The development and validation of a functional assessment tool for the upper extremity in the overhead athlete.

BACKGROUND: There are no validated upper extremity instruments designed specifically to evaluate the performance and function of overhead athletes. Current shoulder and elbow scoring systems may not be sensitive to subtle changes in performance in this high-demand population. HYPOTHESIS: The scoring system developed in this study will be valid, reliable, and responsive in the evaluation of overhead athletes. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Based on the results of a pilot questionnaire administered to 21 overhead athletes, a final 10-item questionnaire was developed. Two hundred eighty-two healthy, competitive overhead athletes completed the new questionnaire, as well as 2 established upper extremity questionnaires, and were self-assigned into injury categories: (1) playing without pain, (2) playing with pain, and (3) not playing due to pain. Correlations between the scores and differences between injury categories were measured. Responsiveness testing was performed in an additional group of 55 injured athletes, comparing their scores before and after an intervention. RESULTS: The new score showed high correlation with the Disabilities of the Arm, Shoulder and Hand (DASH) score and the DASH sports/performing arts module. The new score correctly stratified overhead athletes by injury category (P < .0001). The new score also demonstrated excellent responsiveness, varying appropriately with improvements in injury category after treatment of injuries (P < .05). CONCLUSION: The new patient-reported instrument is valid and responsive in the evaluation of overhead athletes. Reliability was also demonstrated for the 13-item pilot questionnaire. The results support its use for the functional assessment of overhead athletes in future studies.

Arthroscopic evaluation of radiofrequency chondroplasty of the knee.

BACKGROUND: Considerable debate exists over the use of radiofrequency-based chondroplasty to treat partial-thickness chondral defects of the knee. This study used second-look arthroscopy to evaluate cartilage defects previously treated with bipolar radiofrequency-based chondroplasty. HYPOTHESIS: Partial-thickness articular cartilage lesions treated with bipolar radiofrequency-based chondroplasty will show no progressive deterioration. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: One hundred ninety-three consecutive patients underwent bipolar radiofrequency-based chondroplasty over 38 months; 15 (25 defects treated with bipolar radiofrequency-based chondroplasty) underwent repeat arthroscopy for recurrent or new injuries. Time from the initial to repeat arthroscopy ranged from 0.7 to 32.7 months. At both procedures, the location, size, grade, and stability of lesions were evaluated, recorded, and photographed arthroscopically. RESULTS: At the initial procedure, 25 lesions treated using bipolar radiofrequency-based chondroplasty ranged from 9 to 625 mm2 (mean, 170.2 +/- 131.2 mm2; median, 120 mm2); at second look, lesion size was 9 to 300 mm2 (mean, 107.7 +/- 106.7 mm2; median, 100 mm2). At second look, 3 (12%) demonstrated unstable borders with damage in the surrounding cartilage that appeared to be progressive. Eight (32%) lesions were unchanged in size. Eight (32%) demonstrated partial filling with stable repair tissue, and 6 (24%) demonstrated complete filling with stable repair tissue. Lesions in the tibiofemoral compartments showed better response to radiofrequency chondroplasty than did those within the patellofemoral joint (P < .05). CONCLUSION: Only 3 of 25 lesions demonstrated progression. More than 50% showed partial or complete filling of the defect. Bipolar radiofrequency chondroplasty is an effective way to treat partial-thickness cartilage lesions; however, long-term effects of this treatment on cartilage remain unknown.