Outcomes After Medial Ulnar Collateral Ligament Graft Repair in Professional Baseball Pitchers With Minimum 2-Year Follow-up.

Background: Rerupture of the reconstructed ulnar collateral ligament (UCL) is becoming more frequent at the professional level of baseball. However, there is no literature describing outcomes after UCL graft repair. Purpose: To evaluate rerupture rate, return to play, performance upon return, and patient-reported outcomes after a novel UCL graft repair technique. Study Design: Case series; Level of evidence, 4. Methods: All included patients underwent UCL graft repair after a previous UCL reconstruction, pitched in at least 1 professional baseball game before repair, and were at least 2 years postprocedure within the same 10-year time period. The authors evaluated patient characteristics and performance metrics, including wins, losses, win percentage, earned run average, innings pitched, walks and hits per inning pitched, for the 2 seasons before and after the procedure. Patients were contacted to assess UCL rerupture, timing of return to sport, current level of competition, Conway score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score. Results: Six players met the inclusion criteria. All had proximal UCL graft ruptures and underwent flexor-pronator tendon repair in combination with graft repair. At a mean (±SD) follow-up of 56.7 ± 37.8 months, no reruptures were encountered, and the mean KJOC score was 87.9 ± 14.6. Of the 6 pitchers who underwent UCL graft repair, 4 (67%) returned to professional pitching at a mean of 17 ± 6 months. Three of the 6 (50%) achieved an excellent Conway score, signifying a return to prior level of sport. There was no significant difference in demographic or preoperative pitching performance metrics between players who did and did not return to pitching. For those players who returned to professional pitching, there was no significant difference between preprocedure and postprocedure performance statistics. Conclusion: Repair of the UCL graft appears to yield comparable rates of return to play and performance with revision UCL reconstruction. This technique serves as a viable alternative for proximal avulsion ruptures of the UCL graft.

Return to play after ulnar collateral ligament reconstruction with concurrent posterior-compartment decompression.

BACKGROUND: Medial ulnar collateral ligament (UCL) injuries and posterior elbow impingement commonly affect throwing athletes. Surgical intervention for each of these pathologies individually has been demonstrated to be successful with high return-to-play (RTP) rates. Our purpose was to report RTP rates for patients treated with concurrent UCL reconstruction (UCLR) and arthroscopic posterior débridement performed by the senior author. MATERIALS AND METHODS: We retrospectively reviewed all elbow medial UCL procedures performed by the senior author from January 2016 through September 2020. The inclusion criteria included an elbow medial UCL operation with arthroscopic posterior-compartment débridement in a throwing athlete. The exclusion criteria included isolated UCLR surgery, non-primary surgery, and revision UCLR with either autograft or allograft. Using a chart review and publicly available information, we were able to determine patients' playing levels after their operations. RESULTS: Twelve patients met the inclusion and exclusion criteria. The average age was 24.27 years (standard deviation, 4.92 years). Of the 12 patients, 10 returned to play at the same level (4 Major League Baseball players and 1 Triple A player) or at a higher level (2 players from Single A to Double A, 1 player from National Collegiate Athletic Association Division I to Single A, 1 player from rookie league to Single A, and 1 player from high school to National Collegiate Athletic Association Division I), 1 did not return to play, and 1 returned to play at a lower level, with an average RTP time of 14.64 months (standard deviation, 2.64 months). Of the 12 patients, 11 were pitchers; of these 11 pitchers, 9 had statistics available both before and after UCLR. Before UCLR, the average statistics for the pitchers were as follows: earned run average, 4.11 ± 0.85; walks and hits per inning pitched, 1.42 ± 0.26; strikeout-to-walk ratio, 3.00 ± 1.83; strikeouts per 9 innings, 8.80 ± 1.14; and innings pitched, 234.88 ± 316.74. After UCLR, their average statistics were as follows: earned run average, 5.24 ± 2.18 (P = .189); walks and hits per inning pitched, 1.55 ± 0.34 (P = .379); strikeout-to-walk ratio, 2.15 ± 0.98 (P = .263); strikeouts per 9 innings, 9.67 ± 1.91 (P = .293); and innings pitched, 138.71 ± 162.97 (P = .487). DISCUSSION AND CONCLUSION: Although surgical intervention to address both posterior impingement and UCL injury is relatively rare (comprising 8.5% of all the senior author's UCLR procedures), our experience demonstrates that primary UCLR with concurrent arthroscopic posterior decompression is a reliable, safe, and successful surgical treatment for patients with UCL injury and posterior impingement and our results show no significant difference in statistical performance in pitchers before surgery vs. after surgery.

The Impact of COVID-19 on Orthopedic Surgery Fellowship Training: A Survey of Fellowship Program Directors.

Background: The COVID-19 pandemic has had a wide-reaching impact. Graduate medical education of orthopedic surgeons was not spared from the jarring changes. Purpose: We sought to survey fellowship program directors in the field of orthopedic surgery about how the COVID-19 pandemic affected the education of the 2019 to 2020 and 2020 to 2021 fellowship classes and the future of their programs. Methods: In October 2020, an 18-item survey was distributed by an official of the American Academy of Orthopedic Surgeons (AAOS) to the specialty societies that govern fellowship training. Each specialty society then distributed the survey to its respective program directors. A reminder email was sent during the enrollment period. Each respondent was able to complete the survey once. Survey questions were grouped into 3 sections: general information about the fellowship training programs, the impact of COVID-19 on the 2019 to 2020 fellowship class, and the future impact of COVID-19 on the fellowship training programs. Results: Of the 564 accredited orthopedic surgery fellowship programs in the United States, 190 directors responded. Of these, 73.59% reported COVID-19 had a negative impact on the 2019 to 2020 fellowship class. A normal distribution of responses was found regarding didactic and academic learning, research, and mentorship opportunities. A majority of respondents said they believe that there will be no negative impact on patient care the fellows provide in the years to come. Conclusion: Orthopedic surgery fellowship program directors acknowledged that while there were negative effects to training in the pandemic, they did not think these would negatively affect patient care provided by 2019 to 2020 fellows in the short and medium term. They also reported positive outcomes from the experience of the pandemic, including new ways to educate fellows.

Arthroscopic Latarjet Procedure Utilizing a Latarjet With Cortical Button Fixation Performed in the Lateral Position.

Shoulder instability is a commonly seen pathology. The Latarjet procedure was first described in 1954 to address recurrent instability or patients with glenoid bone loss. Since its introduction, the procedure has been widely adopted and modified, including being performed all-arthroscopically. Various arthroscopic techniques have been described, but we present a technique performed in the lateral decubitus position that takes advantage of a pneumatic arm holder. After arthroscopic diagnosis, multiple accessory portals are established and used to accomplish the technique. Next, the coracoid is prepared and cut using a cannulated drill guide, followed by arthroscopic glenoid preparation using a cannulated drill system to ensure appropriate position of the coracoid. The subscapularis split is performed arthroscopically, and finally the coracoid is fixed with use of the EndoButton device.

Epidemiologic impact of COVID-19 on a multi-subspecialty orthopaedic practice.

The purpose of this study is to report the change in surgical case volume and composition encountered by a multi-subspecialty orthopaedic practice due to COVID-19. We reviewed electronic medical records for patients who had surgery at our institution and collected multiple variables including age and the joint that was operated on. In the post-COVID-19 period, we found a significant increase in the percentage of hip procedures, and a significant decrease in the percentage of hand/wrist procedures. Overall, the total surgical volume of our multi-subspecialty orthopaedic practice decreased due to the COVID-19 pandemic, and the composition of surgical cases changed.

Lumbosacral Transitional Vertebrae Predict Inferior Patient-Reported Outcomes After Hip Arthroscopy.

BACKGROUND: While the association between spinal disease and hip arthroplasty outcomes has been well studied, there is less known about the effect of spinal pathology in hip arthroscopy (HA) outcomes. Lumbosacral transitional vertebrae (LSTV) are anatomic variations where caudal vertebrae articulate or fuse with the sacrum or ilium. HYPOTHESIS: LSTV can lead to inferior outcomes after HA for treatment of femoroacetabular impingement. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively reviewed the prospectively collected Hip Arthroscopy Database at our institution for patients with LSTV who underwent HA between 2010 and 2017. A total of 62 patients with LSTV were identified and then matched to controls. Patient-reported outcome measures (PROMs) were collected, including the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports, and the 33-item International Hip Outcome Tool. They were collected at 4 time points: preoperatively and 5 to 11 months, 12 to 23 months, and 24 to 35 months postoperatively. Longitudinal analysis of the PROMs was done using generalized estimating equation modeling. Additionally, alpha angles were measured from preoperative radiographic data. RESULTS: Preoperatively, there was no significant difference between patients with and without LSTV on 3 of the 4 PROMs; however, patients with LSTV did have significantly lower preoperative scores than controls for the Hip Outcome Score-Activities of Daily Living (P = .029). Patients with LSTV reported significantly lower scores on all 4 PROMs at each postoperative time point. Radiographic data showed no significant difference in alpha angles across cohorts. When LSTV were compared by Castellvi type, types 3 and 4 tended to have lower scores than types 1 and 2; however, these comparisons were not significant. CONCLUSION: The data support our hypothesis that HA has less benefit in patients with LSTV as compared with patients without LSTV. In patients with LSTV, careful evaluation of the anomaly is recommended to help guide surgical counseling and manage expectations.

Improving Estimates of Annual Survival Rates for Medial Unicompartmental Knee Arthroplasty, a Meta-Analysis.

BACKGROUND: Medial unicompartmental knee arthroplasty (mUKA) is an increasingly popular treatment option for medial compartment knee osteoarthritis. Published mUKA survival rates have varied. The purpose of this meta-analysis was to provide pooled estimates of mUKA survival 5 and 10 years postoperatively. METHODS: We included studies in English within the last 15 years with a clear description of mUKA failure. Random-effects models were used to pool complementary log-log transformed implant survival estimates at 5 and 10 years postoperatively. Between-study variance was estimated using the restricted maximum likelihood method. Between-study heterogeneity was tested using the χ2 test and quantified using the I2 statistic. I2 values <25%, 25%-75%, and >75% were considered low, moderate, and high, respectively. Multivariable meta-regression was used to assess the potential association of mean patient age and study start year with survival estimates at 5 and 10 years. All analyses were performed using the metafor and meta packages implemented in R software version 3.3.4 (R Foundation for Statistical Computing, Vienna, Austria). RESULTS: Twenty-six studies met inclusion criteria, representing 42,791 knees. Study-level and pooled 5- and 10-year mUKA survival estimates were 95.3% (95% confidence interval, 93.6-96.6) and 91.3% (88.9-93.3), respectively. Between-study heterogeneity was high (>88%) for all years. Mean patient age and study start year explained only 12.3% and 30.7% of between-study heterogeneity at 5 and 10 years, respectively. CONCLUSION: Five- and 10-year pooled mUKA survival estimates were 95.3% and 91.3%, respectively. These data establish better estimates of mUKA survivorship and can help when counseling patients considering mUKA.