The impact of total knee arthroplasty on golfing activity.

Background: Total knee arthroplasty (TKA) is frequently performed among individuals who golf. This study examines the effect of TKA on pre- and postoperative pain, frequency of sport participation, handicap, driving distance, use of a cart, and overall game enjoyment. Methods: This is a survey-based retrospective review of 71 patients after primary TKA at a tertiary medical facility in upstate New York. Patients were evaluated using postoperative pain scores and asked to complete a survey that included questions about their return to sport. Results: A total of 71 patients were included, with an average age of 70 years old. Postoperatively 85% of patients returned to play within 7.9 months, driving distance increased by 4 yards, patients' golf game improved by 1.07 strokes, and pain during and after golf was significantly decreased. Most patients did not change golf cart usage, and reported unchanged or improved performance in and enjoyment of golf. Conclusions: We found that a majority of patients undergoing TKA returned to playing golf postoperatively. Patients were more likely to report decreased pain both before and after play and positive changes to their golf game. Our results suggest that most patients can expect to return to golf after TKA and the majority will enjoy the sport with less pain postoperatively.

The Incidence of Concussion and Symptom Non-Reporting Among Professional Women's Ice Hockey Players.

BACKGROUND: Female ice hockey players have rates of sports-related concussion that are similar to male participants at various levels of play, despite differences in the rules that do not allow for body checking in the women's game. At the elite level, there are limited data regarding concussion rates and concussion symptom reporting. Therefore, it was hypothesized that there would be a high incidence of concussion and concussion symptom-reporting in professional women's ice hockey players. METHODS: A survey was given to 54 players in the National Women's Hockey League at the end of the 2018-2019 season. Players reported on the number of concussions diagnosed by a physician throughout their careers, the number of times they have had concussion symptoms, if they had ever continued playing after experiencing concussion symptoms, and if they had ever failed to report concussion symptoms to a medical professional or coach. RESULTS: Fifty-four players completed the survey. Thirtyone (57%) respondents reported at least one concussion diagnosed during their playing career, with 16 (30%) reporting two or more diagnosed concussions. Thirty-six (67%) players reported experiencing concussion symptoms at least once, with 26 (48%) reporting two or more occurrences of such symptoms. Of the 36 players who had experienced symptoms of concussion, 25 (69%) reported that they continued playing at least once after experiencing concussion symptoms. Seventeen players (36%) reported that they did not initially tell anyone about their concussion symptoms on at least one occasion, while seven players (19%) never disclosed their symptoms. CONCLUSION: There is a high incidence of sport-related concussions reported in women's professional ice hockey players as well as an alarming rate of symptom nonreporting. CLINICAL RELEVANCE: This study provides new data on rates of concussion and symptom non-reporting among female professional ice hockey players and will aid clinicians in decision making when caring for these athletes.

Characterizing Sport Specialization Patterns in Professional Women's Ice Hockey Players.

BACKGROUND: Early year-round training in a single sport has been associated with high rates of overuse injuries. Despite this increasingly well-known risk of early sport specialization, many young athletes elect to specialize in a single sport due to the perception that this practice gives them the best chance of attaining elite athletic status. However, early specialization in women's ice hockey has not previously been shown to be reliably associated with attainment of elite levels of performance. We hypothesized that professional women's ice hockey players specialize in mid-adolescence, at an age comparable to their male counterparts. METHODS: An anonymous survey was given to members of two National Women's Hockey League teams. The athletes were asked how many years they have been playing hockey, at what age they began playing only hockey on a year-round basis, how many sports they played in addition to hockey, and if they felt that playing multiple sports while growing up positively affected their hockey careers. RESULTS: Fifty-four players completed the survey. The players reported playing hockey for an average of 19.4 ± 3.4 years. They began specializing in ice hockey at an average of 16.1 ± 3.3 years of age, 2 years later than previously reported in male NHL and NCAA athletes. Before specializing in hockey, players played an average of 3.5 ± 1.4 other sports. Ninetyone percent of players reported feeling as though playing other sports positively affected their hockey career.

Characterizing cam-type hip impingement in professional women's ice hockey players.

OBJECTIVE: There is a high prevalence of femoroacetabular impingement (FAI) amongst elite men's ice hockey players, yet little is known about the hips of players in the National Women's Hockey League (NWHL). The primary purpose of this study was to determine the prevalence of radiographic cam-type FAI in women's professional ice hockey players. The secondary purpose was to analyze the relationship between the cam deformity and both menarchal age and hip range-of-motion (ROM). METHODS: Data were collected for NWHL players during pre-participation physicals. Alpha angles were measured on 45° Dunn radiographs, with alpha angles >55° defined as cam-positive. Pearson correlation coefficients (ρ) were performed to analyze the relationship between alpha angle and both ROM measurements and menarchal age, with statistical significance set at p < 0.05. RESULTS: Twenty-six athletes were included. Twenty-four (92%) had alpha angles >55°; 20 players (77%) had bilateral cam deformity. Average menarchal age was 13.8 ± 1.7 years. There was a significant association between age of menarche and alpha angle (ρ = 0.36, p < 0.02). There was no significant association between alpha angle and hip ROM (p > 0.05). CONCLUSION: Elite women's ice hockey players have a higher prevalence of cam-type morphology than the general population. The positive association between alpha angle and menarchal age lends additional support to the etiological hypothesis of the cam lesion resulting from activity-related stress at the proximal femoral physis during skeletal development. Professional women's ice hockey players have a high risk of developing cam-type morphology, although each player's menarchal age may mediate her individual risk for cam development.

Surgeon Energy Expenditure and Substrate Utilization During Simulated Spine Surgery.

INTRODUCTION: Orthopaedic surgery can be a physically demanding occupation with high rates of fatigue and burnout. Fatigue has been shown to affect surgeon performance with higher rates of errors in fatigued surgeons. The metabolic cost of performing surgery has yet to be quantified. A better understanding of these costs may provide insights into surgeon fatigue and its effect on patient safety. METHODS: Eight subjects performed a one-level lumbar laminectomy and fusion on cadavers. Oxygen consumption (VO2) was measured via indirect calorimetry and used to calculate energy expenditure (EE). Substrate utilization was estimated from measurements of inspired and expired gases (ie, O2 and CO2, respectively). EE was also measured with the use of triaxial accelerometers. RESULTS: The peak VO2 was 11.3 ± 0.4 mL/kg/min. The EEtotal was 132 ± 6 kcal corresponding to the EEtotal/hr of 142 ± 7 kcal/hr. Upper arm accelerometers (154.8 ± 9.8 kcal; r = 0.54) accurately estimated total EE. Subjects used, on average, 53% ± 4% CHO versus 47% ± 7% fat, with peak utilization of 65% ± 5% CHO versus 35% ± 15% fat. DISCUSSION: Simulated orthopaedic spine surgery elicited modest but significant increases in EE over resting. Surgeons used a higher percentage of carbohydrate than would be expected for the intensity of the activity.

Relationship Between the Risk of Suffering a First-Time Noncontact ACL Injury and Geometry of the Femoral Notch and ACL: A Prospective Cohort Study With a Nested Case-Control Analysis.

BACKGROUND: The morphometric characteristics of the anterior cruciate ligament (ACL) and the femoral intercondylar notch within which it resides have been implicated as risk factors for injuries to this important stabilizer of the knee. Prior research has produced equivocal results with differing methodologies, and consequently, it is unclear how these characteristics affect the injury risk in male and female patients. HYPOTHESIS: The morphometric characteristics of the ACL and femoral intercondylar notch are individually and independently associated with the risk of suffering a noncontact ACL injury, and these relationships are different in male and female patients. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Magnetic resonance imaging scans of the bilateral knees were obtained on 88 case-control pairs (27 male, 61 female) matched for age, sex, and participation on the same sports team. Patients had suffered a grade III, first-time, noncontact ACL tear. The femoral notch width at 4 locations, the thickness of the bony ridge at the anteromedial outlet of the femoral notch, the femoral notch volume, ACL volume, and ACL cross-sectional area were measured. RESULTS: Multivariate analysis of combined data from male and female patients revealed that decreased ACL volume (odds ratio [OR], 0.829), decreased femoral notch width (OR, 0.700), and increased bony ridge thickness at the anteromedial outlet of the femoral notch (OR, 1.614) were significant independent predictors of an ACL injury. Separate analyses of male and female patients indicated that the femoral notch ridge may be more strongly associated with a risk in female patients, while ACL volume is more strongly associated with a risk in male patients. However, statistical analysis performed with an adjustment for body weight strengthened the association between ACL volume and the risk of injuries in female patients. CONCLUSION: Morphometric features of both the ACL and femoral notch combine to influence the risk of suffering a noncontact ACL injury. When included together in a multivariate model that adjusts for body weight, the effects of the morphometric measurements are similar in male and female patients. If body weight is not taken into consideration, ACL volume is not associated with a risk in female patients.

Neuromuscular dysfunction in the mutant superoxide dismutase mouse model of amyotrophic lateral sclerosis.

To better understand the interaction between motor neuron dysfunction and denervation in amyotrophic lateral sclerosis (ALS), we have evaluated motor neuron number and the retrograde uptake and transport of fluorogold by motor neurons in mice overexpressing mutant superoxide dismutase (mSOD), and wild-type controls. N-CAM immunoreactivity and protein kinase expression were determined in skeletal muscle during denervation. We found that in severely affected mSOD mice, motor neuron loss is moderate (approximate 40% reduction), whereas retrograde uptake/transport as assessed using fluorogold is profoundly impaired (approximately 90% reduction). The impairment in fluorogold uptake/transport corresponds to measures of progressive muscle denervation such as increased N-CAM immunoreactivity of muscle and increased expression of protein kinase B (PKB) in denervated muscle. These data suggest that the debility in the mSOD mouse model of ALS is produced, in part, by impaired retrograde uptake/transport in motor neuron axons in spite of regenerative support from muscle such as elevated expression of PKB.