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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. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent surgical treatment of TOS between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Demographic and performance data (before and after surgery) for each player were recorded. Performance variables were then compared between players who underwent TOS surgery and matched controls. The matching criteria were no history of previous surgeries on affected arm, age at time of surgery, throwing side, level of play (Major or Minor League Baseball), and years of experience playing professional baseball. Results: Overall, 52 players underwent surgery for TOS, of whom 46 (88%) were pitchers. The type of TOS was neurogenic in 69% and venous in 29%. One player had arterial TOS. After TOS surgery, 79% of players returned to play at the same or higher level (RTSP) by 9.5 months and played ≥3 years after surgery. No differences were found in RTSP rate based on the type of TOS. No statistical difference was found in RTP rates between major and minor league players. Pitchers had a 76% RTSP, which was similar to the natural attrition for control pitchers (P =.874). After TOS surgery, pitchers saw a decline in several performance metrics, but these declines were not different from those of control pitchers, indicating that the decline in performance after TOS surgery was no faster than is seen in healthy professional pitchers as they age. Conclusion: The rate of RTSP after surgery for TOS in professional baseball players was 79%. There was no difference in RTP based on the type of TOS. Pitchers who underwent surgery for TOS had no significant differences in pitching performance metrics after surgery compared with matched controls. [ABSTRACT FROM AUTHOR]

Background: Although pitch count and rest guidelines have been promoted for youth and adolescent baseball players for nearly 2 decades, compliance with guidelines remains poorly understood. Purpose/Hypothesis: The purpose of this study was to determine the frequency of compliance with Major League Baseball (MLB) Pitch Smart guidelines as well as the association between compliance and range of motion (ROM), strength, velocity, injury, and pitcher utilization. It was hypothesized that pitchers in violation of current recommendations would have increased strength, velocity, and injury. Study Design: Case-control study; Level of evidence, 3. Methods: This was a prospective, multicenter study of 115 high school pitchers throughout the United States. Pitchers were surveyed about their compliance with current off-season, rest-related guidelines, and history of injury. During the preseason, pitchers underwent standardized physical examinations, and pitch velocity was measured. Pitch counts were collected during the baseball season that followed. Dynamometer strength testing of shoulder forward flexion, and external rotation as well as grip strength was recorded. We compared pitchers who were compliant with recommendations with those who were noncompliant using Student t and Mann-Whitney U tests. Results: Based on preseason data, 84% of pitchers had violated current Pitch Smart guidelines. During the season, 14% had at least 1 violation of the Pitch Smart guidelines. Across both the preseason survey and in-season pitch counts, 89% of players had at least 1 violation of the Pitch Smart guidelines. While there were no significant differences in ROM or strength, the noncompliant group had higher maximum pitch velocity than the compliant group (74 ± 8 vs 69 ± 5 mph [119 ± 13 vs 111 ± 8 kph], respectively; P =.009). Players' self-reported velocity differed significantly from the direct measurement, for both peak velocity (80 ± 6 vs 73 ± 8 mph [129 ± 9 vs 117 ± 13 kph], respectively; P <.001) and mean velocity (73 ± 8 vs 53 ± 27 mph [117 ± 13 vs 85 ± 43 kph], respectively; P <.001). Conclusion: Most high school pitchers were not fully compliant with current Pitch Smart guidelines, and they tended to overestimate their peak velocity by 7 mph (11 kph). Pitchers who threw with greater velocity were at higher risk for violating Pitch Smart recommendations. [ABSTRACT FROM AUTHOR]

Background: The application of orthobiologics at the time of arthroscopic rotator cuff repair (RCR) has received an increasing amount of clinical interest despite a relative scarcity of human clinical studies on their efficacy. Purpose: To utilize a national administrative database to determine the association of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) applied at the time of RCR with revision surgery rates. Study Design: Cohort study; Level of evidence, 3. Methods: The Mariner data set from the PearlDiver patient records repository was utilized to identify patients undergoing RCR using Current Procedural Terminology (CPT) code 29827. Patients receiving BMAC or PRP at the time of RCR were then identified using CPT coding. For comparison purposes, a matched cohort was created consisting of patients who underwent RCR without biologic augmentation in a 5:1 fashion for each biologic separately. Cases were matched according to age, sex, tobacco use, biceps tenodesis, distal clavicle excision, and subacromial decompression. All groups were then queried for revision RCR or conversion to reverse shoulder arthroplasty. Revision rates were compared utilizing a multivariate binomial logistic regression analysis. Adjusted odds ratios (ORs) and 95% CIs were calculated. Results: A total of 760 patients who underwent biologic augmentation during RCR were identified, including 646 patients in the PRP group and 114 patients in the BMAC group. They were compared with 3800 matched controls without documented biologic application at the time of surgery. Compared with matched controls, patients who received BMAC at the time of surgery experienced a significantly lower incidence of revision surgery at 2 years (OR, 0.36; 95% CI, 0.15-0.82; P =.015). There was no significant difference in revision rates between PRP and matched controls (OR, 0.87; 95% CI, 0.62-1.23; P =.183). Conclusion: The application of BMAC at the time of RCR was associated with a significant decrease in the incidence of revision surgery. There was no apparent effect of PRP on the incidence of revision surgery after primary RCR. Higher-level clinical studies considering surgical factors are needed to more clearly define the role of biologic adjuvants in RCR. [ABSTRACT FROM AUTHOR]

Background: Meniscal repair is an effective treatment option for certain meniscal injuries to preserve meniscal function and limit the progression of knee osteoarthritis. Outcomes after meniscal repair in professional baseball players are not well documented. Purposes/Hypothesis: The purposes of this study were to determine performance and return to sport (RTS) in professional baseball players after meniscal repair and compare the results of medial versus lateral meniscal repair. It was hypothesized that there would be a high RTS rate, with no difference in the rate or timing of RTS between players who underwent medial versus lateral meniscal repair. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent meniscal repair between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Descriptive information and performance data (before and after injury) for each player were recorded. The rate and timing of RTS were then compared between players who underwent medial versus lateral meniscal repair. Results: Included were 31 patients (mean age, 24 ± 3 years). There were 6 players (19%) who had failed repair, underwent subsequent meniscectomy within 2 years of meniscal repair, and were thus excluded from the performance analysis. Of the remaining 31 players, 68% returned to the same or a higher level of play, and 6% of players returned to a lower level of play. Most repair procedures (60%) were performed using the all-inside technique, and 72% of players underwent lateral meniscal repair. The mean time missed was 187 ± 67 days, and the mean time to RTS at full competitive play was 209 ± 84 days. There were no significant differences in the rate or timing of RTS between players who underwent medial versus lateral meniscal repair (P ≥.999 and P =.574, respectively). Pitchers saw a decrease in usage but no change in performance after meniscal repair. For batters, most metrics were unchanged, but there was a significant decrease in base stealing and on-base percentage after surgery. Conclusion: The RTS rate after meniscal repair in Major League Baseball players was 74% at a mean of 209 days; 19% of players had failed repair and underwent subsequent meniscectomy within 2 years of repair. No difference in the rate or timing of RTS was observed between players who underwent medial versus lateral meniscal repair. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present study was to analyze the association between sex hormone deficiency and rotator cuff repair (RCR) with use of data from a large United States insurance database.Methods: A retrospective analysis of insured subjects from the Truven Health MarketScan database was conducted, collecting data for RCR cases as well as controls matched for age, sex, and years in the database. Multivariable logistic regression models adjusted for matching variables were utilized to compare RCR status with estrogen deficiency status and testosterone deficiency status. These associations were confirmed with use of data from the Veterans Genealogy Project database, with which the relative risk of RCR was estimated for patients with and without sex hormone deficiency.Results: The odds of RCR for female patients with estrogen deficiency were 48% higher (odds ratio, 1.48; 95% confidence interval, 1.44 to 1.51; p < 0.001) than for those without estrogen deficiency. The odds of RCR for males with testosterone deficiency were 89% higher (odds ratio, 1.89; 95% confidence interval, 1.82 to 1.96; p < 0.001) than for those without testosterone deficiency. Within the Veterans Genealogy Project database, the relative risk of estrogen deficiency among RCR patients was 2.58 (95% confidence interval, 2.15 to 3.06; p < 0.001) and the relative risk of testosterone deficiency was 3.05 (95% confidence interval, 2.67 to 3.47; p < 0.001).Conclusions: Sex hormone deficiency was significantly associated with RCR. Future prospective studies will be necessary to understand the pathophysiology of rotator cuff disease as it relates to sex hormones.Level Of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Meniscal injuries are common in athletes across many sports. How professional baseball players respond to partial meniscectomy is not well documented. Purpose/Hypothesis: The purpose was to determine the performance and return-to-sports (RTS) rate in professional baseball players after arthroscopic partial knee meniscectomy and compare the results of partial medial meniscectomy versus partial lateral meniscectomy. The hypothesis was that there would be a high RTS rate in professional baseball players after partial meniscectomy with no difference in the RTS rate or timing of RTS between players who underwent partial medial meniscectomy versus partial lateral meniscectomy. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent arthroscopic partial meniscectomy between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Demographic and performance data (before and after injury) for each player were recorded. The RTS rate and timing of RTS were then compared between players who underwent partial medial meniscectomy versus partial lateral meniscectomy. Results: A total of 168 knees (168 players) underwent arthroscopic partial meniscectomy (mean age, 25 ± 5 years; 46% medial meniscectomy, 45% lateral meniscectomy, and 9% both medial and lateral meniscectomy). The most common mechanism of injury was fielding in the infield on natural grass. Injuries were spread evenly across positions: 18% catchers, 24% infielders, 20% outfielders, and 38% pitchers. The overall RTS rate was 80% (76% returned to the same or a higher level, and 4% returned to a lower level). For performance, pitchers saw significant decreases in usage but significant improvements in performance using the advanced statistics of fielding independent pitching (P <.001) and wins above replacement (P =.011). Hitters saw significant decreases in usage but increases in efficiency as seen by improvements in wins above replacement (P =.003). Of the 79 athletes who returned during the same season, the median time to return to play was 42 days. Conclusion: The RTS rate after meniscectomy in professional baseball players was 80%. Player efficiency improved after surgery in pitchers and position players. No difference in the RTS rate or timing of RTS existed between players who underwent partial medial meniscectomy versus partial lateral meniscectomy. [ABSTRACT FROM AUTHOR]

Background: Bicipital disorders are common among overhead athletes, especially professional baseball players. The ideal treatment for bicipital problems in professional baseball players is unknown. Purpose/Hypothesis: The purpose was to determine the return-to-sport (RTS) rate and performance after RTS in professional baseball players who underwent biceps tenodesis. It was hypothesized that there will be a high RTS rate in this population, with no difference between the biceps tenodesis and control groups in the RTS rate or performance. Study Design: Case series; Level of evidence, 4. Methods: All professional Major League Baseball players who underwent biceps tenodesis between 2014 and 2017 were included. Players with concomitant rotator cuff repair were excluded. Demographic and performance data (preoperative and postoperative) were recorded for each player. Performance metrics were then compared between players with biceps tenodesis and matched controls (no history of biceps tenodesis). Results: Included were 14 players (mean age, 27 ± 4 years; 12 pitchers, 2 position outfielders). Most surgeries (79%) were open subpectoral tenodeses, 2 were arthroscopic biceps transfers, and 1 was an arthroscopic suprapectoral tenodesis. Fixation methods included cortical button (42%), interference screw (25%), suture anchor (25%), and drill holes (8%). Most players (79%) underwent concomitant procedures (43% underwent superior labral anterior-posterior repairs). While 86% (12/14) were able to RTS, 50% (7/14) returned at the same or a higher level, and 50% of the whole study were either unable to return or returned to a lower level. Among pitchers, 100% (12/12) were able to RTS, but only 50% (6/12) were able to return to the same or a higher level. For those players who did RTS, it took 245 ± 84 days, and their performance after RTS was unchanged and did not differ from that of matched controls. Conclusion: Open subpectoral tenodesis was the most common tenodesis technique performed on professional baseball players. While 86% of players returned to sport after biceps tenodesis, only 50% returned to the same or higher level. No decline in performance was noted in players who returned successfully. [ABSTRACT FROM AUTHOR]

Background: There are some professional baseball players who begin their career as a position player and later convert to a pitcher; injury rates in these players are unknown. Purpose: To compare injury rates of professional baseball players who started their career as position players and converted to pitchers with a control group of pitchers who have been only pitchers throughout their professional career. Hypothesis: Injury rates would be lower in the conversion players. Study Design: Cohort study; Level of evidence, 3. Methods: All players who began their professional baseball career as position players and converted to pitchers between 2011 and 2018 were included. All injuries that occurred after they converted to pitchers were included. The conversion players were matched 1 to 1 with a control group of pitchers who entered professional baseball as pitchers and never changed position. Injury rates were compared between groups. The performance between groups was also compared. Results: Overall, 221 players were identified who converted from position players to pitchers. There were significantly more injuries per year in the control pitcher group (0.8 ± 0.9) than in the conversion pitcher group (0.7 ± 0.9; P =.015). Injuries in the control group resulted in 61 ± 112 days missed per injury, while injuries in the conversion player group resulted in 54 ± 102 days missed per injury (P =.894). Injury characteristics differed between groups. However, in both groups, most of the injuries were related to pitching or throwing, were noncontact or gradual overuse injuries, and involved the upper extremity. Converted pitchers had lower pitcher usage, with fewer games and innings pitched (P <.001), with significantly worse statistics for walks plus hits per inning pitched (P =.018). Conclusion: Professional baseball players who convert from position players to pitchers are injured at lower rates than control pitchers. Conversion pitchers have lower pitcher usage, which may contribute to their reduced injury rates. [ABSTRACT FROM AUTHOR]

Background: Ulnar collateral ligament reconstruction (UCLR) is a common procedure in professional baseball position players. Timing of return to hitting after UCLR is unknown. Purpose/Hypothesis: The purpose was to determine the time to return to batting milestones after UCLR as well as the effect of UCLR upon batting performance in professional baseball players. The hypothesis was that position players would return to batting in an in-season game before fielding in an in-season game, and hitting performance would remain unchanged after UCLR. Study Design: Cohort study; Level of evidence, 3. Methods: All professional position players who underwent UCLR between 2010 and 2018 were included. Time to batting milestones after UCLR was analyzed. Batting performance before and after UCLR was compared and analyzed. Results: Overall, 141 UCLRs (96% performed on the dominant arm) in 137 position players were included (86% Minor League players). Four players underwent revision, all within 1 year of the primary UCLR. With regard to position, catchers and shortstops were overrepresented. With regard to batting side, 57% batted from the right and 12% batted as switch-hitters. Of the surgeries, 76% were on the trail/back arm. While 91% of players returned to some form of throwing, there was a progressive gradual decline as the rehabilitation process progressed, as only 77% were able to return to hitting in a real game and 75% were able to return to fielding in a real game. The first dry swing occurred at 150 ± 49 days after surgery, the first batting practice occurred at 195 ± 58 days after surgery, the first hitting in a real game occurred at 323 ± 92 days after surgery, and the first fielding in a real game occurred at 343 ± 98 days after surgery. However, players generally saw a decrease in their utilization, with fewer at bats (P <.001) translating into fewer hits (P <.001) and runs (P <.001). Conclusion: Professional position players begin swinging at 150 days (approximately 5 months) after UCLR, while they do not hit in batting practice until 195 days (approximately 6.5 months) and do not hit in a real game until 323 days (approximately 10.7 months) after UCLR. Players see a decrease in hitting utilization after UCLR. On average, players hit in a real game 20 days before fielding in a real game. [ABSTRACT FROM AUTHOR]

Background: The critical shoulder angle (CSA) has been reported to be associated with rotator cuff disease and has been suggested as an etiology for cuff tears. However, it is unclear whether acromial morphologic characteristics such as CSA are a cause or effect because all studies to date have been retrospective.Questions/purposes: (1) How often can the CSA be reliably measured? (2) Is the CSA associated with rotator cuff disease? (3) Is the CSA correlated with baseline tear size or tear enlargement? (4) Does the CSA change with time?Methods: In this retrospective comparison of longitudinally collected data, patients with asymptomatic rotator cuff tears underwent ultrasonography and standardized AP radiographs at enrollment and yearly thereafter during a median of 4 years. Three hundred ninety-five patients were included, of whom 14 were excluded as they were not yet eligible for 2-year followup and 68 (18%) were lost to followup, leaving 313 study patients who were evaluated with 1433 radiographs. Patients with adhesive capsulitis with normal rotator cuffs and radiographically normal scapulae were included as control subjects (119 subjects). Two observers (PNC, DS) measured the CSA in a blinded fashion. Radiographs that met Suter-Henninger criteria for CSA measurement reliability were included. For the study group, 179 of the 313 (57%) patients with radiographs that met Suter-Henninger criteria were further analyzed; the remainder were excluded from this study. For the control group, 50 of 119 (42%) subjects met criteria and were further analyzed. Tear enlargement was found in 94 patients, and the CSA was compared in patients with tears and control subjects, and in tears with or without enlargement, and was correlated with tear size. In a subgroup of the study group in which 59 of 179 patients had a minimum of 3 years between initial and followup radiographs, two CSA measurements were performed to measure change.Results: In total, of the 1552 radiographs evaluated, only 326 (21%) were of sufficient quality to measure the CSA. The CSA was higher among patients with cuff tears than control subjects (34° ± 4° versus 32° ± 4°; mean difference, 2.0°; 95% CI, 0.7°-3.2°; p = 0.003). The CSA did not correlate with baseline tear length (ρ = 0.22, p = 0.090) or width (ρ = 0.16, p = 0.229). The CSA was not different between tears that enlarged and those that were stable (34° ± 3° versus 34° ± 4°; mean difference, 0.2°; 95% CI, -0.9° to -1.4°; p = 0.683). The CSA did not change over time (CSA Time 1: mean 33° ± 4° SD; CSA Time 2: mean 33° ± 4° SD; mean difference, -0.2°; 95% CI, -0.6° to 0.1°; p = 0.253).Conclusions: Even with a longitudinal protocol, most radiographs are of insufficient quality for CSA measurement. Although patients with a history of degenerative cuff disease have higher CSA values than control subjects, the difference is small enough that it could be influenced by measurement error in practice; in any case, a difference of the magnitude we observed is likely to be clinically unimportant. The CSA is not correlated with tear size or tear progression, and does not seem to change with time. These results suggest that the CSA is unlikely to be related to rotator cuff disease.Level Of Evidence: Level II, prognostic study. [ABSTRACT FROM AUTHOR]

Background: Recent studies evaluating nonoperative treatment of elbow ulnar collateral ligament (UCL) injuries augmented with platelet-rich plasma (PRP) have shown promising results. To date, no comparative studies have been performed on professional baseball players who have undergone nonoperative treatment with or without PRP injections for UCL injuries. Hypothesis: Players who received PRP injections would have better outcomes than those who did not receive PRP. Study Design: Cohort study; Level of evidence, 3. Methods: The Major League Baseball (MLB) Health and Injury Tracking System identified 544 professional baseball players who were treated nonoperatively for elbow UCL injuries between 2011 and 2015. Of these, 133 received PRP injections (PRP group) before starting their nonoperative treatment program, and 411 did not (no-PRP group). Player outcomes and a Kaplan-Meier survival analysis were compared between groups. In addition, to reduce selection bias, a 1:1 matched comparison of the PRP group versus the no-PRP group was performed. Players were matched by age, position, throwing side, and league status: major (MLB) and minor (Minor League Baseball [MiLB]). A single radiologist with extensive experience in magnetic resonance imaging (MRI) interpretation of elbow injuries in elite athletes analyzed 243 MRI scans for which images were accessible for tear location and grade interpretation. Results: Nonoperative treatment of UCL injuries resulted in an overall 54% rate of return to play (RTP). Players who received PRP had a significantly longer delay in return to throwing (P <.001) and RTP (P =.012). The matched cohort analysis showed that MLB and MiLB pitchers in the no-PRP group had a significantly faster return to throwing (P <.05) and the MiLB pitchers in the no-PRP group had a significantly faster RTP (P =.045). The survival analysis did not reveal significant differences between groups over time. The use of PRP, MRI grade, and tear location were not statistically significant predictors for RTP or progression to surgery. Conclusion: In this retrospective matched comparison of MLB and MiLB pitchers and position players treated nonoperatively for a UCL tear, PRP did not improve RTP outcomes or ligament survivorship, although there was variability with respect to PRP preparations, injection protocols, time from injury to injection, and rehabilitation programs. MRI grade and tear location also did not significantly affect RTP outcomes or progression to surgery. [ABSTRACT FROM AUTHOR]

Background: The results of open reduction and internal fixation (ORIF) of stress reactions and fractures of the olecranon among professional baseball players with regard to return to sport (RTS) are unknown. Purpose/Hypothesis: To determine the RTS rate and performance of professional baseball players after ORIF of acute, displaced olecranon fractures and olecranon stress fractures and to compare the RTS rate and performance with that of matched controls. The authors hypothesized that there is a high rate of RTS among professional baseball players after ORIF of acute, displaced olecranon fractures and olecranon stress fractures with no significant difference in rate of RTS or performance between cases and controls. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent ORIF of the olecranon between 2010 and 2016 were included. Demographic and performance data (before and after surgery) for each player were recorded. Performance metrics were then compared between cases and a group of matched controls. Results: Overall, 52 professional baseball players (mean ± SD age, 22.6 ± 3.6 years) underwent ORIF of an olecranon fracture. The majority of players sustained a primary olecranon stress fracture (73%) that was fixed with 1 screw (60%), with an overall RTS rate of 67.5%. No difference in RTS rate existed between matched controls and the cases. No significant difference existed between the primary pre- and postoperative performance metrics (ie, change in performance) for pitchers who underwent ORIF of an acute, displaced olecranon fracture or ORIF of a primary olecranon stress fracture. No significant difference existed between pitchers who underwent ORIF of a primary olecranon stress fracture and matched controls in any of the primary performance metrics. Three cases and 2 controls underwent ulnar collateral ligament reconstruction later in their careers after olecranon ORIF. Conclusion: Professional baseball players who undergo ORIF of an olecranon fracture (acute, displaced, or stress) have an RTS rate of 67.5% (57.6% to the same or higher level), which is no different from natural attrition among matched controls. No decline in performance metrics was seen among players who were able to RTS when compared with their preoperative performance or the performance of matched controls. [ABSTRACT FROM AUTHOR]

Background: Ulnar collateral ligament reconstruction (UCLR) is a successful procedure in professional baseball players. It is unclear whether graft choice affects results. Purpose: Determine performance and rate of return to sport (RTS) in professional baseball players after UCLR and compare performance and RTS rate, as well as injury rates, between players who underwent UCLR with hamstring versus palmaris autograft. Hypothesis: A high RTS rate exists in professional baseball players after UCLR, with no significant difference in injury rates, RTS rates, or performance specifically related to primary outcome performance variables—WHIP ([walks + hits]/innings pitched), fielding independent pitching (FIP), and wins above replacement (WAR)—between those who undergo UCLR with palmaris versus hamstring autograft. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent UCLR with hamstring autograft between 2010 and 2015 were included. Surgical details were gathered from operative reports. Players with hamstring UCLR were compared with a matched control group of players who underwent UCLR with palmaris autograft. Results: Overall, 195 players underwent UCLR with hamstring autograft. No differences in RTS rates or timing to RTS were found between the hamstring and palmaris groups. Significantly more subsequent injuries to the contralateral lower extremity were seen in the hamstring group versus the palmaris group (25 vs 13, respectively) (P =.040). More subsequent injuries to the upper extremity were found in the palmaris group versus the hamstring group (73 vs 55, respectively), although this difference was not significant (P =.052). No consistent differences in performance metrics upon RTS existed between hamstring and palmaris groups, although both groups significantly declined in many performance metrics after surgery. Both hamstring and palmaris groups showed a decline postoperatively in WAR (0.86 vs 0.35 and 1.23 vs 0.34, respectively) and WHIP (1.33 vs 1.44 and 1.36 vs 1.51, respectively); FIP did not decline (4.56 vs 5.27 and 4.51 vs 4.53, respectively). No significant difference in WAR, WHIP, or FIP existed between groups postoperatively. Conclusion: Baseball players who underwent UCLR with hamstring autograft were more likely to sustain a subsequent lower extremity injury, whereas those who underwent UCLR with palmaris autograft had a trend toward sustaining more upper extremity injuries. No difference in performance or RTS rates existed between groups. Both groups significantly declined in WAR and WHIP after UCLR. [ABSTRACT FROM AUTHOR]

Background: Latissimus dorsi and teres major (LD/TM) tears are becoming an increasingly common cause of injury and disability among professional baseball pitchers. Purpose/Hypothesis: To determine performance and return to sport (RTS) among professional baseball pitchers after LD/TM tears treated operatively and nonoperatively and to compare the RTS rate and performance between pitchers who sustained an LD/TM tear and matched controls. The authors hypothesized a high RTS rate among professional baseball pitchers after LD/TM tears, with no significant difference in RTS rate or performance between cases and controls for operative and nonoperative treatment—specifically, in the primary performance outcome variables of WHIP ([walks + hits] / innings pitched), fielding independent pitching, and wins above replacement. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball pitchers who sustained an LD/TM tear between 2011 and 2016 were identified with the Health and Injury Tracking System database of Major League Baseball. Demographic and performance data (before and after injury) were recorded for each player. Performance metrics were then compared between cases and matched controls by operative and nonoperative treatment. Results: Overall, 120 pitchers had a documented LD/TM tear; 42 (35%) were major league players. Most players (n = 107, 89.2%) were treated nonoperatively. Time to return to the same level of competition was 170 ± 169 days (mean ± SD) for pitchers treated nonoperatively and 406 ± 146 days for those treated operatively. The RTS rate among players treated nonoperatively and operatively was identical at 75%. Players treated nonoperatively had no change in fielding independent pitching or wins above replacement after injury but had a higher (ie, worse) WHIP after injury (P = .039); they also performed significantly worse in several secondary performance metrics, including number of games played per year (P < .001). Players treated operatively had no change in any measured performance metrics after surgery. No difference existed between cases and controls in the primary performance variables. Conclusion: The majority of LD/TM tears are treated nonoperatively. The RTS rate is 75% for professional baseball pitchers after LD/TM tears treated operatively or nonoperatively. Players treated nonoperatively saw a decline in several performance metrics, while players treated operatively had no significant difference in performance after surgery. [ABSTRACT FROM AUTHOR]

Background: Ulnar collateral ligament reconstruction (UCLR) is a successful procedure among professional baseball pitchers. It is unclear if hamstring tendon harvest side for UCLR affects the outcome or alters the risk for subsequent hamstring injury. Hypothesis: Players with prior UCLR with ipsilateral (drive leg) hamstring autograft will have the same return-to-sport (RTS) rate and performance upon RTS but a higher number of subsequent lower extremity injuries than those with contralateral (landing leg) hamstring autograft. Study Design: Cohort study; Level of evidence, 3. Methods: All players between 2010 and 2015 who underwent UCLR with hamstring autograft were included. Surgical details of their procedures were recorded from operative reports. Outcomes for UCLR with hamstring autograft harvested from the drive leg were compared with UCLR with the graft harvested from the landing leg. Results: Overall, 191 players underwent UCLR with hamstring autograft (drive leg, n = 58, 30%; landing leg, n = 133, 70%). The docking technique was more common in the drive leg group, while the figure-of-8 technique was more common in the landing leg group (P > .001). More patients in the landing leg group underwent concomitant treatment of the ulnar nerve than the drive leg group (P < .001). No difference existed in RTS rates or timing of RTS between groups. No differences in subsequent ipsilateral or contralateral hamstring injuries occurred between players who underwent UCLR with hamstring autograft from the drive leg or the landing leg (P≥ .999 and P = .460, respectively). No difference in overall upper or lower extremity injury rates existed between groups (all P > .05), and no difference in performance metrics existed between groups upon RTS. Conclusion: No difference in RTS rate, performance upon RTS, or subsequent injury rates (hamstring, lower extremity, or upper extremity) existed between players who underwent UCLR with hamstring autograft whether the graft came from the drive or the landing leg. [ABSTRACT FROM AUTHOR]

Purpose: Long-head biceps tenodesis has been suggested as an alternative to superior labral anterior-posterior (SLAP) repair. However, an unrepaired superior labral tear may increase glenohumeral translation, and thus, labral repair may be considered in the setting of biceps tenodesis.Methods: Patients who underwent tenodesis, SLAP repair, or combined tenodesis and labral repair for SLAP tears were included. The indication for combined tenodesis and labral repair was biceps tendonitis in the setting of a SLAP lesion with labral instability. Demographics, range of motion, return to work, return to sport, American Shoulder and Elbow Surgeons (ASES) scores, and visual analogue pain scale (VAS) scores were recorded.Results: Eighty-six patients were included: 18 underwent combined tenodesis and labral repair, 45 underwent SLAP repair alone, and 23 underwent tenodesis alone. There were no significant differences in rates of return to pre-operative level of play (n.s.) or return to full duties at work (n.s.). These groups differed significantly in ASES scores (p = 0.015) and VAS scores (p = 0.019) with combined tenodesis and labral repair patients having lower scores than patients undergoing either tenodesis or SLAP repair alone. A subgroup analysis of patients who did not have Worker's Compensation claims demonstrated similar results with significant differences in ASES scores, which were lowest among the combined tenodesis and labral repair cohort (p = 0.045).Conclusions: High-demand patients with biceps tendonitis in the setting of a SLAP lesion with labral instability who undergo combined tenodesis and SLAP repair have significantly worse outcomes than patients who undergo either isolated labral repair for type II SLAP tears or isolated biceps tenodesis for a SLAP tear and biceps tendonitis.Level Of Evidence: Treatment, Level III. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure that is highly successful in restoring knee stability and function. The incidence of early ACLR complications and the risk factors for these complications are not well defined. Purpose: To determine the incidence of 30-day complications and patient and surgical risk factors for complications after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent ACLR between 2005 and 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using Current Procedural Terminology billing codes. Postoperative complications in the 30-day period after surgery were identified. Potential patient and surgical risk factors for 30-day complications after ACLR were analyzed using univariate and multivariate analyses. Results: A total of 4933 patients were identified. Major complications occurred in 27 patients (0.55%), and minor complications occurred in 43 patients (0.87%), with overall complications occurring in 66 patients (1.34%). The most common complications were symptomatic deep venous thrombosis requiring treatment (n = 27; 0.55%), return to the operating room (n = 18; 0.36%), superficial infections (n = 10; 0.20%), deep infections (n = 7; 0.14%), and pulmonary embolism (n = 6; 0.12%). A single mortality (0.02%) occurred. Multivariate analyses demonstrated that smoking, dyspnea, a history of chronic obstructive pulmonary disease, and recent weight loss were all risk factors for the development of overall complications, although in combination, these factors accounted for only 3% of the variance in the complication rate. Conclusion: ACLR has a low incidence of complications (1.34%) in the early postoperative period, with the most common being symptomatic venous thromboembolic disease requiring treatment, return to the operating room, and infections. Because ACLR is an elective procedure, surgeons should use this information to counsel patients on risks and to guide their decision making about patient selection. [ABSTRACT FROM AUTHOR]

The article discusses the effectiveness of labral repair in restoring neuromascular control and motion during the overhand pitch. Topcics discussed include the etiology of superior labral anterior-posterior (SLAP) tears, as well as outcomes of its surgical intervention and the results of the comparison of the activity of the short head of the biceps muscle (SHBM) and the long head of the biceps muscle (LHBM) in the overhead pitching motion after bicep tenodesis.

The article discusses a study which aimed to determine the incidence and trends of anterior cruciate ligament (ACL) reconstruction in the U.S. Results show that the incidence of ACLR increased from 86,687 in 1994 to 129,836 per 100,000 person-years in 2006 and that the common treatment were partial meniscectomy and chondroplasty. It concluded that increased incidence were observed in females as well as those younger than 20 years and those 40 years or older.