Injuries Sustained by the Mixed Martial Arts Athlete.

CONTEXT: Mixed martial arts (MMA) is rapidly growing in popularity in the United States and abroad. This combat sport joins athletes from a wide variety of martial art disciplines, each with characteristic and distinguishing injury profiles, together in competition. Because of increasing participation by professionals and amateurs alike, injuries sustained by MMA athletes have been on the rise. EVIDENCE ACQUISITION: A review of relevant publications using the search term mixed martial arts and each of its component combat sports (eg, Muay Thai, Brazilian jiu-jitsu) from 1980 through 2015 was completed using PubMed and Google Scholar. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 5. RESULTS: The majority of studies on MMA injuries evaluate those sustained during competition, which range in incidence from 22.9 to 28.6 per 100 fight-participations. Striking-predominant disciplines such as boxing, karate, and Muay Thai have high rates of head and facial injuries, whereas submission-predominant disciplines such as Brazilian jiu-jitsu, judo, and wrestling have high rates of joint injuries. CONCLUSION: Numerous studies have evaluated injuries in athletes who participate in MMA and its component disciplines during competition but much remains to be discovered about injuries sustained during training and in specific patient populations such as adolescents and women.

Development of a surgical skills curriculum for the training and assessment of manual skills in orthopedic surgical residents.

OBJECTIVE: To develop and conduct a pilot study of a curriculum of 4 surrogate bone training modules to assess and track progress in basic orthopedic manual skills outside the operating room. DESIGN: Four training modules were developed with faculty and resident input. The modules include (1) cortical drilling, (2) drill trajectory, (3) oscillating saw, and (4) pedicle probing. Orthopedic resident's performance was evaluated. Validity and reliability results were calculated using standard analysis of variance and multivariate regression analysis accounting for postgraduate year (PGY) level, number of attempts, and specific outcome target results specific to the simulation module. SETTING: St. Mary's Medical Center in San Francisco, CA. PARTICIPANTS: These modules were tested on 15 orthopedic surgery residents ranging from PGY 1 to PGY 5 experience. RESULTS: The cortical drilling module had a mean success rate of 56% ± 5%. There was a statistically significant difference in performance according to the diameter of the drill used from 33% ± 7% with large diameter to 70% ± 6% with small diameter. The drill trajectory module had a success rate of 85% ± 3% with a trend toward improvement across PGY level. The oscillating saw module had a mean success rate of 25% ± 5% (trajectory) and 84% ± 6% (depth). We observed a significant improvement in trajectory performance during the second attempt. The pedicle probing module had a success rate of 46% ± 10%. CONCLUSION: The results of this pilot study on a small number of residents are promising. The modules were inexpensive and easy to administer. Conclusions of statistical significance include (1) residents who could easily detect changes in surrogate bone thickness with a smaller diameter drill than with a larger diameter drill and (2) residents who significantly improved saw trajectory with an additional attempt at the module.

Acetabular labral tear and postpartum hip pain.

OBJECTIVE: To educate the obstetrics community regarding postpartum labral tears, an avoidable and treatable potential complication of pregnancy in the postpartum period. METHODS: From 2009 to 2011, 10 women presented to the second author's office with persistent hip pain that had begun during pregnancy or during delivery. These 10 postpartum women presented with signs and symptoms of labral tears, which were subsequently confirmed with arthroscopy and surgically repaired. RESULTS: Each patient experienced relief of symptoms within 4 months after the procedure. All patients were satisfied with surgery, and all patients had improvement in modified Harris hip score. The average preoperative modified Harris hip score was 53.1 and the average postoperative modified Harris hip score was 84.3 (P<.001). CONCLUSION: An acetabular labral tear should be considered part of the differential diagnosis for hip pain in postpartum women. Additionally, freeing the distal lower extremity to externally rotate during labor may prevent an acute labral tear. When nonoperative management fails, surgery may lead to positive outcomes. LEVEL OF EVIDENCE: II.

Clinical follow-up of professional baseball players undergoing ulnar collateral ligament reconstruction using the new Kerlan-Jobe Orthopaedic Clinic overhead athlete shoulder and elbow score (KJOC Score).

BACKGROUND: There are no validated outcome measures consistently used in the literature to report results of ulnar collateral ligament reconstruction in overhead athletes. HYPOTHESIS: The Kerlan-Jobe Orthopaedic Clinic Overhead Athlete Shoulder and Elbow score (KJOC score) will correlate with other validated scores for upper extremity assessment but will be more accurate in evaluating ulnar collateral ligament reconstruction outcomes in professional baseball players. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Fifty-five professional baseball players who underwent ulnar collateral ligament reconstruction were asked to complete the KJOC score, the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the DASH sports module. Players were separated into 3 categories-(1) playing without pain, (2) playing with pain, and (3) not playing because of pain-and compared with 123 asymptomatic throwers. Pearson (parametric) and Spearman rank (nonparametric) correlations among the 3 systems were conducted to validate the KJOC score. Means across categories were compared using a Wilcoxon rank-sum test, and a threshold score separating categories 1 and 3 was determined using receiver operator characteristic discrimination analysis. RESULTS: Significant correlations were found between the KJOC score and the DASH (-.693, P < .0001), and the DASH sports module (-0.804, P < .0001). Only the KJOC score was able to discriminate between categories 2 and 3, as well as category 1 and the uninjured population. In addition, the KJOC score was the most sensitive and accurate method of discriminating category 1 from category 3, with a threshold score of 81.3. CONCLUSION: The results of this study validate the use of the KJOC score for evaluation of overhead athletes undergoing ulnar collateral ligament reconstruction. The KJOC score is the most sensitive score for detecting subtle changes in performance in the throwing athlete.