Prevalence of femoroacetabular impingement in elite baseball players.

CAM-type femoroacetabular impingement continues to be an underrecognized cause of hip pain in elite athletes. Properties inherent to baseball such as throwing mechanics and hitting may enhance the risk of developing a cam deformity. Our goal is to gain an appreciation of the radiographic prevalence of cam deformities in elite baseball players. Prospective evaluation and radiographs of 80 elite baseball players were obtained during the 2016 preseason entrance examination. A sports medicine fellowship-trained orthopedic surgeon with experience treating hip disorders used standard radiographic measurements to assess for the radiographic presence of cam impingement. Radiographs with an alpha angle >55° on modified Dunn views were defined as cam positive. Of the 122 elite baseball players included in our analysis, 80 completed radiographic evaluation. Only 7.3% (9/122) of players reported hip pain and 1.6% (4/244) had a positive anterior impingement test. The prevalence of cam deformities in right and left hips were 54/80 (67.5%) and 40/80 (50.0%), respectively. The mean alpha angle for cam-positive right and left hips were 64.7 ± 6.9° and 64.9 ± 5.8°, respectively. Outfielders had the highest risk of right-sided cam morphology (Relative Risk (RR) = 1.6). Right hip cam deformities were significantly higher in right-handed pitchers compared with left-handed pitchers (P = 0.02); however, there was no significant difference in left hip cam deformities between left- and right-handed pitchers (P = 0.307). Our data suggest that elite baseball players have a significantly higher prevalence of radiographic cam impingement than the general population.

Effect of Patient Height and Sex on the Patellar Tendon and Anterior Cruciate Ligament.

BACKGROUND: Graft-tunnel mismatch is an avoidable complication in anterior cruciate ligament (ACL) reconstruction. Patient height and sex may be predictors of patellar tendon length (PTL) and intra-articular ACL length (IAL). Understanding these relationships may assist in reducing graft-tunnel mismatch during ACL reconstruction with bone-patellar tendon-bone (BTB) autograft. PURPOSE: To determine the association of patient height and sex with PTL and IAL. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Magnetic resonance imaging (MRI) studies were obtained on the healthy knees of 100 male and 100 female patients. Patients with prior surgery, open physes, significant degenerative changes, ACL rupture, or extensor mechanism injury were excluded. Three independent readers measured PTL, IAL, and Caton-Deschamps Index (CDI) on MRI. Bivariate and linear regression analysis was performed to detect the association of anthropometric data with anatomic parameters measured on MRI studies. RESULTS: The mean age and body mass index were not significantly different between the male and female patients; however, male patients were significantly taller than female patients (1.75 vs 1.72 m, respectively; P < .001). There was a substantial agreement between the 3 readers for all parameters (κ > 0.75). Overall, female patients had significantly longer PTL (47.38 vs 43.92 mm), higher CDI (1.146 vs 1.071), and shorter IAL (33.05 vs 34.39 mm) (P < .001 for all). Results of the linear regression analysis demonstrated that both height and female sex were predictive of longer PTL. Further, height was independently predictive of IAL but sex was not. CONCLUSION: PTL was correlated more with patient sex than height. IAL was also correlated with patient sex. Longer BTB grafts are expected to be harvested in female patients compared with male patients of the same height despite shorter IAL. These associations should be considered during BTB ACL reconstruction to minimize graft-tunnel mismatch.

Total Hip Arthroplasty After Proximal Femoral Osteotomy: A Technique That Can Be Used to Address Presence of a Retained Intracortical Plate.

Total hip arthroplasty (THA) can be challenging in the setting of internal fixation devices previously placed in the proximal femur. When these devices are used in adolescent patients, endosteal hypertrophy can lead to significant bony overgrowth. Removal of these implants can result in significant cortical defects that may compromise the results of THA. This article describes a technique that can be used when a plate applied to the lateral femoral cortex has become "intracortical" as a result of extensive bony overgrowth. In using this technique to avoid plate removal, the surgeon eliminates the need for more extensive procedures aimed at compensating for deficiency of the femoral cortex in the area of plate removal.

Postoperative pain control after arthroscopic rotator cuff repair.

Arthroscopic rotator cuff repair (ARCR) can provide excellent clinical results for patients who fail to respond to conservative management of symptomatic rotator cuff tears. ARCR, however, can be associated with severe postoperative pain and discomfort that requires adequate analgesia. As ARCR continues to shift toward being performed as an outpatient procedure, it is incumbent on physicians and ambulatory surgical centers to provide appropriate pain relief with minimal side effects to ensure rapid recovery and safe discharge. Although intravenous and oral opioids are the cornerstone of pain management after orthopedic procedures, they are associated with drowsiness, nausea, vomiting, and increased length of hospital stay. As health care reimbursements continue to become more intimately focused on quality, patient satisfaction, and minimizing of complications, the need for adequate pain control with minimal complications will continue to be a principal focus for providers and institutions alike. We present a review of alternative modalities for pain relief after ARCR, including cryotherapy, intralesional anesthesia, nerve blockade, indwelling continuous nerve block catheters, and multimodal anesthesia. In choosing among these modalities, physicians should consider patient- and system-based factors to allow the efficient delivery of analgesia that optimizes recovery and improves patient satisfaction.

Everything Achilles: Knowledge Update and Current Concepts in Management: AAOS Exhibit Selection.

Achilles tendon pathology is common and affects athletes and nonathletes alike. The cause is multifactorial and controversial, involving biological, anatomical, and mechanical factors. A variety of conditions characterized by Achilles tendon inflammation and/or degeneration can be clinically and histologically differentiated. These include insertional Achilles tendinopathy, retrocalcaneal bursitis, Achilles paratenonitis, Achilles tendinosis, and Achilles paratenonitis with tendinosis. The mainstay of treatment for all of these diagnoses is nonoperative. There is a large body of evidence addressing treatment of acute and chronic Achilles tendon ruptures; however, controversy remains.

Current trends in the management of recurrent anterior shoulder instability.

The glenohumeral joint is innately complex and comprised of both static and dynamic stabilizers. Anterior glenohumeral instability has been estimated to have an incidence of 11.2 cases per 100,000 persons and typically follows a traumatic injury. Although there are specific instances when conservative management is advocated, a majority of these patients are treated with operative stabilization. Recent advancements in arthroscopy have created a shift from the traditional open stabilization procedures towards more minimally invasive arthroscopic stabilization procedures. This comprehensive review will summarize current concepts involved in evaluating patients with anterior glenohumeral instability and specifically focus on those patients who suffer from recurrent instability.

The arthroscopic-assisted removal of a distal femoral condylar locking plate--a case report.

We describe a minimally invasive procedure for removal of a distal femur locking plate using arthroscopic assistance. Using lateral accessory portals, we performed arthroscopically-assisted removal of distal locking screws. Under fluoroscopic image, proximal screws were removed from the diaphysis. The accessory lateral portal sites used to remove the distal screws were connected. Through this arthrotomy, the plate was elevated from the distal femur and removed without difficulty. With this method we were able to concomitantly visualize the intra-articular regions while accomplishing the hardware removal.