Publications by authors named "Hasani W Swindell"

28 Publications

  • Page 1 of 1

Osteochondral Allograft Transplantation of the Lateral Femoral Condyle and Distal Femoral Osteotomy in the Setting of Failed Osteochondritis Dissecans Fixation.

Arthrosc Tech 2022 Jul 21;11(7):e1301-e1310. Epub 2022 Jun 21.

Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.

Osteochondritis dissecans (OCD) is a pathologic condition, most commonly affecting the knee joint in adolescents and young adults, although pathology can also be found at the elbow and ankle. Lesions to the medial femoral condyle are classically associated with varus alignment, while lesions to the lateral femoral condyle are seen in patients with valgus malalignment. Common risk factors for failed fixation of OCD lesions include unstable lesions to the lateral femoral condyle, screw breakage, older age, and closed physes. The purpose of this technical note is to describe the preoperative planning and step-by-step surgical approach for treatment of failed fixation of an OCD lesion of the posterior aspect of the lateral femoral condyle in young, active patients using an osteochondral allograft, a lateral opening wedge distal femoral osteotomy to correct malalignment, and a tibial tubercle osteotomy to facilitate access to the lesion.
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http://dx.doi.org/10.1016/j.eats.2022.03.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9353333PMC
July 2022

Return to Play Criteria Following Surgical Management of Osteochondral Defects of the Knee: A Systematic Review.

Cartilage 2022 Jul-Sep;13(3):19476035221098164

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

Objective: The objective of this study was to identify and describe the existing literature on criteria used for return to play (RTP) following surgical management of osteochondral defects of the knee.

Design: A systematic review was performed to evaluate the surgical management of osteochondral defects of the knee in skeletally mature patients with a minimum of 2-year follow-up using Level I to IV studies in PubMed EMBASE from January 1998 to January 2016.

Results: Twelve studies with at least one explicitly stated criterion for RTP were identified from a review of 253 published articles. The majority of included studies were Levels II and IV (33%, respectively). Autologous chondrocyte implantation (ACI) was exclusively evaluated in 33.3% of papers and 16.7% evaluated osteochondral allograft transplantation (OCA). Eight different RTP criteria were used alone or in combination across the reviewed studies and time was the most often utilized criterion (83.3%). Minimum time to RTP ranged from 3 to 18 months.

Conclusions: This systematic review identifies current criteria used in the available literature to dictate RTP. Time from surgery was the most commonly employed criterion across the reviewed studies. Given the complex biological processes inherent to the healing of cartilaginous defects, further research is needed to design more comprehensive guidelines for RTP that are patient-centered and utilize multiple functional and psychological domains relevant to the process of returning to sport.
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http://dx.doi.org/10.1177/19476035221098164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9280827PMC
July 2022

Rehabilitation Variability Following Osteochondral Autograft and Allograft Transplantation of the Knee.

Cartilage 2022 Apr-Jun;13(2):19476035221093071

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

Objective: The aim of this study is to assess the variability of postoperative rehabilitation protocols used by orthopedic surgery residency programs for osteochondral autograft transplantation (OAT) and osteochondral allograft transplantation (OCA) of the knee.

Design: Online postoperative OAT and OCA 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 16 programs (10.3%) from 155 US academic orthopedic programs published online protocols and a total of 35 protocols were analyzed. Twenty-one protocols (88%) recommended immediate postoperative bracing following OAT and 17 protocols (100%) recommended immediate postoperative bracing following OCA. The average time protocols permitted weight-bearing as tolerated (WBAT) was 5.2 weeks (range = 0-8 weeks) following OAT and 6.2 weeks (range = 0-8 weeks) following OCA. There was considerable variation in the inclusion and timing of strength, proprioception, agility, and pivoting exercises. Following OAT, 2 protocols (8%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks). Following OCA, 1 protocol (6%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks).

Conclusion: A minority of US academic orthopedic programs publish OAT and OCA 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/10.1177/19476035221093071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9247380PMC
June 2022

Arthroscopic all - Inside repair of meniscal ramp lesions.

J ISAKOS 2022 Apr 30. Epub 2022 Apr 30.

Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.

Meniscal ramp lesions are disruptions of the posterior meniscotibial attachment of the medial meniscus and are commonly associated with anterior cruciate ligament injuries. However, they can be frequently missed when reviewing standard magnetic resonance imaging and difficult to treat. In this presentation, we describe our approach to repair a meniscal ramp lesion using a minimally invasive all-inside technique. We use this technique for the following surgical indications: meniscal tears involving the peripheral and meniscocapsular attachment of the posterior horn resulting in increased meniscal translation. The procedure is performed using standard arthroscopic portals along with a posteromedial portal placed using spinal needle localisation to ensure access around the lesion. Advantages of this technique include a minimally invasive repair that avoids the typical medial knee incision and dissection needed for traditional inside-out repairs, as well as direct visualisation of the repair site to ensure an appropriately tensioned anatomic repair. Technical pearls including adequate arthroscopic visualisation of the posteromedial compartment allowing the creation of a posteromedial working portal, direct passage of sutures through the edges of the ramp lesion facilitating an anatomic repair, and tensioning of the repair with arthroscopic knots to ensure restoration of the posterior horn stability are all critical to a good outcome. Furthermore, the use of two different curve directions for more displaced tears may be necessary to achieve an anatomic repair. In this case and in our experience, we use a Corkscrew SutureLasso 45° curve left for the meniscus bite and right for the capsular bite, as well as a long 8.25 mm by 70 mm twist-in cannula to accommodate the passing of insertion instrumentation in larger patients.
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http://dx.doi.org/10.1016/j.jisako.2022.04.004DOI Listing
April 2022

Minimally Invasive Surgical Approach for Open Common Peroneal Nerve Neurolysis in the Setting of Previous Posterior Schwannoma Removal.

Arthrosc Tech 2022 Apr 28;11(4):e705-e710. Epub 2022 Mar 28.

Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.

The common peroneal nerve (CPN) runs laterally around the fibular neck and enters the peroneal tunnel, where it divides into the deep, superficial, and recurrent peroneal nerves. CPN entrapment is the most common neuropathy of the lower extremity and is vulnerable at the fibular neck because of its superficial location. Schwannomas are benign, encapsulated tumors of the nerve sheath that can occur sporadically or in cases of neurocutaneous conditions, such neurofibromatosis type 2. In cases with compressive neuropathy resulting in significant or progressive motor loss, decompression and neurolysis should be attempted. We present a technical note for the treatment of CPN compressive neuropathy in the setting of a previous ipsilateral schwannoma removal with a minimally invasive surgical approach and neurolysis of the CPN at the fibular neck.
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http://dx.doi.org/10.1016/j.eats.2021.12.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9052142PMC
April 2022

Disparities in Telemedicine Utilization During COVID-19 Pandemic: Analysis of Demographic Data from a Large Academic Orthopaedic Practice.

JB JS Open Access 2022 Apr-Jun;7(2). Epub 2022 Apr 8.

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

Background: The coronavirus-19 (COVID-19) pandemic has prompted a shift in health-care provision toward implementation of telemedicine. This study investigated demographic information on orthopaedic telemedicine utilization at a single academic orthopaedic institution in an effort to identify factors associated with telemedicine usage.

Methods: Demographic and appointment data were collected from the electronic medical record during equivalent time periods prior to the onset of the COVID pandemic (pre-COVID) and during the COVID pandemic (peri-COVID). Multivariate analyses were performed to identify demographic and socioeconomic correlates of telemedicine utilization.

Results: There was a significant increase in telemedicine visits between the eras of study, with significant differences in telemedicine usage in association with age, sex, marital status, English as the primary language, and insurance type (p < 0.001). Multivariate analyses found American Indian/Alaska Native (adjusted odds ratio [aOR] = 0.487, p = 0.004), Black/African American (aOR = 0.622, p < 0.001), Native Hawaiian/other Pacific Islander (aOR = 0.676, p = 0.003), and Asian (aOR = 0.731, p < 0.001) race to be significantly associated with decreased telemedicine usage. Additionally, male sex (aOR = 0.878, p < 0.001) and a non-commercial insurance plan (p < 0.001) were significantly associated with decreased telemedicine usage.

Conclusions: Non-White race, non-commercial insurance plans, and male sex were associated with decreased telemedicine utilization. Further investigation is needed to characterize and better identify underlying factors contributing to disparities in telemedicine access and utilization.
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http://dx.doi.org/10.2106/JBJS.OA.21.00116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9000049PMC
April 2022

The Subacromial Bursa: Current Concepts Review.

JBJS Rev 2021 11 10;9(11). Epub 2021 Nov 10.

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

»: The subacromial bursa is a distinct anatomic structure with distinct histologic features; it plays a critical role in the symptoms of the painful shoulder and in the local healing capacity of the rotator cuff tendon.

»: Treatment of pain from bursitis of the subacromial bursa largely involves nonoperative interventions; however, operative treatment may be considered in certain instances.

»: Preservation of the subacromial bursa should occur whenever possible given its intrinsic trophic and pluripotent factors, which have been shown to play important roles in rotator cuff tendon pathology.
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http://dx.doi.org/10.2106/JBJS.RVW.21.00110DOI Listing
November 2021

A Systematic Review of the Orthopaedic Literature on Truncal and Lower Extremity Injuries in Major League Baseball Players.

J Am Acad Orthop Surg Glob Res Rev 2021 08 3;5(8). Epub 2021 Aug 3.

From the Department of Orthopedics, Columbia University Medical Center, New York, NY (Dr. Swindell, Dr. Coury, Dr. Dantzker, Lopez, Dr. Trofa, Dr. Ahmad), and the Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC (Dr. Saltzman).

Background: Orthopaedic injuries in Major League Baseball (MLB) players can have a tremendous impact on player health, longevity, salaries, and time lost from play.

Purpose: To summarize all data published between January 1980 and August 2019 on truncal and lower extremity orthopaedic injuries sustained by MLB players.

Methods: A literature review of studies examining injuries in MLB was performed using the PubMed and Embase databases. Included studies focused on truncal and lower extremity injuries in professional baseball players. Studies pertaining to nonorthopaedic injuries, and case reports, were excluded.

Results: A total of 41 articles met the inclusion criteria and were selected for the final analysis. Articles were divided based on anatomic region of injury: hip and pelvis (16%), thigh (15%), truncal (14%), knee (13%), and ankle (11%). Most studies (83.7%) were level 3 evidence. Most studies obtained data using publicly available internet resources (29.8%) compared with the MLB Health and Injury Tracking System (22.1%).

Conclusion: This review provides physicians with a single source of the most current literature regarding truncal and lower extremity orthopaedic injuries in MLB players. Most research was published on hip and pelvic, truncal, and thigh injuries and consisted of level III evidence.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8337061PMC
August 2021

An Analysis of In Vivo Hip Kinematics in Elite Baseball Batters Using a Markerless Motion-Capture System.

Arthrosc Sports Med Rehabil 2021 Jun 17;3(3):e909-e917. Epub 2021 May 17.

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

Purpose: The aim of this study was to investigate the kinematics of the asymptomatic baseball batter's hips by comparing passive range of motion (PROM) and real-time active hip range of motion (AROM) and determine whether differences in ROM exist between lead and trail hips.

Methods: Parameters of passive hip ROM were obtained using a goniometer and physical examination standards. Active hip ROM during batting swings was captured with the Dynamic Athletic Research Institute's markerless motion-capture system.

Results: Twenty-nine elite-level baseball players were recruited for participation. Comparison of lead and trail hips showed no significant differences in PROM. Statistically significant differences in AROM were found between lead and trail legs with large effect sizes for flexion (mean difference [MD°], 11.22), extension (MD°, 30.30), abduction (MD°, 6.24), adduction (MD°, 18.63), external rotation (MD°, 14.87) and total arc of rotation (MD°, 17.17) ( < .001 for all). External rotation in the lead hip approached maximum passive endpoint during early phases of the swing, whereas trail hip extension reached maximum passive endpoint during follow-through.

Conclusion: There is a significant difference in the AROM of the lead and trail hips during the batting swing, with active extension in the trail hip, active external rotation of the lead hip, and total arc of rotation of the lead hip nearing their respective passive endpoints and suggesting a potential for bony interaction in the hips of baseball batters.

Level Of Evidence: Level 3, Cross-Sectional Study.
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http://dx.doi.org/10.1016/j.asmr.2021.03.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220628PMC
June 2021

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

Cartilage 2021 12 19;13(1_suppl):1801S-1813S. 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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8808894PMC
December 2021

Nonsurgical Management of Ulnar Collateral Ligament Injuries.

J Am Acad Orthop Surg Glob Res Rev 2021 04 9;5(4). Epub 2021 Apr 9.

From the Department of Orthopedics, New York Presbyterian, Columbia University Medical Center, New York, NY (Dr. Swindell, Dr. Trofa, Dr. Alexander, and Dr. Ahmad); the OrthoCarolina Sports Medicine Center, Charlotte, NC (Dr. Sonnenfeld and Dr. Saltzman); and the Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC (Dr. Saltzman).

Ulnar collateral ligament (UCL) injuries are a common source of pain and disability in the overhead athlete and often result in notable loss of time from competition. Over the past 10 to 15 years, the prevalence of UCL injury and reconstruction has undergone a dramatic increase, making it imperative to determine which patients may benefit from a nonsurgical regimen. Nonsurgical treatment involves a multidisciplinary approach of rehabilitation with tailored physical therapy programs and, in certain cases, biologic adjuncts. Physical therapy protocols should focus on strengthening the periscapular muscles, rotator cuff, core musculature, and flexor pronator mass to help stabilize the injured elbow and prevent injury recurrence before the initiation of a progressive throwing program. The implementation of injury prevention programs has shifted the focus from just the elbow and have included the shoulder, legs, and core in an effort to help decrease the stress on the upper extremity. In addition, biologic therapies such as platelet-rich therapy are promising modalities to augment the conservative treatment of UCL injuries but remain under investigation. The purpose of this study is to review available strategies and outcomes for conservatively treating UCL injuries.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-20-00257DOI Listing
April 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

Statistical fragility of randomized clinical trials in shoulder arthroplasty.

J Shoulder Elbow Surg 2021 Aug 30;30(8):1787-1793. Epub 2020 Nov 30.

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

Background: The P value is a statistical tool used to assess the statistical significance of clinical trial outcomes in orthopedic surgery. However, the P value does not evaluate research quality or clinical significance. The Fragility Index (FI) is an alternative statistical method that can be used to assess the quality and significance of clinical research and is defined as the number of patients in a study intervention group necessary to convert an outcome from statistically significant to statistically insignificant or vice versa. The primary purpose of this study was to evaluate the statistical robustness of clinical trials regarding shoulder arthroplasty using the FI. The secondary goal was to identify trial characteristics associated greater statistical fragility.

Methods: A systematic review of randomized clinical trials in shoulder arthroplasty was performed. The FI was calculated for all dichotomous, categorical study outcomes discussed in the identified studies. Descriptive statistics and the Pearson correlation coefficient were used to evaluate all studies and characterize associations between study variables.

Results: A total of 13 randomized controlled trials were identified and evaluated; these trials had a median sample size of 47 patients (mean, 54 patients; range, 26-102 patients) and a median of 7 patients (mean, 5.8 patients; range, 0-14 patients) lost to follow-up. The median FI was 6 (mean, 5; range, 1-11), a higher FI than what has been observed in other orthopedic subspecialties. However, the majority of outcomes (74.4%) had an FI that was less than the number of patients lost to follow-up, and most outcomes (89.7%) were statistically insignificant.

Conclusion: Randomized controlled trials in shoulder arthroplasty have comparable statistical robustness to the literature in other orthopedic surgical subspecialties. We believe that the inclusion of the FI in future comparative studies in the shoulder arthroplasty literature will allow surgeons to better assess the statistical robustness of future research.
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http://dx.doi.org/10.1016/j.jse.2020.10.028DOI Listing
August 2021

Increased Risk of Humeral Fracture With Open Versus Arthroscopic Tenodesis of the Long Head of the Biceps Brachii.

Arthrosc Sports Med Rehabil 2020 Aug 16;2(4):e329-e332. Epub 2020 Jul 16.

Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, U.S.A.

Purpose: To determine the risk of postoperative humeral fracture following tenotomy, open tenodesis and arthroscopic tenodesis of the long head of the biceps brachii.

Methods: A retrospective review of deidentified patient data from the Medicare Standard Analytic File using the PearlDiver software was conducted to identify procedures performed between 2005 and 2014. Groups were matched by age, gender, region, and medical comorbidities.

Results: We evaluated 157,163 patients who had undergone arthroscopic or open tenodesis or tenotomy of the long head of the biceps brachii over a 10-year period (2005-2014), and we identified 2,196 postoperative humeral fractures (1.4%). Matched subgroup analysis consisting of 44,292 patients demonstrated a statistically significant increase in humeral fracture risk in open (280; 1.26%) compared to arthroscopic tenodesis (232; 1.04%) with a value of 0.03 and an odds ratio of 1.21. The majority of fractures were sustained by patients 65-74 years of age.

Conclusion: In this study, an increased risk of postoperative humeral fracture was associated with open tenodesis of the LHB.

Level Of Evidence: III, Retrospective Comparative Trial.
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http://dx.doi.org/10.1016/j.asmr.2020.04.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451862PMC
August 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

Performance in Collegiate-Level Baseball Players After Elbow Ulnar Collateral Ligament Reconstruction.

Orthop J Sports Med 2020 Apr 17;8(4):2325967120913013. Epub 2020 Apr 17.

Department of Orthopedics, Columbia University Medical Center, New York, New York, USA.

Background: The increase in ulnar collateral ligament (UCL) elbow reconstructions over the past 20 years has affected younger athletes more than any other age group. Although return to play and postoperative performance have been extensively studied in professional baseball players, outcomes in collegiate baseball players are less known.

Purpose/hypothesis: The purpose of this study was to characterize return to play and changes in performance after UCL reconstruction (UCLR) in collegiate baseball players. We hypothesized that collegiate baseball players would have similar return-to-play rates compared with professional athletes and no significant differences in performance compared with matched controls.

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

Methods: Collegiate athletes undergoing UCLR by a single surgeon were identified. Postoperatively, individual collegiate career paths were analyzed through use of publicly available data from team websites, injury reports, and press releases. Data obtained included time to return to competition, number of collegiate seasons played after surgery, total games started and played, seasonal wins, losses, saves, innings played, hits, earned run average (ERA), home runs, shutouts, strikeouts, walks, and walks plus hit per inning pitched (WHIP). The UCLR group was compared with a matched control group of collegiate pitchers without elbow injury.

Results: Of the 58 collegiate baseball players analyzed (mean ± SD age, 19.95 ± 1.19 years), 84.5% returned to play at the collegiate level. Players returned to competition at 16.98 ± 6.16 months postoperatively and competed for 1.60 ± 0.84 seasons postoperatively. In terms of career longevity, 81.0% of collegiate pitchers either completed their collegiate eligibility or remained on active rosters, and 2 players (4.1%) ultimately played at the professional level after UCLR. Compared with a matched cohort, the UCLR group had no significant differences in collegiate pitching performance statistics after surgery.

Conclusion: College baseball players returned to play at a rate comparable with the rate published in prior literature on professional pitchers and often completed their collegiate playing eligibility postoperatively. Compared with controls, the UCLR group had no statistically significant differences in pitching performance postoperatively. Further studies are needed to determine the exact reasons why college players retire despite having endured extensive surgical and postoperative rehabilitation processes related to UCLR. Younger populations are experiencing elbow injuries at an increasing rate secondary to increased workloads at the amateur level. As these athletes matriculate into the collegiate ranks, they are at continued risk of sustaining UCL injury, and little explicit information is available on their prospects of return to play and career longevity after UCLR.
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http://dx.doi.org/10.1177/2325967120913013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168778PMC
April 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

Assessing the Readability of Online Information About Achilles Tendon Ruptures.

Foot Ankle Spec 2020 Dec 26;13(6):470-477. Epub 2019 Nov 26.

Department of Orthopedics, Columbia University Medical Center, New York (ODP, HWS, CLH, PCN, JTV).

The American Medical Association (AMA) and National Institutes of Health (NIH) currently suggest that health care materials be written at a sixth-grade reading level. Our study investigates the readability of online information on Achilles rupture and reconstruction. , and were queried using advanced search functions of Google, Bing, and Yahoo!. Individual websites and text from the first 3 pages of results for each search engine were recorded and categorized as physician based, academic, commercial, government and nongovernmental organization, or unspecified. Individual readability scores were calculated via 6 different indices: Flesch-Kincaid grade level, Flesch Reading Ease, Gunning Fog, SMOG, Coleman-Liau index, and Automated Readability Index along with a readability classification score and average grade level. A total of 56 websites were assessed. Academic webpages composed the majority (51.8%), followed by physician-based sources (32.1%). The average overall grade level was 10.7 ± 2.54. Academic websites were written at the highest-grade level (11.5 ± 2.77), significantly higher than physician-based websites ( = .040), and only 2 were written at, or below, a sixth-grade reading level. Currently, online information on Achilles tendon rupture and reconstruction is written at an inappropriately high reading level compared with recommendations from the AMA and NIH.: .
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http://dx.doi.org/10.1177/1938640019888058DOI Listing
December 2020

Is surgical duration associated with postoperative complications in primary shoulder arthroplasty?

J Shoulder Elbow Surg 2020 Apr 31;29(4):807-813. Epub 2019 Oct 31.

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

Background: Surgical duration is an independent predictor of short-term adverse outcomes after a variety of orthopedic procedures, both arthroscopic and open. However, this association in shoulder arthroplasty remains unclear. The purpose of this study was to identify the association between surgical duration and postoperative complications, as well as increased use of health care resources, after shoulder arthroplasty.

Methods: Primary shoulder arthroplasty procedures performed from 2005 to 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes. Surgical duration was divided into 3 cohorts: (1) surgical procedures lasting less than 90 minutes, (2) those lasting between 90 and 120 minutes, and (3) those lasting more than 120 minutes. Baseline patient characteristics and outcome variables were compared using bivariate analysis. Outcome variables were compared using multivariate analysis.

Results: Overall, 14,106 patients were identified. Longer surgical duration was significantly associated with younger age, male patients, higher body mass index, and use of general anesthesia, (P < .001 for each), as well as smoking history (P < .39). Relative to operative times shorter than 90 minutes, surgical procedures lasting more than 120 minutes had higher rates of any complication (P = .002), return to the operating room (P = .008), urinary tract infection (P = .02), non-home discharge (P < .001), blood transfusion (P < .001), and unplanned 30-day hospital readmission (P = .03).

Conclusion: Increasing surgical duration was associated with a variety of postoperative medical complications and increased use of health care resources including discharge to acute care facilities, blood transfusions, and hospital readmission. These data suggest that surgical duration should be considered for postoperative risk stratification, as well as patient counseling, and may be a surgeon-modifiable risk factor independent of patient risk factors.
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http://dx.doi.org/10.1016/j.jse.2019.08.015DOI Listing
April 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

Rehabilitation Variability After Elbow Ulnar Collateral Ligament Reconstruction.

Orthop J Sports Med 2019 Mar 25;7(3):2325967119833363. Epub 2019 Mar 25.

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

Background: Investigations specifically delineating the safest and most efficacious components of physical therapy after ulnar collateral ligament (UCL) reconstruction of the elbow are lacking. As such, while a number of recommendations regarding postoperative therapy have been published, no validated rehabilitation guidelines currently exist.

Purpose: To assess the variability of rehabilitation protocols utilized by orthopaedic residency programs in the United States (US) and those described in the scientific literature.

Study Design: Cross-sectional study.

Methods: Online UCL reconstruction rehabilitation protocols from US orthopaedic programs and from the scientific literature were reviewed. A comprehensive scoring rubric was developed to assess each protocol for the presence of various rehabilitation components as well as the timing of their introduction.

Results: Overall, 22 protocols (14%) from 155 US Electronic Residency Application Service (ERAS) orthopaedic programs and 8 protocols published in the scientific literature detailing UCL reconstruction postoperative rehabilitation were identified and reviewed. After reconstruction, the majority of ERAS and review article protocols (77% and 88%, respectively) advised immediate splinting at 90° of elbow flexion. The mean time to splint discontinuation across all protocols was 2.0 weeks (range, 1-3 weeks). There was considerable variability in elbow range of motion recommendations; however, most protocols detailed goals for full extension and full flexion (>130°) at a mean 5.3 weeks (range, 4-6 weeks) and 5.5 weeks (range, 4-6 weeks), respectively. Significant diversity in the inclusion and timing of strengthening, proprioceptive, and throwing exercises was also apparent. Thirteen ERAS (59%) and 7 review article (88%) protocols specifically mentioned return to competition as an endpoint. ERAS protocols permitted return to competition significantly earlier than review article protocols (29.6 vs 39.0 weeks, respectively; = .042).

Conclusion: There is notable variability in both the composition and timing of rehabilitation components across a small number of protocols available online. While our understanding of postoperative rehabilitation for UCL reconstruction evolves, outcome-based studies focused on identifying clinically beneficial modalities and metrics are necessary to enable meaningful standardization.
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http://dx.doi.org/10.1177/2325967119833363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434436PMC
March 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

Seasonal Variation of Achilles Tendon Injury.

J Am Acad Orthop Surg Glob Res Rev 2018 Aug 22;2(8):e043. Epub 2018 Aug 22.

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

Background: Achilles tendon rupture (ATR) is a common injury with increasing incidence. Several risk factors have been identified; however, little is known about seasonal variations in injury prevalence. Previous reports have generated mixed results, with no clear consensus in the literature. The purpose of this investigation was to retrospectively review ATRs seen at a major academic orthopaedic surgery department in New York City to determine whether a statistically significant seasonal pattern of ATRs exists.

Methods: A retrospective chart review was conducted, identifying patients with an acute ATR. Patients were excluded if they had a chronic rupture, laceration, débridement for tendinitis, Haglund deformity, or other nonacute indications for surgery. Date and mechanism of injury were determined from the clinical record.

Results: The highest rate of injury was seen in spring ( = 0.015) and the lowest in fall ( < 0.001), both of which were statistically significant. Overall, no statistically significant difference was noted in summer or winter, although more injuries were seen in summer. When only sports-related injuries are considered, a similar trend is seen, with most injuries occurring in spring (n = 48, = 0.076) and fewest in fall (n = 25, = 0.012); however, only the lower number in fall reaches statistical significance. No statistically significant difference was noted between seasons when only non-sports-related injuries were considered.

Conclusion: A statistically significant increase was noted in the incidence of ATRs in spring and a statistically significant decrease in fall. The need for recognition of risk factors and preventive education is increasingly important in the orthopaedic surgery community and for primary care physicians, athletic trainers, coaches, and athletes.

Level Of Evidence: Prognostic level IV.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-18-00043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286903PMC
August 2018

Fifty Most-cited Articles on Lateral Epicondylitis of the Elbow.

J Am Acad Orthop Surg Glob Res Rev 2018 Jul 11;2(7):e004. Epub 2018 Jul 11.

Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY (Dr. Swindell, Dr. Trofa, Dr. Noticewala, Dr. Grosso, Dr. Levine, and Dr. Ahmad); Department of Orthopedics, Boston University Medical Center, Boston University, Boston, Massachusetts (Dr. Parisien).

Introduction: Citation number can be used as a marker of a scientific article's influence. This study sought to determine and characterize the most-cited investigations on lateral epicondylitis and identify the most influential studies pertaining to this pathology.

Methods: The Institute for Scientific Information Web of Science database was queried for articles investigating lateral epicondylitis, and the 50 most-cited articles were selected. For each article, number of citations, citation density, journal, publication year, country of origin, language, article type, article subtype, and level of evidence were recorded.

Results: Citation numbers ranged from 72 to 332 (mean, 127.4), and densities ranged from 1.6 to 34.0 (mean, 9.4). Articles were published across 26 different journals. Most articles (41) were clinical, with randomized controlled trials (29.3%) being the most commonly cited articles.

Discussion: Compared with previous investigations looking at citation density within orthopaedics, the most commonly cited clinical articles on lateral epicondylitis had a high percentage of level I or II evidence (39.0%). This compilation of the literature can aid in establishing reading curriculums for trainees in both orthopaedic residencies and fellowships. This is a Level V study.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-18-00004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145552PMC
July 2018

Outcomes Following Posterior and Posterolateral Plating of Distal Fibula Fractures.

Foot Ankle Spec 2019 Jun 17;12(3):246-252. Epub 2018 Jul 17.

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

Ankle fractures are common orthopaedic injuries often requiring open reduction and internal fixation. A variety of positions for plate placement exist for surgical fixation of distal fibula fractures, including direct lateral, posterior, or posterolateral. Direct lateral is more common, despite evidence that posterior and posterolateral placement is mechanically superior. However, concern for peroneal tendon injury from posterior plating remains. Our study investigates clinical and functional outcomes of patients who underwent operative fixation of distal fibula fractures with posterior or posterolateral plating over a 3-year period. Analyses were performed on 59 patients with at least 2 years of follow-up. Questionnaires were used to obtain demographic data, in addition to information regarding the presence of ankle pain, subsequent hardware removal, and Foot and Ankle Outcome Scores (FAOS). In patients with at least 2 years of follow-up (average 39.6 ± 10.6 months), 37.2% reported ongoing ankle pain; 11 patients underwent hardware removal (18.6%), with 8 patients undergoing removal because of hardware-related pain (13.6%). FAOS scores (n = 51) were as follows: pain (79.9 ± 22.3), activities of daily living (84.2 ± 22.6), symptoms (75.7 ± 23.5), sports (69.4 ± 31.6), and quality of life (58.3 ± 30.5). Posterior and posterolateral plating achieved good clinical and high functional outcomes across our study population. The percentage of hardware removal in our study was either equivalent to, or less than, historical controls for any type of fibular fixation, and removal may be helpful for those patients whose postoperative ankle pain is subjectively related to the hardware. Therapeutic, Level IV: Retrospective.
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http://dx.doi.org/10.1177/1938640018788433DOI Listing
June 2019

Assessing the Readability of Online Information About Hip Arthroscopy.

Arthroscopy 2018 07 7;34(7):2142-2149. Epub 2018 Apr 7.

Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, U.S.A.. Electronic address:

Purpose: To investigate the current readability of online information pertaining to hip arthroscopy.

Methods: The terms "hip arthroscopy" and "hip scope" were entered into the advanced search functions of Google, Yahoo!, and Bing on March 25, 2017, and results from the first 3 pages were analyzed. Results were required to be unique, accessible websites with information about hip arthroscopy conveyed primarily via analyzable text. Two reviewers applied inclusion criteria to the initial 97 results, discussing to reach consensus in cases of disagreement. Overall, 60 unique results were reviewed with 48 meeting inclusion criteria. Websites were categorized as physician-sponsored, academic, commercial, governmental and nonprofit organization (NPO), or unspecified. Readability was measured via 6 different indices: the Flesch-Kincaid grade level (FKGL), Flesch Reading Ease (FRE), Gunning Fog Score, SMOG Index, Coleman-Liau Index (CLI), and Automated Readability Index (ARI) along with an average grade level and readability classification score.

Results: Forty-eight unique websites were assessed for readability, with physician-sponsored webpages composing the majority (47.92%) followed by academic sources (35.42%). The webpages' average grade level, incorporating information from all 6 metrics, was 12.79 ± 1.98.

Conclusions: The current readability of online information pertaining to hip arthroscopy is at an inappropriately high reading level compared with the sixth-grade level recommended by the American Medical Association and National Institutes of Health, thus introducing significant barriers to understanding for many patients. Online materials should be edited to reduce word and sentence length and complexity, use simpler terms, and minimize use of passive voice to facilitate patient knowledge acquisition and understanding of online information about hip arthroscopy.

Clinical Relevance: This study shows that the current readability of online information on hip arthroscopy exceeds the suggested sixth-grade reading level. It also emphasizes the need for simplifying written materials and offers specific suggestions on doing so to increase accessibility of information for patients.
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http://dx.doi.org/10.1016/j.arthro.2018.02.039DOI Listing
July 2018

Variability of United States Online Rehabilitation Protocols for Proximal Hamstring Tendon Repair.

Orthop J Sports Med 2018 Feb 23;6(2):2325967118755116. Epub 2018 Feb 23.

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

Background: The optimal postoperative rehabilitation protocol following repair of complete proximal hamstring tendon ruptures is the subject of ongoing investigation, with a need for more standardized regimens and evidence-based modalities.

Purpose: To assess the variability across proximal hamstring tendon repair rehabilitation protocols published online by United States (US) orthopaedic teaching programs.

Study Design: Cross-sectional study.

Methods: Online proximal hamstring physical therapy protocols from US academic orthopaedic programs were reviewed. A web-based search using the search term provided an additional 14 protocols. A comprehensive scoring rubric was developed after review of all protocols and was used to assess each protocol for both the presence of various rehabilitation components and the point at which those components were introduced.

Results: Of 50 rehabilitation protocols identified, 35 satisfied inclusion criteria and were analyzed. Twenty-five protocols (71%) recommended immediate postoperative bracing: 12 (34%) prescribed knee bracing, 8 (23%) prescribed hip bracing, and 5 (14%) did not specify the type of brace recommended. Fourteen protocols (40%) advised immediate nonweightbearing with crutches, while 16 protocols (46%) permitted immediate toe-touch weightbearing. Advancement to full weightbearing was allowed at a mean of 7.1 weeks (range, 4-12 weeks). Most protocols (80%) recommended gentle knee and hip passive range of motion and active range of motion, starting at a mean 1.4 weeks (range, 0-3 weeks) and 4.0 weeks (range, 0-6 weeks), respectively. However, only 6 protocols (17%) provided specific time points to initiate full hip and knee range of motion: a mean 8.0 weeks (range, 4-12 weeks) and 7.8 weeks (range, 0-12 weeks), respectively. Considerable variability was noted in the inclusion and timing of strengthening, stretching, proprioception, and cardiovascular exercises. Fifteen protocols (43%) required completion of specific return-to-sport criteria before resuming training.

Conclusion: Marked variability is found in both the composition and timing of rehabilitation components across the various complete proximal hamstring repair rehabilitation protocols published online. This finding mirrors the variability of proposed rehabilitation protocols in the professional literature and represents an opportunity to improve patient care.
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http://dx.doi.org/10.1177/2325967118755116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5826004PMC
February 2018

Effect of Preoperative Indications Conference on Procedural Planning for Treatment of Scoliosis.

Spine Deform 2016 Jan 23;4(1):27-32. Epub 2015 Dec 23.

Department of Orthopaedic Surgery, Columbia University, 116th St & Broadway, New York, NY 10027, USA.

Study Design: This study determines the rate of change in the scoliosis surgery plan in cases presented in preoperative indications conference.

Objectives: To determine the effect of preoperative indications conference on the plan of surgery and to identify characteristics that increased the likelihood of change.

Summary Of Background Data: Preoperative indications conferences are used as a teaching and planning tool. Levels of fusion, construct options, and necessity for osteotomies are often debated in the planning of scoliosis surgery.

Methods: Scoliosis surgeries were presented at preoperative indications conference with four attending pediatric orthopedic surgeons present. The operative surgeon committed to a surgical plan before conference. A consensus-based plan was made without knowledge of the operative surgeon's preconference plan. Changes of plan were classified as major, minor, or no change.

Results: Of the 107 surgical plans, 50 were index surgeries, 13 were revisions, and 44 were scheduled growing rod lengthenings. There were two major changes, including a change to a growing construct from planned fusion, and a change in fusion levels in an adolescent idiopathic scoliosis (AIS) patient. There were 13 minor changes, which included changes in fusion levels (1 to 3; mean = 1.23) and the addition of an osteotomy. The rate of change was 28% for index surgeries and 7.69% for revisions. Of the 14 changes in the 50 index surgeries, there were 8 AIS, 3 cerebral palsy, 1 congenital scoliosis, 1 Ehlers-Danlos, and 1 patient with an undetermined neuromuscular condition. There was 1 change in 13 revision surgeries. There were no changes for growing rod lengthenings and no cancellations as a result of indications conference.

Conclusions: Although revision scoliosis surgery is complex, index AIS/JIS surgery was most subject to the influence of indications conference. This likely reflects controversy around choosing levels of fusion.

Level Of Evidence: IV.
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http://dx.doi.org/10.1016/j.jspd.2015.05.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561733PMC
January 2016
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