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.

Primary versus revision total shoulder arthroplasty: comparing relative value and reimbursement trends.

Background: Total shoulder arthroplasty (TSA) has been demonstrated to be an effective treatment for multiple shoulder pathologies. The purpose of our study was to compare the relative value units (RVUs) per minute of surgical time for primary and revision TSA.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients that underwent primary TSA, one-component revision TSA, and two-component revision TSA between January 1, 2015 and December 31, 2017 using current procedure terminology codes.

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.

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.

Reverse Total Shoulder Arthroplasty: Implant Design Considerations.

Purpose Of Review: Our understanding of the reverse total shoulder arthroplasty (RTSA) has grown exponentially since Grammont first introduced his design in 1985. There are a multitude of implant-related variables to consider when performing RTSA. The purpose of this article is to provide a review of these design considerations.

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).

Evaluation of cerebral oxygen perfusion during shoulder arthroplasty performed in the semi-beach chair position.

Background: The beach chair position is commonly used when performing shoulder arthroplasty. However, this position has been associated with hypotension, potentially leading to cerebral hypoperfusion, which may cause neurologic injury. In addition, shoulder arthroplasty cases are associated with longer operative times, posing a potentially greater risk of cerebral hypoperfusion.

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).

Late inception of a resiliently oxygenated upper ocean.

Rising oceanic and atmospheric oxygen levels through time have been crucial to enhanced habitability of surface Earth environments. Few redox proxies can track secular variations in dissolved oxygen concentrations around threshold levels for metazoan survival in the upper ocean. We present an extensive compilation of iodine-to-calcium ratios (I/Ca) in marine carbonates.

Phanerozoic O and the early evolution of terrestrial animals.

Concurrent gaps in the Late Devonian/Mississippian fossil records of insects and tetrapods (i.e. Romer's Gap) have been attributed to physiological suppression by low atmospheric O Here, updated stable isotope inputs inform a reconstruction of Phanerozoic oxygen levels that contradicts the low oxygen hypothesis (and contradicts the purported role of oxygen in the evolution of gigantic insects during the late Palaeozoic), but reconciles isotope-based calculations with other proxies, like charcoal.

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.

Earliest land plants created modern levels of atmospheric oxygen.

The progressive oxygenation of the Earth's atmosphere was pivotal to the evolution of life, but the puzzle of when and how atmospheric oxygen (O2) first approached modern levels (∼21%) remains unresolved. Redox proxy data indicate the deep oceans were oxygenated during 435-392 Ma, and the appearance of fossil charcoal indicates O2 >15-17% by 420-400 Ma. However, existing models have failed to predict oxygenation at this time.