Publications by authors named "Peter N Chalmers"

The incidence of ulnar collateral ligament injuries has increased over the past decade. As a result, the rate of ulnar collateral ligament reconstruction has increased dramatically at all levels of competition in overhead athletes. Currently, there is no consensus on milestones during rehabilitation or a largely agreed-upon structured throwing program after ulnar collateral ligament injuries.

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The medial ulnar collateral ligament (MUCL) complex is integral for valgus elbow stability, especially in individuals engaged in repetitive overhead activities such as throwing. MUCL injuries often necessitate surgical intervention to restore elbow stability. Early studies reporting outcomes after MUCL repair demonstrated suboptimal return to play compared with ulnar collateral ligament reconstruction, prompting a shift toward reconstruction techniques.

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Ulnar collateral ligament injury of the elbow is a problem most associated with baseball pitchers but can be a challenging pathology for any overhead throwing athlete. The prevalence of these injuries has been steadily increasing over the past several decades, as has the need for surgical management. Surgical reconstruction has long been considered the gold standard for complete ulnar collateral ligament injuries in throwers, but repair has surfaced as a viable option for younger patients or those with isolated proximal or distal injuries with good tissue quality.

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The medial ulnar collateral ligament of the elbow is the primary stabilizer against valgus load. It can tear acutely or through attritional damage as in repetitive overhead sports. Although baseball players, particularly pitchers, are the most vulnerable athletes, these injuries also occur in contact athletes, gymnasts, and javelin throwers.

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The biological factors that affect healing after rotator cuff repair (RCR) are not well understood. Genetic variants in the extracellular matrix protein Tenascin C (TNC) are associated with impaired tendon healing and it is expressed in rotator cuff tendon tissue after injury, suggesting it may have a role in the repair process. The purpose of the current study was to determine the role of TNC on tendon healing after RCR in a murine model.

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Article Synopsis
  • Shoulder stabilization surgery has developed to include more bony augmentation techniques, such as the Latarjet procedure, which can alter the subscapularis muscle anatomy. The newer arthroscopic anatomic glenoid reconstruction (AAGR) aims to preserve this anatomy by using a distal tibial allograft and maintaining the muscle structure.
  • The study reviewed the radiographic changes in the subscapularis muscle after the AAGR procedure, assessing muscle volume and quality with CT scans in patients who had experienced traumatic anterior shoulder instability.
  • Results showed a significant increase in the volume of the subscapularis muscle post-surgery and an improved muscle ratio, suggesting that AAGR effectively preserves subscapularis
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Background: Humeral distalization is inherent to reverse total shoulder arthroplasty (rTSA) and is often produced with concomitant humeral lateralization via the level of the humeral head cut, implant positioning, implant neck shaft angle, and polymer insert thickness. Biomechanical data on the isolated effects of humeral distalization remain limited but could be important to consider when optimizing postoperative rTSA shoulder function. This study investigated the effects of isolated humeral distalization on shoulder biomechanics using a biorobotic shoulder simulator.

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Article Synopsis
  • The study investigates how genetic variants of the extracellular matrix protein Tenascin C (TNC) affect healing after rotator cuff repair using a mouse model.
  • Mice lacking TNC exhibited severe tendon and bone defects post-repair and showed reduced physical activity compared to control mice.
  • Results indicated that the absence of TNC altered gene expression related to sex hormones and WNT pathways, suggesting a need for further research to explore tissue-specific changes and potential treatments to improve healing.
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Hypothesis: The purpose of this study is to identify and compare demographic, clinical, historical, and intraoperative variables in patients who have received arthroscopic treatment for single vs. multiple anterior shoulder dislocations.

Methods: This is a retrospective chart review of patients who underwent arthroscopic labral repair of the shoulder by six surgeons at a single institution between 2012 and 2020.

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Background: This study aimed to characterize patient, imaging, and surgical factors associated with re-tear patterns after rotator cuff repair, as well as to identify predictors of type 2 failure in a large patient cohort.

Methods: A retrospective case-control study was performed at a single urban academic institution. All patients who underwent an arthroscopic rotator cuff repair by 2 fellowship-trained shoulder and elbow surgeons between 2005 and 2022 and were subsequently found to have a symptomatic re-tear on magnetic resonance imaging were included.

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Background: The incidence of proximal humerus fractures (PHFs) continues to increase with an aging population, and intramedullary nailing (IMN) and locking plate fixation are two commonly employed techniques for the surgical management of PHF. However, the optimal fixation method can be a source of ongoing controversy. Some influencing factors include the extent of humeral head involvement, fracture complexity, patient age, and surgeon preference.

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Purpose Of Review: Reverse shoulder arthroplasty (rTSA) is a commonly performed procedure to treat degenerative conditions of the shoulder. With its growing utilization, techniques to reliably diagnose and treat prosthetic joint infection (PJI) have become increasingly important. In this review we outline the current research and prevention methods of prosthetic joint infection in rTSA.

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Background: Prior to the Major League Baseball (MLB) draft, some pitchers undergo predraft magnetic resonance imaging (MRI). This study aimed to evaluate pre-draft elbow MRI on baseball pitchers who were entering the MLB draft to determine the presence or absence of pathology, the associations between these pathologies and ulnar collateral ligament (UCL) tears, and interobserver reliability regarding common MRI pathology.

Methods: Predraft elbow MRI performed on prospective MLB pitchers between 2011 and 2017 were deidentified and then reviewed by two separate authors.

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Background: Data on the 1-year postoperative revision, complication, and economic outcomes in a hospital setting after total shoulder arthroplasty (TSA) are sparse.

Methods: A retrospective cohort study using the Premier Healthcare Database, a hospital-billing data source, evaluated 1-year postoperative revision, complication, and economic outcomes of reverse (RTSA) and anatomic (ATSA) TSA for patients who underwent the procedure from 2015 until 2021. All-cause revisits, including revision-related events (categorized as either irrigation and débridement or revision procedures and device removals) and shoulder/nonshoulder complications were collected.

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Background: Overprescription of opioids in the United States increases risks of opioid dependence, overdose, and death. Increased perioperative and postoperative opioid use during orthopedic shoulder surgery is a significant risk factor for long-term opioid dependence. The authors hypothesized that a multidisciplinary perioperative pain management program (Transitional Pain Service [TPS]) for major shoulder surgery would lead to a reduced amount of opioids required postoperatively.

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Background: Oblique strains have become a common injury among professional baseball players. The influence of player workload on oblique strains remains unknown.

Purpose/hypothesis: To determine whether workload is a risk factor for oblique strains in professional baseball players.

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Background: Preoperative planning is an integral aspect of managing complex deformity in reverse shoulder arthroplasty (RSA). The purpose of this study was to compare the success of patient-specific instrumentation (PSI) and 3D computer-assisted planning with standard instrumentation (non-PSI) in achieving planned corrections of the glenoid among patients undergoing RSA with severe bony deformity requiring glenoid bone grafts.

Methods: A retrospective case-control study was performed, including all patients that underwent RSA with combined bone grafting procedures (BIO-RSA or structural bone grafting) for severe glenoid deformity by a single study between June 2016 and July 2023.

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Background: The purpose of this study was to determine whether the addition of hydrogen peroxide to the preoperative skin preparation for primary total shoulder arthroplasty is associated with a difference in patient-reported outcomes, risk for postoperative infection, and risk for revision surgery at a minimum of 2-year follow-up.

Methods: This was a prospective, blinded, and controlled trial, which included a consecutive series of patients undergoing primary shoulder arthroplasty. The control group underwent standard sterile skin preparation using ethyl alcohol and ChloraPrep applicators, and the peroxide group had the same preparation with the addition of hydrogen peroxide between the alcohol and ChloraPrep applications.

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Background: The purpose of this study was to evaluate the relationship between multiple radiographic measures of lateralization and distalization and clinical outcome scores after a reverse total shoulder arthroplasty (RTSA).

Methods: We retrospectively evaluated all RTSAs performed by the senior author between January 1, 2007, and November 1, 2017. We then evaluated the visual analog scale for pain (VAS pain), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) scores and complication and reoperation rates at a minimum of 2-year follow-up.

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Purpose: To establish consensus statements on glenoid bone grafting, glenoid osteotomy, rehabilitation, return to play, and follow-up for posterior shoulder instability.

Methods: A consensus process on the treatment of posterior shoulder instability was conducted, with 71 shoulder/sports surgeons from 12 countries participating on the basis of their level of expertise in the field. Experts were assigned to 1 of 6 working groups defined by specific subtopics within posterior shoulder instability.

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Hypothesis And/or Background: The incidence of elbow medial ulnar collateral ligament (MUCL) injuries has been increasing, leading to advances in surgical treatments. However, it is not clear that there is consensus among surgeons regarding diagnostic imaging, the indications for acute surgery and postoperative rehabilitation. The purpose of this study is evaluate surgeon variability in the presurgical, surgical, and postsurgical treatment of MUCL injuries regarding the imaging modalities used for diagnosis, indications for acute surgical treatment, and postoperative treatment recommendations for rehabilitation and return to play (RTP).

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Background: Thoracic outlet syndrome (TOS) remains a rare diagnosis but is being recognized as a cause of upper extremity dysfunction in professional baseball players.

Purpose/hypothesis: The purpose was to determine performance and return-to-play (RTP) outcomes in professional baseball players after surgical treatment of TOS. The hypothesis was that there would be a high RTP rate in professional baseball players after TOS surgery with no statistical differences in performance between pitchers who had TOS surgery and matched controls.

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Context: The quality and interprogram variability of publicly available throwing programs have not been assessed.

Objective: To (1) identify publicly available interval throwing programs, (2) describe their components and structure, and (3) evaluate their quality, variability, and completeness.

Data Sources: Google, Bing, Yahoo; keyword: "interval throwing program.

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Background: Superior augment use may help avoid superior tilt while minimizing removal of inferior glenoid bone. Therefore, our goal was to compare superior augments vs. no-augment baseplates in reverse shoulder arthroplasty (RSA) for patients with rotator cuff dysfunction and no significant superior glenoid erosion.

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Case: A 15-year-old female rock climber presented with a traumatic coracoid process fracture of her dominant upper extremity that failed extensive nonoperative treatment. She was treated successfully by arthroscopic reduction and suture anchor fixation.

Conclusion: A novel surgical technique for coracoid fracture that combines arthroscopic reduction with suture anchor fixation can result in expeditious and durable clinical improvement in a young, high-demand athlete.

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