Publications by authors named "Charles A Popkin"

53 Publications

Athletes With Anterior Shoulder Instability: A Prospective Study on Player Perceptions of Injury and Treatment.

Orthop J Sports Med 2021 Sep 15;9(9):23259671211032239. Epub 2021 Sep 15.

Columbia University Center for Shoulder, Elbow and Sports Medicine, New York, New York, USA.

Background: Many in-season athletes choose to delay or avoid surgery in order to continue playing and avoid downtime such as missed games or seasons.

Purpose: To learn about the attitudes toward the injury and treatment of in-season shoulder instability in competitive athletes who have suffered a shoulder dislocation.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: A study-specific questionnaire about athletes' perceptions of injury and treatment was administered to injured players. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score and the Western Ontario Shoulder Instability Index (WOSI). Mean scores and standard deviations were calculated, and between-group analyses with tests were performed to compare the ASES and WOSI scores. The Mann-Whitney test was used for analyses performed on the following groups: early operative versus nonoperative management; age <18 versus ≥18 years; first-time dislocators versus recurrent dislocators; self-reducing subluxations versus dislocations requiring assistance; and dominant arm affected versus nondominant arm.

Results: There were 45 patients included in this study (33 male, 12 female) with a mean age of 18 ± 2.8 years. Several sports were represented, with the most common being football, baseball, soccer, and rugby. In this study of in-season athletes with shoulder instability, 13 (28.9%) chose early surgery, 4 (8.9%) chose surgery at season's end, while 28 (62.2%) chose physical therapy followed by a wait-and-see approach, with 13 (46.4%) of these patients ultimately requiring surgery. Athletes who chose nonoperative treatment were statistically more likely to believe that their shoulder would heal on its own ( < .001) or with physical therapy ( < .025); they were also more likely to agree that they would rather stop sports than undergo surgery ( < .04). Athletes with worse ASES and WOSI scores at injury were more likely to choose surgery ( < .03 and < .05, respectively). Athletes with >1 dislocation were less likely to believe that the shoulder would heal without surgery ( < .025). Most athletes agreed that seasonal timing and recruitment prospects were an important factor in their decision in favor of surgery ( < .038), and most agreed that their doctor influenced their ultimate treatment decision ( < .006). Most athletes also agreed that a repeat dislocation would cause further injury to the shoulder.

Conclusion: Treatment decisions were most strongly related to the athletes' perceptions of injury severity and the influence of the treating surgeon.
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http://dx.doi.org/10.1177/23259671211032239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8447104PMC
September 2021

Rehabilitation Variability Following Femoral Condyle and Patellofemoral Microfracture Surgery of the Knee.

Cartilage 2021 Jun 19:19476035211025818. Epub 2021 Jun 19.

Center for Shoulder, Elbow and Sports Medicine, Columbia University, New York, NY, USA.

Objective: To assess the variability of postoperative rehabilitation protocols used by orthopedic surgery residency programs for microfracture of femoral condyle and patellofemoral lesions of the knee.

Design: Online postoperative microfracture rehabilitation protocols from US orthopedic programs and the scientific literature were reviewed. A custom scoring rubric was developed to analyze each protocol for the presence of discrete rehabilitation modalities and the timing of each intervention.

Results: A total of 18 programs (11.6%) from 155 US academic orthopedic programs' published online protocols and a total of 44 protocols were analyzed. Seventeen protocols (56.7%) recommended immediate postoperative bracing for femoral condyle lesions and 17 (89.5%) recommended immediate postoperative bracing for patellofemoral lesions. The average time to permitting weight-bearing as tolerated (WBAT) was 6.1 weeks (range, 0-8) for femoral condyle lesions and 3.7 weeks (range, 0-8 weeks) for patellofemoral lesions. There was considerable variation in the inclusion and timing of strength, proprioception, agility, and pivoting exercises. For femoral condyle lesions, 10 protocols (33.3%) recommended functional testing prior to return to sport at an average of 23.3 weeks postoperatively (range, 12-32 weeks). For patellofemoral lesions, 4 protocols (20.0%) recommended functional testing for return to sport at an average of 21.0 weeks postoperatively (range, 12-32 weeks).

Conclusion: A minority of US academic orthopedic programs publish microfracture rehabilitation protocols online. Among the protocols currently available, there is significant variability in the inclusion of specific rehabilitation components and timing of many modalities. Evidence-based standardization of elements of postoperative rehabilitation may help improve patient care and subsequent outcomes.
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http://dx.doi.org/10.1177/19476035211025818DOI Listing
June 2021

The Fragility of Statistical Significance in Cartilage Restoration of the Knee: A Systematic Review of Randomized Controlled Trials.

Cartilage 2021 May 10:19476035211012458. Epub 2021 May 10.

Department of Orthopaedics, Columbia University Irving Medical Center, New York, NY, USA.

Objective: The purpose of this study was to utilize fragility analysis to assess the robustness of randomized controlled trials (RCTs) evaluating the management of articular cartilage defects of the knee. We hypothesize that the cartilage restorative literature will be fragile with the reversal of only a few outcome events required to change statistical significance.

Design: RCTs from 11 orthopedic journals indexed on PubMed from 2000 to 2020 reporting dichotomous outcome measures relating to the management of articular cartilage defects of the knee were included. The Fragility Index (FI) for each outcome was calculated through the iterative reversal of a single outcome event until significance was reversed. The Fragility Quotient (FQ) was calculated by dividing each FI by study sample size. Additional statistical analysis was performed to provide median FI and FQ across subgroups.

Results: Nineteen RCTs containing 60 dichotomous outcomes were included for analysis. The FI and FQ of all outcomes was 4 (IQR 2-7) and 0.067 (IQR 0.034-0.096), respectively. The average number of patients lost to follow-up (LTF) was 3.9 patients with 15.8% of the included studies reporting LTF greater than or equal to 4, the FI of all included outcomes.

Conclusions: The orthopedic literature evaluating articular cartilage defects of the knee is fragile as the reversal of relatively few outcome events may alter the significance of statistical findings. We therefore recommend comprehensive fragility analysis and triple reporting of the value, FI, and FQ to aid in the interpretation and contextualization of clinical findings reported in the cartilage restoration literature.
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http://dx.doi.org/10.1177/19476035211012458DOI Listing
May 2021

Athletic Injuries of the Thoracic Cage.

Radiographics 2021 Mar-Apr;41(2):E20-E39

From the Department of Radiology, Division of Musculoskeletal Radiology (S.L.V., E.M.H., M.B., T.T.W.), and Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine (C.A.P., C.S.A., W.N.L.), New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032.

A variety of sports require exposure to high-impact trauma or characteristic repetitive movements that predispose to injuries around the thorax. Appropriate prognostication and timely management are vital, as untreated or undertreated injuries can lead to pain, disability, loss of playing time, or early termination of sports participation. The authors review common athletic injuries of the thoracic cage, encompassing muscular, osseous, and vascular conditions, with an emphasis on mechanism, imaging features, and management. The authors also review pertinent soft-tissue and bony anatomy, along with relevant sports biomechanics. Generalized muscle trauma and more specific injuries involving the pectoralis major, latissimus dorsi, teres major, pectoralis minor, lateral abdominal wall and intercostals, serratus anterior, and rectus abdominis muscles are discussed. Osseous injuries such as stress fractures, sternoclavicular dislocation, costochondral fractures, and scapular fractures are included. Finally, thoracic conditions such as snapping scapula, thoracic outlet syndrome, and Paget-Schroetter syndrome are also described. Specific MRI protocols are highlighted to address imaging challenges such as the variable anatomic orientation of thoracic structures and artifact from breathing motion. Athletes are susceptible to a wide range of musculoskeletal thoracic trauma. An accurate imaging diagnosis of thoracic cage injury and assessment of injury severity allow development of an adequate treatment plan. This can be facilitated by an understanding of functional anatomy, sports biomechanics, and the unique injuries for which athletes are at risk. RSNA, 2021.
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http://dx.doi.org/10.1148/rg.2021200105DOI Listing
March 2021

Eponyms in Pediatric Sports Medicine: A Historical Review.

Open Access J Sports Med 2021 14;12:11-22. Epub 2021 Jan 14.

Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA.

The use of eponyms in the orthopedics literature has come under scrutiny, and there is a growing body of literature evaluating the utility of these terms in modern healthcare delivery. Although the field of pediatric orthopedic sports medicine is a relatively modern subspecialty, it is built on a foundation of over 100 years of pediatric musculoskeletal medicine. As a result, eponyms account for a significant portion of the vernacular used in the field. The purpose of this review is to summarize and describe the history of common eponyms relevant to pediatric sports pathology, examination maneuvers, classification systems, and surgical procedures. Use of eponyms in medicine is flawed. However, an improved understanding of these terms allows for informed use in future scientific discourse, patient care and medical education and may encourage future innovation and research into understanding pediatric orthopedic pathologies.
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http://dx.doi.org/10.2147/OAJSM.S287663DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814277PMC
January 2021

Shoulder instability, performance, and return to play in National Hockey League players.

JSES Int 2020 Dec 22;4(4):786-791. Epub 2020 Sep 22.

Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA.

Background: The shoulder is a commonly injured area in hockey, yet information is lacking on the prevalence and effect of shoulder instability. Our study investigates the incidence of shoulder dislocation events in the National Hockey League (NHL) and the effects on return-to-play (RTP) and player performance. We hypothesize that NHL players would have high RTP rates without significant changes in performance after injury.

Methods: NHL players who suffered in-season shoulder instability events between 2003-2004 and 2017-2018 seasons were identified. Demographic characteristics, incidence of injury, recurrences, RTP, and statistical performance data were collected. Postinjury performance was compared with experience-matched, era-matched, position-matched, and age-matched controls. A mixed generalized linear regression model was used to compare postinjury performance as a function of operative and nonoperative treatment.

Results: A total of 57 players experienced 67 shoulder instability events with 98.5% of players returning to play after an average of 26.3 ± 20.8 regular season games missed. Surgery was performed in 47.8% of players with no recurrent injuries postoperatively. Nonoperatively managed players experienced a decrease in points per game ( = .034) compared with surgically treated patients. Recurrence occurred in 14.3% of conservatively managed players, with 33.3% experiencing a season-ending injury. Players with recurrent injuries missed significantly more career games compared with those treated initially with surgery ( = .00324).

Conclusion: Professional hockey players experience high rates of RTP with acceptable performance outcomes after shoulder instability events; however, recurrent injuries led to significantly more career games missed when treated nonoperatively at the time of injury.
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http://dx.doi.org/10.1016/j.jseint.2020.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738589PMC
December 2020

The prevalence of high school multi-sport participation in elite national football league athletes.

Phys Sportsmed 2020 Dec 6:1-4. Epub 2020 Dec 6.

Columbia University Irving Medical Center, Department of Orthopedic Surgery, New York, NY, USA.

: Early youth specialization is increasingly being researched and identified as a risk factor for overuse injuries and burnout. This study aimed to characterize high school sport specialization in top National Football League (NFL) athletes and determine whether associations exist between single-sport specialization and future injury risk, performance, and longevity.: For NFL first-round draft picks from 2008-2017, data on the number of games played in the NFL, overuse injuries causing athletes to miss one or more regular season games, Pro Bowl selections, and current status in the NFL were collected using publicly available information.: A total of 318 athletes were analyzed. Multi-sport athletes were highly prevalent (88%, n = 280), while only 12% (n = 38) of athletes were classified as single-sport. No difference between multi-sport and single-sport athletes was found regarding games missed to upper (p = 0.93) or lower extremity injuries (p = 0.49), total games played (p = 0.57), or NFL longevity (p = 0.97). There was no significant difference in the proportions of athletes reaching at least 1 Pro Bowl.: The majority of NFL first-round draft picks were multi-sport athletes in high school. Single-sport football participation in high school does not appear to aid athletes in reaching or succeeding in the NFL.
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http://dx.doi.org/10.1080/00913847.2020.1856632DOI Listing
December 2020

Cervical Spine Injuries in the Ice Hockey Player: Current Concepts in Epidemiology, Management and Prevention.

Global Spine J 2021 Oct 18;11(8):1299-1306. Epub 2020 Nov 18.

Department of Orthopedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.

Study Design: This review article examines the biomechanics that underly hockey-related cervical spine injuries, the preventative measures to curtail them, optimal management strategies for the injured player and return to play criteria.

Objective: Hockey is a sport with one of the highest rates of cervical spine injury, but by understanding the underlying pathophysiology and context in which these injuries can occur, it is possible to reduce their incidence and successfully manage the injured player.

Methods: Multiple online databases including PubMed, Google Scholar, Columbia Libraries Catalog, Cochrane Library and Ovid MEDLINE were queried for original articles concerning spinal injuries in ice hockey. All relevant papers were screened and subsequently organized for discussion in our subtopics.

Results: Cervical fractures in ice hockey most often occur due to an increased axial load, with a check from behind the most common precipitating event.

Conclusions: Despite the recognized risk for cervical spine trauma in ice hockey, further research is still needed to optimize protocols for both mitigating injury risk and managing injured players.
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http://dx.doi.org/10.1177/2192568220970549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453685PMC
October 2021

A Systematic Review of the Orthopedic Literature Involving National Hockey League Players.

Open Access J Sports Med 2020 14;11:145-160. Epub 2020 Oct 14.

Center for Shoulder, Elbow and Sports Medicine, Department of Orthopedics, Columbia University Medical Center, New York, NY, USA.

Background: Orthopedic injuries of National Hockey League (NHL) players are common and may significantly affect players' health and careers. Evidence-based injury management is important in guiding players' timely return to sport and their ability to play at their pre-injury levels of competition.

Purpose: To summarize all data published between January 1980 and March 2020 on orthopedic injuries experienced by professional ice hockey players competing in the NHL.

Study Design: Systematic review.

Methods: A literature review of studies examining orthopedic injuries in the NHL was performed using the Embase, PubMed, and CINAHL databases. The review included studies focusing on NHL players and players attending the NHL Combine and preseason NHL team camps. Studies pertaining to non-orthopedic injuries and case reports were excluded.

Results: A total of 39 articles met the inclusion criteria and were analyzed. The articles were divided by anatomic site of injury for further analysis: hip and pelvis (24%), general/other (14%), ankle (10%), knee (10%), foot (7%), shoulder (7%), thigh (7%), trunk (7%), spine (6%), elbow (4%), and hand and wrist (4%). The majority of articles were Level IV Evidence (51.3%), followed by Level III Evidence (38.5%). Most studies obtained data from publicly available internet resources (24.7%), player medical records (19.5%) or surveys of team physicians and athletic trainers (15.5%). A much smaller number of studies utilized the NHL Injury Surveillance System (NHLISS) (6.5%) or the Athlete Health Management System (AHMS) (2.6%).

Conclusion: This systematic review provides NHL team physicians with a single source of the current literature regarding orthopedic injuries in NHL players. Most research was published on hip and pelvis (24%) injuries, did not utilize the NHLISS and consisted of Level IV Evidence.
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http://dx.doi.org/10.2147/OAJSM.S263260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569065PMC
October 2020

MRI following medial patellofemoral ligament reconstruction: assessment of imaging features found with post-operative pain, arthritis, and graft failure.

Skeletal Radiol 2021 May 20;50(5):981-991. Epub 2020 Oct 20.

Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine, New York Presbyterian Hospital - Columbia University Irving Medical Center, 622 West 168th Street, PH-11, New York, NY, 10032, USA.

Objective: To assess MR features following MPFL reconstruction and determine their influence on post-operative pain, progressive arthritis, or graft failure.

Materials And Methods: Retrospective study on 38 patients with MPFL reconstruction and a post-operative MRI between January 2010 and June 2019. Two radiologists assessed MPFL graft signal, graft thickness, femoral screw, femoral tunnel widening, and patellofemoral cartilage damage. The third performed patellofemoral instability measurements. All three assessed femoral tunnel position with final result determined by majority consensus. Imaging findings were evaluated in the setting of post-operative pain, patellofemoral arthritis, and MPFL graft failure including need for MPFL revision. Statistics included chi-square, Fisher's exact test, t test, and kappa.

Results: Mean graft thickness was 6.0 ± 1.8 mm; 24% of the grafts were diffusely hypointense. Mean femoral tunnel widening was 2.5 ± 1.8 mm; 34% of the femoral screws were broken or extruded. Fifty-two percent of the patients had no interval cartilage change. Non-anatomic femoral tunnels were found in 66% of patients, including in all 9 patients requiring revision MPFL reconstruction (p = 0.013). Revised MPFL grafts had more abnormal femoral screws compared to those that did not (67% vs. 24%) (p = 0.019). Other MR features did not significantly influence the evaluated outcomes.

Conclusion: The need for revision MPFL reconstruction occurs more frequently when there is a non-anatomic femoral tunnel and broken or extruded femoral screws. The appearance of the MPFL graft itself is not an influencing factor for post-operative pain, progression of patellofemoral arthritis, or graft failure.
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http://dx.doi.org/10.1007/s00256-020-03655-xDOI Listing
May 2021

A Current Concepts Review of Clavicle Injuries in Ice Hockey From Sternoclavicular to Acromioclavicular Joint.

Orthop J Sports Med 2020 Sep 24;8(9):2325967120951413. Epub 2020 Sep 24.

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

Clavicle injuries are common in ice hockey, and a number of high-profile fractures and dislocations have occurred in elite hockey players in recent years. Acromioclavicular joint injuries, clavicle fractures, and sternoclavicular joint injuries are some of the most frequent hockey-related injuries treated by orthopaedic surgeons, and familiarity with the management of these injuries and sport-specific considerations for treatment and recovery are critical. Injuries involving the clavicle can sometimes be life-threatening, and subtle findings on physical examination and radiographic studies can have profound implications for treatment. The recent literature pertinent to the diagnosis and treatment of clavicle-related injuries in ice hockey players was reviewed and compiled into a clinical commentary. For ice hockey players, the upper extremity was traditionally considered a relatively well-protected area. However, given the evolution of the game and its protective equipment, the upper extremity now accounts for the majority of youth ice hockey injuries, of which clavicle injuries comprise a significant proportion. Acromioclavicular joint injuries are the most common injury in this population, followed closely by clavicle fractures. Sternoclavicular joint injuries are rare but can be associated with serious complications. The treatment of these injuries often differs between athletes and the general population, and surgical indications continue to evolve in both groups. Although the evidence regarding clavicle injuries is ever-increasing and the treatment of these injuries remains controversial, clavicle injuries are increasingly common in ice hockey players. Rule and equipment changes, most notably the increased use of flexible boards and glass, have been shown to significantly decrease the risk of clavicle injuries. We also recommend compulsory use of shoulder pads, even at a recreational level, as well as continued enforcement and evolution of rules aimed at reducing the rate of clavicle injuries. Future research should focus on equipment design changes directed toward clavicle injury prevention, standardized return-to-play protocols, and studies weighing the risks and benefits of nonoperative management of controversial injuries, such as type III acromioclavicular joint dislocations and diaphyseal clavicle fractures.
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http://dx.doi.org/10.1177/2325967120951413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520938PMC
September 2020

Current Trends and Impact of Early Sports Specialization in the Throwing Athlete.

Orthop Clin North Am 2020 Oct 13;51(4):517-525. Epub 2020 Aug 13.

Department of Orthopedic Surgery, Columbia University Medical Center, 622 West 168th Street PH-11, New York, NY 10032, USA. Electronic address:

Early sports specialization (ESS) is a relatively new trend that has led to many youth athletes to focus on only 1 sport at an increasingly young age. Although parents and coaches perceive that this will improve their athlete's chances of success at the collegiate and professional levels, studies have shown the opposite. ESS leads to increased injury risk, higher rates of burnout, and lower lifelong sports participation without increasing elite achievement. Throwing athletes are particularly vulnerable to these overuse injuries of the shoulder and elbow, which have been shown to correlate directly to the number of throws and innings played.
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http://dx.doi.org/10.1016/j.ocl.2020.06.006DOI Listing
October 2020

The Evidence for Common Nonsurgical Modalities in Sports Medicine, Part 2: Cupping and Blood Flow Restriction.

J Am Acad Orthop Surg Glob Res Rev 2020 01;4(1):e1900105

From the Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY (Dr. Trofa, Mr. Obana, Dr. Herndon, Dr. Noticewala, Dr. Popkin, and Dr. Ahmad), and the Department of Orthopaedics, Boston Medical Center, Boston University, Boston, MA (Dr. Parisien).

Objective: There are a number of nonsurgical modalities used by athletes in attempts to improve performance or prevent, treat, and rehabilitate musculoskeletal injuries. A concise review of available evidence on common nonsurgical modalities used today is necessary, so that practitioners may appropriately counsel patients.

Methods: A comprehensive review of relevant publications regarding cupping and blood flow restriction (BFR) from 2006 through 2019 was completed using PubMed and Google Scholar.

Results: There have been numerous investigations evaluating the efficacy of nonsurgical modalities for a myriad of musculoskeletal conditions. Cupping may be an effective option with low risk in treating nonspecific, musculoskeletal pain. Studies comparing BFR with non-BFR controls suggest that it may increase muscle strength and endurance for individuals undergoing rehabilitation or sport-specific training by mimicking the low oxygen environment during exercise.

Conclusions: Nonsurgical modalities are low-cost treatment strategies with rates of adverse outcomes as low as 0.008% that will likely continue to increase in popularity. Despite the paucity of recent research in cupping and BFR, evidence suggests benefits with use. High-quality studies are needed to effectively evaluate these treatments, so that care providers can provide appropriate guidance based on evidence-based medicine.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-19-00105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028774PMC
January 2020

The Evidence for Common Nonsurgical Modalities in Sports Medicine, Part 1: Kinesio Tape, Sports Massage Therapy, and Acupuncture.

J Am Acad Orthop Surg Glob Res Rev 2020 01;4(1):e1900104

From the Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY (Dr. Trofa, Mr. Obana, Dr. Herndon, Dr. Noticewala, Dr. Popkin, and Dr. Ahmad); and the Department of Orthopaedics, Boston Medical Center, Boston University, Boston, MA (Dr. Parisien).

Objective: There are a number of nonsurgical modalities used by athletes in attempts to improve performance or prevent, treat, and rehabilitate musculoskeletal injuries. A concise review of available evidence on common nonsurgical modalities used today is necessary so that practitioners may appropriately counsel patients.

Methods: A comprehensive review of relevant publications regarding Kinesio taping, sports massage therapy, and acupuncture from 2006 through 2019 was completed using PubMed and Google Scholar.

Results: There have been numerous investigations evaluating the efficacy of nonsurgical modalities for a myriad of musculoskeletal conditions. There is some low level evidence to suggest the use of Kinesio tape for athletes with acute shoulder symptoms and acupuncture for carpal tunnel syndrome and as an adjunct treatment for low back pain. There is a need for higher quality research to better elucidate the effect of sports massage therapy on sports performance, recovery, and musculoskeletal conditions in general.

Conclusions: Nonsurgical modalities are low-cost treatment strategies with very few reported adverse outcomes that will likely continue to increase in popularity. High-quality studies are needed to effectively evaluate these treatments, so that care providers can provide appropriate guidance based on evidence-based medicine.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-19-00104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028772PMC
January 2020

Evaluation and Management of Hand, Wrist and Elbow Injuries in Ice Hockey.

Open Access J Sports Med 2020 28;11:93-103. Epub 2020 Apr 28.

Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA.

Ice hockey continues to be a popular, fast-paced, contact sport enjoyed internationally. Due to the physicality of the game, players are at a higher risk of injury. In the 2010 Winter Olympics, men's ice hockey had the highest injury rate compared to any other sport. In this review, we present a comprehensive analysis of evaluation and management strategies of common hand, wrist, and elbow injuries in ice hockey players. Future reseach focusing on the incidence and outcomes of these hand, wrist and elbow injuries in ice hockey players is warranted.
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http://dx.doi.org/10.2147/OAJSM.S246414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196194PMC
April 2020

Rethinking Patellar Tendinopathy and Partial Patellar Tendon Tears: A Novel Classification System.

Am J Sports Med 2020 02 8;48(2):359-369. Epub 2020 Jan 8.

Center for Shoulder, Elbow and Sports Medicine, Columbia University, New York, New York, USA.

Background: Patellar tendinopathy is an overuse injury of the patellar tendon frequently affecting athletes involved in jumping sports. The tendinopathy may progress to partial patellar tendon tears (PPTTs). Current classifications of patellar tendinopathy are based on symptoms and do not provide satisfactory evidence-based treatment guidelines.

Purpose: To define the relationship between PPTT characteristics and treatment guidelines, as well as to develop a magnetic resonance imaging (MRI)-based classification system for partial patellar tendon injuries.

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

Methods: MRI characteristics and clinical treatment outcomes were retrospectively reviewed for 85 patients with patellar tendinopathy, as well as 86 physically active control participants who underwent MRI of the knee for other conditions. A total of 56 patients had a PPTT and underwent further evaluation for tear size and location. The relationship between tear characteristics and clinical outcome was defined with use of statistical comparisons and univariate and logistic regression models.

Results: Of the 85 patients, 56 had partial-thickness patellar tendon tears. Of these tears, 91% involved the posterior and posteromedial regions of the proximal tendon. On axial MRI views, patients with a partial tear had a mean tendon thickness of 10 mm, as compared with 6.2 mm for those without ( < .001). Eleven patients underwent surgery for their partial-thickness tear. All of these patients had a tear >50% of tendon thickness (median thickness of tear, 10.3 mm) on axial views. Logistic regression showed that tendon thickness >8.8 mm correlated with the presence of a partial tear, while tendon thickness >11.45 mm and tear thickness >55.7% predicted surgical management.

Conclusion: Partial-thickness tears are located posterior or posteromedially in the proximal patellar tendon. The most sensitive predictor for detecting the presence of a partial tear was patellar tendon thickness, in which thickness >8.8 mm was strongly correlated with a tear of the tendon. Tracking thickness changes on axial MRI may predict the effectiveness of nonoperative therapy: athletes with patellar tendon thickness >11.5 mm and/or >50% tear thickness on axial MRI were less likely to improve with nonoperative treatment. A novel proposed classification system for partial tears, the Popkin-Golman classification, can be used to guide treatment decisions for these patients.
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http://dx.doi.org/10.1177/0363546519894333DOI Listing
February 2020

Increased Surgical Duration Associated With Prolonged Hospital Stay After Isolated Posterior Cruciate Ligament Reconstruction.

Ther Clin Risk Manag 2019 10;15:1417-1425. Epub 2019 Dec 10.

Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA.

Purpose: Although often performed using a variety of reconstructive techniques and strategies, no clinically significant differences presently exist between the approaches available for isolated PCL reconstructions. Given the operatively challenging nature of these procedures, there lies a potentially increased risk of postoperative complications and healthcare expenditures. Our investigation sought to identify patient and surgical risk factors associated with prolonged hospital stays following isolated PCL reconstruction and determine the incidence of 30-day complications after PCL reconstruction using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.

Method: Patients undergoing isolated PCL reconstructions between 2005 and 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using Current Procedural Terminology codes. Baseline patient and operative characteristics were evaluated as possible risk factors for overnight hospital admissions following PCL reconstruction and analyzed using multivariate analyses.

Results: A total of 249 patients were identified. Multivariate analyses demonstrated that increased operative duration >120 mins (OR 5.04, CI 2.44-10.40; p <0.001) was associated with an increased risk of overnight hospital stay. Major complications occurred in 0.4% (N=1), and minor complications occurred in 0.8% (N=2) with overall complications occurring in 1.2% (N=3) of all patients. Wound dehiscence was the only major complication while superficial surgical site infection and deep vein thrombosis were the only minor complications. 34.1% (N=85) of patients required an overnight hospital stay postoperatively.

Conclusion: Surgical duration >120 mins carried an increased risk of overnight hospital stay after isolated PCL reconstructions. As there are presently minimal significant clinical differences between current PCL reconstruction techniques, improved surgeon familiarity and comfort with a single technique is recommended to decrease operative time and avoid prolonged hospital stays and healthcare expenditures.

Level Of Evidence: III, retrospective comparative study.
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http://dx.doi.org/10.2147/TCRM.S216384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911333PMC
December 2019

Epidemiology of Foot and Ankle Injuries in National Collegiate Athletic Association Men's and Women's Ice Hockey.

Orthop J Sports Med 2019 Aug 28;7(8):2325967119865908. Epub 2019 Aug 28.

Center for Shoulder, Elbow and Sports Medicine, Columbia University, New York, New York, USA.

Background: Ice hockey is a high-speed contact sport in which athletes are prone to many different injuries. While past studies have examined overall injury rates in ice hockey, foot and ankle injuries among collegiate ice hockey players have yet to be analyzed.

Purpose/hypothesis: The purpose of this study was to elucidate the epidemiology of foot and ankle injuries among collegiate ice hockey players utilizing data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program. We hypothesized that male ice hockey players would sustain more injuries compared with female ice hockey players and that the injuries sustained would be more severe.

Study Design: Descriptive epidemiology study.

Methods: Data on all foot and ankle injuries sustained during the academic years 2004 through 2014 were obtained from the NCAA Injury Surveillance Program. Injury rates, rate ratios (RRs), and injury proportion ratios were reported with 95% CIs.

Results: Over the study period, the overall rate of foot and ankle injuries for men was higher than that for women (413 vs 103 injuries, respectively; RR, 4.01 [95% CI, 3.23-4.97]). Injury rates were highest during the regular season for both men (358 injuries; RR, 64.78 [95% CI, 58.07-71.49]) and women (89 injuries; RR, 38.37 [95% CI, 30.40-46.35]) compared with the preseason or postseason. The most common injury in men was a foot and/or toe contusion (22.5%), while women most commonly sustained a low ankle sprain (31.1%). For men, foot and/or toe contusions accounted for the most non-time loss (≤24 hours ) and moderate time-loss (2-13 days) injuries, while high ankle sprains accounted for the most severe time-loss (≥14 days) injuries. For women, foot and/or toe contusions accounted for the most non-time loss injuries, low ankle sprains accounted for the most moderate time-loss injuries, and high ankle sprains accounted for the most severe time-loss injuries.

Conclusion: Foot and ankle injuries were frequent among collegiate ice hockey players during the period studied. For men, contusions were the most commonly diagnosed injury, although high ankle sprains resulted in the most significant time lost. For women, low ankle sprains were the most common and resulted in the most moderate time lost. These findings may direct future injury prevention and guide improvements in ice skate design.
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http://dx.doi.org/10.1177/2325967119865908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6713968PMC
August 2019

Computer Navigation for Pediatric Femoral ACL Tunnel Placement.

Iowa Orthop J 2019 ;39(1):121-129

Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY USA.

Background: To compare accuracy, time and radiation exposure of pediatric femoral tunnel placement using computer navigation with a traditional freehand technique.

Methods: A single all-epiphyseal femoral tunnel was placed in the distal femur of 20 Sawbones™ adolescent knee models. Ten tunnels were drilled using standard fluoroscopic guidance (FG). An additional 10 tunnels were drilled using 3D fluoroscopic computer navigation (CN). Both techniques aimed to match an exact point described by the quadrant system of Bernard. Time to perform the procedure was recorded as were number of single shot fluoroscopic images and approximate effective radiation doses.

Results: The deviation from ideal femoral tunnel position was on average 6.4 ± 4.2 mm for FG tunnels and 2.7 ± 3.1 mm for CN tunnels (p<0.05) . There was no violation of the femoral growth plate using either technique. The surgeon was exposed to 17 ± 5.3 and 3 ± 0.66 single fluoroscopy exposures for FG and CN guidance, respectively (p<0.05). However, the effective dose for the CN because of the acquisition of 3D images was 0.52±.003 mSv and for FG was only 0.09mSv ± .027 (p <0.001). CN however required on average 12.5 ± 3.4 min compared to 4.6 ± 1.7 for FG (p<0.05) to complete drilling of the tunnel.

Concluson: CN achieves a more accurate epiphyseal femoral ACL tunnel position but requires more time to complete and has a higher effective radiation dose than FG. Whether the CN ACL tunnels can translate to improved clinical outcomes is still unknown. V.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604552PMC
February 2020

Increasing Burden of Youth Baseball Elbow Injuries in US Emergency Departments.

Orthop J Sports Med 2019 May 14;7(5):2325967119845636. Epub 2019 May 14.

Columbia University Medical Center, New York, New York, USA.

Background: Youth athletes are starting sports earlier and training harder. Intense, year-round demands are encouraging early sports specialization under the perception that it will improve the odds of future elite performance. Unfortunately, there is growing evidence that early specialization is associated with increased risk of injury and burnout. This is especially true of pediatric and adolescent baseball players.

Purpose/hypothesis: The purpose of this investigation was to analyze national injury trends of youth baseball players. We hypothesized that while the total number of baseball injuries diagnosed over the past decade would decrease, there would be an increase in adolescent elbow injuries seen nationally. A further hypothesis was that this trend would be significantly greater than other injuries to the upper extremity and major joints.

Study Design: Descriptive epidemiology study.

Methods: Injury data from the National Electronic Injury Surveillance System, a United States Consumer Product Safety Commission database, were analyzed between January 1, 2006, and December 31, 2016, for baseball players aged ≤18 years. Data were collected on the location of injury, diagnosis, and mechanism of injury.

Results: Between 2006 and 2016, an estimated 665,133 baseball injuries occurred nationally. The mean age of the injured players was 11.5 years. The most common injuries diagnosed included contusions (26.8%), fractures (23.6%), and strains and sprains (18.7%). Among major joints, the ankle (25.6%) was most commonly injured, followed by the knee (21.3%), wrist (19.2%), elbow (17.7%), and shoulder (16.2%). The incidence of the ankle, knee, wrist, and shoulder injuries decreased over time, while only the incidence of elbow injuries increased. A linear regression analysis demonstrated that the increasing incidence of elbow injuries was statistically significant against the decreasing trend for all baseball injury diagnoses, as well as ankle, knee, wrist, hand, and finger injuries ( < .05). Additionally, the only elbow injury mechanism that increased substantially over time was throwing.

Conclusion: The current investigation found that while the incidence of baseball injuries sustained by youth players is decreasing, elbow pathology is becoming more prevalent and is more commonly being caused by throwing. Given that the majority of elbow injuries among adolescent baseball players are overuse injuries, these findings underscore the importance of developing strategies to continue to ensure the safety of these youth athletes.
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http://dx.doi.org/10.1177/2325967119845636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537065PMC
May 2019

Early Sport Specialization.

J Am Acad Orthop Surg 2019 Nov;27(22):e995-e1000

From the Orthopedic Surgery, Columbia University Center for Shoulder, Elbow and Sports Medicine New York, NY (Dr. Popkin and Dr. Ahmad) and the Division of Sports Medicine, The Cleveland Clinic, Cleveland, OH (Dr. Bayomy).

Recent estimates are that close to 30 million children between the ages of 6 and 18 years participate in team sport and close to 60 million in some type of organized athletics in the United States. This has resulted in an increase in sport-related injuries, but the reasons for this are complex and multifactorial. Sport participation offers multiple benefits for children and adolescents, but there is concern that early sport specialization (ESS) may lead to adverse health and social effects. ESS has been defined as intensive training or competition in organized sport by prepubescent children (<12 years of age) for more than 8 months per year, with focus on a single sport to the exclusion of other sport and free play. An increased prevalence of ESS has been attributed to multiple variables, including coach/caregiver influence and the perception that developing athletes can attain mastery and gain a competitive advantage. Trends vary across individual and team sport and by sex. It has been proposed in the literature and lay press that a lack of diversified activity in youth leads to overuse injury, psychological fatigue, and burnout. ESS may not be necessary for elite athletic achievement, and the contrary has been proposed that early sport diversification leads to superior results. This review will summarize the current understanding of ESS, report evidence for and against its merits, highlight areas of future research, and provide recommendations for orthopaedic providers involved in the care of young athletes.
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http://dx.doi.org/10.5435/JAAOS-D-18-00187DOI Listing
November 2019

Variability in rehabilitation protocols following pediatric anterior cruciate ligament (ACL) reconstruction.

Phys Sportsmed 2019 11 4;47(4):448-454. Epub 2019 Jun 4.

Department of Orthopedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY, USA.

: The objective of this study was to assess the variability of publicly available pediatric anterior cruciate ligament (ACL) reconstruction rehabilitation protocols produced by academic orthopedic surgery departments and children's hospitals.: A web-based search was performed to identify rehabilitation protocols. Protocol and literature review guided the development of a comprehensive scoring rubric that was used to assess protocols for the presence and timing of postoperative adjunctive therapy and physical therapy recommendations.: A search of 180 academic orthopedic surgery programs and 250 children's hospitals identified 21 rehabilitation protocols. A majority of these protocols (90%) recommended postoperative adjunctive therapies such as bracing (81%), cryotherapy (43%), electrical muscle stimulation (24%), and/or continuous passive motion (14%). Several protocols (57%) recommended a specific weight-bearing status in the immediate postoperative period, but there was minimal consensus on that status. Conversely, there was more agreement amongst protocols that recommended strength exercises (52%); a majority of protocols suggested quad sets (91%), ankle pumps (73%), leg press (64%), and/or double-leg squats (55%). Ten protocols (48%) recommended initiation of stretches in the first week following surgery, and most commonly suggested patella mobilizations start at an average of 1.9 weeks postop (range 0-8 weeks). Twelve protocols (57%) discussed return to play, with an average recommended return to play at 7.5 months (range 3-11 months) postoperatively. However, few protocols recommended that patients get approval from their surgeon (19%) or pass specific tests (24%) prior to return to play.: Few academic departments of orthopedic surgery or children's hospitals publish pediatric ACL reconstruction protocols online. Given the substantial variability observed amongst these protocols and recent findings that patients increasingly turn to the internet for medical information, this study suggests that standardization of pediatric ACL reconstruction rehabilitation has the potential to further optimize patient care.
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http://dx.doi.org/10.1080/00913847.2019.1622472DOI Listing
November 2019

An Analysis of Sports Specialization in NCAA Division I Collegiate Athletics.

Orthop J Sports Med 2019 Jan 28;7(1):2325967118821179. Epub 2019 Jan 28.

Department of Orthopedics, New York-Presbyterian Columbia University, New York, New York, USA.

Background: Youth sports specialization has become more prevalent despite consequences such as increased injury rates and burnout. Young athletes, coaches, and parents continue to have misconceptions about the necessity of sports specialization, giving athletes the encouragement to focus on a single sport at a younger age.

Purpose: To characterize the motivations for specialization and determine when elite athletes in various individual and team sports made the decision to specialize.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: A Likert-style survey was developed and distributed to athletes from two National Collegiate Athletic Association (NCAA) Division I institutions. The survey's Flesch-Kincaid grade level was 6.3. Statistical analysis was performed via the Student test, where a value less than .05 was considered significant.

Results: A total of 303 athletes with a mean ± SD age of 19.9 ± 1.52 years across 19 sports were surveyed; 94.7% of specialized athletes had previously played another organized sport prior to college, and 45% of athletes had played multiple sports up to age 16 years. The mean age of specialization was 14.9 years, with a significant difference between athletes competing in team (15.5 years) and individual (14.0 years) sports ( = .008). Males in individual sports specialized earlier than those in team sports ( ≤ .001). Nearly one-fifth (17.4%) of athletes reported specializing at age 12 years or earlier. Personal interest, skill level, time constraints, and potential scholarships were the most important reasons for specialization overall. For individual sports, the motivations for specialization were similar, but collegiate ( < .001) or professional ( < .001) ambitions were significantly larger contributing factors.

Conclusion: Early sports specialization is uncommon among NCAA Division I athletes for most team sports, whereas individual sports tend to have athletes who specialize earlier and are more motivated by professional and collegiate goals. This study characterized the timing of specialization among elite athletes, providing a basis for understanding the motivations behind youth sports specialization. Physicians should be prepared to discuss the misconception that early sports specialization is necessary or common among most team-focused collegiate-level athletes. Knowing the motivations for sports specialization will guide clinicians in their discussions with youth athletes.
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http://dx.doi.org/10.1177/2325967118821179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350152PMC
January 2019

Lower Extremity Injuries in Ice Hockey: Current Concepts.

Am J Orthop (Belle Mead NJ) 2018 Nov;47(11)

Columbia University, Center for Shoulder, Elbow and Sports Medicine, 622 W 168th Street, 11th Floor, New York, New York 10032, USA. Email:

Ice hockey is a fast-paced, collision sport requiring tremendous skill and finesse, yet ice hockey can be a harsh and violent game. It has one of the highest musculoskeletal injury rates in all of competitive sports. Razor sharp skates, aluminum sticks and boards made from high density polyethylene (HDPE), all contribute to the intrinsic hazards of the game. The objective of this article is to review evaluation, management, and return-to-the-rink guidelines after common lower extremity ice hockey injuries.
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http://dx.doi.org/10.12788/ajo.2018.0099DOI Listing
November 2018

The Role of Athletic Event Coverage in Orthopaedic Residency Training: A National Survey of Residency Program Directors.

J Am Acad Orthop Surg 2019 May;27(10):365-369

From the Department of Orthopaedics, Columbia University Medical Center, New York, NY (Dr. Trofa, Mr. Noback, Dr. Lynch, Dr. Popkin, Dr. Jobin, Dr. Levine, and Dr. Ahmad), the Department of Orthopaedics, Gillette Children's Specialty Healthcare, Saint Paul, MN (Dr. Miller), and the Department of Orthopaedics, Boston Medical Center, Boston, MA (Dr. Parisien).

Introduction: No Accreditation Council for Graduate Medical Education guidelines exist regarding athletic event coverage by orthopaedic residents. This study assesses the availability and characteristics of event coverage opportunities in residency programs.

Methods: An anonymous web-based survey assessing resident athletic event coverage opportunities was distributed to members (n = 158) of the American Orthopaedic Association's Council of Orthopaedic Residency Directors.

Results: The survey response rate was 39% (n = 62). Most of the programs (76%) offer athletic event coverage opportunities for residents, most (54%) of which are optional. Of the programs with coverage opportunities, 34 (74%) have a teaching curriculum and 10 (22%) report that residents are always under the direct supervision of an attending orthopaedic surgeon. Thirty programs (64%) count the time spent at athletic events toward duty hours.

Discussion: A comprehensive and uniform resident experience for athletic event coverage does not exist. This finding may represent an area of deficiency in orthopaedic training requiring enhanced national standards.
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http://dx.doi.org/10.5435/JAAOS-D-18-00005DOI Listing
May 2019

Pediatric and Adolescent T-type Distal Humerus Fractures.

J Am Acad Orthop Surg Glob Res Rev 2017 Nov 1;1(8):e040. Epub 2017 Nov 1.

Department of Orthopedic Surgery, New York Presbyterian, Columbia University Medical Center, New York, NY (Dr. Popkin, Dr. Rosenwasser), and the Department of Orthopaedic Surgery, University of Texas Southwestern, Children's Medical Center, Texas Scottish Rite Hospital for Children, Dallas, TX (Dr. Ellis).

Although fractures of the elbow are extremely common in pediatric patients, the T-type distal humerus fracture is rare and offers unique challenges. The mechanism of injury may be similar to the adult counterpart and is usually caused by a fall onto a flexed elbow or from a direct blow. Diagnosing these injuries may be difficult. They often resemble extension-type supracondylar fractures, yet the treatment algorithm is quite different. In younger patients, percutaneous pinning remains a viable option, but for older adolescents, open reduction and internal fixation provides stable fixation at the elbow and the most reliable restoration of the articular surface. Appropriate imaging, careful radiographic diagnosis, and choice of surgical technique are of paramount importance when treating young patients with this injury. Most pediatric and adolescent patients with T-type distal humerus fractures have results better than those of adults but often worse than other elbow fractures in this age group.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-17-00040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132339PMC
November 2017

Prevalence of Posttraumatic Stress Disorder Symptoms Among Young Athletes After Anterior Cruciate Ligament Rupture.

Orthop J Sports Med 2018 Jul 26;6(7):2325967118787159. Epub 2018 Jul 26.

Columbia University Medical Center, New York, New York, USA.

Background: The risk of depression and the fear of reinjury were documented in recent investigations of patients after anterior cruciate ligament (ACL) ruptures. The extent of psychological trauma accompanying these injuries among young athletes, however, has never been assessed.

Hypothesis: Posttraumatic stress disorder (PTSD) symptoms after ACL injury are present among young athletes with high athletic identities.

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

Methods: Patients ≤21 years of age who had suffered an acute ACL rupture were consecutively recruited at a tertiary care center. Patients completed the Horowitz Impact of Event Scale - Revised (IES-R) to analyze for PTSD symptomatology, the Athletic Identity Measurement Scale, and an athlete specialization instrument created at the authors' institution.

Results: A total of 24 patients were consecutively recruited. The mean patient age was 14.5 ± 2.7 years, and 50% of patients were male. More than 87.5% of patients experienced avoidance symptoms, 83.3% acknowledged symptoms of intrusion, and 75% had symptoms of hyperarousal. Patients aged 15 to 21 years incurred a higher severity of PTSD symptoms than younger patients ( = .033). Female patients experienced greater emotional trauma than male patients ( = .017). Finally, patients with high athletic identities experienced greater emotional trauma than those with lesser athletic identities, but this finding was not statistically significant ( = .14).

Conclusion: Following ACL rupture, young athletes experience significant emotional trauma, including symptoms of avoidance, intrusion, and hyperarousal. High school and college athletes, female athletes, and patients with high athletic identities may be most susceptible.
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http://dx.doi.org/10.1177/2325967118787159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083780PMC
July 2018

Rehabilitation variability following medial patellofemoral ligament reconstruction.

Phys Sportsmed 2018 11 2;46(4):441-448. Epub 2018 Jul 2.

a Department of Orthopedic Surgery , New York Presbyterian/Columbia University Medical Center , New York , NY , USA.

Background: Medial patellofemoral ligament (MPFL) reconstruction is an increasingly utilized surgical option for recurrent patellar instability. Recent studies have highlighted the potential benefits of accelerated functional rehabilitation; however, no validated MPFL rehabilitation guidelines currently exist.

Objective: To assess the variability of MPFL reconstruction rehabilitation protocols published online by academic orthopaedic programs.

Methods: Online MPFL rehabilitation protocols from U.S. teaching orthopaedic programs were reviewed. A comprehensive scoring rubric was developed to assess each protocol for both the presence of various rehabilitation components and the timing of their introduction.

Results: Thirty-one protocols (20%) were identified from 155 U.S. academic orthopaedic programs. Thirty protocols (97%) recommended immediate postoperative knee bracing. Twenty protocols (65%) allowed for weight-bearing as tolerated using crutches immediately postoperatively, whereas seven protocols (23%) recommended partial weight-bearing and four protocols (13%) recommended toe-touch weight-bearing. For those protocols advising partial and toe-touch weight-bearing, advancement to full weight-bearing was achieved at averages of 4.7 (range, 3-8) weeks and 6.3 (range, 6-7) weeks, respectively. There was considerable variation in range of motion (ROM) goals; however, most protocols (97%) recommended achieving 90 degrees of knee flexion at an average of 1.4 (range, 0-6) weeks. Significant diversity was found in the inclusion and timing of strengthening, stretching, proprioception, and basic cardiovascular exercises. Twenty-five protocols (81%) recommended return to training after completing specific athletic criteria.

Conclusions: A minority of U.S. teaching orthopaedic institutions publish MPFL reconstruction rehabilitation protocols online. Furthermore, there is a high degree of variability in both the composition and timing of rehabilitation modalities across these protocols.
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http://dx.doi.org/10.1080/00913847.2018.1487240DOI Listing
November 2018

Preoperative Use of a 3D Printed Model for Femoroacetabular Impingement Surgery and Its Effect on Planned Osteoplasty.

AJR Am J Roentgenol 2018 08 6;211(2):W116-W121. Epub 2018 Jun 6.

1 Department of Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032.

Objective: The purpose of this study was to determine the effect that preoperative use of 3D printed models has on planned osteoplasty for femoroacetabular impingement (FAI) surgery.

Materials And Methods: This experimental study utilizing retrospective data included 10 consecutive patients from July 1, 2013, to January 1, 2015, with a clinical diagnosis of FAI and imaging consisting of radiographs, CT scans, and MR images. Three-dimensional models of each patient's affected hip were printed to scale from CT data. Two orthopedic surgeons evaluated each patient in a routine preoperative manner. The effect of the 3D models in altering the planned osteoplasty was then determined. Proportions of osteoplasty change were calculated at various positions, and categoric variables were assessed with the chi-square test for independence.

Results: Proportions of osteoplasty changes ranged from 20% to 55% at femoral positions (greatest at lateral and depth positions) and 35-75% at acetabular positions (greatest at anterior and depth positions). More osteoplasty changes occurred in patients with alpha angles of 60° or more (p = 0.00030) and without a radiographic crossover sign (p = 0.0075). We found no difference in the proportion of osteoplasty changes when stratifying by lateral center edge angle and coxa profunda (p = 0.190 and 0.109, respectively). The planned osteoplasty was changed for at least one reader in 9/10 (90%) femurs and 10/10 (100%) acetabula.

Conclusion: Use of 3D models in preoperative planning can change both the extent and location of planned osteoplasty for FAI surgery and is particularly influential in patients with alpha angles of 60° or more and without a radiographic crossover.
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http://dx.doi.org/10.2214/AJR.17.19400DOI Listing
August 2018

Patellar Instability in the Skeletally Immature.

Curr Rev Musculoskelet Med 2018 Jun;11(2):172-181

Elbow and Sports Medicine and Morgan Stanley Children's Hospital, Columbia University Center for Shoulder, 622 W 168th Street 11th floor, New York, NY, 10032, USA.

Purpose Of Review: This review will focus on the evaluation and management of patellar instability in the developing patient.

Recent Findings: A large number of surgical techniques have been described to prevent recurrent patellofemoral instability in the pediatric population, including both proximal and distal realignment procedures. The wide variety of treatment options highlights the lack of agreement as to the best surgical approach. However, when a comprehensive exam and workup are paired with a surgical plan to address each of the identified abnormalities, outcomes are predictably good. Patellar instability is a common knee disorder in the skeletally immature patient that presents a unique set of challenges. Rates of re-dislocation in pediatric and adolescent patients are higher than in their adult counterparts. Careful consideration of the physeal and apophyseal anatomy is essential in these patients. While the majority of primary patellar instability events can be treated conservatively, multiple events often require surgical intervention.
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http://dx.doi.org/10.1007/s12178-018-9472-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5970107PMC
June 2018
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