excellent outcomes per the Conway-Jobe scale (68.8%) are lower than what has been previously reported in baseball players and javelin throwers. Further investigation regarding outcomes in javelin throwers after UCLR is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jse.2021.10.003DOI Listing
March 2022

Effect of COVID-19 on Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers.

Orthop J Sports Med 2021 Sep 2;9(9):23259671211041359. Epub 2021 Sep 2.

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

Background: The coronavirus disease of 2019 (COVID-19) pandemic led to the suspension and shortening of the 2020 Major League Baseball (MLB) season from 162 to 60 regular season games. The effect of this disruption on injury rates, specifically injury to the ulnar collateral ligament (UCL), has not been quantified.

Purpose/hypothesis: The purpose of this study was to compare the rate of UCL reconstruction (UCLR), surgery timing, and pitching workload in MLB pitchers from before and after the COVID-19 pandemic lockdown. We hypothesized that UCLR rates relative to games played would be increased and pitching workload would be decreased in 2020 compared with previous seasons.

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

Methods: An extensive online search using publicly available data was conducted to identify all MLB pitchers who underwent UCLR between January 1, 2017, and December 31, 2020. Only pitchers who were competing at the MLB level when undergoing reconstruction were included. Player characteristics and surgery date, as well as career and season of surgery pitching workload, were collected for all included pitchers. All data were compared as a pooled sample (2017-2019 vs 2020).

Results: A similar number of pitchers underwent UCLR during or after the 2020 regular season (n = 18) compared with the 2017-2019 seasons (n = 16, 20, and 16, respectively). However, after accounting for the decrease in games played during the 2020 regular season, an MLB pitcher was 2.9 times more likely to undergo surgery per game after the COVID-19 lockdown compared with the previous years ( < .001). MLB pitchers who underwent surgery in 2020 threw fewer preseason innings than did pitchers who underwent surgery between 2017 and 2019 (5.98 vs 9.39; = .001).

Conclusion: MLB pitchers were almost 3 times more likely to undergo UCLR per game after the COVID-19 lockdown. A decreased preseason pitching workload because of the COVID-19 lockdown may have had an effect on per game UCLR rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/23259671211041359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419557PMC
September 2021

Rehabilitation and Return to Sport Criteria Following Ulnar Collateral Ligament Reconstruction: A Systematic Review.

Am J Sports Med 2021 Sep 8:3635465211033994. Epub 2021 Sep 8.

Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.

Background: Ulnar collateral ligament (UCL) reconstruction (UCLR) is a viable treatment option for patients with UCL insufficiency, especially in the overhead throwing athlete. Within the clinical literature, there is still no universally agreed upon optimal rehabilitation protocol and timing for return to sport (RTS) after UCLR.

Hypothesis: There will be significant heterogeneity with respect to RTS criteria after UCLR. Most surgeons will utilize time-based criteria rather than functional or performance-based criteria for RTS after UCLR.

Study Design: Systematic review; Level of evidence, 4.

Methods: All level 1 to 4 studies that evaluated UCLR with a minimum 1-year follow-up were eligible for inclusion. Studies lacking explicit RTS criteria, studies that treated UCL injury nonoperatively or by UCL repair, or studies reporting revision UCLR were excluded. Each study was analyzed for methodologic quality, RTS, timeline of RTS, and RTS rate.

Results: Overall, 1346 studies were identified, 33 of which met the inclusion criteria. These included 3480 athletes across 21 different sports. All studies reported RTS rates either as overall rates or via the Conway-Jobe scale. Timelines for RTS ranged from 6.5 to 16 months. Early bracing with progressive range of motion (ROM) (93.9%), strengthening (84.8%), and participation in an interval throwing program (81.8%) were the most common parameters emphasized in these rehabilitation protocols. While all studies included at least 1 of 3 metrics for the RTS value assessment, most commonly postoperative rehabilitation (96.97%) and set timing after surgery (96.97%), no article completely defined RTS criteria after UCLR.

Conclusion: Overall, 93.9% of studies report utilizing bracing with progressive ROM, 84.8% reported strengthening, and 81.8% reported participation in an interval throwing program as rehabilitation parameters after UCLR. In addition, 96.97% reported timing after surgery as a criterion for RTS; however, there is a wide variability within the literature on the recommended time from surgery to return to activity. Future research should focus on developing a comprehensive checklist of functional and performance-based criteria for safe RTS after UCLR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/03635465211033994DOI Listing
September 2021

Failed Reverse Total Shoulder Arthroplasty: What Are Our Bailouts?

Curr Rev Musculoskelet Med 2021 Oct 18;14(5):291-296. Epub 2021 Aug 18.

Rothman Orthopaedic Institute, 645 Madison Ave, New York, NY, 10022, USA.

Purpose Of Review: As the population continues to age and indications continue to expand, the number of reverse total shoulder arthroplasty (RSTA) procedures has increased significantly. While RTSA is an effective solution to many shoulder problems, it is not without complications. Furthermore, as the number of RTSA procedures increases, so will the number of complications following this procedure. While some complications can be managed with revision RTSA, there are some complications that, unfortunately, cannot. The purpose of this review is to discuss the revision options for failed RTSA.

Recent Findings: While there has been a significant amount of recent literature surrounding RTSA, much of this literature has been aimed at improving outcomes for primary RTSA by improving glenoid placement, maximizing range of motion, etc., or improving outcomes following conversion of another surgery to RTSA [1••, 2, 3]. There has been little evidence surrounding options for failed RTSA that cannot be salvaged to a revision RTSA. These options are limited and often involve resection arthroplasty and hemiarthroplasty, although neither option provides patients with significant function of the shoulder [4, 5•]. Complications following RTSA are becoming more common as the number of RTSA continues to increase. Furthermore, as the indications for RTSA expand, the complications will continue to increase as this implant is used to tackle more difficult problems about the shoulder. When possible, the etiology of the problem with the RTSA should be addressed and may involve component revision, bone grafting, etc. When the problem cannot be solved with revision RTSA, then the patient can be converted to a hemiarthroplasty, or have a resection arthroplasty, with the understanding that their shoulder function will be limited.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12178-021-09712-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497668PMC
October 2021

Is there a difference in outcomes between the first and second surgical procedures in patients who have bilateral shoulder operations?

J Shoulder Elbow Surg 2022 Jan 30;31(1):43-47. Epub 2021 Jun 30.

Cleveland Shoulder Institute, Beachwood, OH, USA.

Background: Some patients who have shoulder surgery on 1 shoulder go on to have surgery on their contralateral shoulder. It is unclear whether the clinical improvements following the second surgical procedure are as significant as the improvements after the first surgical procedure.

Methods: All patients who underwent surgery on both shoulders performed by a single surgeon between March 2013 and June 2018 were eligible for inclusion. Visual analog scale (VAS) scores were obtained preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years for both shoulders. Scores were then compared based on hand dominance and which shoulder was treated first. Complications were also recorded.

Results: Overall, 105 patients (210 surgical procedures) were included. Of the patients, 66 underwent bilateral open shoulder surgery and 39 underwent bilateral arthroscopic shoulder surgery. There was a significant reduction in VAS scores from preoperative to postoperative levels following surgery (5.9 before surgery vs. 1.7 after surgery). We found no difference in VAS scores at any time point when comparing whether the dominant or nondominant shoulder was operated on first. Significantly higher VAS scores were observed at 2 weeks, 6 weeks, and 3 months following the first shoulder operation compared with the second; by 6 months and beyond, there was no longer a difference.

Conclusion: Patients who undergo bilateral shoulder surgery have more pain in the first 3 months following their first shoulder operation compared with their second. However, there is no difference in pain scores at 6 months and beyond between shoulders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jse.2021.05.027DOI Listing
January 2022

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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 Oct;29(19):827-831

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5435/JAAOS-D-19-00876DOI Listing
October 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.

View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jse.2020.07.004DOI Listing
November 2020
-->