Anterior Cruciate Ligament Injuries in Baseball Players.

PURPOSE: To determine common mechanisms of anterior cruciate ligament (ACL) injury in baseball players and to quantify the rate of return to play after primary surgical reconstruction and review intermediate clinical outcomes. METHODS: Surgical injuries involving the ACL in youth, high school, collegiate, and professional baseball players were queried for an 11-year period (2001 to 2011). Over the study period, 42 baseball players were identified who had undergone arthroscopically assisted primary ACL reconstruction by 1 of 3 attending surgeons. Retrospective chart review was performed for all 42 patients to evaluate variables of age, level of competition, position, mechanism of injury, graft choice, and associated meniscal injuries. Twenty-six patients were reached for telephone survey and International Knee Documentation Committee questionnaire and they answered questions about their original injury and playing history. RESULTS: The most common mechanism of injury was fielding, followed by base running. Infielders and outfielders (32% each) were the most commonly injured position, followed by pitchers (29%). Among the 32 players for whom it could be determined, 30 (94%) were able to return to playing baseball at a mean follow-up of 4.2 years (range 1.0 to 9.9 years). The mean International Knee Documentation Committee score was 84.0 (range 63 to 91). Among the 26 patients contacted for telephone interview, no one required revision ACL surgery, but 3 required a subsequent procedure for meniscal tear. Twenty-five patients (96%) denied any episodes of instability in the knee after reconstruction. CONCLUSIONS: The overwhelming majority of baseball players that sustain ACL injuries do so while fielding or base running. Outfielders are significantly more likely than infielders to suffer ACL injuries while fielding versus base running. The results with respect to return to play are promising, as nearly all patients were able to return to baseball and none required a revision ACL surgery at a mean follow-up of 4.2 years. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Symptomatic Heterotopic Ossification After Ulnar Collateral Ligament Reconstruction: Clinical Significance and Treatment Outcome.

BACKGROUND: Ulnar collateral ligament (UCL) reconstruction is an increasingly common procedure being performed in overhead throwing athletes. Recently, postoperative imaging has revealed the presence of heterotopic ossification (HO) in symptomatic patients. PURPOSE: To determine the incidence of symptomatic HO after UCL reconstruction as well as the clinical outcomes after nonoperative or operative treatment of HO. STUDY DESIGN: Case series, Level of evidence, 4. METHODS: A search was performed of diagnostic codes for all UCL reconstructions at a single institution between 2002 and 2012, and the charts were then reviewed of patients who returned to clinic for symptomatic HO after UCL reconstruction. All relevant clinical information, imaging findings, and return-to-play data were obtained. RESULTS: Eight patients were found to have developed symptomatic HO after UCL reconstruction. Of the 8 patients, 6 had gracilis tendon autograft at their primary surgery. All 8 patients had HO on the proximal end of their graft. Two patients were treated nonoperatively, and the remainder had excision of HO performed either arthroscopically or open. Six patients were able to return to the same or higher level of competition after treatment of HO. CONCLUSION: Symptomatic HO after UCL reconstruction is very uncommon but may prove to be a significant complication among athletes. With appropriate treatment, the majority of patients were able to return to the same level of play. Early identification of this complication is important, as revision surgery with excision of osteophytes resulted in a return to a similar level of play in most patients.

Return to play after chondroplasty of the knee in National Football League athletes.

BACKGROUND: Knee injuries, including articular cartilage damage, are common in football players and are potentially career threatening. The rate of return to play (RTP) as well as the factors affecting return after arthroscopic chondroplasty of the knee is performed in National Football League (NFL) athletes are not known. PURPOSE: To determine the rate of return to regular season NFL competition after arthroscopic knee surgery including chondroplasty of articular cartilage lesions. In addition, identification of factors that influence successful return was investigated. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Athletes in the NFL who underwent arthroscopic chondroplasty at a single institution were identified. Retrospective chart review and review of the NFL online database were utilized to determine the rate of RTP and factors affecting an athlete's ability to return. Chi-square and Student t tests were used to assess differences among players who were and were not able to RTP, and logistic regression was employed to determine a player's odds of return. RESULTS: There were 52 patients (54 procedures) identified from the surgical database who met the inclusion criteria for the study operated on between August 1, 2001, and March 31, 2011. Of these players, 36 (67%) were able to return to regular season NFL game play at an average of 8.2 months, including 13 (24%) who were still active in the NFL. The average time to follow-up was 5.9 years, and all players were allowed at least 2 years of follow-up. There was no significant correlation of RTP to athlete age, lesion size, lesion location, position played, or round selected in the NFL draft. Players who underwent concomitant microfracture were 4.4 times less likely to return to the NFL than were those who did not undergo this procedure (95% CI, 1.3-15.5). Athletes who played more than 11.6 games per season were 4.7 times more likely to RTP than were those who played fewer games per season (95% CI, 1.4-16.6). Athletes who returned to play competed in 56 fewer games, 3.3 fewer seasons, and played in 3.2 fewer games per season compared with their level of competition before surgery. CONCLUSION: A majority (67%) of NFL players are able to RTP after arthroscopic knee surgery including chondroplasty of articular cartilage lesions. Athletes who play more games per season are more likely to RTP after chondroplasty of articular cartilage lesions of the knee, but those undergoing concomitant microfracture are less likely to return. No statistical significance was determined when comparing the athletes who returned to play with respect to age at surgery, lesion location, lesion size, lesion grade, position that the athlete played, or draft round.