During the COVID impacted 2020-2021 season of the English soccer league, there was an appreciable number of injuries experienced by players. These injuries, however, have not been quantified against ...previous seasons to highlight the altered season as a causative factor.
A review of an online database was conducted to search for injuries to football players in the Premier League across three seasons; 2018-2019, 2019-2020, and 2020-2021, to compare for difference in injury rates across the years and assess for higher rates in this current season, where athletes have had less play time due to COVID-19. Injury number and injury characteristics were abstracted from the online database Transfermarkt, with the provided information allowing for the sorting of the data into muscular and ligamentous injuries and skeletal injuries.
Overall 226, 260, and 289 muscular and ligamentous injuries were observed across the 2018/2019, 2019/2020, and 2020/2021 seasons, respectively. There were 495 minutes on average played leading up to first injury in the 2020/2021 season, compared with 521 minutes in the 2019/2020 season and 536 minutes in the 2018/2019. There was an average of games played to injury of 5.6 games in the 2020/2021 year, with 6.0 in the 2019/2020 year and 6.1 in the 2018/2019 year. Additionally, there was a significantly shorter time in between games was noted during the COVID-affected season with a mean time of 6.8 days in-between games played during the 2020-2021 season as compared to the previous years of 9.12 and 7.12 days.
Our study found that there were more injuries and a decreased time to first injury observed during the COVID-impacted 2020-2021 season than the two preceding seasons, perhaps demonstrating a link between fixture congestion and athlete injuries as evidenced by the significantly shorter time between games. It is therefore prudent to retain fixture spacing for athlete recovery even against the backdrop of an overall shortened season.
Objectives:
Increased posterior tibial slope (PTS) is a risk factor for primary anterior cruciate ligament (ACL) tear, as well as subsequent ACL graft tear. Prior literature has shown conflicting ...relationships between an increased PTS and bilateral ACL tears. The purpose of this study is to compare PTS angles for patients who had bilateral ACL tears to those who had only sustained a unilateral ACL tear.
Methods:
Retrospectively we identified patients who had bilateral and unilateral ACL tears at our institution over the last 10 years. Those who had bilateral surgery were matched to those who had unilateral surgery on a ratio of 1:1 based on age, sex, and BMI. Patients with unilateral ACL reconstruction were excluded if they had subsequent revisions or were less than 5 years post-operative. Lateral knee radiographs were used to measure the posterior tibial slope. The tibial axis was found using the circles measurement method which consisted of drawing circles along the tibial shaft and placing a line through the center of each to estimate the anatomical tibial axis. The PTS was then defined as the angle between the perpendicular line to this axis and the tibial plateau tangent line. Three blinded orthopedic residents performed these measurements. In addition to comparison of mean PTS between cohorts, both cohorts were stratified into “high slope” and “low slope” using 10-degress of PTS as a cutoff. An interclass correlation coefficient (ICC) was then calculated.
Results:
Fifty-three patients with bilateral ACL tears were successfully matched to 53 patients with unilateral tears. The average PTS in patients with bilateral ACL tears was found to be significantly higher than patients with unilateral ACL tears (11.17 vs. 9.72, p = 0.005). An intraclass correlation coefficient was calculated to 0.80 (95% confidence interval: 0.75 – 0.85). These cohorts were then stratified by the aforementioned sub-groups, finding that 69.8% of the bilateral cohort had more than 10-degrees of PTS, while this was true for only 46.4% of the unilateral cohort (p = 0.006).
Conclusions:
These results demonstrate that patients with bilateral ACL tears have higher PTS angles than those who only had unilateral ACL tear. Clinicians should consider routinely assessing PTS in a newly-presenting patient with an initial ACL tear, as marked deviations from the general population could be a predisposing risk factor for subsequent contralateral tear. Further prospective research is necessary to determine if patients with unilateral ACL tears who present with this radiographic finding are at greater risk for contralateral tear.
Identifying the specific source of gluteal pain can elude the most seasoned orthopaedic diagnosticians. Patients will often present with a protracted course of symptoms, and failure to successfully ...identify and treat the underlying etiology leads to frustration for both patient and clinician. Pain deep in the buttocks can arise from compression, inflammation, or injury of one or more of the structures in this anatomically dense area. Although sacroiliitis, hip arthritis, and trochanteric bursitis may also masquerade as gluteal pain, sciatic nerve irritation in its various presentations causes a substantial percentage of cases. Deep gluteal syndrome, hamstring syndrome, and ischiofemoral impingement can have overlapping presentations but can be differentiated by clinical examination and judiciously placed diagnostic corticosteroid injections. Although nonsurgical management, including physical therapy, relative rest, and injections represent the mainstay of treatment, open and endoscopic surgical approaches have yielded encouraging success rates in refractory cases.
This biomechanical study compared 2 repair techniques for high-grade, partial, articular-sided supraspinatus tendon tears of the rotator cuff: transtendon in situ repair and tear completion with ...repair. Standardized, 50% partial, articular-sided supraspinatus lesions were created in 10 pairs of matched fresh, frozen cadaveric shoulders: 10 underwent partial lesion repair with an in situ transtendon technique using 2 suture anchors. In the contralateral 10 shoulders, the partial lesion was converted to a full-thickness tear and repaired with a double-row technique, using 4 suture anchors. Cyclic loading to failure of the supraspinatus tendon was performed using a material testing machine. Gap formation was measured for each rotational position and each incremental load. The in situ transtendon repair had statistically significant less gapping (P = .0001) and higher mean ultimate failure strength (P = .0011) than the double-row repair. In situ transtendon repair was biomechanically superior to tear completion for partial, articular-sided supraspinatus tears.
To analyze the effects of 1 or more patient-reported allergies on clinical outcomes, in particular graft failure rate, and patient-reported outcomes (PROs) following osteochondral allograft ...transplantation (OCA) of the knee.
Retrospective review of patients who underwent knee OCA from August 2010 to May 2021 with a minimum of 2-year follow-up. Patients were initially divided into 2 cohorts: those with at least 1 allergy and those without any allergies. Clinical outcomes assessed included graft failure, reoperation rates, deep vein thrombosis/pulmonary embolism, and manipulation under anesthesia/lysis of adhesions (MUA/LOA). PROs assessed, including the visual analog scale (VAS) for pain and satisfaction, the Knee injury and Osteoarthritis Outcome Score (KOOS), and return to sport rates, were compared.
In total, 285 patients were included with a mean clinical follow-up of 4.8 ± 2.0 years. The allergy cohort had a significantly higher rate of graft failure (P = .008). In a regression analysis controlling for confounding variables, graft failure remained significantly associated with the presence of medication allergies (odds ratio OR, 3.631; 95% CI, 1.139-11.577; P = .029). Furthermore, an increasing number of allergies were associated with an increased rate of graft failure (OR, 1.644; 95% CI, 1.074-2.515; P = .022). There was no difference in rate of reoperation, complications, infection, and MUA/LOA. Of the 100 patients who completed PROs, there was no difference in VAS satisfaction, pain, and any of the KOOS outcome scores or return to sport.
The presence of 1 or more patient-reported allergies was shown to be significantly associated with OCA graft failure. Furthermore, an increasing number of patient-reported allergies were associated with a higher rate of graft failure. However, there were no significant differences in VAS satisfaction or pain, KOOS symptom, quality of life, pain, or return to sport in patients with at least 1 patient-reported allergy and those without allergies.
Level III, retrospective cohort study.
Ski jumping (SJ) and Nordic combined (NC) athletes are at higher risk for femoroacetabular impingement (FAI) compared to the general population.
The purpose of this study was to determine the ...relationship between force plate testing metrics, Functional Movement Screen (FMS) scores, and radiographic signs of FAI and SJ performance.
Elite SJ and NC athletes were prospectively recruited. FMS testing was performed to assess muscular imbalance, instability, and immobility. Vertical jump testing was performed using a commercially available force plate device. Ski jump score and distance score were measured on a single jump for each athlete.
Twenty-one athletes (10 SJ, 11 NC) with competition scores were included. On FMS testing, most SJ (67%) and NC (73%) athletes demonstrated core instability. There were higher rates of hip instability and ankle stiffness among SJ athletes, although not statistically significant (P > .05). Ski jump distance score was significantly positively correlated with force plate vertical jump height, maximum acceleration, maximum velocity, concentric impulse, counter-movement depth, and flight time (P < .05). FMS testing results and radiographic FAI were not significantly associated with competition scores.
Our results show significant positive correlations between competition scores and force plate jump testing performance as measured by jump height, acceleration, maximum velocity, counter-movement depth, and concentric impulse in elite SJ and NC athletes. Our findings suggest that ski jumpers may benefit from training that emphasizes stretch-shortening cycles and eccentric-to-concentric contraction transition, which may optimize their performance and promote joint stability.
To evaluate the effects of socioeconomic factors on the operative treatment of anterior cruciate ligament injuries and outcomes following surgical reconstruction.
A retrospective cohort study of ...primary anterior cruciate ligament reconstruction surgeries at a single institution performed from 2011 to 2015 with minimum 2-year follow-up was conducted. Patient demographics, insurance type, workers’ compensation status, surgical variables, International Knee Documentation Committee score, and failure were recorded from chart review. Education level and income were obtained via phone interview. Differences between functional outcome were compared between Medicaid and non-Medicaid groups.
In total, 268 patients were included in the analysis (43 patients in the Medicaid group and 225 patients in the non-Medicaid group, overall mean follow-up of 3.1 ± 0.8 years). The Medicaid group demonstrated lower annual income (P < .001) and a lower level of completed education compared with the non-Medicaid group (P < .001). Patients who received Medicaid had a greater duration between time of initial knee injury and surgery compared with the those in non-Medicaid group (11.8 ± 16.3 months vs 6.1 ± 16.5 months, P < .001). At the time of follow-up, patients in the non-Medicaid group had a significantly greater International Knee Documentation Committee score compared with patients who received Medicaid (82.5 ± 13.8 vs 75.3 ± 20.8, P = .036).
Patients with Medicaid insurance were seen in the clinic significantly later after initial injury and had worse outcomes compared with patients with other insurance types. Also, patients in higher annual income brackets had significantly better clinical outcomes scores at a minimum of 2 years postoperatively.
Level III, retrospective cohort study.
Single-stage medial meniscus allograft transplantation (MAT) with concomitant anterior cruciate ligament reconstruction (ACLR) is a technically challenging procedure for management of knee pain and ...instability in younger patients, but clinical and functional outcomes data are sparse. The purpose of this study was to assess surgical and patient-reported outcomes following concomitant ACLR and medial MAT.
We conducted a retrospective case series of patients who underwent medial MAT with concomitant primary or revision ACLR at our institution from 2010 to 2021 and had minimum 12-month follow-up. Complications, reoperations, visual analog scale (VAS) pain, satisfaction, Lysholm score, return to sport, and return to work outcomes were assessed. Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, Pain Intensity, and Physical Function Scores were used to measure patients' functional status relative to the US population. P-values < 0.05 were considered significant.
The cohort consisted of 17 knees of 16 individual patients. The cohort was majority male (82.4%) with mean age of 31.9 years (range 19-49 years) and mean body mass index (BMI) of 27.9 kg/m
(range 22.5-53.3 kg/m
). Mean follow-up time was 56.8 months (range 13-106 months). Most patients underwent revision ACLR (64.7%). The 1-year reoperation rate was high (23.5%), with two patients (11.8%) tearing their meniscus graft. Patient-reported outcomes indicated low VAS pain (mean 2.2), high satisfaction (mean 77.9%), and fair Lysholm score (mean 81.1). Return to work rate was high (92.9%), while return to sport rate was low (42.9%). Postoperative PROMIS scores were comparable or superior to the national average and correlated significantly with patient satisfaction (p < 0.05).
The concomitant ACLR and MAT procedure is associated with excellent knee pain and functional outcomes and high rate of return to work after surgery, though the 1-year reoperation rate is high and rate of return to sport is low.
IV.
Background The purpose of this study was to identify predictors of the time from initial presentation to total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis (OA) ...and rotator cuff (RTC) arthropathy who were conservatively managed with corticosteroid injections. Methods We conducted a retrospective cohort study of patients who underwent TSA from 2010 to 2021. Kaplan-Meier survival analysis was used to estimate median time to TSA for primary OA and RTC arthropathy patients. The Cox proportional hazards model was used to identify significant predictors of time to TSA and to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical significance was set at P<0.05. Results The cohort included 160 patients with primary OA and 92 with RTC arthropathy. In the primary OA group, median time to TSA was 15 months. Significant predictors of shorter time to TSA were older age at presentation (HR, 1.02; 95% CI, 1.00–1.04; P=0.03) and presence of moderate or severe acromioclavicular joint arthritis (HR, 1.45; 95% CI, 1.05–2.01; P=0.03). In the RTC arthropathy group, median time to TSA was 14 months, and increased number of corticosteroid injections was associated with longer time to TSA (HR, 0.87; 95% CI, 0.80–0.95; P=0.003). Conclusions There are distinct prognostic factors for progression to TSA between primary OA patients and RTC arthropathy patients managed with corticosteroid injections. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients. Level of evidence III.
Anterior cruciate ligament (ACL) repair is a procedure that has been used to treat torn ACLs dating back to the early 1900s. With unpredictable outcomes of repair, a paradigm shift led to surgeons to ...opt for ACL reconstruction as a new gold standard, as the evidence showed a more reliable outcome. However, there has been a recent resurgence in ACL repair worthy of review, particularly in proximal avulsions. Suture anchor repair is one repair technique in which recent studies show low failure rates, low reoperation rates, and favorable clinical outcomes. More recent data supports augmenting this strategy with suture tape. An innovation in ACL repair techniques is the Bridge-Enhanced ACL Repair (BEAR) technique, which combines a patient's whole blood with a collagen-based scaffold to augment the repair. While promising results have been shown with these techniques, narrow indications are necessary for a successful ACL repair.
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