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1.
Orthop J Sports Med ; 11(9): 23259671231196492, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37693810

ABSTRACT

Background: Previous studies of concomitant meniscal injury in athletes with anterior cruciate ligament (ACL) injury have examined age, sex, body mass index (BMI), injury mechanism, and time from injury to surgery as potential risk factors. Purpose: To identify additional risk factors for concomitant meniscal injury, including preinjury joint laxity and lower extremity alignment, in athletes with sport-related ACL injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included 180 participants aged 13 to 26 years who underwent ACL reconstruction (ACLR) after a first-time ACL injury sustained during participation in sport. Contralateral lower extremity alignment and joint laxity were used as surrogate measures for the injured knee before trauma. Concomitant meniscal tear patterns were identified at the time of ACLR. Sex-specific analyses were conducted. Results: Concomitant meniscal injury was observed in 60.6% of the subjects. The prevalence of concomitant injury was higher in male than female participants (69.9% vs 54.2%; P = .035) due to a higher prevalence of lateral meniscal injuries (56.2% vs 38.3%; P = .018). Among male patients, there was a significant difference in the prevalence of concomitant lateral meniscal tear according to sport participation (≥9 vs <9 h/week: 67.4% vs 35.7%; P = .032). Among male patients, the likelihood of concomitant injury to both the lateral and medial menisci increased by 28.8% for each 1-mm decrease in navicular drop. Among female patients, the likelihood of concomitant injury to the lateral meniscus increased by 15% per degree increase in genu recurvatum and 14% per degree decrease in standing quadriceps angle, with similar effects on the likelihood of concurrent injury to both the lateral and medial menisci. Conclusion: Measures of lower extremity alignment and genu recurvatum previously identified as risk factors for ACL injury were also associated with concomitant meniscal injury in female patients while other risk factors, including BMI and joint laxity, were not. Increased time spent participating in sport and navicular drop were associated with concomitant meniscal injury in male patients.

2.
J Shoulder Elbow Surg ; 32(12): 2473-2482, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37308074

ABSTRACT

BACKGROUND: This study investigates the potential role of preoperative 25(OH)D supplementation as a cost-effective strategy to decrease revision rotator cuff repair (RCR) rates and lower the total health care burden from patients undergoing primary arthroscopic RCR. Previous literature has emphasized the importance of vitamin D on bone health maintenance, soft tissue healing, and outcomes in RCR. Inadequate preoperative vitamin D levels may increase revision RCR rates following primary arthroscopic RCR. Although 25(OH)D deficiency is common in RCR patients, serum screening is not routinely performed. METHODS: A cost-estimation model was developed to determine the cost-effectiveness of both preoperative selective and nonselective 25(OH)D supplementation in RCR patients in order to reduce revision RCR rates. Prevalence and surgical cost data were obtained from published literature through systematic reviews. Cost of serum 25(OH)D assay and supplementation were obtained from public-use data. Mean and lower and upper bounds of 1-year cost savings were calculated for both the selective and nonselective supplementation scenarios. RESULTS: Preoperative 25(OH)D screening and subsequent selective 25(OH)D supplementation was calculated to result in a mean cost savings of $6,099,341 (range: -$2,993,000 to $15,191,683) per 250,000 primary arthroscopic RCR cases. Nonselective 25(OH)D supplementation of all arthroscopic RCR patients was calculated to result in a mean cost savings of $11,584,742 (range: $2,492,401-$20,677,085) per 250,000 primary arthroscopic RCR cases. Univariate adjustment projects that selective supplementation is a cost-effective strategy in clinical contexts where the cost of revision RCR exceeds $14,824.69 and prevalence of 25(OH)D deficiency exceeds 6.67%. Additionally, nonselective supplementation is a cost-effective strategy in clinical scenarios where revision RCR cost is ≥$4216.06 and prevalence of 25(OH)D deficiency is ≥1.93%. CONCLUSIONS: This cost-predictive model promotes the role of preoperative 25(OH)D supplementation as a cost-effective mechanism to reduce revision RCR rates and lower the overall health care burden from arthroscopic RCR. Nonselective supplementation appears to be more cost-effective than selective supplementation, likely due to the lower cost of 25(OH)D supplementation compared to serum assays.


Subject(s)
Rotator Cuff Injuries , Vitamin D , Humans , Vitamin D/therapeutic use , Rotator Cuff/surgery , Rotator Cuff Injuries/surgery , Cost-Benefit Analysis , Treatment Outcome , Arthroscopy , Dietary Supplements , Retrospective Studies
3.
Sports Health ; 15(1): 142-147, 2023.
Article in English | MEDLINE | ID: mdl-35354392

ABSTRACT

STUDY DESIGN: Case series. LEVEL OF EVIDENCE: Level 4C.


Subject(s)
Lacerations , Skiing , Humans , Research
4.
Arthroscopy ; 39(2): 142-144, 2023 02.
Article in English | MEDLINE | ID: mdl-36332853

ABSTRACT

Tears of the quadriceps or patellar tendon usually occur after a sudden eabccentric contraction and are diagnosed by a palpable gap at the injury site combined with an inability to perform a straight leg raise. Bilateral knee radiographs may demonstrate patella alta with patellar tendon tears and patella baja with quadriceps tendon tears compared with the uninjured knee. Ultrasound and magnetic resonance imaging can be helpful when there is uncertainty in the diagnosis. Surgical treatment is indicated for complete tears and some high-grade, partial tears. Nonabsorbable high-strength sutures or suture tape are placed in running locking fashion along the injured tendon and secured to the patella with bone tunnels (i.e., transosseous) or suture anchors. The transosseous technique requires exposure of the length of the patella to drill 3 bone tunnels to shuttle the sutures and tie over either pole of the patella. The suture anchor technique allows for a smaller incision and less soft-tissue dissection and may use a knotted or knotless technique. Biomechanical testing with load to failure is not statistically different between the transosseous and anchor techniques, although anchors have been shown to have less gap formation at the repair site. Repair augmentation with a graft may be beneficial in mid-substance injuries, chronic tears, and in cases of compromised tissue quality. Rehabilitation usually can be initiated immediately with protected weight-bearing in an orthosis, safe-zone knee passive range of motion, and avoidance of active extension. After a period of 6 weeks, rehabilitation can progress with full range of motion and a concentric strengthening program.


Subject(s)
Patellar Ligament , Tendon Injuries , Humans , Patellar Ligament/surgery , Tendon Injuries/diagnostic imaging , Tendon Injuries/surgery , Patella/surgery , Biomechanical Phenomena , Tendons/surgery , Rupture/surgery , Suture Techniques , Suture Anchors
5.
Am J Sports Med ; 50(11): 2925-2934, 2022 09.
Article in English | MEDLINE | ID: mdl-35980007

ABSTRACT

BACKGROUND: Anterior cruciate ligament (ACL) trauma and ACL reconstruction (ACLR) are associated with the loss of strength and function of the muscles that span the knee joint. The underlying mechanism associated with this is not completely understood. PURPOSE: To determine whether the duration of tourniquet use during ACLR has an effect on knee extensor muscle contractile function and size at the cellular (ie, fiber) level 3 weeks after surgery and at the whole-muscle level at 6 months after surgery. STUDY DESIGN: Descriptive laboratory study and case series; Level of evidence, 4. METHODS: Study participants sustained an acute, first-time ACL injury. All participants underwent ACLR with the use of a tourniquet placed in a standardized location on the thigh; the tourniquet was inflated (pressure range, 250-275 mm Hg), and the time of tourniquet use during surgery was documented. Participants were evaluated 1 week before surgery (to measure patient function, strength, and subjective outcome with the Knee injury and Osteoarthritis Outcome Score [KOOS] and International Knee Documentation Committee [IKDC] score), at 3 weeks after ACLR surgery (to obtain muscle biopsy specimens of the vastus lateralis and assess muscle fiber cross-sectional area, contractile function, and mitochondrial content and morphometry), and at 6 months after ACLR (to evaluate patient function, strength, and subjective outcomes via KOOS and IKDC scores). Data were acquired on both the injured/surgical limb and the contralateral, normal side to facilitate the use of a within-subjects study design. Results are based on additional analysis of data acquired from previous research that had common entry criteria, treatments, and follow-up protocols. RESULTS: At 3 weeks after ACLR, the duration of tourniquet use at the time of surgery did not explain the variation in single-muscle fiber contractile function or cross-sectional area (myosin heavy chain [MHC] I and II fibers) or subsarcolemmal and intermyofibrillar mitochondrial content or morphometry. At 6 months after ACLR, the duration of tourniquet use was not associated with the peak isometric and isokinetic torque measurements, patient function, or patient-reported outcomes. CONCLUSION: The duration of tourniquet use at the time of ACLR surgery did not explain variation in muscle fiber size, contractile function, or mitochondrial content at 3 weeks after surgery or strength of the quadriceps musculature or patient-reported function or quality of life at 6-month follow-up.


Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction/methods , Humans , Knee Joint/surgery , Muscle Strength/physiology , Quadriceps Muscle/physiology , Quality of Life , Thigh/surgery , Tourniquets/adverse effects
6.
J Orthop Res ; 40(3): 727-737, 2022 03.
Article in English | MEDLINE | ID: mdl-33969521

ABSTRACT

Muscle dysfunction following anterior cruciate ligament reconstruction (ACLR) may evolve from alterations in muscle contractility at the myofilament protein level. Using a prospective, within-subject case-control design, we evaluated cellular-level contractility, cross-sectional area (CSA), and myosin heavy chain (MHC) isoform expression on single muscle fibers 3 weeks post ACLR, and evaluated their relationship to whole muscle strength and patient-oriented outcomes 6 months post operation. Biopsies of the vastus lateralis were performed 3 weeks post ACLR in 11 subjects (5 females, mean age ± SD = 24.7 ± 6.5 years, height = 172.7 ± 8.2 cm, mass = 75.7 ± 12.5 kg) following first-time ACL rupture and whole muscle strength and self-reported pain, function, and quality of life assessed 6 months post ACLR. At 3 weeks post ACLR, force production was reduced (p < 0.01) in MHC I (-36%) and IIA (-48%) fibers compared with the non-injured leg. When force production was expressed relative to CSA to account for fiber atrophy, reductions remained in MHC IIA fibers (-40%; p < 0.001), but MHC I fibers showed only a trend toward being lower (-13%; p = 0.09). Finally, skeletal muscle fiber functional deficits at 3 weeks post ACLR were associated with whole muscle weakness and less favorable patient-reported outcomes at 6-month follow-up. Thus, ACLR promotes early cellular contractile dysfunction that may contribute to decreased whole muscle strength and patient function, and increased patient-reported symptoms, at 6-month follow-up.


Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament Reconstruction/adverse effects , Female , Follow-Up Studies , Humans , Male , Muscle Fibers, Skeletal , Muscle Strength/physiology , Prospective Studies , Quadriceps Muscle , Quality of Life
7.
Knee Surg Sports Traumatol Arthrosc ; 30(7): 2291-2297, 2022 Jul.
Article in English | MEDLINE | ID: mdl-34800136

ABSTRACT

PURPOSE: Injury to the anterior cruciate ligament (ACL) is common in alpine skiing in the form of either an intra-substance ACL tear or anterior tibial spine fracture (ATSF). Anterior tibial spine fractures are typically reported in children. However, several case reports describe these injuries in adults while skiing. The purpose of this study is to describe the sport specific incidence of ATSF in alpine skiing. METHODS: The study was conducted over a 22-year period. Skiers who suffered an ATSF were identified and radiographs were reviewed to confirm the diagnosis. Additionally, control data from intra-substance ACL injury groups were collected. The incidence of these injuries in children, adolescents, and adults (grouped as ages 0-10, 11-16, and 17 + years old, respectively) was evaluated and the risk factors for ATSF versus ACL tear were determined. RESULTS: There were 1688 intra-substance ACL and 51 ATSF injuries. The incidence of intra-substance ACL injury was greater in adults (40.0 per 100,000 skier days) compared to the adolescent (15.4 per 100,000) and child (1.1 per 100,000) age groups. In contrast, the incidence of ATSF was similar in the adult (0.9 per 100,000), adolescent (1.9 per 100,000), and child (1.9 per 100,000) age groups. Loose ski boot fit was identified as a risk factor for ATSF. CONCLUSION: The incidence of ATSF in alpine skiers is similar among all age groups. However, the incidence of intra-substance ACL injuries is far greater in adult skiers compared to adolescents and children. Risk factors for ATSF relate to compliance between the foot/ankle and the ski boot. LEVEL OF EVIDENCE: III.


Subject(s)
Anterior Cruciate Ligament Injuries , Skiing , Spinal Fractures , Tibial Fractures , Adolescent , Adult , Anterior Cruciate Ligament Injuries/epidemiology , Anterior Cruciate Ligament Injuries/etiology , Child , Humans , Incidence , Infant, Newborn , Skiing/injuries , Spinal Fractures/complications , Tibial Fractures/complications , Tibial Fractures/epidemiology
8.
Am J Sports Med ; 48(10): 2429-2437, 2020 08.
Article in English | MEDLINE | ID: mdl-32631074

ABSTRACT

BACKGROUND: Anterior cruciate ligament (ACL) injuries and reconstruction (ACLR) promote quadriceps muscle atrophy and weakness that can persist for years, suggesting the need for more effective rehabilitation programs. Whether neuromuscular electrical stimulation (NMES) can be used to prevent maladaptations in skeletal muscle size and function is unclear. PURPOSE: To examine whether early NMES use, started soon after an injury and maintained through 3 weeks after surgery, can preserve quadriceps muscle size and contractile function at the cellular (ie, fiber) level in the injured versus noninjured leg of patients undergoing ACLR. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Patients (n = 25; 12 men/13 women) with an acute, first-time ACL rupture were randomized to NMES (5 d/wk) or sham (simulated microcurrent electrical nerve stimulation; 5 d/wk) treatment to the quadriceps muscles of their injured leg. Bilateral biopsies of the vastus lateralis were performed 3 weeks after surgery to measure skeletal muscle fiber size and contractility. Quadriceps muscle size and strength were assessed 6 months after surgery. RESULTS: A total of 21 patients (9 men/12 women) completed the trial. ACLR reduced single muscle fiber size and contractility across all fiber types (P < .01 to P < .001) in the injured compared with noninjured leg 3 weeks after surgery. NMES reduced muscle fiber atrophy (P < .01) through effects on fast-twitch myosin heavy chain (MHC) II fibers (P < .01 to P < .001). NMES preserved contractility in slow-twitch MHC I fibers (P < .01 to P < .001), increasing maximal contractile velocity (P < .01) and preserving power output (P < .01), but not in MHC II fibers. Differences in whole muscle strength between groups were not discerned 6 months after surgery. CONCLUSION: Early NMES use reduced skeletal muscle fiber atrophy in MHC II fibers and preserved contractility in MHC I fibers. These results provide seminal, cellular-level data demonstrating the utility of the early use of NMES to beneficially modify skeletal muscle maladaptations to ACLR. CLINICAL RELEVANCE: Our results provide the first comprehensive, cellular-level evidence to show that the early use of NMES mitigates early skeletal muscle maladaptations to ACLR. REGISTRATION: NCT02945553 (ClinicalTrials.gov identifier).


Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction , Electric Stimulation Therapy , Quadriceps Muscle/physiology , Anterior Cruciate Ligament Injuries/surgery , Female , Humans , Male , Muscle Contraction , Muscle Fibers, Skeletal/physiology , Muscle Strength , Organ Size
9.
J Orthop Trauma ; 34(4): 186-192, 2020 Apr.
Article in English | MEDLINE | ID: mdl-31688408

ABSTRACT

OBJECTIVE: To compare the clinical and radiographic outcomes between patients treated with fibula allograft-augmented locking compression fixation and patients treated with locking compression fixation alone for 2- and 3-part proximal humeral fractures with varus displacement. DESIGN: Retrospective review. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: One hundred two patients treated with locking plate fixation ± fibular allograft augmentation confirmed intraoperatively by visual inspection to have varus-angulated, 2- and 3-part proximal humerus fractures with at least 45 degrees of varus angulation at the neck/shaft and at least 1 cm of displacement. INTERVENTION: Proximal humerus locking plate (PHILOS; Synthes, Paoli, PA) with or without fibula allograft augmentation. MAIN OUTCOME MEASUREMENTS: Statistical analysis to determine the differences between fractures treated with locking compression fixation ± fibula allograft augmentation regarding complications, shoulder reported outcome measures, and patient ROMs (Visual Analog Score (VAS), Disabilities of the Arm, Shoulder and Hand, and Simple Shoulder Test scores). Medical comorbidities as potential risk factors for complication from surgery were also evaluated. RESULTS: Of 102 surgical cases, 27 were augmented with fibula allograft and 75 were not. Postoperatively, there were 16 noncatastrophic varus collapses of the fracture, 6 catastrophic varus collapses, and 5 deaths. Addition of fibula allograft did not significantly affect postoperative varus collapse, shoulder ROM, pain, or PROMs. CONCLUSION: Addition of fibula allograft to patients sustaining varus-angulated, 2- and 3-part proximal humeral fractures conferred no benefit to patient outcomes at our institution. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Subject(s)
Fibula , Shoulder Fractures , Allografts , Bone Plates , Fibula/surgery , Fracture Fixation, Internal , Humans , Retrospective Studies , Shoulder Fractures/diagnostic imaging , Shoulder Fractures/surgery , Treatment Outcome
10.
Sports Health ; 11(1): 18-26, 2019.
Article in English | MEDLINE | ID: mdl-30782106

ABSTRACT

CONTEXT:: Alpine skiing is a popular sport worldwide but has significant risk for injury. The epidemiology of skiing-related injuries has been described, which has led to the identification of risk factors for specific types of injuries. EVIDENCE ACQUISITION:: Pertinent literature from peer-reviewed publications was reviewed. STUDY DESIGN:: Clinical review. LEVEL OF EVIDENCE:: Level 5. RESULTS:: The adoption of international standards for ski-boot-binding systems has changed the profile of skiing-related injuries over time, as has the widespread use of helmets. An understanding of mechanisms of injury, risk factors, and preventative measures may decrease the incidence of skiing-related injuries. CONCLUSION:: Advances in standards for skiing equipment have been effective at decreasing both the frequency and severity of skiing-related injuries, but additional efforts are required to improve the safety of the sport.


Subject(s)
Skiing/injuries , Age Distribution , Craniocerebral Trauma/epidemiology , Craniocerebral Trauma/prevention & control , Head Protective Devices , Humans , Incidence , Lower Extremity/injuries , Neck Injuries/epidemiology , Neck Injuries/prevention & control , Risk Factors , Sex Distribution , Sports Equipment , United States/epidemiology , Upper Extremity/injuries
11.
Sports Health ; 11(3): 265-271, 2019.
Article in English | MEDLINE | ID: mdl-30689522

ABSTRACT

CONTEXT: This article reviews the epidemiology of alpine ski racing-related injuries, risk factors, mechanisms of injury, and injury prevention strategies. EVIDENCE ACQUISITION: Pertinent literature from peer-reviewed publications from 1976 through 2018. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 5. RESULTS: The rate of injury in alpine ski racing is high. In general, knee injuries are the most common, with anterior cruciate ligament (ACL) disruptions being the most significant in terms of time loss from sport. Three specific mechanisms of ACL injury in alpine ski racers have recently been described (slip-catch, dynamic snowplow, and landing back-weighted). In contrast to other sports, female ski racers are not clearly at greater risk for ACL injury, especially at the highest level of competition. A high percentage of ski racers are able to return to their previous level of competition after ACL injury. Risk factors for injury and methods of injury prevention have been proposed; however, the rate of injury, particularly ACL injuries, has not decreased significantly. CONCLUSION: Alpine ski racing has a high injury rate. ACL injuries in particular remain problematic. Further study is needed to identify modifiable risk factors and implementation of injury prevention strategies.


Subject(s)
Athletic Injuries/epidemiology , Skiing/injuries , Age Factors , Anterior Cruciate Ligament Injuries/epidemiology , Humans , Incidence , Risk Factors , Sex Factors
12.
Orthopedics ; 41(5): 256-260, 2018 Sep 01.
Article in English | MEDLINE | ID: mdl-30231184

ABSTRACT

Osteoarthritis has one of the highest associations for all-cause mortality in the United States. Comorbidities are common in patients with end-stage disease. In most cases, it is critical to exhaust conservative modalities of care before resorting to surgical intervention. This article discusses common conservative approaches focusing on injectable treatments that can be employed prior to total knee replacement. [Orthopedics. 2018; 41(5):256-260.].


Subject(s)
Conservative Treatment/methods , Hyaluronic Acid/administration & dosage , Osteoarthritis, Knee/therapy , Platelet-Rich Plasma , Stem Cell Transplantation , Steroids/administration & dosage , Humans , Injections, Intra-Articular
13.
Curr Rev Musculoskelet Med ; 11(2): 231-240, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29744697

ABSTRACT

PURPOSE OF REVIEW: Trochlear dysplasia is a well-described risk factor for patellar instability. Trochleoplasty has emerged as a procedure within the surgical armamentarium for patellar instability, yet its role is unclear. A variety of trochleoplasty procedures have emerged. The purpose of this review is to clarify indications for trochleoplasty, outline the technical steps involved in performing common trochleoplasties and report the published outcomes and potential complications of these procedures. RECENT FINDINGS: Patellar instability with severe trochlear dysplasia is the main indication for trochleoplasty. Three types of trochleoplasty have emerged: (1) lateral facet elevation; (2) sulcus deepening; and (3) recession wedge. Deepening and recession wedge trochleoplasties are the most commonly performed. Trochleoplasty is a surgical option for addressing patellar instability in patients with severe trochlear dysplasia. Deepening and recession wedge trochleoplasties that address Dejour B and D dysplastic trochleas are the most studied, with both short- and midterm outcomes reported. Long-term outcomes are lacking and comparative studies are needed.

14.
Curr Rev Musculoskelet Med ; 11(2): 285-289, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29675743

ABSTRACT

PURPOSE OF REVIEW: The goal of this paper is to review the biomechanical and clinical rationale for single-bundle versus double-bundle posterior cruciate ligament (PCL) reconstruction. The primary question is whether there has been demonstrated any clear biomechanical or clinical superiority of a double-bundle reconstruction over a single-bundle reconstruction. RECENT FINDINGS: There is some recent evidence demonstrating biomechanical superiority of double-bundle versus single-bundle reconstruction; however, this is not definitive. Clinical superiority has not been clearly demonstrated as of yet. The primary question which served as the basis of this review remains unanswered. There is recent biomechanical data to suggest a potential benefit of double-bundle versus single-bundle reconstruction, but not all studies are in agreement. Furthermore, the possible biomechanical advantages have not yet been borne out in clinical studies. At this point, we cannot clearly recommend one technique versus another and the decision should be left to the treating surgeon.

15.
Arthroscopy ; 33(12): 2284-2286, 2017 Dec.
Article in English | MEDLINE | ID: mdl-29198361

ABSTRACT

It was an honor to be selected to participate in the 2017 Arthroscopy Association of North America Advanced Arthroscopy Traveling Fellowship. This year's group included Michael J. Alaia, M.D., Assistant Professor and Associate Sports Medicine Fellowship Director at NYU Hospital for Joint Diseases; Nathan K. Endres, M.D., Associate Professor at the University of Vermont; LCDR Patrick W. Joyner, M.D., Assistant Professor at Naval Medical Center Portsmouth, and Head Physician East Coast Navy Seals; and LTC Christopher J. Tucker, M.D., Assistant Professor at the Uniformed Services University and Chief of Sports Service at Fort Belvoir Community Hospital. This year, we were honored to have a true pioneer in sports medicine and arthroscopic surgery, Dr. Jack M. Bert, Past President of Arthroscopy Association of North America and Adjunct Clinical Professor at the University of Minnesota, serve as our Godfather.


Subject(s)
Fellowships and Scholarships , Orthopedic Surgeons , Travel , Humans , North America , Societies, Medical
16.
Am J Sports Med ; 40(4): 770-6, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22268231

ABSTRACT

BACKGROUND: Participation in snowboarding as a winter sport is comparable to alpine skiing concerning the demographics of the participants, risk of injury, and variation in types of injuries sustained. PURPOSE: To examine the types of snowboarding injuries and changes in injury patterns over time. We also sought to highlight important differences in injury patterns between snowboarders and alpine skiers as affected by age, experience, and sex. STUDY DESIGN: Case control; Level of evidence, 3. METHODS: Data were collected on injured snowboarders and skiers in a base-lodge clinic of a ski resort in Vermont over 18 seasons (1988-2006) and included extensive information about injury patterns, demographics, and experience. Control data were also obtained during this time period to provide information about the population at risk. RESULTS: The injury rates were assessed as mean days between injuries (MDBI). The average MDBI for all injuries among snowboarders was 345 as compared with 400 for skiers (the lower the number, the higher the injury rate). The most common type of injury for snowboarders was a wrist injury (MDBI, 1258), while for skiers, it was an anterior cruciate ligament (ACL) sprain (MDBI, 2332). Wrist injuries accounted for 27.6% of all snowboard injuries and 2.8% of skiing injuries, and ACL injuries composed 1.7% of all snowboard injuries and 17.2% of skiing injuries. Among snowboarders, more wrist injuries, shoulder soft tissue injuries, ankle injuries, concussions, and clavicle fractures were seen, while skiers had more ACL sprains, medial collateral ligament (MCL) sprains of the knee, lateral collateral ligament (LCL) sprains of the knee, lower extremity contusions, and tibia fractures. The trend analysis revealed an increased incidence of clavicle fractures (P < .01) and a decrease in MCL injuries (P < .01) and ankle injuries (P < .025) among snowboarders over time. Skiers had a decrease in thumb metacarpophalangeal-ulnar collateral ligament (MCP-UCL) injuries (P < .001) and MCL injuries of the knee (P < .001) over time. We found the highest rate of injury among young, inexperienced, female snowboarders. When examining the location of injury, 21.8% of snowboard injuries occurred in the terrain park compared with 6.5% of ski injuries. CONCLUSION: Injury rates in snowboarders have fluctuated over time but currently remain higher than in skiers. Wrist, shoulder, and ankle injuries are more common among snowboarders, while knee ligament injuries are more common in skiers. Injured snowboarders were significantly younger, less experienced, and more likely to be female than injured skiers or snowboard control participants. We did not find any evidence that those who spend time in terrain parks are overrepresented in the injury population.


Subject(s)
Athletic Injuries/classification , Athletic Injuries/epidemiology , Skiing/injuries , Adolescent , Adult , Case-Control Studies , Female , Humans , Male , Prospective Studies , Surveys and Questionnaires , Vermont/epidemiology , Young Adult
18.
J Shoulder Elbow Surg ; 19(3): 446-51, 2010 Apr.
Article in English | MEDLINE | ID: mdl-19800259

ABSTRACT

HYPOTHESIS: The management options for proximal humeral fractures have expanded in recent years. Patients with displaced, unstable proximal humeral fractures may have improved outcomes if managed operatively. We investigated the decision making of fellowship-trained orthopedic surgeons when presented with the same group of cases. We hypothesized that interobserver and intraobserver agreement for surgical management would be poor and independent of fellowship training. METHOD: Eight fellowship-trained orthopedic surgeons (3 shoulder, 5 trauma) viewed the preoperative plain radiographs of patients with proximal humeral fractures. All surgeons viewed the same 38 radiographs in a blinded fashion. Surgeons chose from 1 of 6 management options. Interobserver variability was calculated by using the weighted kappa coefficient. Intraobserver variability was calculated by comparing each surgeon's survey results with the operation they originally performed. RESULTS: Overall interobserver agreement on management was moderate (weighted kappa=0.41) and did not differ significantly between trauma surgeons and shoulder surgeons. Reducing the number of management choices increased agreement between all surgeons. Testing for intraobserver agreement showed that surgeons picked the same operation in the survey as in the actual clinical setting only 56% of the time. CONCLUSION: Interobserver agreement was moderate overall and improved when the number of management choices was reduced. Intraobserver agreement was less frequent, however, raising the question about consistent decision making by a given surgeon. Although surgeons agree in the method of treatment only to a modest degree, it remains for further outcomes research to establish if the choice of treatment actually influences the clinical outcome.


Subject(s)
Orthopedic Procedures/methods , Shoulder Fractures/surgery , Attitude of Health Personnel , Decision Making , Fellowships and Scholarships , Humans , Orthopedics
20.
Instr Course Lect ; 57: 153-66, 2008.
Article in English | MEDLINE | ID: mdl-18399577

ABSTRACT

The management of massive, irreparable rotator cuff tears is challenging. Arthroscopic débridement has produced reasonable short-term outcomes in patients who experience good relief from pain and improved range of motion after a subacromial injection with local anesthetic. Arthroscopic débridement with partial repair also has resulted in good outcomes, especially in patients with documented suprascapular nerve traction neurapraxia. Tendon transfer can offer a long-lasting solution in a patient with a weak shoulder who still has the ability to raise the shoulder past the horizontal position. Shoulder replacement with the use of a reverse prosthesis has emerged as a viable option in patients with pseudoparalysis with or without osteoarthritis of the glenohumeral joint.


Subject(s)
Arthroscopy/methods , Rotator Cuff Injuries , Salvage Therapy/methods , Shoulder Injuries , Tendon Injuries/surgery , Tendon Transfer/methods , Debridement/methods , Humans , Rotator Cuff/surgery , Rupture , Tendon Injuries/diagnosis , Trauma Severity Indices
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