Publications by authors named "F W Gwathmey"

64 Publications

Favorable Reoperation Rate at 2 Years Following Repair of Horizontal Cleavage Tears Using an All Suture-Based Technique: A Prospective, Multicenter Trial.

Arthrosc Sports Med Rehabil 2021 Jun 13;3(3):e773-e780. Epub 2021 Mar 13.

The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, U.S.A.

Purpose: This prospective, multicenter trial evaluates the clinical success (as measured by reoperation rates and improvements in patient-reported outcome measures) of using circumferential compression stitches with all-suture techniques for horizontal cleavage tears (HCTs) of the meniscus.

Methods: Investigators enrolled 30 patients (mean age, 38.2 years; standard deviation, 11.1 years) aged 18 to 60 years with HCTs in the symptomatic compartment at 8 centers in the United States who underwent HCT repair with all-suture circumferential stitches using a self-retrieving all-inside suture passing device. Postoperative follow-up visits were conducted at 6 months, 1 year, and 2 years. Study outcomes included freedom from reoperation of the index meniscus repair site; knee pain and function, as measured by International Knee Documentation Committee Knee evaluation (IKDC), Knee injury and Osteoarthritis Outcome Score, Lysholm Knee Scale, and Tegner Activity Scale; and serious complications observed during the study. Minimal clinically important difference at 1 year was assessed for IKDC and Lysholm.

Results: Twenty-three patients had 2-year follow-up data available. Freedom from reoperation was 96.0% at 6 months (26/27, 91.7% at 1 year [23/25], and 82.6% at 2 years [19/23]). Significant improvement was observed in over baseline at 2 years for IKDC (36.7-82.5; < .001), Knee injury and Osteoarthritis Outcome Score (52.2-89.3; < .001), Lysholm (50.2-87.4; < .001), and Tegner scores (3.3-5.3;  = .007). Minimal clinically important difference was met or exceeded for IKDC and Lysholm scores at 1 year 69.2% and 65.4% of patients, respectively. Four patients (6.7%) experienced serious complications, of which 2 were assessed as being related to the procedure.

Conclusions: Repair of HCTs using all-suture circumferential stitches placed with a self-retrieving all-inside suture passing device leads to a favorable reoperation rate (17.4%), significant improvements in clinical outcomes, and an acceptable rate of serious complications (6.7%) at 2 years, supporting the viability of this treatment approach in this indication.

Level Of Evidence: Level IV, therapeutic case series.
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June 2021

Predicting ACL Reinjury from Return to Activity Assessments at 6-months Post-Surgery: A Prospective Cohort Study.

J Athl Train 2021 Jun 15. Epub 2021 Jun 15.

Department of Kinesiology. University of Virginia, Charlottesville, VA.

Context: Return to activity(RTA) assessments are commonly administered following ACL-Reconstruction(ACLR) to manage post-operative progressions back to activity. To date, there is little knowledge on the clinical utility of these assessments to predict patient outcomes such as secondary ACL injury once returned to activity.

Objective: To identify what measures of patient function at 6-months post-ACLR best predict return to activity and second ACL injury at a minimum of 2-years following ACLR.

Design: Prospective-cohort Setting: Laboratory Patients: A total of 234 patients with primary, unilateral ACLR completed functional assessments at approximately 6-months post-ACLR. A total of 192(82%) completed follow-up ≥ 2-years post ACLR.

Main Outcome Measures: Six-month functional assessments consisted of patient reported outcomes, isokinetic knee flexor and extensor strength, and single-leg hopping. The ability to return to activity and secondary ACL injury were collected at a minimum of two-years following ACLR.

Results: In patients who did RTA(n=155), a total of 44(28%) individuals had a subsequent ACL injury; graft n=24(15.5%), contralateral ACL n=20(13%). A greater proportion of females had a secondary injury to the contralateral ACL(15/24, 63%) whereas a greater proportion of males reinjured the ipsilateral ACL graft(15/20, 75%, P=.017) Greater knee extension symmetry at 6-months increased the probability of reinjury(B=.016, P=.048). In patients who RTA before 8-months, every 1% increase in quadriceps strength symmetry at 6-months increased the risk of reinjury by 2.1%(B=.021, P=.05). In patients who RTA after 8-months, every month that RTA was delayed reduced the risk of reinjury by 28.4%(B=-284, P=.042).

Conclusions: Patients with more symmetric quadriceps strength at 6-months post ACLR were more likely to experience another ACL rupture, especially in those who returned to sport earlier than 8-months after the index surgery. Clinicians should be cognizant that returning high functioning patients to activity earlier than 8-months post-ACLR may place them at an increased risk for reinjury.
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June 2021

Hip Pain in the Athlete: The Source is Key.

Clin Sports Med 2021 04 5;40(2):xv-xvi. Epub 2021 Feb 5.

Department of Orthopaedic Surgery, University of Virginia School of Medicine, PO Box 800159, Charlottesville, VA 22908, USA. Electronic address:

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April 2021


Int J Sports Phys Ther 2020 Oct;15(5):792-803

University of Virginia, Department of Orthopaedic Surgery - Sports Medicine, Charlottesville, VA, USA.

Background: Recent research has focused on the epidemiology of shoulder and elbow injuries among high school and professional baseball players. Shoulder and elbow injury data has not been comprehensively reported among college baseball student-athletes.

Purpose: The purpose of this study is to describe shoulder and elbow injury rates and their characteristics among collegiate baseball student-athletes in order to improve injury prevention.

Study Design: Descriptive Epidemiology Study.

Methods: Shoulder and elbow injury data were obtained from the NCAA Injury Surveillance System for baseball from 2004-2014. Incidence rate ratios and descriptive analyses described injury characteristics for the shoulder and elbow, separately.

Results: The injury rate for the shoulder was 4.02/10,000 athlete-exposures and for the elbow was 2.44/10,000 athlete-exposures. During the ten-year period, the injury rate of the shoulder has approximately decreased by 75% and of the elbow by approximately 50%. Injury rates were higher during competitions compared to practice for the shoulder (rate ratio, 1.81;95% CI, 1.51, 2.18) and elbow (rate ratio, 2.19;95% CI, 1.73, 2.78). Freshmen and juniors were most likely to sustain shoulder (F=40.6%, J = 29%) and elbow (F=33%, J=33.7%) injuries. Regarding shoulder injuries, surgery was required for 7.1%, and the outcome was season ending for 14.5%. More elbow injuries (17.5%) ended in surgery, and a greater proportion (28.9%) had season-ending injuries.

Conclusion: In collegiate baseball, shoulder and elbow injury rates have decreased but still result in high morbidity. More granular analyses, especially during Division 1 competitions, are necessary for more specific interventions. While shoulder injuries are more common, elbow injuries result in a longer time to return to play and a higher proportion of surgical interventions.

Level Of Evidence: Level 3.
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October 2020

The Affect of Patient Sex and Graft Type on Postoperative Functional Outcomes After Primary ACL Reconstruction.

Orthop J Sports Med 2020 Jun 23;8(6):2325967120926052. Epub 2020 Jun 23.

Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.

Background: Graft choice in anterior cruciate ligament reconstruction (ACLR) and postoperative rehabilitation may affect strength recovery differently in men than women and therefore affect a timely and successful return to sport.

Purpose: To compare knee extensor and flexor strength between men and women who underwent isolated ACLR with either patellar tendon or hamstring tendon (HST) autografts.

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

Methods: A total of 166 patients (87 women, 79 men) with primary unilateral and uncomplicated ACLRs were recruited for participation. A total of 100 patients had bone-patellar tendon-bone (BPTB) autografts and 66 had HST autografts. At 6 months postoperatively, all patients completed the Tegner activity scale and International Knee Documentation Committee Subjective Knee Evaluation as well as underwent bilateral isokinetic (90 deg/s) tests of the knee extensor and flexor groups. Outcomes were recorded in a single session as part of a return-to-sport test battery. Surgical notes were obtained to determine the type of autograft and nerve block used at the time of ACLR.

Results: There was a significant sex × graft type interaction for mass-normalized knee flexor torque ( = .017). Female patients with an HST graft had a significantly lower knee flexor torque compared with female patients with a BPTB graft (0.592 ± 0.49 N·m/kg vs 0.910 ± 0.24 N·m/kg; Cohen [95% CI] = 0.91 [0.45, 1.36]). They also had a significantly lower knee flexor torque when compared with male patients with an HST graft (0.592 ± 0.49 N·m/kg vs 0.937 ± 0.35 N·m/kg; Cohen [95% CI]= 0.88 [0.45, 1.31]). There were significant main effects for graft type with knee flexion ( = .001) and extension ( = .008) symmetry. Patients with a BPTB graft demonstrated lower knee extensor symmetry (65.7% ± 17.0%) and greater knee flexor symmetry (98.7% ± 18.0%) compared with patients with an HST graft (extension: 77.1% ± 32%, Cohen [95% CI] = 0.47 [0.16, 0.79]; flexion: 82.9% ± 33.3%, Cohen [95% CI] = 0.63 [0.31, 0.95]). We also observed a significant main effect for sex ( = .028) and graft type ( = .048) for mass-normalized knee extensor strength. Female participants and patients of either sex with BPTB grafts had lower knee extensor strength compared with male participants and patients with HST grafts, respectively.

Conclusion: At approximately 6 months after ACLR, female patients reconstructed with HST autografts demonstrated weaker HST strength compared with female patients with a BPTB autograft. There were no differences in HST strength between graft types in male patients. Female patients appear to be recovering HST strength differently than male patients when using an HST autograft. These findings may have implications in surgical planning, postoperative rehabilitation, and return-to-sport decision making.
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June 2020