bluuebunny/crossref_metadata_2025_split huggingface dataset:
MRI Predictors of Failure in Non-operative Management of Ulnar Collateral Ligament Injuries in Professional Baseball Pitchers
Authors: Lynch Thomas Sean , Frangiamore Salvatore , Vaughn Michael Derek , Soloff Lonnie , Schickendantz Mark S. 
Published: July 2016

Objectives: Ulnar collateral injuries (UCL) of the elbow are prevalent among professional baseball pitchers. The decision on initial operative versus nonoperative management of these injuries remains subjective in many cases, with reported success rates with nonoperative management ranging from 42 to 93% in professional throwing athletes. No studies to date have identified objective characteristics specific to success or failure of nonoperative intervention. The purpose of this study was to identify radiologic predictors for success or failure in nonoperative management of ulnar collateral ligament injuries in professional pitchers. Methods: A retrospective review of pitchers sustaining UCL injuries between 2006 and 2015 from one professional baseball organization (one major league team and all minor league teams included) was performed. UCL injuries were identified in 38 players based on clinical and radiographic findings. Six players underwent initial surgical intervention without attempted nonoperative intervention and were excluded from analysis. This left 32 (84%) professional pitchers who underwent an initial trail of nonoperative treatment for partial UCL tears. Success was defined as return to same level of play (RTSP) or higher for >1 year. Failure was defined as recurrent pain or weakness requiring surgical intervention after a minimum of 3 months’ rest when attempting a return to throw rehabilitation program. MRI findings were classified as high or low grade sprains, proximal or distal location of injury, and with or without the presence of concomitant chronic findings. Results: Of the 32 patients who underwent nonoperative management, 10 (36%) failed and required subsequent ligament reconstruction. Between the success and failure groups, there was no significant difference seen in total shoulder arc of motion (P=.7776), shoulder internal rotation deficit (P=.3846) or loss in elbow extension (P=.0644) at the time of injury. When comparing MRI findings between the groups, distal tears were found in 90% (9/10) of those who failed nonoperative management compared to 18.2% (4/22) who were successful nonoperatively (P=<.0001). No significant difference was seen with high grade tears (P=.0817) between the groups. When adjusting for age, location and evidence of chronic changes on MRI, the likelihood of failing nonoperative management was 22.7 times greater (P=.001) with distal tears. No other variable reached significance, and no combination of variables showed a greater likelihood than distal location alone. Conclusion: In professional pitchers, distal ulnar collateral ligament tears described on MRI show significantly higher rates of failure with nonoperative management compared to proximal tears. This information provides an objective measure for evaluating operative versus nonoperative management of ulnar collateral ligament injuries in throwing athletes.
The Prevalence and Clinical Characteristics of Medial Epicondyle Apophysitis in Juvenile Baseball Player - Ultrasonographic Assessment of 2,926 Cases
Authors: Otoshi Kenichi 
Published: July 2016

Objectives: Apophysitis of humeral medial epicondyle, often referred to as “Little Leaguer’s Elbow, is one of the major throwing injuries in juvenile baseball players as common as osteochondritis dissecans of humeral capitellum. Repetitive valgus stress to the skeletally immature elbow can result in fragmentation, hypertrophy, or separation of the medial epicondyle apophysis, and these injuries may induce elbow pain and adversely influence on elbow function and throwing performance. Although several reports have described various morphological variations of the medial epicondyle apophysis, little is known about the natural course and clinical significance of these variations. The purpose of this study was to investigate the prevalence of these variations in each age group and clarify the association with elbow pain using the large epidemiologic data from medical check-ups of juvenile baseball players. Methods: Of 3,626 juvenile baseball players aged 6 to 17 years, 2,926 players were enrolled in this study. Experience of elbow pain was rated by self-completed questionnaires. Ultrasonographic assessment was used to assess the morphological variations of the antero-inferior medial epicondyle (MEC) and humeral capitellum. Regarding MEC lesion, enthesis of medial ulnar collateral ligament (MUCL) was classified into four types: normal, irregular (IR), fragmentation (FG), and hypertrophy (HT). Osteochondral lesion (OCL) of humeral capitellum was judged by the irregularity or fragmentation of subchondral bone. The prevalence of these lesions was investigated in each age group and evaluated the influence on elbow pain using multivariable logistic regression analysis. Results: The overall prevalence of MEC lesions and capitellum OCL was 49.9% (IR:6.7%, FG:11.7%, HT:31.5%) and 2.1%, respectively. The prevalence of IR and FG gradually increased until reaching its highest at 11-12 years of age. At 12-17 years of age, the prevalence of IR was decreased with age, whereas that of FG persisted at approximately 10% after a temporally decrease. Conversely, the prevalence of HT increased while those of IR and FG simultaneously decreased (Figure 1). Age- and position adjusted multivariable analysis revealed that the presence of MEC lesions were high risk of elbow pain, and significantly higher risk for FG (odds ratio [OR]: 4.25, 95% confidence interval [CI]: 3.23-5.62) compared to IR (OR:3.17, 95%CI:2.31-4.39) and HT (OR:2.12, 95%CI:1.76-2.55). Capitellum OCL of was also significantly high risk of elbow pain (OR:,2.69, 95%CI:1.42-5.45) (Table 1). Conclusion: Our study demonstrated that morphology of MEC apophysis in juvenile baseball player varied with age. As the presence of FG was a significantly high- risk factor for elbow pain as compared to HT, appropriate management of “Little Leaguer’s Elbow” in the preadolescent period might be quite important to accelerate the bony healing of medial epicondyle apophysitis and decrease preventable adulthood elbow pain.
Treatment of Low Energy Lisfranc Joint Injuries in a Young Athletic Population
Authors: Cochran Grant , Renninger Christopher , Tompane Trevor , Bellamy Joseph , Kuhn Kevin 
Published: July 2016

Objectives: Acute Lisfranc joint injuries have historically been associated with high-energy trauma, and high quality data exists describing injury patterns and recommended treatment protocols. There is a lack of comparable data investigating injuries associated with low energy mechanisms. The objective of this study is to report low energy injury patterns and to retrospectively compare primary arthrodesis with open reduction and internal fixation in a young athletic population. Methods: All surgically managed low-energy (sustained during athletic activity, ground level twisting, or fall from less than three feet) Lisfranc injuries were identified at a single military tertiary referral center from July 2010 to June 2015. The injury pattern, time to diagnosis, and method of treatment (open reduction internal fixation (ORIF) or primary arthrodesis) were reviewed. Complication rates, secondary procedures, VAS pain score, and return to full military activity (defined as the ability to perform their primary job functions and participate in mandatory athletic activity) were reviewed. Results: Of the thirty-three injuries identified, twenty (60.6%) were primarily ligamentous. Only one patient had evidence of lateral column instability. Average patient age was twenty-eight. Eleven injuries (33%) were initially missed, delaying diagnosis an average of thirty-four days. Primary arthrodesis was performed in fifteen patients; most were secondary to subacute or chronic presentation. ORIF was performed on the remaining eighteen patients. All fixation constructs included solid screws, dorsal plates, or a combination of both. Minor complications occurred in twelve patients and included sensory changes, superficial infection treated with antibiotics, and symptomatic hardware. Complications requiring surgery other than hardware removal were seen in two patients including one ORIF patient who underwent secondary arthrodesis. VAS pain at final evaluation averaged 1.6. Thirty-one of thirty-three (93.9%) were able to return to full military activity. There were no significant differences in demographic data, injury patterns, complication rates, VAS pain score, and return to full activity. Hardware removal was performed in thirteen ORIF and two arthrodesis patients (p<0.005). The arthrodesis group returned to full activity at an average of 4.7 months while the ORIF returned at an average of 6.7 months (P<0.05). Conclusion: Low energy Lisfranc injuries are most commonly ligamentous, almost always spare the lateral column, and are commonly missed on initial presentation. Arthrodesis and ORIF consistently result in the ability to resume work and athletic activity with low rates of serious complication. Predictably, hardware removal is more common with ORIF. In this study, primary arthrodesis led to earlier return to work and athletic activity by an average of two months.
Recreational Athletes Return to Sport at a Comparable Rate to Elite Athletes Following Hip Arthroscopy for Femoroacetabular Impingement
Authors: Weber Alexander E. , Kuhns Benjamin , Cvetanovich Gregory , Levy David , Nho Shane Jay 
Published: July 2016

Objectives: The objective of the current study was to evaluate patient reported outcomes and return to sport in a cohort of distinctly recreational and amateur level athletes following hip arthroscopy for femoroacetabular impingement (FAI). Methods: Following IRB approval, clinical data was retrospectively retrieved for 66 consecutive FAI patients (26 men, 40 women) who had undergone hip arthroscopy and identified themselves as recreational or amateur athletes on intake forms. Two-year patient-reported outcomes (PRO) included a sport-specific questionnaire, modified Harris Hip Score (mHHS), and Hip Outcome Scores with Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales were analyzed. Results: The mean age and BMI of all subjects was 26.8 ± 7.6 years and 23.9 ± 3.2 kg/m2, respectively. Athletes had withdrawn from sport for an average of 9.5 ± 6.7 months prior to surgery and on average required 9.7 ± 5.1 months to return to sport. After two years, all mean PRO scores had improved significantly (Figure 1), and 57 patients (92%) had returned to play and continued participation. Patients who had withdrawn from sport for greater than 8 months before surgery returned to sport significantly more slowly than those who had withdrawn for less than 8 months (p=0.01). Greater withdrawal from sport prior to surgery also correlated with lower postoperative improvements in HOS-ADL and HOS-SS scores. Bivariate analysis revealed that increasing body-mass index (BMI) was associated with lower improvements in PROs. Conclusion: Recreational athletes, following hip arthroscopy for FAI, return to play at a high rate. Increasing BMI and preoperative withdrawal from sport both significantly prolong return to play and diminish two-year PROs. Most return-to-play studies following hip arthroscopy for FAI have focused on professional athletes, with limited generalizability to the average sports medicine surgeon practice. This is the first study of its kind to focus on the recreational athlete and demonstrates comparable return-to-play rates while increasing the generalizability to the average sports medicine practice.
The Fate of the Contralateral Hip in Femoroacetabular Impingement
Authors: Nepple Jeffrey J. , Louer Craig , Clohisy John C. 
Published: July 2016

Objectives: The pathophysiology of femoroacetabular impingement (FAI) remains to be better understood. Only a fraction of all individuals with bony FAI morphology will ever develop hip symptoms or osteoarthritis. The purpose of the current study was to determine (1) rates of initial and subsequent symptom development in the contralateral hip of patients with symptomatic ipsilateral FAI and (2) to identify predictors of symptomatic contralateral FAI. Methods: The study cohort included 179 consecutive patients presenting for surgical treatment of FAI. Patients were excluded if they had previously underwent contralateral surgery. At baseline and postoperative follow-up time points, patients recorded standardized outcome questionnaires, including the presence of symptoms in the contralateral hip. Significant symptoms were defined as the presence of at least mild pain, while none or slight pain was not included. All patients underwent AP pelvis and bilateral 45 degree Dunn lateral radiographs at baseline. Patients developing symptoms in the contralateral hip were subclassified as having symptoms at presentation (initial symptoms) or developing symptoms during the follow-up period (symptom development). Patients were followed over a minimum of one year time period postoperatively. Multivariate logistic regression was performed to identify independent predictors of symptoms development. Results: The study cohort had a mean age of 30.2 years and included 60.3% females. FAI was classified as isolated cam in 63.1% (n=113), isolated pincer 1.1% (n=2), and combined type in 35.8% (n=64). Forty-two (23.5%) of patients had initial symptoms in the contralateral hip. Twenty-two additional hips developed symptoms during the follow-up period (16.1% of initially asymptomatic hips). For multivariate logistic regression of any symptoms development (initial or subsequent), competitive athletes (p=0.041) and contralateral HNO ratio on AP pelvis (p=0.009). However, the overall model poorly predicted symptoms development. Conclusion: Approximately one in four patients with FAI presents with symptoms in the contralateral hip. Additionally, 16% of initially asymptomatic contralateral hips will develop symptoms during the next several years. A variety of clinical, radiographic, and physical examination factors poorly predict the development of symptoms. Competitive athletes may be less likely to have contralateral symptoms, while significant contralater al cam deformity on the AP pelvis radiograph may make a patient more likely to have contralateral symptoms.
Pectoralis Major Tendon Repair
Authors: Cordasco Frank A. , Degen Ryan , Mahony Gregory Thomas , Tsouris Nicholas 
Published: July 2016

Objectives: Systematic reviews of the literature have identified 365 reported cases of Pectoralis Major Tendon (PMT) injuries. While surgical treatment has demonstrated improved outcomes compared to non-operative treatment, there is still relatively limited data on the functional outcome, return to sport and need for 2nd surgery in athletes following PMT repair. This study comprises the largest series of athletes following PMT repair reported to date. The Objective is to report on the functional outcomes, return to sport and need for 2nd surgery in a consecutive series of PMT tears. Methods: From 2009, 81 patients with PMT tears were enrolled in this prospective series. Baseline evaluation included patient demographics, mechanism of injury, physical examination and PMT specific MRI for confirmation of the diagnosis and analysis of the extent of injury. Each patient underwent surgical repair by the senior author utilizing a previously published surgical technique. Patients were then followed at 2 weeks, 6 weeks, 3 months and 6 months and further follow-up was conducted annually thereafter with functional outcome scores and adduction strength testing. The return to sport and incidence of 2nd surgery data were recorded. This study includes the first 40 athletes to reach the 2-year post-operative period. Results: All athletes were male, with an average age of 34.4 years (range 23-59). The patient cohort consisted of 4 professional NFL players and 36 recreational athletes. Average follow-up duration was 2.5 years (range 2 - 6.0 years). The most common mechanisms of injury occurred during the bench press (n=26) and contact sport participation (n=14). Sixteen injuries were complete avulsions involving both the clavicular and sternocostal heads, while 24 were isolated sternocostal head avulsions. Average pre-injury bench press of 396 lbs (range 170-500 lbs) was restored to 241 lbs post-operatively (range 140-550 lbs). Single Assessment Numeric Evaluation (SANE) scores averaged 93.6 (range 62-100) with an average overall patient satisfaction rated at 9.6 out of 10 (range 6-10). All athletes returned to their pre-injury level of activity at average 5.5 months post-op (range 4.5-6.5 months). Isokinetic evaluation assessing adduction strength revealed an average decrease of <11% (avg. 9.9%, range -18 - 41%) compared with the contralateral extremity. Application of the Bak criteria revealed 50% of athletes scored as excellent, 35% as good and 15% as fair. One athlete developed a pulmonary embolus 10 days post-op. Two athletes required a 2nd surgery (5%), both were re-injured within 3 weeks of surgery. Conclusion: As demonstrated in this consecutive series, which represents the largest cohort of PMT repairs reported to date, surgical repair resulted in 96% patient satisfaction, with 85% good to excellent restoration of function and adduction strength. The athletes returned to sport on average at 5.5 months post-operatively and the incidence of 2nd surgery was 5%.
Incidence, Mechanisms, and Severity of Game-Related High School Football Injuries across Artificial Turf Systems of Various Infill Weight
Authors: Meyers Michael Clinton 
Published: July 2016

Objectives: Today’s new generations of artificial turf are increasingly being installed to duplicate or exceed playing characteristics of natural grass. Rather than playing on the polyethylene turf fibers, shoe: surface interaction actually occurs between the cleat and the various proprietary sand/rubber infill composites of varying weight. At this time, the influence of surface infill weight on football trauma is unknown. Therefore, this study was conducted to quantify incidence, mechanisms, and severity of game-related high school football trauma across artificial turf systems of various infill weight. Methods: Artificial turf systems were divided into four sand/rubber infill weight groups based on lbs per square foot: (A) > 9.0, (B) 6.0 - 8.9, (C) 3.1 - 5.9 and, (D) 0.0 - 3.0. A total of 52 high schools participating across four states over 5 competitive seasons were evaluated for injury incidence, injury category, time of injury, injury time loss, player position, injury mechanism and situation, primary type of injury, injury grade and anatomical location, field location at time of injury, injury severity, head, shoulder, and lower extremity trauma, elective imaging and surgical procedures, cleat design, turf age, and environmental factors. Results: Of the 1,467 high school games documented, 494 games (33.7%) were played on infill (A), 404 (27.5%) on infill (B), 379 (25.8%) on infill (C), and 190 (13.0%) on infill (D). A total of 3,741 injuries were documented, with significantly lower total injury incidence rates (IIR), [18.4 (95% CI, 18.0-18.7) vs 27.5 (26.8-27.9) vs 33.5 (32.7-34.0) and 23.7 (22.7-24.4)], substantial IIRs [3.4 (95% CI, 3.0-3.8) vs 6.6 (6.2-7.1), 8.5 (8.2-8.9) and 6.5 (5.8-7.1)], trauma from shoe: surface interaction during contact [4.6 (95% CI, 4.1-5.0) vs 7.5 (7.0-7.9), 6.4 (5.9-6.9) and 6.9 (6.2-7.5)], playing surface impact trauma [2.4 (95% CI, 2.1-2.8) vs 4.9 (4.4-5.4), 6.1 (5.6-6.6) and 4.4 (3.7-5.1)], and less total elective imaging and surgical procedures [4.6 (95% CI, 4.1-5.0) vs 7.5 (7.0-7.9), 6.4 (5.9-6.9) and 6.9 (6.2-7.5)], while competing on infill weighing >9.0 (A) versus 6.0 -8.9 (B), 3.0 - 5.9 (C), and 0.0-3.0 (D), respectively. Significantly lower trauma (P<.05) was also observed across player-to-player collisions, muscle-tendon overload, injury time loss, injury grade, skill positions, injury mechanism and situation, various cleat styles, adverse weather conditions, and turf age while competing on infill (A) when compared to infill (C). Conclusion: As the artificial infill surface weight decreased, the incidence of game-related high school football trauma significantly increased across numerous playing conditions. This is the first study to investigate the influence of artificial infill surface weight on the incidence of game-related high school football trauma. Since this study is in the early stages, initial findings warrant further investigation.
Expected Time to Return to Athletic Participation Following Stress Fracture in Division I Collegiate Athletes
Authors: Jamieson Marissa , Everson Sonsecharae , Siegel Courtney , Miller Timothy Lee 
Published: July 2016

Objectives: The objective of this study was to evaluate and determine the expected time to return to athletic participation in Division I collegiate Track and Field athletes. Methods: All stress fractures diagnosed in athletes on a single Division I collegiate men’s and women’s track and field/ cross-country team were recorded over a 4-year period. Site and severity of the injury were recorded and graded based on the Kaeding-Miller Classification System for stress fractures. Time to return to full unrestricted athletic participation was recorded for each athlete and correlated with the site and severity grade of the injury. Time to return to athletic participation was also analyzed for gender differences. Results: Fifty-seven stress fractures were diagnosed in 38 athletes over a 4-year period. Thirty-seven of these injuries occurred in women; twenty in men. Mean time to return to participation in women was 13.9 weeks and 11.2 weeks in men. There were 10 athletes who sustained recurrent or multiple stress fractures. Thirty-three stress fractures occurred in the tibia, and 10 occurred in the 2nd through 4th metatarsals. Three occurred in the 5th metatarsal, 6 in the tarsal bones (2 navicular), and 5 in the pelvis. Mean times to return to athletic activity based on site of injury and with extreme outliers removed were as follows: tibia- 13.3 weeks, 2nd through 4th metatarsals- 11.7 weeks, 5th metatarsal- 11.7 weeks, tarsals- 12.1 weeks, and pelvis- 13.0 weeks. There were 31 grade 2 stress fractures, 11 grade 3 stress fractures, and two grade 5 stress fractures that occurred bilaterally in the same patient. Mean times to return to athletic participation again with extreme outliers excluded were as follows: Grade 2- 12.3 weeks, Grade 3- 14.1 weeks, and Grade 5- 17 weeks. There were no Grade 4 (displaced) stress fractures diagnosed in this cohort of patients. Conclusion: Stress injuries to bone occur frequently in track and field athletes. Based on data collected from review of all recorded stress fractures diagnosed in members of a single Division I collegiate men’s and women’s track and field team over a period of four seasons, the expected time to return to full unrestricted athletic participation following diagnosis of a stress fracture is 12 to 13 weeks for all injury sites. Greater severity of injury correlated with increased time to return to participation with small numbers in the Grade 5 (nonunion) category making determining expected time to return to activity difficult.