Lower Opioid Prescription Quantity Does Not Negatively Impact Pain Control or Patient Satisfaction After ACL Reconstruction: A Randomized, Prospective Trial.

Background: The purpose of this study was to evaluate the effects of different quantities of prescribed opioid tablets on patient opioid utilization, postoperative pain and function, and satisfaction after anterior cruciate ligament reconstruction (ACLR).

Methods: This was a prospective, randomized trial enrolling patients undergoing primary ACLR. Patients were assigned to 1 of 3 prescription groups: 15, 25, or 35 tablets containing 5-mg oxycodone.

The Use of Biologics in NFL Athletes: An Expert Consensus of NFL Team Physicians.

Background: There is a lack of published information outlining the use of biologics in National Football League (NFL) athletes and limited data to guide biologic treatment strategies.

Purpose: To develop a consensus on the use of biologics among NFL team physicians.

Study Design: Consensus statement.

The shoulder function "tipping-point" for elective rotator cuff repair: demographic and longitudinal trends.

Background: A patient's decision to undergo an elective orthopedic procedure is largely based on their symptoms and functional limitations. This point where patients choose to undergo surgery is known as the "tipping point." The primary aim of this study is to determine the relationship between demographic parameters and the tipping point for elective rotator cuff repair.

Efficacy of transdermal 4% lidocaine patches for postoperative pain management after arthroscopic rotator cuff repair: a prospective trial.

Background: Postoperative pain management continues to be a challenging aspect of patient care. Lidocaine patches have shown efficacy in reducing pain in other surgical specialties and mixed results in orthopedic trials. We sought to determine the effectiveness of nonprescription lidocaine patches in reducing postoperative pain after arthroscopic rotator cuff repair.

Combined MPFL reconstruction and tibial tubercle osteotomy for patellar instability: A retrospective review of 23 patients.

The primary objective of this retrospective study is to compare patient outcomes following a combined approach (MPFL reconstruction and TTT) to outcomes reported in the literature by patients who required either only an isolated TTT procedure to treat pathologic lateral patellar instability or isolated MPFL reconstruction to treat patellar dislocation due to MPFL insufficiency. Twenty-three patients (74%) were available for follow-up and are included in our analysis. MPFL reconstruction combined with TTT has a high rate of success for patients presenting with patellar instability and extensor mechanism mal-alignment.

Do Relaxation Exercises Decrease Pain After Arthroscopic Rotator Cuff Repair? A Randomized Controlled Trial.

Background: Pain after rotator cuff repair is commonly managed with opioid medications; however, these medications are associated with serious adverse effects. Relaxation exercises represent a potential nonpharmacologic method of pain management that can be easily implemented without substantial adverse effects; however, the effects of relaxation exercises have not been studied in a practical, reproducible protocol after arthroscopic rotator cuff repair.

Questions/purposes: (1) Does performing relaxation exercises after arthroscopic rotator cuff repair (ARCR) decrease pain compared with standard pain management medication? (2) Does performing relaxation exercises after ARCR decrease opioid consumption? (3) What proportion of patients who used the relaxation techniques believed they decreased their pain level, and what proportion continued using these techniques at 2 weeks? (4) Does performing relaxation exercises after ARCR affect shoulder function?

Methods: During the study period, 563 patients were eligible for inclusion; however, only 146 were enrolled, randomized, and postoperatively followed (relaxation group: 74, control group: 72); 68% (384 of 563) of patients were not contacted due to patient and research staff availability.

Overview of Traumatic Brain Injury in American Football Athletes.

Objective: The aim of this review is to provide a summary of the epidemiology, clinical presentation, pathophysiology, and treatment of traumatic brain injury in collision athletes, particularly those participating in American football.

Data Sources: A literature search was conducted using the PubMed/MEDLINE and Google Scholar databases for publications between 1990 and 2019. The following search phrases were used: "concussion," "professional athletes," "collision athletes," "mild traumatic brain injury," "severe traumatic brain injury," "management of concussion," "management of severe traumatic brain injury," and "chronic traumatic encephalopathy.

The efficacy of docusate sodium and senna glycoside for the treatment of constipation after rotator cuff repair: A randomized controlled study.

Background: Although stool softeners and laxatives are commonly prescribed for postoperative constipation, it is unclear if they are effective during the postoperative period. The data gained from this study will be beneficial for advanced practitioners when examining for postoperative constipation concerns.

Purpose: This study aimed to investigate the efficacy of docusate sodium and senna glycoside in the prevention and treatment of constipation following rotator cuff repair (RCR).

Are Patient and Surgeon Expectations after ACL Reconstruction Realistic?

Background: Patient expectations may affect their satisfaction and functional outcomes after treatment of musculoskeletal injuries. Although there is evidence that patient expectations of ACL reconstruction (ACLR) are inflated, there is limited knowledge about the relationship between physician and patient expectations and patient outcomes after they completely recover from ACLR. Furthermore, it is unclear if specific patient factors influence these expectations.

A Prospective Study of Patient Factors and Decision-making for Surgical Repair of Symptomatic Full-Thickness Rotator Cuff Tears.

Factors motivating patients to undergo rotator cuff repair (RCR) have not been thoroughly investigated. The purpose of this study was to investigate patient and surgeon decision-making factors for RCR, as well as the use of conservative treatment, and their relationship with shoulder function. A total of 144 adult patients undergoing arthroscopic RCR completed a 13-item questionnaire assessing the importance of surgical decision-making factors.

Prevalence of Clinical Depression Among Patients After Shoulder Stabilization: A Prospective Study.

Background: Depression is a potential risk factor for poor postoperative outcomes. This study aimed to identify the prevalence of clinical depression symptoms before and after shoulder stabilization, as well as the relationship between depression and functional outcomes.

Methods: Patients undergoing arthroscopic primary glenohumeral stabilization for recurrent instability were eligible for enrollment.

Distal Mononeuropathy Before and After Arthroscopic Rotator Cuff Repair: A Prospective Investigation.

Purpose: The purpose of this study was to characterize the occurrence of distal mononeuropathy (DMN) in patients before and after arthroscopic rotator cuff repair (RCR) as well as resolution of the symptoms.

Methods: One hundred one patients over the age of 18 undergoing arthroscopic RCR +/- concurrent procedures completed a questionnaire regarding the presence of a symptomatic DMN. Patients with history of diabetic neuropathy, cervical radiculopathy, brachial plexopathy, or Spurling sign were excluded.

Long-term Correction in Sleep Disturbance Is Sustained After Arthroscopic Rotator Cuff Repair.

Background: Sleep disturbance is a major complaint of patients with rotator cuff disease that often leads them to seek treatment. The authors previously reported a prospective analysis of patients who underwent rotator cuff repair and found that sleep disturbance significantly improved at 3 months after surgery. That improvement in sleep was maintained at 6 months.

Arthroscopic Transosseous and Transosseous-Equivalent Rotator Cuff Repair: An Analysis of Cost, Operative Time, and Clinical Outcomes.

The incidence of arthroscopic rotator cuff repair (RCR) continues to rise. Given the changing healthcare climate, it is becoming increasingly important to critically evaluate current practice and attempt to make modifications that decrease costs without compromising patient outcomes. We conducted a study of the costs associated with arthroscopic anchorless (transosseous [TO]) RCR and those associated with the more commonly performed anchor-based TO-equivalent (TOE) method to determine whether there are any cost savings with the TO-RCR method.

Accuracy of Athletic Trainer and Physician Diagnoses in Sports Medicine.

It is standard practice in high school athletic programs for certified athletic trainers to evaluate and treat injured student athletes. In some cases, a trainer refers an athlete to a physician for definitive medical management. This study was conducted to determine the rate of agreement between athletic trainers and physicians regarding assessment of injuries in student athletes.

Conflict of interest in sports medicine: does it affect our judgment?

The American Academy of Orthopaedic Surgeons (AAOS) and other orthopedic societies require authors to disclose conflicts of interest (COIs). We conducted a study to evaluate how a hypothetical research team's reported COI would influence the perceived value of its data. Using a hypothetical prospective study, we asked orthopedic surgeons and nonoperative sports medicine specialists to rate the value of the data, given different study designs, statistical significance, and research institutions (academic vs private).

Triceps Tendon Ruptures Requiring Surgical Repair in National Football League Players.

Background: Complete triceps tendon ruptures are relatively rare in the general population but slightly more prevalent in professional football. One prior study found 11 complete ruptures over a 6-season period.

Hypothesis: Triceps ruptures occur more commonly in football linemen due to forced elbow flexion during an eccentric contraction and may occur more commonly with the increasing size and speed of professional players.

Clinical Differentiation of Upper Extremity Pain Etiologies.

Upper extremity pain can result from many overlapping etiologies. These can be categorized into anatomic regions and specific organ systems. Anatomically, pain etiologies are classified into four major groups: neurologic, musculoskeletal, vascular, and other (eg, tumor, infection).

Sleep disturbance associated with rotator cuff tear: correction with arthroscopic rotator cuff repair.

Background: Sleep disturbance is a common complaint of patients with a rotator cuff tear. Inadequate and restless sleep, along with pain, is often a driving symptom for patients to proceed with rotator cuff repair. To date, no studies have examined sleep disturbance in patients undergoing rotator cuff repair, and there is no evidence that surgery improves sleep disturbance.

Distal peripheral neuropathy after open and arthroscopic shoulder surgery: an under-recognized complication.

Hypothesis: Distal peripheral neuropathy (DPN) is an under-reported complication after anatomic total shoulder arthroplasty (TSA), reverse shoulder arthroplasty (RSA), and arthroscopic rotator cuff repair (RCR).

Methods: We conducted a retrospective review of patients undergoing shoulder arthroplasty or arthroscopic RCR by 4 shoulder surgeons during a 2-year period. The primary outcome measure was the diagnosis of DPN, defined as carpal tunnel syndrome, cubital tunnel syndrome, ulnar tunnel syndrome, and distal radial sensory neuropathy.

Arthroscopic lysis of adhesions for the stiff total knee: results after failed manipulation.

Arthrofibrosis after total knee arthroplasty (TKA) is a potentially devastating complication, resulting in loss of motion and function and residual pain. For patients in whom aggressive physical therapy and manipulation under anesthesia fail, lysis of adhesions may be the only option to rescue the stiff TKA. The purpose of this study is to report the results of arthroscopic lysis of adhesions after failed manipulation for a stiff, cruciate-substituting TKA.

Humerus fractures at a regional trauma center: an epidemiologic study.

The purpose of this study was to outline the epidemiologic criteria of humerus fractures after traumatic injuries. All patients admitted to the trauma service at the authors' institution between 2005 and 2011 were entered into a prospective database. The authors obtained data on age, sex, injury mechanism, presence and location of humerus fracture, associated injuries, mortality, Injury Severity Score, treatment, and length of stay.

Short-/intermediate-term outcomes after medial patellofemoral ligament reconstruction in the treatment of chronic lateral patellofemoral instability.

Purpose: Disruption of the medial patellofemoral ligament (MPFL) is now considered the essential lesion of recurrent lateral patellar dislocation in patients with normal lower extremity alignment. Reconstruction of the MPFL is a technique gaining significant success in the treatment of patients with this disabling condition.

Hypothesis: Reconstruction of the MPFL in patients with chronic patellar instability and normal lower extremity alignment will improve knee function and symptoms, with a high percentage of patients achieving good to excellent results at early follow-up.