Editorial Commentary: Testosterone Replacement Therapy and Anterior Cruciate Ligament Injury Risk: Insights and Cautions for Clinical Application.

The relation between testosterone replacement therapy (TRT) and anterior cruciate ligament injury risk has garnered attention in recent orthopaedic research. With TRT's popularity on the rise, understanding its potential musculoskeletal risks is important for orthopaedic and sports medicine providers. Whereas some studies suggest an association, confounding variables such as activity level, number of hours of sports participation, dosing variations, physiological versus supraphysiological levels of testosterone, and individual patient characteristics may influence outcomes.

Conversion rates and timing to total knee arthroplasty following anterior cruciate ligament reconstruction: a US population-based study.

Purpose: To define the rate of subsequent TKA following ACLR in a large US cohort and to identify factors that influence the risk of later undergoing TKA after ACLR.

Methods: The California's Office of Statewide Health Planning and Development (OSHPD) database was queried from 2000 to 2014 to identify patients who underwent primary ACLR (ACL group). An age-and gender-matched cohort that underwent appendectomy was selected as the control group.

Effect of Ulnar Collateral Ligament Reconstruction on Pitch Accuracy, Velocity, and Movement in Major League Baseball Pitchers.

Background: Ulnar collateral ligament (UCL) reconstruction is frequently performed on Major League Baseball (MLB) pitchers. Previous studies have investigated the effects of UCL reconstruction on fastball and curveball velocity, but no study to date has evaluated its effect on fastball accuracy or curveball movement among MLB pitchers.

Purpose/hypothesis: The primary purpose of this study was to determine the effects of UCL reconstruction on fastball accuracy, fastball velocity, and curveball movement in MLB pitchers.

Epidemiology of Anterior Cruciate Ligament Injury on Natural Grass Versus Artificial Turf in Soccer: 10-Year Data From the National Collegiate Athletic Association Injury Surveillance System.

Background: Anterior cruciate ligament (ACL) injury is prevalent among National Collegiate Athletic Association (NCAA) soccer players. Controversy remains regarding the effect of the surface type on the rate of ACL injury in soccer players, considering differences in sex, type of athletic exposure, and level of competition.

Hypothesis: Natural grass surfaces would be associated with decreased ACL injury rate in NCAA soccer players.

Bipolar Fresh Osteochondral Allograft Transplantation and Joint Reconstruction for Patellar and Trochlear Cartilage Defects.

Patellar instability is a debilitating condition, and trauma due to the dislocations may severely damage the articular cartilage of the patellofemoral joint. The lack of healing capacity of cartilage makes treatment of such lesions challenging. In young patients, preservation of native bone and cartilage is a priority, and therefore arthroplasty procedures should be avoided even in relatively larger lesions.

An Increasing Rate of Surgical Management of Closed Tibia Fractures in an Adolescent Population: A National Database Study.

Background: No consensus exists for the management of closed tibia fractures in the adolescent population.

Methods: The Kids' Inpatient Database was used to extract data on patients aged 10 to 18 years with closed diaphyseal tibia fractures. The frequency of closed reduction and internal fixation (IF) was calculated, and the temporal trends were evaluated.

Performance of PROMIS Computer Adaptive Testing As Compared With Established Instruments for Multiple-Ligament Knee Injuries.

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT) is a patient-reported outcome metric that has been validated for anterior cruciate ligament (ACL) injuries, ACL reconstructions, and meniscal injuries. Thus far, the system has not been validated for multiligament knee injuries. The Multiligament Quality of Life (MLQOL) questionnaire is a validated, disease-specific patient-reported outcome instrument for this population that can serve as a gold standard for validation of the newer PROMIS.

Effect of Preoperative Opioid Usage on Pain After Total Shoulder Arthroplasty.

Introduction: Preoperative opioid use has recently been associated with increased perioperative pain. This study evaluates the effect of preoperative opioid use on postoperative pain and duration of opioid use after total shoulder arthroplasty (TSA).

Methods: We retrospectively identified 138 TSAs (69.

Biomechanical Analysis of Porcine Cartilage Elasticity.

Grafting of tissue-engineered cartilage to joints with osteoarthritis has the potential to supersede arthroplasty as the standard of care. However, in order to support the development of functional tissue engineering methods, the subfailure biomechanics of the individual cartilage types that comprise joints must be determined. Current methods for analyzing tissues are based on imaging and are therefore unable to profile the strain dependence of mechanical behaviors within different cartilage types.

Anabolic steroids and tendons: A review of their mechanical, structural, and biologic effects.

One of the suspected deleterious effects of androgenic-anabolic steroids (AAS) is the increased risk for tendon rupture. However, investigations to date have produced inconsistent results and it is still unclear how AAS influence tendons. A systematic review of the literature was conducted to identify studies that have investigated the mechanical, structural, or biologic effects that AAS have on tendons.

Primary Anterior Cruciate Ligament Single-Bundle Repair With Augmentation for a Partial Anterior Cruciate Ligament Tear.

Although anterior cruciate ligament (ACL) reconstruction remains the gold standard for the treatment of ACL tears, repair is regaining popularity as a treatment option for proximal or distal ACL avulsions. Historically, ACL repairs had poor outcomes. To remedy this, techniques were developed using graft-based augmentation but never gained widespread popularity.

Discharge Destination After Shoulder Arthroplasty: An Independent Risk Factor for Readmission and Complications.

Introduction: Postdischarge disposition after shoulder replacement lacks uniform guidelines. The goal of this study was to identify complication and readmission rates by discharge disposition and determine whether disposition was an independent risk factor for adverse events, using a statewide database.

Methods: Data from the California Office of Statewide Health Planning and Development discharge database were used.

Quality of Life and Functional Outcomes after Multiligament Knee Reconstruction.

We aimed to determine factors that affect the quality of life of patients undergoing a standardized surgical and postoperative management protocol for knee dislocations. A total of 31 patients (33 knees) were included in this study. We contacted patients at a minimum of 12 months postoperatively (mean: 38 months; range, 12-111 months) and administered the previously validated Multiligament Quality of Life questionnaire (ML-QOL), 2000 International Knee Documentation Committee Subjective Knee Form (IKDC), and Lysholm Knee Scoring Scale.

Scapulothoracic pathology: review of anatomy, pathophysiology, imaging findings, and an approach to management.

Symptomatic scapulothoracic disorders, including scapulothoracic crepitus and scapulothoracic bursitis are uncommon disorders involving the scapulothoracic articulation that have the potential to cause significant patient morbidity. Scapulothoracic crepitus is the presence of a grinding or popping sound with movement of the scapula that may or may not be symptomatic, while scapulothoracic bursitis refers to inflammation of bursa within the scapulothoracic articulation. Both entities may occur either concomitantly or independently.

Direct Cost Analysis of Outpatient Arthroscopic Rotator Cuff Repair in Medicare and Non-Medicare Populations.

Background: Providing high-quality care while also containing cost is a paramount goal in orthopaedic surgery. Increasingly, insurance providers in the United States, including government payers, are requiring financial and performance accountability for episodes of care, including a push toward bundled payments.

Hypothesis: The direct cost of outpatient arthroscopic rotator cuff repair was assessed to determine whether, due to an older population, rotator cuff surgery was more costly in Medicare-insured patients than in patients covered by other insurers.

Coracoid Process: The Lighthouse of the Shoulder.

The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. Surgeons often refer to the coracoid process as the "lighthouse of the shoulder" given its proximity to major neurovascular structures such as the brachial plexus and the axillary artery and vein, its role in guiding surgical approaches, and its utility as a landmark for other important structures in the shoulder. The coracoid also serves as a critical anchor for many tendinous and ligamentous attachments.

Surgical management of midshaft clavicle nonunions is associated with a higher rate of short-term complications compared with acute fractures.

Background: Little is known about the perioperative complication rates of the surgical management of midshaft clavicle nonunions. The purpose of the current study was to report on the perioperative complication rates after surgical management of nonunions and to compare them with complication rates of acute fractures using a population cohort.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who had undergone open reduction-internal fixation of midshaft clavicle fractures between 2007 and 2013.

Complication rate and implant survival for reverse shoulder arthroplasty versus total shoulder arthroplasty: results during the initial 2 years.

Background: The use of reverse total shoulder arthroplasty (RTSA) has significantly increased in recent years. However, there is large variance in reported complication rates and sparse data on implant survival. This study used a statewide patient database to investigate complication rates and implant survival for RTSA.

Acute Compartment Syndrome after Non-Contact Peroneus Longus Muscle Rupture.

This case demonstrates a rare variation in the pattern of injury and the presentation of acute lateral compartment syndrome of the leg. Although uncommon, lateral compartment syndrome of the leg after an ankle inversion leading to peroneus longus muscle rupture has been previously documented. This case was unusual because there was no overt ankle injury and the patient was able to continue physical activity, in spite of a significant rupture of the peroneus longus muscle that was determined later.

Preoperative risk factors for discharge to a postacute care facility after shoulder arthroplasty.

Background: Shoulder arthroplasty procedures are becoming increasingly prevalent in the United States due to expanding indications and an aging population. Most patients are discharged home, but a subset of patients is discharged to a postacute care (PAC) facility. The purpose of this study was to identify the risk factors for discharge to a PAC facility after shoulder arthroplasty.

A Comparison of Rehabilitation Methods After Arthroscopic Rotator Cuff Repair: A Systematic Review.

Context: Despite the significant attention directed toward optimizing arthroscopic rotator cuff repair, there has been less focus on rehabilitation after rotator cuff repair surgery.

Objective: To determine the effect of different rehabilitation protocols on clinical outcomes by comparing early versus late mobilization approaches and continuous passive mobilization (CPM) versus manual therapy after arthroscopic rotator cuff repair.

Data Sources: PubMed was searched for relevant articles using the keywords rotator cuff, rotator, cuff, tears, lacerations, and rehabilitation to identify articles published from January 1980 to March 2014.

Partial semitendinosus tendon tear in a young athlete: a case report and review of the distal semitendinosus anatomy.

Distal semitendinosus tears have been infrequently reported in the radiology literature, and a detailed description of the anatomy and imaging features of these injuries is lacking. The semitendinosus tendon is clinically relevant, as it is frequently grafted in knee ligament reconstructions and plays an important role in performing competitive activities. We present a case of a 31-year-old man who developed a partial semitendinosus tear during competitive training.

Anatomy of the femoral footprint of the posterior cruciate ligament: a systematic review.

Purpose: The purpose of this study was to summarize the past 10 years of orthopaedic literature to better delineate the femoral origin of the posterior cruciate ligament (PCL).

Methods: A PubMed search was conducted by 2 independent reviewers (M.P.

Does patient sex affect the anatomic relationships between the sternoclavicular joint and posterior vascular structures?

Background: Despite increased concern for injury during surgical reconstruction of the sternoclavicular joint, to our knowledge there are few studies detailing the vascular relationships adjacent to the joint.

Questions/purposes: We investigated sex differences in the following relationships for sternoclavicular joint reconstruction: (1) safe distance from the posterior surface of the medial clavicle's medial and lateral segments to the major vessels, (2) length of the first costal cartilage and safe distance from the first rib to the internal mammary artery, (3) minimum distance medial to the sternoclavicular joint for optimal hole placement, and (4) safe distance from the manubrium to the great vessels.

Methods: Fifty normal postcontrast CT scans of the chest were reviewed.

Prevalence of Abnormal Vitamin D Levels Among Division I NCAA Athletes.

Background: Up to 1 billion people have insufficient or deficient vitamin D levels. Despite the well-documented, widespread prevalence of low vitamin D levels and the importance of vitamin D for athletes, there is a paucity of research investigating the prevalence of vitamin D deficiency in athletes.

Hypothesis: We investigated the prevalence of abnormal vitamin D levels in National Collegiate Athletic Association (NCAA) Division I college athletes at a single institution.