Preexisting Rotator Cuff Tears as a Predictor of Outcomes in National Football League Athletes.

BACKGROUND: A preexisting rotator cuff tear may affect the draft status and career performance of National Football League (NFL) players. HYPOTHESIS: Preexisting rotator cuff tears decrease a player's draft status, performance, and longevity in the NFL. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Medical reports of prospective NFL players during the NFL Scouting Combine from 2003 to 2011 were evaluated to identify players with a previous rotator cuff tear. Athletes were matched to control draftees without documented shoulder pathology by age, position, year drafted, and round drafted. Career statistics and performance scores were calculated. RESULTS: Between 2003 and 2011, 2965 consecutive athletes were evaluated. Forty-nine athletes had preexisting rotator cuff tears: 22 athletes underwent surgical intervention for their tear and 27 were treated nonoperatively. Those with a rotator cuff tear were significantly less likely to be drafted than those without a previous injury (55.1% vs 77.5%, P = 0.002). The 27 drafted athletes with preexisting rotator cuff tears started significantly fewer games (23.7 vs 43.0, P = 0.02) and played significantly fewer years (4.3 vs 5.7, P = 0.04) and significantly fewer games (47.1 vs 68.4, P = 0.04) than matched control athletes without rotator cuff tears. CONCLUSION: Athletes with a preexisting rotator cuff tear were less likely to be drafted and had decreased career longevity.

Patients' perceptions of the costs of total hip and knee arthroplasty.

With medical economics in the national sociopolitical spotlight, we conducted a study to assess patients' understanding of the cost of 2 common orthopedic procedures: total hip and knee arthroplasty (THA, TKA). We surveyed 284 consecutive THA or TKA patients, at their first postoperative visit, regarding their understanding of reimbursement and cost. On average, patients estimated surgeon reimbursement at $12,014. They estimated that the hospital was reimbursed $28,392 for their perioperative care and that it cost the hospital $24,389 to provide it. The cost of the implant used was estimated at $6447. There is wide variation in patients' estimates and understanding of health care costs. However, patients substantially overestimate reimbursement to the surgeon both in isolation and as a proportion of the total cost of the surgical procedure.

A Computed Tomography Study of Gender Differences in Acetabular Version and Morphology: Implications for Femoroacetabular Impingement.

PURPOSE: To assess the prevalence of acetabular retroversion in a large population of patients with asymptomatic hips. Furthermore, we sought to identify gender differences in acetabular morphology to address the current thinking that retroversion and pincer-type femoroacetabular impingement (FAI) are more common in women. METHODS: We retrospectively reviewed morphologic features of acetabula from a consecutive series of trauma-protocol computed tomography scans of patients without pelvis injury. An automated algorithm determined the acetabular rim profile and center of the femoral head, normalized the frontal plane of the pelvis, and calculated version and coverage. We then compared male and female rim profiles, specifically focusing on version and acetabular wall coverage in the 1-o'clock (anterosuperior), 2-o'clock (central), and 3-o'clock (inferior) positions. RESULTS: Of 1,088 patients in the database, 878 had complete data (i.e., age, ethnicity, and body mass index) and were therefore included in the final analysis. Of these, 34.3% were women and 65.7% were men. Mean global acetabular version was 19.1° for men and 22.2° for women (P < .001). Mean acetabular version for men and women was 15.5° and 18.3°, respectively, in the 1-o'clock position; 21.5° and 24.0°, respectively, in the 2-o'clock position; and 20.2° and 24.3°, respectively, in the 3-o'clock position (P < .001 for all 3). True retroversion (<0°) was observed only in the 1-o'clock position. The prevalence of true acetabular retroversion in the 1-o'clock position for men and women was 4.3% and 3%, respectively (P = .36). CONCLUSIONS: Mean global and focal acetabular anteversion was greater in women, and the prevalence of focal cephalad retroversion in the 1-o'clock position was not significantly different compared with men. Acetabular retroversion and anterior overcoverage are not more prevalent in women in the anterosuperior acetabulum, where femoroacetabular impingement most commonly occurs. LEVEL OF EVIDENCE: Level III, diagnostic study.