Using Pitch-Tracking Data to Identify Risk Factors for Medial Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers.

Background: Approximately 25% of Major League Baseball (MLB) pitchers undergo medial ulnar collateral ligament reconstruction (UCLR) during their careers.

Purpose: To identify risk factors for UCLR that are specific to 2 subgroups of MLB pitchers: right (RHPs)- versus left-handed pitchers (LHPs) and starting (SPs) versus relief pitchers (RPs).

Study Design: Case-control study; Level of evidence, 3.

Trends in leadership at shoulder and elbow fellowships: a cross-sectional demographic review.

Objective: To determine educational characteristics, trends, and demographics among shoulder and elbow fellowship leaders (FLs).

Background: Fellowship leaders in shoulder and elbow impart lasting impact on trainees and field development. Four previous studies have analyzed the characteristics and career path trends among orthopedic surgery subspecialty FLs (spine, adult reconstruction, trauma, and sports medicine).

Shoulder Hemiarthroplasty with Nonprosthetic Glenoid Arthroplasty: The Ream-and-Run Procedure.

»: Glenoid component wear and loosening are the principal failure modes of anatomic total shoulder arthroplasty (aTSA).

»: The ream-and-run (RnR) procedure is an alternative glenohumeral arthroplasty for patients who wish to avoid the risks and limitations of a prosthetic glenoid component.

»: During the RnR procedure, the arthritic glenoid is conservatively reamed to a single concavity, while the prosthetic humeral component and soft tissues are balanced to provide both mobility and stability of the joint.

Imbalance in Axial-plane Rotator Cuff Fatty Infiltration in Posteriorly Worn Glenoids in Primary Glenohumeral Osteoarthritis: An MRI-based Study.

Background: Fatty infiltration of the rotator cuff evaluated with CT has been associated with asymmetric glenoid wear and humeral head subluxation in patients with glenohumeral arthritis. The relationship between rotator cuff pathologic findings and abnormal glenoid wear plays an important role in determining the optimal surgical management of advanced glenohumeral osteoarthritis. Compared with CT, MRI has increased sensitivity for identifying rotator cuff conditions; therefore, prior studies using CT may have underestimated the association between fatty infiltration of the rotator cuff and abnormal glenoid wear.

Clinical Y-view versus 3-dimensional assessments of intramuscular fat in patients with full-thickness rotator cuff tears.

Rationale And Objectives: Recent evidence suggests an inhomogeneous distribution of intramuscular rotator cuff fat infiltration (FI) in a small sample of individuals with rotator cuff tears, yet clinically just a few slices at the scapular Y-view are used to evaluate FI in patients with rotator cuff tears. The purpose of this study was to determine if assessment of FI using the scapular Y-view is representative of the entire muscle in patients with full-thickness rotator cuff tears, and whether this varies by tear size.

Materials And Methods: Patients (N = 25) diagnosed with full-thickness rotator cuff tear and confirmed with magnetic resonance imaging (MRI) were included.

Differences in 30-day outcomes between inpatient and outpatient total elbow arthroplasty (TEA).

Background: As the health care system in the United States shifts toward value-based care, there has been increased interest in performing total joint arthroplasty in the outpatient setting to optimize costs, outcomes, and patient satisfaction. Several studies have demonstrated success in performing ambulatory total knee and hip arthroplasty. The purpose of this study was to compare short-term outcomes and complications after total elbow arthroplasty (TEA) across the inpatient and outpatient operative settings.

Concussion Incidence and Impact on Player Performance in Major League Baseball Players Before and After a Standardized Concussion Protocol.

Background: Sports-related concussions have garnered significant attention in recent years because of the negative effects they can have on a player's cognitive health and performance. In response to this growing concern, Major League Baseball (MLB) introduced a standardized concussion protocol during the 2011-2012 season.

Purpose/hypothesis: The purpose of this study was to compare the reported incidence of concussions and the subsequent performance of MLB players before and after the introduction of the standardized concussion protocol.

The Quality and Accuracy of Online Resources for Total and Reverse Shoulder Replacement.

Recent literature suggests that many online patient resources are poor in quality and lack important clinical information. The purpose of this study was to investigate the value of online resources available to patients considering shoulder arthroplasty. A total of 84 websites were discovered with the terms "total shoulder replacement" (TSR) and "reverse shoulder replacement" (RSR), they were reviewed and graded for quality and accuracy.

The Effect of an Arthroscopic Orthopaedic Procedure on a Professional Tennis Player's Career.

Orthopaedic injuries can significantly impact the careers of professional tennis players. It is currently unknown how professional tennis players fare after arthroscopic surgery. For the purpose of this study, players ranked in the Association of Tennis Professionals (ATP) and Women's Tennis Association (WTA) who underwent arthroscopic surgery of any joint between 1996 and 2016 were identified through a well-established, previously published protocol of injury reports and public archives.

Advanced Baseball Metrics Indicate Significant Decline in MLB Pitcher Value After Tommy John Surgery.

There are conflicting reports regarding the efficacy of Major League Baseball (MLB) pitchers following medial ulnar collateral ligament reconstruction (UCLR). As advanced baseball metrics have revolutionized the way general managers define pitchers' value, the authors believe that these should be used to measure clinical outcomes after UCLR. All MLB pitchers who underwent UCLR from April 1, 1991, through July 1, 2016, were compiled (N=253).

Development of 3D method to assess intramuscular spatial distribution of fat infiltration in patients with rotator cuff tear: reliability and concurrent validity.

Background: Intramuscular fat infiltration is a critical factor in surgical decision-making and is the most important factor used to prognosticate surgical repair outcomes in patients with rotator cuff tears. Quantitative 3D assessment of total rotator cuff fat infiltration in patients with rotator cuff tears has been realized. However, a reproducible method to evaluate 3D spatial distribution of rotator cuff intramuscular fat has not been established.

Editorial Commentary: Already "Stealth" Organism Propionibacterium acnes Goes Covert by Changing Its Name to Cutibacterium acnes: Shoulder Bacterial Contamination.

Propionibacterium acnes, now Cutibacterium acnes, is found on skin and subcutaneous tissue and is thus hard to eradicate. Infection can result in shoulder pain but be indolent and hard to diagnose; in addition, the organism is difficult to identify requiring long-hold cultures. Despite skin preparation, and second preparation before conversion of arthroscopy to mini-open surgery, we do not yet have a way to effectively eradicate C acnes from deeper dermal layers.

Influence of Pitching Release Location on Ulnar Collateral Ligament Reconstruction Risk Among Major League Baseball Pitchers.

Background: Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed among Major League Baseball (MLB) pitchers. The etiology of UCL injury is complex and is not entirely understood.

Hypothesis: To better understand risk factors for requiring UCL reconstruction, we hypothesized that pitchers who eventually undergo the procedure will exhibit different throwing mechanics as measured by pitch-tracking data points, such as velocity and release location.

Risk factors for admission after shoulder arthroscopy.

Background: Shoulder arthroscopy is a common orthopedic procedure typically performed on an outpatient basis. Occasionally, patients require an unplanned hospital admission. An understanding of the incidence and risk factors for admission after shoulder arthroscopy may assist surgeons in determining which patients may be susceptible to unplanned admission after surgery.

Optimizing methods to quantify intramuscular fat in rotator cuff tears with normalization.

Objective: To determine which normalization method may best account for confounding individual factors, such as age or BMI, when quantifying fat infiltration on MRI in patients with rotator cuff tears, the effects of normalization using three different muscles (teres major; triceps brachii; teres minor) were compared.

Methods: Thirty-seven consecutive patients diagnosed with rotator cuff pathology were included. MRI fat-water sequences were used to quantify rotator cuff intramuscular fat (%fat).

Changes in pitching mechanics after ulnar collateral ligament reconstruction in major league baseball pitchers.

Background: Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed on Major League Baseball pitchers. Variations in pitching mechanics before and after UCL reconstructive surgery are not well understood.

Methods: Publicly available pitch tracking data (PITCHf/x) were compared for all Major League Baseball pitchers who underwent UCL reconstruction between 2008 and 2013.

The relationship between the incidence of adhesive capsulitis and hemoglobin A.

Background: Previous studies have shown no correlation between adhesive capsulitis and hemoglobin A (HbA). However, HbA is only a measure of short-term blood sugar control. We created a previously nonvalidated variable, cumulative HbA, that uses HbA values over time to estimate the total disease burden a single individual experiences over a period.

Shoulder Arthroplasty Outcomes in Patients With Multiple Reported Drug Allergies: Does Number of Drug Allergies Have an Effect on Outcome?

Background: The presence of multiple allergies has been correlated with worse outcomes for patients undergoing hip and knee arthroplasty, but the effect of allergies has not yet been elucidated with respect to shoulder arthroplasty.

Purpose/hypothesis: The purpose of this study is to identify any discrepancies in shoulder arthroplasty outcomes with respect to reported drug allergies. We hypothesized that patients with multiple drug allergies would have inferior outcomes.

Bilateral Posterior Sternoclavicular Dislocations.

We present the case of a professional horse jockey with chronic, bilateral, posterior sternoclavicular dislocations. Traumatic dislocation of the sternoclavicular is a relatively rare but potentially devastating injury. Posterior sternoclavicular dislocations occur less frequently than anterior dislocations and require careful and complete evaluation because of the potential for serious complications including respiratory distress, brachial plexus injury, and vascular injury.

Latarjet Fixation: A Cadaveric Biomechanical Study Evaluating Cortical and Cannulated Screw Fixation.

Background: Attritional bone loss in patients with recurrent anterior instability has successfully been treated with a bone block procedure such as the Latarjet. It has not been previously demonstrated whether cortical or cancellous screws are superior when used for this procedure.

Purpose: To assess the strength of stainless steel cortical screws versus stainless steel cannulated cancellous screws in the Latarjet procedure.

Preexisting Rotator Cuff Tears as a Predictor of Outcomes in National Football League Athletes.

Background: A preexisting rotator cuff tear may affect the draft status and career performance of National Football League (NFL) players.

Hypothesis: Preexisting rotator cuff tears decrease a player's draft status, performance, and longevity in the NFL.

Study Design: Retrospective cohort study.

All-arthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii.

Background: Pathologic changes of the long head of the biceps tendon are a recognized source of shoulder pain in adults that can be treated with tenotomy or tenodesis when nonoperative measures are not effective. It is not clear whether arthroscopic or open biceps tenodesis has a clinical advantage.

Hypothesis: Pain relief and shoulder function after all-arthroscopic suprapectoral biceps tenodesis are similar to outcomes after an open subpectoral tenodesis.

The effect of axillary hair on surgical antisepsis around the shoulder.

Background: Infection after shoulder surgery can have devastating consequences. Recent literature has implicated Propionibacterium acnes as a causative agent for postoperative shoulder infections. Axillary hair removal has been suggested as a method for infection prevention, although data quantifying its effect on the bacterial load around the shoulder are lacking.

Acromioclavicular joint injuries in the National Football League: epidemiology and management.

Background: Previous studies investigating acromioclavicular (AC) joint injuries in professional American football players have only been reported on quarterbacks during the 1980s and 1990s. These injuries have not been evaluated across all position players in the National Football League (NFL).

Purpose: The purpose of this study was 4-fold: (1) to determine the incidence of AC joint injuries among all NFL position players; (2) to investigate whether player position, competition setting, type of play, and playing surface put an athlete at an increased risk for this type of injury; (3) to determine the incidence of operative and nonoperative management of these injuries; and (4) to compare the time missed for injuries treated nonoperatively to the time missed for injuries requiring surgical intervention.

Biomechanical comparison of 3 methods to repair pectoralis major ruptures.

Background: Pectoralis major ruptures are closely associated with weight lifting and participation in sports. The anatomy of the pectoralis major tendon is unique with an elongated thin footprint requiring multiple points of fixation to restore the native anatomy. Multiple options exist for tendon repairs, but the strongest construct has yet to be identified.