American Journal of Sports Medicine

BACKGROUND: Ulnar collateral ligament reconstruction (UCLR) is a common procedure in professional baseball position players. Timing of return to hitting after UCLR is unknown. PURPOSE/HYPOTHESIS: The purpose was to determine the time to return to batting milestones after UCLR as well as the effect of UCLR upon batting performance in professional baseball players. The hypothesis was that position players would return to batting in an in-season game before fielding in an in-season game, and hitting performance would remain unchanged after UCLR...

BACKGROUND: Despite success at preventing ankle sprain, prophylactics that restrict ankle plantarflexion motion may produce deleterious knee biomechanics and increase injury risk. PURPOSE: To determine if ankle prophylactics that restrict plantar- and dorsiflexion motion produce changes in knee biomechanics during a single-leg cut and whether those changes differ between sexes. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 17 male and 17 female participants performed a single-leg cut with 4 conditions: Ankle Roll Guard (ARG), lace-up brace, nonelastic tape, and an unbraced control...

BACKGROUND: The biceps tendon is a known source of shoulder pain. Few high-level studies have attempted to determine whether biceps tenotomy or tenodesis is the optimal approach in the treatment of biceps pathology. Most available literature is of lesser scientific quality and shows varying results in the comparison of tenotomy and tenodesis. PURPOSE: To compare patient-reported and objective clinical results between tenotomy and tenodesis for the treatment of lesions of the long head of the biceps brachii...

BACKGROUND: Platelet-rich fibrin (PRF) is a bioactive biomaterial wherein cytokines are enmeshed within the interconnecting fibrin network. PRF can be fabricated into a patch to augment healing of the interface between a tendon graft and bone tunnel. HYPOTHESIS: The bioactivity of a PRF scaffold is preserved after PRF is mechanically compressed into a patch. A bioactive PRF patch could promote the incorporation of a tendon graft within the bone tunnel through the formation of a tendon-bone healing zone composed of both fibrocartilaginous tissue and new bone...

BACKGROUND: Early weightbearing protocols after Achilles tendon repair promote mobilization, yet little is known about their effect on tendon lengthening. PURPOSE: To evaluate tendon lengthening after Achilles tendon repair with accelerated rehabilitation. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Patients undergoing primary repair for acute Achilles tendon ruptures consented to have tantalum beads placed within the tendon...

BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain and disability in athletes. Arthroscopic treatment for FAIS is well-established; however, the long-term results in elite athletes are limited. PURPOSE: To evaluate outcomes 5 years after arthroscopic treatment for FAIS in elite athletes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Elite athletes undergoing arthroscopic treatment for FAIS with a minimum 5-year follow-up were included...

BACKGROUND: There is no consensus on technique of choice for repair of bucket-handle meniscal tears (BHMTs). PURPOSE: To determine factors that affect patient outcomes and failure rates in patients undergoing all-inside repairs of BHMTs. STUDY DESIGN: Systematic review. METHODS: A systematic review of 3 databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed...

BACKGROUND: Treatment of irreparable massive rotator cuff tears (MRCTs) in patients without advanced glenohumeral osteoarthritis remains a challenge. Arthroscopic superior capsule reconstruction (SCR) represents a newer method for treatment with increasing popularity and acceptance. PURPOSE: To analyze the clinical evidence surrounding SCR and determine the current clinical outcomes postoperatively. STUDY DESIGN: Systematic review. METHODS: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines...

BACKGROUND: Articular cartilage has a zonal architecture and biphasic mechanical properties. The recapitulation of surface lubrication properties with high compressibility of the deeper layers of articular cartilage during regeneration is essential in achieving long-term cartilage integrity. Current clinical approaches for cartilage repair, especially with the use of mesenchymal stem cells (MSCs), have yet to restore the hierarchically organized architecture of articular cartilage. HYPOTHESIS: MSCs predifferentiated on surfaces with specific nanotopographic patterns can provide phenotypically stable and defined chondrogenic cells and, when delivered as a bilayered stratified construct at the cartilage defect site, will facilitate the formation of functionally superior cartilage tissue in vivo...

BACKGROUND: The indications for the addition of anterolateral soft tissue augmentation to anterior cruciate ligament (ACL) reconstruction and its effectiveness remain uncertain. PURPOSE: To determine if modified iliotibial band tenodesis (MITBT) can improve clinical outcomes and reduce the recurrence of ACL ruptures when added to ACL reconstruction in patients with a residual pivot shift. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2...

BACKGROUND: Meniscus root tears lead to de-tensioning of the meniscus, increased contact forces, and cartilage damage. Management of older patients with root tears is controversial and the efficacy of different treatment options is unclear. PURPOSE: To compare the clinical outcomes of patients with moderate knee osteoarthritis who underwent an all-inside meniscus root repair technique versus nonoperative management for either medial or lateral meniscus root tears...

BACKGROUND: Safe return to play (RTP) after anterior cruciate ligament (ACL) reconstruction is critical to patient satisfaction. Enhanced rehabilitation after ACL reconstruction with appropriate objective criteria for RTP may reduce the risk of subsequent injury. The cost-effectiveness of an enhanced RTP (eRTP) strategy relative to standard post-ACL reconstruction rehabilitation has not been investigated. PURPOSE: To determine if an eRTP strategy after ACL reconstruction is cost-effective compared with standard rehabilitation...

BACKGROUND: Time to return-to-sport (RTS) after acute adductor injuries varies among athletes, yet we know little about which factors determine this variance. PURPOSE: To investigate the association between initial clinical and imaging examination findings and time to RTS in male athletes with acute adductor injuries. STUDY DESIGN: Cohort study (Prognosis); Level of evidence, 2. METHODS: Male adult athletes with an acute adductor injury were included within 7 days of injury...

BACKGROUND: Femoral tunnels that are not anatomically placed within the native anterior cruciate ligament (ACL) footprint during ACL reconstruction are associated with residual instability, graft rupture, and poor clinical outcomes. Although surgeons may intend to place their femoral tunnels within the native ACL attachment, this is not always achieved. This study assesses the variation between intended and achieved femoral tunnel positions in a large cohort of experienced ACL surgeons...

BACKGROUND: An unsalvageable osteochondritis dissecans (OCD) fragment has been defined as one that cannot be saved. Unsalvageable OCD lesions have been treated with various techniques, including fragment excision, microfracture, osteochondral autograft transfer, fresh osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI). HYPOTHESIS: Patients who underwent ACI as treatment for unsalvageable OCD more than 10 years ago would maintain satisfactory patient-oriented outcome measures and have a low need for additional open surgery, especially arthroplasty...

BACKGROUND: Chronic incomplete proximal hamstring avulsion injuries are debilitating injuries associated with prolonged periods of convalescence and poor return to preinjury level of function. This study explores the efficacy of operative intervention for these injuries on patient satisfaction, muscle strength, range of motion, functional performance, return to preinjury level of sporting activity, and injury recurrence. HYPOTHESIS: Surgical intervention of chronic incomplete proximal hamstring avulsion injuries enables return to preinjury level of sporting function with low risk of clinical recurrence...

BACKGROUND: Few studies have reported the healing process of anterolateral ligament (ALL) injuries. PURPOSE/HYPOTHESIS: This study investigated the healing status of ALL injuries after primary anterior cruciate ligament (ACL) reconstruction (ACLR). Additionally, we investigated the association between the healing status of ALL injuries and associated lesions such as osseous lesions and meniscal tears occurring at the time of an ACL rupture. We hypothesized that acute ALL injuries show a high rate (more than two-thirds) of healing at the 1-year follow-up after ACLR and that concomitant lesions observed at the time of an ACL rupture affect the healing status of the ALL...

BACKGROUND: Minimally invasive repair of acute Achilles tendon ruptures has been performed for several years, resulting in reduced morbidity as compared with open repair. HYPOTHESIS: A minimally invasive technique can be used to manage Achilles tendon ruptures in patients presenting between 14 and 30 days from injury. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We prospectively recruited 21 consecutive patients who presented between 14 and 30 days after the index injury, and we compared them with 21 patients who were matched according to sex, age (±2 years), and level of activity, who presented within 14 days of the index injury...

BACKGROUND: During nonoperative or postoperative rehabilitation after sports injuries, exercise selection is often based on minimal load on the injured/repaired glenohumeral structures, while optimally activating scapulothoracic muscles. Previous research explored scapular muscle activity during rehabilitation exercises using surface electromyography (EMG). However, limited information exists about the deeper lying muscle activity, measured with fine-wire electrodes, even more in combination with 3-dimensional scapular kinematics...

BACKGROUND: Atypical knee joint biomechanics after anterior cruciate ligament reconstruction (ACLR) are common. It is, however, unclear whether knee robustness (ability to tolerate perturbation and maintain joint configuration) and whole body movement strategies are compromised after ACLR. PURPOSE: To investigate landing control after ACLR with regard to dynamic knee robustness and whole body movement strategies during sports-mimicking side hops, and to evaluate functional performance of hop tests and knee strength...