The American Journal of Orthopedics

SEATTLE—Identification and patient education regarding modifiable risk factors may minimize the chance of a future anterior cruciate ligament (ACL) tear, according to research presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. “Our research suggests that a few risk factors such as, age, activity level and type of graft utilized may point to the possibility of re-injury,” said lead author, Christopher C. Kaeding, MD, of the Ohio State University in Columbus, and his research colleagues.

The researchers analyzed data from 2,695 patients through the MOON ACL database from 2002 to 2008. Subjects who had a primary ACL reconstruction with no history of contralateral knee surgery and had 2-year follow-up data were included. Subjects who had multi-ligament surgery were excluded.

Graft type, age, Marx score at time of index surgery, sport played post–ACL reconstruction, sex, smoking status, lateral meniscus tear at the time of ACL reconstruction, medial meniscus tear at the time of ACL reconstruction, body mass index (BMI), and MOON site were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear.

The analysis was repeated using the 2002 to 2003 and 2007 to 2008 cohort and included age, graft, sex, and Marx. An analysis of variance with post-hoc analysis was performed to detect significant differences in age and Marx score by graft type over time.

Study findings also indicate:

• There were 165/2801 (5.89%) ipsilateral and 177/2801 (6.32%) contralateral ACL tears identified in the cohort at the two-year follow-up.

• The odds of ipsilateral retear are 1.68 times greater for hamstring autograft (P = 0.04) and 4.67 times greater for an allograft (P < 0.001) compared to auto-BTB.

• The odds of ipsilateral retear decrease by 8% for every yearly increase in age (P < 0.001) and increases by 6% for every increased point on the Marx score (P = 0.017).

• The odds of contralateral ACL tear increase by 7% for every increased point on the Marx score (P = 0.004) and decreases by 5% for every one-point increase in BMI (P = 0.03).

• In 2002 to 2003, there were 61 out of 815 (7.5%) retears compared to 37 out of 1056 (3.5%) in 2007 and 2008.

“The study highlights that younger age, higher activity levels at time of injury, and what type of graft used (allograft) may increase risk of same side ACL injury within two years. With individuals having higher activity levels and lower age, retears on the opposite leg were more prominent,” said Dr. Kaeding. “Physicians and physical therapists need to better educate their patients about continued neuromuscular training even after the immediate rehabilitation process has ended to help prevent future tears.”

SEATTLE—Identification and patient education regarding modifiable risk factors may minimize the chance of a future anterior cruciate ligament (ACL) tear, according to research presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. “Our research suggests that a few risk factors such as, age, activity level and type of graft utilized may point to the possibility of re-injury,” said lead author, Christopher C. Kaeding, MD, of the Ohio State University in Columbus, and his research colleagues.

The researchers analyzed data from 2,695 patients through the MOON ACL database from 2002 to 2008. Subjects who had a primary ACL reconstruction with no history of contralateral knee surgery and had 2-year follow-up data were included. Subjects who had multi-ligament surgery were excluded.

Graft type, age, Marx score at time of index surgery, sport played post–ACL reconstruction, sex, smoking status, lateral meniscus tear at the time of ACL reconstruction, medial meniscus tear at the time of ACL reconstruction, body mass index (BMI), and MOON site were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear.

The analysis was repeated using the 2002 to 2003 and 2007 to 2008 cohort and included age, graft, sex, and Marx. An analysis of variance with post-hoc analysis was performed to detect significant differences in age and Marx score by graft type over time.

Study findings also indicate:

• There were 165/2801 (5.89%) ipsilateral and 177/2801 (6.32%) contralateral ACL tears identified in the cohort at the two-year follow-up.

• The odds of ipsilateral retear are 1.68 times greater for hamstring autograft (P = 0.04) and 4.67 times greater for an allograft (P < 0.001) compared to auto-BTB.

• The odds of ipsilateral retear decrease by 8% for every yearly increase in age (P < 0.001) and increases by 6% for every increased point on the Marx score (P = 0.017).

• The odds of contralateral ACL tear increase by 7% for every increased point on the Marx score (P = 0.004) and decreases by 5% for every one-point increase in BMI (P = 0.03).

• In 2002 to 2003, there were 61 out of 815 (7.5%) retears compared to 37 out of 1056 (3.5%) in 2007 and 2008.

“The study highlights that younger age, higher activity levels at time of injury, and what type of graft used (allograft) may increase risk of same side ACL injury within two years. With individuals having higher activity levels and lower age, retears on the opposite leg were more prominent,” said Dr. Kaeding. “Physicians and physical therapists need to better educate their patients about continued neuromuscular training even after the immediate rehabilitation process has ended to help prevent future tears.”

SEATTLE—Identification and patient education regarding modifiable risk factors may minimize the chance of a future anterior cruciate ligament (ACL) tear, according to research presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. “Our research suggests that a few risk factors such as, age, activity level and type of graft utilized may point to the possibility of re-injury,” said lead author, Christopher C. Kaeding, MD, of the Ohio State University in Columbus, and his research colleagues.

The researchers analyzed data from 2,695 patients through the MOON ACL database from 2002 to 2008. Subjects who had a primary ACL reconstruction with no history of contralateral knee surgery and had 2-year follow-up data were included. Subjects who had multi-ligament surgery were excluded.

Graft type, age, Marx score at time of index surgery, sport played post–ACL reconstruction, sex, smoking status, lateral meniscus tear at the time of ACL reconstruction, medial meniscus tear at the time of ACL reconstruction, body mass index (BMI), and MOON site were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear.

The analysis was repeated using the 2002 to 2003 and 2007 to 2008 cohort and included age, graft, sex, and Marx. An analysis of variance with post-hoc analysis was performed to detect significant differences in age and Marx score by graft type over time.

Study findings also indicate:

• There were 165/2801 (5.89%) ipsilateral and 177/2801 (6.32%) contralateral ACL tears identified in the cohort at the two-year follow-up.

• The odds of ipsilateral retear are 1.68 times greater for hamstring autograft (P = 0.04) and 4.67 times greater for an allograft (P < 0.001) compared to auto-BTB.

• The odds of ipsilateral retear decrease by 8% for every yearly increase in age (P < 0.001) and increases by 6% for every increased point on the Marx score (P = 0.017).

• The odds of contralateral ACL tear increase by 7% for every increased point on the Marx score (P = 0.004) and decreases by 5% for every one-point increase in BMI (P = 0.03).

• In 2002 to 2003, there were 61 out of 815 (7.5%) retears compared to 37 out of 1056 (3.5%) in 2007 and 2008.

“The study highlights that younger age, higher activity levels at time of injury, and what type of graft used (allograft) may increase risk of same side ACL injury within two years. With individuals having higher activity levels and lower age, retears on the opposite leg were more prominent,” said Dr. Kaeding. “Physicians and physical therapists need to better educate their patients about continued neuromuscular training even after the immediate rehabilitation process has ended to help prevent future tears.”

SEATTLE—An investigation into the association of the (GT)n variable nucleotide tandem repeats (VNTR) within the GRIN2A gene and concussion recovery found that athletes carrying the long allele genotype are predisposed to prolonged recovery following a concussive injury. The findings were presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine.

“We identified that patients with a long allele in the (GT)n genotype were four times more likely to have a prolonged concussion recovery,” said lead author Jane McDevitt, PhD, from Temple University in Philadelphia, Pennsylvania, and her research colleagues.

Fifty-one athletes with a diagnosed concussion from a hospital concussion program completed a standardized initial evaluation. Concussion injury characteristics and acute signs and symptoms were assessed, followed by an objective screening that included vestibular ocular assessments, the BESS test, and an ImPACT exam.

Participants provided salivary samples for isolation of DNA. The number of (GT) VNTR within the promoter region of GRIN2A was genotyped. The long (L) allele was defined as an allele with 25 or more dinucleotide repeats in the GT tract. The short (S) allele was defined as an allele with < 25 dinucleotide repeats in the GT tract.

Based on the results of genetic analysis, participants were genotyped as LL homozygotes, SS homozygotes, or LS heterozygotes. Participants’ concussion recovery time was followed prospectively until the full return to play clearance date determined by the treating physician.

Participant’s recovery time was categorized as normal (≤ 20 days) or prolonged (> 20 days). The DNA region surrounding position (-975 to -776) in the promoter of GRIN2A was amplified by PCR, and was analyzed by capillary electrophoresis. Fragment length polymorphism analysis was performed by measuring the migration time of a PCR product, and extrapolation to the known fragments in the DNA standard ladder using computer software. The number of GT dinucleotide repeats was calculated using the following equation: n(GT)=(L -167)/2, where L is the length of the PCR fragment estimated in base pairs.

Results indicated there was a significant association between the GT VNTR (recessive model: LL versus SS + LS) and recovery, where the chance of prolonged recovery was 4.3 times greater for homozygous carriers of the long allele.

“Making the genetic connection in this data is an exciting step for concussion injury research,” said Dr. McDevitt. “Knowing this information could help improve monitoring and management of athletes who experience concussion, and may also aid in the development of genetic counseling in athletes exposed to concussive head impacts.”

SEATTLE—An investigation into the association of the (GT)n variable nucleotide tandem repeats (VNTR) within the GRIN2A gene and concussion recovery found that athletes carrying the long allele genotype are predisposed to prolonged recovery following a concussive injury. The findings were presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine.

“We identified that patients with a long allele in the (GT)n genotype were four times more likely to have a prolonged concussion recovery,” said lead author Jane McDevitt, PhD, from Temple University in Philadelphia, Pennsylvania, and her research colleagues.

Fifty-one athletes with a diagnosed concussion from a hospital concussion program completed a standardized initial evaluation. Concussion injury characteristics and acute signs and symptoms were assessed, followed by an objective screening that included vestibular ocular assessments, the BESS test, and an ImPACT exam.

Participants provided salivary samples for isolation of DNA. The number of (GT) VNTR within the promoter region of GRIN2A was genotyped. The long (L) allele was defined as an allele with 25 or more dinucleotide repeats in the GT tract. The short (S) allele was defined as an allele with < 25 dinucleotide repeats in the GT tract.

Based on the results of genetic analysis, participants were genotyped as LL homozygotes, SS homozygotes, or LS heterozygotes. Participants’ concussion recovery time was followed prospectively until the full return to play clearance date determined by the treating physician.

Participant’s recovery time was categorized as normal (≤ 20 days) or prolonged (> 20 days). The DNA region surrounding position (-975 to -776) in the promoter of GRIN2A was amplified by PCR, and was analyzed by capillary electrophoresis. Fragment length polymorphism analysis was performed by measuring the migration time of a PCR product, and extrapolation to the known fragments in the DNA standard ladder using computer software. The number of GT dinucleotide repeats was calculated using the following equation: n(GT)=(L -167)/2, where L is the length of the PCR fragment estimated in base pairs.

Results indicated there was a significant association between the GT VNTR (recessive model: LL versus SS + LS) and recovery, where the chance of prolonged recovery was 4.3 times greater for homozygous carriers of the long allele.

“Making the genetic connection in this data is an exciting step for concussion injury research,” said Dr. McDevitt. “Knowing this information could help improve monitoring and management of athletes who experience concussion, and may also aid in the development of genetic counseling in athletes exposed to concussive head impacts.”

SEATTLE—An investigation into the association of the (GT)n variable nucleotide tandem repeats (VNTR) within the GRIN2A gene and concussion recovery found that athletes carrying the long allele genotype are predisposed to prolonged recovery following a concussive injury. The findings were presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine.

“We identified that patients with a long allele in the (GT)n genotype were four times more likely to have a prolonged concussion recovery,” said lead author Jane McDevitt, PhD, from Temple University in Philadelphia, Pennsylvania, and her research colleagues.

Fifty-one athletes with a diagnosed concussion from a hospital concussion program completed a standardized initial evaluation. Concussion injury characteristics and acute signs and symptoms were assessed, followed by an objective screening that included vestibular ocular assessments, the BESS test, and an ImPACT exam.

Participants provided salivary samples for isolation of DNA. The number of (GT) VNTR within the promoter region of GRIN2A was genotyped. The long (L) allele was defined as an allele with 25 or more dinucleotide repeats in the GT tract. The short (S) allele was defined as an allele with < 25 dinucleotide repeats in the GT tract.

Based on the results of genetic analysis, participants were genotyped as LL homozygotes, SS homozygotes, or LS heterozygotes. Participants’ concussion recovery time was followed prospectively until the full return to play clearance date determined by the treating physician.

Participant’s recovery time was categorized as normal (≤ 20 days) or prolonged (> 20 days). The DNA region surrounding position (-975 to -776) in the promoter of GRIN2A was amplified by PCR, and was analyzed by capillary electrophoresis. Fragment length polymorphism analysis was performed by measuring the migration time of a PCR product, and extrapolation to the known fragments in the DNA standard ladder using computer software. The number of GT dinucleotide repeats was calculated using the following equation: n(GT)=(L -167)/2, where L is the length of the PCR fragment estimated in base pairs.

Results indicated there was a significant association between the GT VNTR (recessive model: LL versus SS + LS) and recovery, where the chance of prolonged recovery was 4.3 times greater for homozygous carriers of the long allele.

“Making the genetic connection in this data is an exciting step for concussion injury research,” said Dr. McDevitt. “Knowing this information could help improve monitoring and management of athletes who experience concussion, and may also aid in the development of genetic counseling in athletes exposed to concussive head impacts.”

SEATTLE—The type of material used to create a new anterior cruciate ligament (ACL) may determine the length of time an athlete can stay in the game, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society of Sports Medicine. “Our study results highlight that in a young athletic population, allografts fail more frequently than using autografts,” said Craig R. Bottoni, MD, lead author from Tripler Army Medical Center in Honolulu, Hawaii, and his team of researchers.

In their study, which lasted from June 2002 to August 2003, researchers randomized 99 patients with a symptomatic ACL-deficient knee (87 male; 95 active-duty military) to either hamstring autograft or tibialis posterior allograft for their ACL construction. All allografts were from a single tissue bank, aseptically processed and fresh frozen without terminal irradiation. Graft fixation was identical in all knees and all patients followed the same post-operative rehabilitation protocol, blinded to the therapists.

Preoperative and postoperative assessments were performed via examination and/or telephone and internet-based questionnaire to ascertain functional and subjective status using established knee metrics. The primary outcome measures were graft integrity, subjective knee stability, and functional status.

Overall, both groups were similar in demographics and preoperative activity level. The mean and median age of both groups was similar (29 and 26). Concomitant meniscal and chondral pathology, microfracture, and meniscal repairs performed at the time of reconstruction were similar in both groups.

At a minimum 10 years (range: 120-134 months) from surgery, 96 patients (97 knees) were contacted (2 patients were deceased and 1 was lost to follow-up). There were four (8.3%) autograft and 13 (26.5%) allograft failures, which required revision reconstruction. In the remaining patients whose graft was intact, there was no difference in the mean SANE, Tegner, or IKDC scores.

“After following the patients for 10 years, more than 80% of all grafts were intact and had maintained stability. However, those patients who had an allograft failed at a rate more than three times higher than those reconstructed with an autograft. This study was also of only one type of allograft—tibialis posterior. Therefore, we can make a strong statement about that type and not necessarily extrapolate to other types of allografts, most notably those with bone,” said Dr. Bottoni. “By better understanding why and how grafts fail in ACL reconstructions, we can increase the life span of these procedures and minimize future surgeries where feasible,” he said.

SEATTLE—The type of material used to create a new anterior cruciate ligament (ACL) may determine the length of time an athlete can stay in the game, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society of Sports Medicine. “Our study results highlight that in a young athletic population, allografts fail more frequently than using autografts,” said Craig R. Bottoni, MD, lead author from Tripler Army Medical Center in Honolulu, Hawaii, and his team of researchers.

In their study, which lasted from June 2002 to August 2003, researchers randomized 99 patients with a symptomatic ACL-deficient knee (87 male; 95 active-duty military) to either hamstring autograft or tibialis posterior allograft for their ACL construction. All allografts were from a single tissue bank, aseptically processed and fresh frozen without terminal irradiation. Graft fixation was identical in all knees and all patients followed the same post-operative rehabilitation protocol, blinded to the therapists.

Preoperative and postoperative assessments were performed via examination and/or telephone and internet-based questionnaire to ascertain functional and subjective status using established knee metrics. The primary outcome measures were graft integrity, subjective knee stability, and functional status.

Overall, both groups were similar in demographics and preoperative activity level. The mean and median age of both groups was similar (29 and 26). Concomitant meniscal and chondral pathology, microfracture, and meniscal repairs performed at the time of reconstruction were similar in both groups.

At a minimum 10 years (range: 120-134 months) from surgery, 96 patients (97 knees) were contacted (2 patients were deceased and 1 was lost to follow-up). There were four (8.3%) autograft and 13 (26.5%) allograft failures, which required revision reconstruction. In the remaining patients whose graft was intact, there was no difference in the mean SANE, Tegner, or IKDC scores.

“After following the patients for 10 years, more than 80% of all grafts were intact and had maintained stability. However, those patients who had an allograft failed at a rate more than three times higher than those reconstructed with an autograft. This study was also of only one type of allograft—tibialis posterior. Therefore, we can make a strong statement about that type and not necessarily extrapolate to other types of allografts, most notably those with bone,” said Dr. Bottoni. “By better understanding why and how grafts fail in ACL reconstructions, we can increase the life span of these procedures and minimize future surgeries where feasible,” he said.

SEATTLE—The type of material used to create a new anterior cruciate ligament (ACL) may determine the length of time an athlete can stay in the game, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society of Sports Medicine. “Our study results highlight that in a young athletic population, allografts fail more frequently than using autografts,” said Craig R. Bottoni, MD, lead author from Tripler Army Medical Center in Honolulu, Hawaii, and his team of researchers.

In their study, which lasted from June 2002 to August 2003, researchers randomized 99 patients with a symptomatic ACL-deficient knee (87 male; 95 active-duty military) to either hamstring autograft or tibialis posterior allograft for their ACL construction. All allografts were from a single tissue bank, aseptically processed and fresh frozen without terminal irradiation. Graft fixation was identical in all knees and all patients followed the same post-operative rehabilitation protocol, blinded to the therapists.

Preoperative and postoperative assessments were performed via examination and/or telephone and internet-based questionnaire to ascertain functional and subjective status using established knee metrics. The primary outcome measures were graft integrity, subjective knee stability, and functional status.

Overall, both groups were similar in demographics and preoperative activity level. The mean and median age of both groups was similar (29 and 26). Concomitant meniscal and chondral pathology, microfracture, and meniscal repairs performed at the time of reconstruction were similar in both groups.

At a minimum 10 years (range: 120-134 months) from surgery, 96 patients (97 knees) were contacted (2 patients were deceased and 1 was lost to follow-up). There were four (8.3%) autograft and 13 (26.5%) allograft failures, which required revision reconstruction. In the remaining patients whose graft was intact, there was no difference in the mean SANE, Tegner, or IKDC scores.

“After following the patients for 10 years, more than 80% of all grafts were intact and had maintained stability. However, those patients who had an allograft failed at a rate more than three times higher than those reconstructed with an autograft. This study was also of only one type of allograft—tibialis posterior. Therefore, we can make a strong statement about that type and not necessarily extrapolate to other types of allografts, most notably those with bone,” said Dr. Bottoni. “By better understanding why and how grafts fail in ACL reconstructions, we can increase the life span of these procedures and minimize future surgeries where feasible,” he said.

SEATTLE—It was previously believed that children and adolescents with anterior cruciate ligament (ACL) injuries should wait until skeletal maturity to have their knee injuries surgically corrected; however, this is no longer the case, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine.

“In reviewing records of young patients who received ACL reconstructions, our data showed higher rates and severity of secondary meniscus injuries when surgery is delayed,” said study author Allen F. Anderson, MD, from the Tennessee Orthopaedic Alliance in Nashville, Tennessee.

Dr. Anderson’s findings suggest that early reconstruction is preferable to nonoperative treatment because increased time from injury to surgery may be associated with a higher rate of meniscal and articular cartilage injury.

In the study 135 consecutive patients, ages 8 to 16 years, (mean age, 13.8) with ACL tears were evaluated from 2000 and 2012. The time from surgery was divided into three groups based on timing—acute (< 6 weeks), subacute (6 weeks to 3 months), and chronic (> 3 months). The type and grade of lateral and medial meniscus tears was documented according to the ISAKOS Meniscal Documentation Criteria and chondral injury location and grade was documented according to ICRS Criteria.

A total of 112 meniscal tears (70 lateral, 42 medial) were found in the study cohort. Sixty two patients were treated acutely, 37 subacute, and 36 chronic. Eighty percent of the patients ages 8 to 12 years had a meniscal tear and 84% of patients ages 13 to 16 years had a meniscal tear. Multivariant logistic regression revealed the risk factors for lateral meniscus tears were younger age (P = .007) and increased time to surgery (P = .008).

Study findings also conclude:

• The odds ratio of lateral meniscus tears for patients who had a single episode of instability was 3.1.

• For time to surgery, the odds ratio was 1 for acute reconstruction, 2.6 for subacute, and 2.59 for reconstruction of chronic injuries.

• The odds ratio for increased grade of tear was 3.3 for a giving-way episode and 6.5 for increased time to surgery.

• For medial meniscus tears, the risk factors were: older age (P = .001), increasing time to surgery (P =.007), return to sports (P = .044), and instability episodes (P = .001).

• Risk factors for increasing grade of medial meniscus tears were: time to surgery, return to sports, and any instability episode (P = < .001 for all).

“These data provide evidence that initial nonoperative treatment of ACL tears in this age group carries a high risk of additional meniscal and chondral injury, which may result in long-term knee injury,” Dr. Anderson concluded.

SEATTLE—It was previously believed that children and adolescents with anterior cruciate ligament (ACL) injuries should wait until skeletal maturity to have their knee injuries surgically corrected; however, this is no longer the case, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine.

“In reviewing records of young patients who received ACL reconstructions, our data showed higher rates and severity of secondary meniscus injuries when surgery is delayed,” said study author Allen F. Anderson, MD, from the Tennessee Orthopaedic Alliance in Nashville, Tennessee.

Dr. Anderson’s findings suggest that early reconstruction is preferable to nonoperative treatment because increased time from injury to surgery may be associated with a higher rate of meniscal and articular cartilage injury.

In the study 135 consecutive patients, ages 8 to 16 years, (mean age, 13.8) with ACL tears were evaluated from 2000 and 2012. The time from surgery was divided into three groups based on timing—acute (< 6 weeks), subacute (6 weeks to 3 months), and chronic (> 3 months). The type and grade of lateral and medial meniscus tears was documented according to the ISAKOS Meniscal Documentation Criteria and chondral injury location and grade was documented according to ICRS Criteria.

A total of 112 meniscal tears (70 lateral, 42 medial) were found in the study cohort. Sixty two patients were treated acutely, 37 subacute, and 36 chronic. Eighty percent of the patients ages 8 to 12 years had a meniscal tear and 84% of patients ages 13 to 16 years had a meniscal tear. Multivariant logistic regression revealed the risk factors for lateral meniscus tears were younger age (P = .007) and increased time to surgery (P = .008).

Study findings also conclude:

• The odds ratio of lateral meniscus tears for patients who had a single episode of instability was 3.1.

• For time to surgery, the odds ratio was 1 for acute reconstruction, 2.6 for subacute, and 2.59 for reconstruction of chronic injuries.

• The odds ratio for increased grade of tear was 3.3 for a giving-way episode and 6.5 for increased time to surgery.

• For medial meniscus tears, the risk factors were: older age (P = .001), increasing time to surgery (P =.007), return to sports (P = .044), and instability episodes (P = .001).

• Risk factors for increasing grade of medial meniscus tears were: time to surgery, return to sports, and any instability episode (P = < .001 for all).

“These data provide evidence that initial nonoperative treatment of ACL tears in this age group carries a high risk of additional meniscal and chondral injury, which may result in long-term knee injury,” Dr. Anderson concluded.

SEATTLE—It was previously believed that children and adolescents with anterior cruciate ligament (ACL) injuries should wait until skeletal maturity to have their knee injuries surgically corrected; however, this is no longer the case, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine.

“In reviewing records of young patients who received ACL reconstructions, our data showed higher rates and severity of secondary meniscus injuries when surgery is delayed,” said study author Allen F. Anderson, MD, from the Tennessee Orthopaedic Alliance in Nashville, Tennessee.

Dr. Anderson’s findings suggest that early reconstruction is preferable to nonoperative treatment because increased time from injury to surgery may be associated with a higher rate of meniscal and articular cartilage injury.

In the study 135 consecutive patients, ages 8 to 16 years, (mean age, 13.8) with ACL tears were evaluated from 2000 and 2012. The time from surgery was divided into three groups based on timing—acute (< 6 weeks), subacute (6 weeks to 3 months), and chronic (> 3 months). The type and grade of lateral and medial meniscus tears was documented according to the ISAKOS Meniscal Documentation Criteria and chondral injury location and grade was documented according to ICRS Criteria.

A total of 112 meniscal tears (70 lateral, 42 medial) were found in the study cohort. Sixty two patients were treated acutely, 37 subacute, and 36 chronic. Eighty percent of the patients ages 8 to 12 years had a meniscal tear and 84% of patients ages 13 to 16 years had a meniscal tear. Multivariant logistic regression revealed the risk factors for lateral meniscus tears were younger age (P = .007) and increased time to surgery (P = .008).

Study findings also conclude:

• The odds ratio of lateral meniscus tears for patients who had a single episode of instability was 3.1.

• For time to surgery, the odds ratio was 1 for acute reconstruction, 2.6 for subacute, and 2.59 for reconstruction of chronic injuries.

• The odds ratio for increased grade of tear was 3.3 for a giving-way episode and 6.5 for increased time to surgery.

• For medial meniscus tears, the risk factors were: older age (P = .001), increasing time to surgery (P =.007), return to sports (P = .044), and instability episodes (P = .001).

• Risk factors for increasing grade of medial meniscus tears were: time to surgery, return to sports, and any instability episode (P = < .001 for all).

“These data provide evidence that initial nonoperative treatment of ACL tears in this age group carries a high risk of additional meniscal and chondral injury, which may result in long-term knee injury,” Dr. Anderson concluded.

SEATTLE—Among mid-season contact athletes with shoulder instability, 73% of athletes return to play after 1 week, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. Regardless of whether the initial injury was a subluxation or dislocation, 63% of the cases developed recurrent instability.

There is no consensus on the optimal treatment of young in-season athletes with anterior shoulder instability and limited data are available to guide return to play and treatment. MAJ Jonathan F. Dickens, MD, from the John A. Feagin Jr. Sports Medicine Fellowship and Keller Army Hospital in West Point, New York, and colleagues conducted a study to examine the likelihood of return to sport following an in-season shoulder instability event based on the type of instability (subluxation vs. dislocation). Additionally, injury factors and patient reported outcome scores administered at the time of injury were evaluated to assess the predictability of eventual successful return to sport and time to return to sport during the competitive season following injury.

Dr. Dickens and colleagues examined 45 male and female intercollegiate athletes over 2 academic years, to assess return to play following in-season anterior glenohumeral instability. Athletes included in the sample were both male and female and participated in sports including basketball, soccer, lacrosse, and football. All observed athletes underwent a standardized accelerated rehabilitation program without shoulder immobilization, following the initial shoulder instability event. Subjects were followed during the course of their competitive season to determine return to play success and recurrent instability.

Of the 45 athletes who suffered an anterior shoulder instability event, 33 (73%) returned to play for at least part of the season after a median 5 days lost from competition. “While a large portion of the athletes in this observational study return to mid-season sport, only 36% completed the season without subsequent instability,” said Dr. Dickens. Athletes with a subluxation injury (partial dislocation) of the shoulder were 5.3 times more likely to return in the same season compared to those with a complete dislocation. The most common reason for athletes not returning was the inability to reach sufficient shoulder function for athletic participation.

“These early results should be valuable to physicians caring for the in-season athlete with shoulder instability, as we have not yet reached a consensus treatment approach on these injuries,” said Dr. Dickens. “More research is needed to determine the effect of multiple recurrent instability events on long-term outcomes and this study will hopefully be a first good step in understanding this relationship.”

SEATTLE—Among mid-season contact athletes with shoulder instability, 73% of athletes return to play after 1 week, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. Regardless of whether the initial injury was a subluxation or dislocation, 63% of the cases developed recurrent instability.

There is no consensus on the optimal treatment of young in-season athletes with anterior shoulder instability and limited data are available to guide return to play and treatment. MAJ Jonathan F. Dickens, MD, from the John A. Feagin Jr. Sports Medicine Fellowship and Keller Army Hospital in West Point, New York, and colleagues conducted a study to examine the likelihood of return to sport following an in-season shoulder instability event based on the type of instability (subluxation vs. dislocation). Additionally, injury factors and patient reported outcome scores administered at the time of injury were evaluated to assess the predictability of eventual successful return to sport and time to return to sport during the competitive season following injury.

Dr. Dickens and colleagues examined 45 male and female intercollegiate athletes over 2 academic years, to assess return to play following in-season anterior glenohumeral instability. Athletes included in the sample were both male and female and participated in sports including basketball, soccer, lacrosse, and football. All observed athletes underwent a standardized accelerated rehabilitation program without shoulder immobilization, following the initial shoulder instability event. Subjects were followed during the course of their competitive season to determine return to play success and recurrent instability.

Of the 45 athletes who suffered an anterior shoulder instability event, 33 (73%) returned to play for at least part of the season after a median 5 days lost from competition. “While a large portion of the athletes in this observational study return to mid-season sport, only 36% completed the season without subsequent instability,” said Dr. Dickens. Athletes with a subluxation injury (partial dislocation) of the shoulder were 5.3 times more likely to return in the same season compared to those with a complete dislocation. The most common reason for athletes not returning was the inability to reach sufficient shoulder function for athletic participation.

“These early results should be valuable to physicians caring for the in-season athlete with shoulder instability, as we have not yet reached a consensus treatment approach on these injuries,” said Dr. Dickens. “More research is needed to determine the effect of multiple recurrent instability events on long-term outcomes and this study will hopefully be a first good step in understanding this relationship.”

SEATTLE—Among mid-season contact athletes with shoulder instability, 73% of athletes return to play after 1 week, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. Regardless of whether the initial injury was a subluxation or dislocation, 63% of the cases developed recurrent instability.

There is no consensus on the optimal treatment of young in-season athletes with anterior shoulder instability and limited data are available to guide return to play and treatment. MAJ Jonathan F. Dickens, MD, from the John A. Feagin Jr. Sports Medicine Fellowship and Keller Army Hospital in West Point, New York, and colleagues conducted a study to examine the likelihood of return to sport following an in-season shoulder instability event based on the type of instability (subluxation vs. dislocation). Additionally, injury factors and patient reported outcome scores administered at the time of injury were evaluated to assess the predictability of eventual successful return to sport and time to return to sport during the competitive season following injury.

Dr. Dickens and colleagues examined 45 male and female intercollegiate athletes over 2 academic years, to assess return to play following in-season anterior glenohumeral instability. Athletes included in the sample were both male and female and participated in sports including basketball, soccer, lacrosse, and football. All observed athletes underwent a standardized accelerated rehabilitation program without shoulder immobilization, following the initial shoulder instability event. Subjects were followed during the course of their competitive season to determine return to play success and recurrent instability.

Of the 45 athletes who suffered an anterior shoulder instability event, 33 (73%) returned to play for at least part of the season after a median 5 days lost from competition. “While a large portion of the athletes in this observational study return to mid-season sport, only 36% completed the season without subsequent instability,” said Dr. Dickens. Athletes with a subluxation injury (partial dislocation) of the shoulder were 5.3 times more likely to return in the same season compared to those with a complete dislocation. The most common reason for athletes not returning was the inability to reach sufficient shoulder function for athletic participation.

“These early results should be valuable to physicians caring for the in-season athlete with shoulder instability, as we have not yet reached a consensus treatment approach on these injuries,” said Dr. Dickens. “More research is needed to determine the effect of multiple recurrent instability events on long-term outcomes and this study will hopefully be a first good step in understanding this relationship.”

SEATTLE—The return to play rates for National Football League (NFL) athletes following shoulder stabilization is approximately 90%, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. There is no difference in return to play rates between open and arthroscopic repairs.

Shoulder instability is a common injury among football players but the rate of return to play has not been regularly determined following surgery. Matthew J. White, MD, from the American Sports Medicine Institute (ASMI) in Birmingham, AL, and colleagues conducted a study to highlight the success rate of return to play in the NFL following shoulder stabilization surgery, and to determine what factors may affect return to play in these professional athletes.

Sixty NFL players who had undergone shoulder stabilization at ASMI were followed to determine the rate of return to play and the factors predicting return to play. Researchers performed chart review and analyzed follow-up data by accessing the NFL statistics database. Successful return to play was defined as participation in at least 1 regular season NFL game following surgery. Chi square and t-tests were performed to examine differences between perioperative and athletic history variables and a player’s ability to return to play. “Age, number of games before surgery, and career length were not statistically different between those that returned and those that did not,” said Dr. White.

Ninety percent (54 of 60) of NFL players were able to return to play following shoulder stabilization, with an average return to play time of 8.6 months. Eleven of the 60 patients underwent open stabilization. Ninety-two percent (45/49) of the arthroscopically treated and 82% (9/11) of the openly treated athletes were able to return to play. “It was also interesting to note, that players selected before the fourth round of the NFL draft were 7.6 times more likely to return to play following shoulder stabilization surgery,” said Dr. White.

In addition, circumferential labral tears were found in 7 athletes, all of whom returned to play following surgery. “Additional investigation on shoulder function and outcome scores long-term would be beneficial in this group of athletes to determine better standards of care,” noted Dr. White.

SEATTLE—The return to play rates for National Football League (NFL) athletes following shoulder stabilization is approximately 90%, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. There is no difference in return to play rates between open and arthroscopic repairs.

Shoulder instability is a common injury among football players but the rate of return to play has not been regularly determined following surgery. Matthew J. White, MD, from the American Sports Medicine Institute (ASMI) in Birmingham, AL, and colleagues conducted a study to highlight the success rate of return to play in the NFL following shoulder stabilization surgery, and to determine what factors may affect return to play in these professional athletes.

Sixty NFL players who had undergone shoulder stabilization at ASMI were followed to determine the rate of return to play and the factors predicting return to play. Researchers performed chart review and analyzed follow-up data by accessing the NFL statistics database. Successful return to play was defined as participation in at least 1 regular season NFL game following surgery. Chi square and t-tests were performed to examine differences between perioperative and athletic history variables and a player’s ability to return to play. “Age, number of games before surgery, and career length were not statistically different between those that returned and those that did not,” said Dr. White.

Ninety percent (54 of 60) of NFL players were able to return to play following shoulder stabilization, with an average return to play time of 8.6 months. Eleven of the 60 patients underwent open stabilization. Ninety-two percent (45/49) of the arthroscopically treated and 82% (9/11) of the openly treated athletes were able to return to play. “It was also interesting to note, that players selected before the fourth round of the NFL draft were 7.6 times more likely to return to play following shoulder stabilization surgery,” said Dr. White.

In addition, circumferential labral tears were found in 7 athletes, all of whom returned to play following surgery. “Additional investigation on shoulder function and outcome scores long-term would be beneficial in this group of athletes to determine better standards of care,” noted Dr. White.

SEATTLE—The return to play rates for National Football League (NFL) athletes following shoulder stabilization is approximately 90%, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. There is no difference in return to play rates between open and arthroscopic repairs.

Shoulder instability is a common injury among football players but the rate of return to play has not been regularly determined following surgery. Matthew J. White, MD, from the American Sports Medicine Institute (ASMI) in Birmingham, AL, and colleagues conducted a study to highlight the success rate of return to play in the NFL following shoulder stabilization surgery, and to determine what factors may affect return to play in these professional athletes.

Sixty NFL players who had undergone shoulder stabilization at ASMI were followed to determine the rate of return to play and the factors predicting return to play. Researchers performed chart review and analyzed follow-up data by accessing the NFL statistics database. Successful return to play was defined as participation in at least 1 regular season NFL game following surgery. Chi square and t-tests were performed to examine differences between perioperative and athletic history variables and a player’s ability to return to play. “Age, number of games before surgery, and career length were not statistically different between those that returned and those that did not,” said Dr. White.

Ninety percent (54 of 60) of NFL players were able to return to play following shoulder stabilization, with an average return to play time of 8.6 months. Eleven of the 60 patients underwent open stabilization. Ninety-two percent (45/49) of the arthroscopically treated and 82% (9/11) of the openly treated athletes were able to return to play. “It was also interesting to note, that players selected before the fourth round of the NFL draft were 7.6 times more likely to return to play following shoulder stabilization surgery,” said Dr. White.

In addition, circumferential labral tears were found in 7 athletes, all of whom returned to play following surgery. “Additional investigation on shoulder function and outcome scores long-term would be beneficial in this group of athletes to determine better standards of care,” noted Dr. White.

SEATTLE— Eighty-seven percent of Major League Baseball (MLB) pitchers who underwent ulnar collateral ligament (UCL) reconstructive surgery returned to the Major League level of sport, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. However, the study also documented a decline in pitching performance after undergoing reconstructive surgery. Entering the Major Leagues at a younger age also increased a player’s risk for requiring surgery.

A tremendous amount of stress is placed on the elbow while pitching a baseball. Due to these stresses, MLB pitchers are at increased risk for UCL injuries. Robert A. Keller, MD, of Henry Ford Hospital in Detroit, Michigan, and colleagues, reviewed the statistics for 168 MLB pitchers, who threw at least 1 season at the Major League level and underwent UCL reconstruction. Statistical data, including earned run average (ERA), walks and hits per innings pitched (WHIP), win percentage, innings pitched, and salary were compared for the 3 years before and 3 years after undergoing UCL reconstruction. “Having athletic trainers and team physicians closely look at when players pitching performance stats start to decrease may allow for steps to be taken with a pitcher before a surgery is needed,” said Dr. Keller.

Of the 87% of pitchers that returned to the Major League level after undergoing UCL reconstruction, a statistically significant decline in their ERA (P = 0.001), WHIP (P = 0.011), and innings pitched (P = 0.026) was seen compared to pre-reconstruction performance. Reconstructed pitchers also had a statistically decline in their pitching performance in the season before their surgery (ERA P = 0.014, WHIP P = 0.036, innings pitched P < 0.001, win percentage P = 0.004). Approximately 60% of pitchers requiring UCL reconstruction had surgery within the first 5 years of being in the Major Leagues. Validated by a multivariable generalized estimating equation model that examined risk factors, arm stress from earlier Major League experience contributed to injury. In addition, players who entered the MLB at an earlier age also appeared to have a greater risk for surgery.

“Our results suggest that UCL reconstructive surgery does a tremendous job in allowing players to return to their same level of sport but it also describes a decline in pitching performance after undergoing reconstruction,” said Dr. Keller. “Our study also further highlights the need for kids not to overuse their arms early in their pitching careers.”

SEATTLE— Eighty-seven percent of Major League Baseball (MLB) pitchers who underwent ulnar collateral ligament (UCL) reconstructive surgery returned to the Major League level of sport, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. However, the study also documented a decline in pitching performance after undergoing reconstructive surgery. Entering the Major Leagues at a younger age also increased a player’s risk for requiring surgery.

A tremendous amount of stress is placed on the elbow while pitching a baseball. Due to these stresses, MLB pitchers are at increased risk for UCL injuries. Robert A. Keller, MD, of Henry Ford Hospital in Detroit, Michigan, and colleagues, reviewed the statistics for 168 MLB pitchers, who threw at least 1 season at the Major League level and underwent UCL reconstruction. Statistical data, including earned run average (ERA), walks and hits per innings pitched (WHIP), win percentage, innings pitched, and salary were compared for the 3 years before and 3 years after undergoing UCL reconstruction. “Having athletic trainers and team physicians closely look at when players pitching performance stats start to decrease may allow for steps to be taken with a pitcher before a surgery is needed,” said Dr. Keller.

Of the 87% of pitchers that returned to the Major League level after undergoing UCL reconstruction, a statistically significant decline in their ERA (P = 0.001), WHIP (P = 0.011), and innings pitched (P = 0.026) was seen compared to pre-reconstruction performance. Reconstructed pitchers also had a statistically decline in their pitching performance in the season before their surgery (ERA P = 0.014, WHIP P = 0.036, innings pitched P < 0.001, win percentage P = 0.004). Approximately 60% of pitchers requiring UCL reconstruction had surgery within the first 5 years of being in the Major Leagues. Validated by a multivariable generalized estimating equation model that examined risk factors, arm stress from earlier Major League experience contributed to injury. In addition, players who entered the MLB at an earlier age also appeared to have a greater risk for surgery.

“Our results suggest that UCL reconstructive surgery does a tremendous job in allowing players to return to their same level of sport but it also describes a decline in pitching performance after undergoing reconstruction,” said Dr. Keller. “Our study also further highlights the need for kids not to overuse their arms early in their pitching careers.”

SEATTLE— Eighty-seven percent of Major League Baseball (MLB) pitchers who underwent ulnar collateral ligament (UCL) reconstructive surgery returned to the Major League level of sport, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. However, the study also documented a decline in pitching performance after undergoing reconstructive surgery. Entering the Major Leagues at a younger age also increased a player’s risk for requiring surgery.

A tremendous amount of stress is placed on the elbow while pitching a baseball. Due to these stresses, MLB pitchers are at increased risk for UCL injuries. Robert A. Keller, MD, of Henry Ford Hospital in Detroit, Michigan, and colleagues, reviewed the statistics for 168 MLB pitchers, who threw at least 1 season at the Major League level and underwent UCL reconstruction. Statistical data, including earned run average (ERA), walks and hits per innings pitched (WHIP), win percentage, innings pitched, and salary were compared for the 3 years before and 3 years after undergoing UCL reconstruction. “Having athletic trainers and team physicians closely look at when players pitching performance stats start to decrease may allow for steps to be taken with a pitcher before a surgery is needed,” said Dr. Keller.

Of the 87% of pitchers that returned to the Major League level after undergoing UCL reconstruction, a statistically significant decline in their ERA (P = 0.001), WHIP (P = 0.011), and innings pitched (P = 0.026) was seen compared to pre-reconstruction performance. Reconstructed pitchers also had a statistically decline in their pitching performance in the season before their surgery (ERA P = 0.014, WHIP P = 0.036, innings pitched P < 0.001, win percentage P = 0.004). Approximately 60% of pitchers requiring UCL reconstruction had surgery within the first 5 years of being in the Major Leagues. Validated by a multivariable generalized estimating equation model that examined risk factors, arm stress from earlier Major League experience contributed to injury. In addition, players who entered the MLB at an earlier age also appeared to have a greater risk for surgery.

“Our results suggest that UCL reconstructive surgery does a tremendous job in allowing players to return to their same level of sport but it also describes a decline in pitching performance after undergoing reconstruction,” said Dr. Keller. “Our study also further highlights the need for kids not to overuse their arms early in their pitching careers.”

SEATTLE—Proximal humeral epiphysiolysis, or little league shoulder (LLS), is being diagnosed with increasing frequency, according to data presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. Concomitant elbow pain may also be seen in up to 13% of youth athletes diagnosed with LLS. After rest and physical therapy, recurrent symptoms can occur, generally 6 to 12 months after return to sports.  

With rising participation in youth sports such as baseball and tennis, there remains a paucity of literature regarding the causes or outcomes of LLS. Benton E. Heyworth, MD, from Children’s Hospital Boston, Division of Sports Medicine in Boston, Massachusetts, and colleagues examined 95 patients with LLS. The researchers reviewed cases of LLS between 1999 and 2013 at a single pediatric referral center. The study analyzed age, sex, physical examination, radiologic findings, treatment approaches, and rates of recurrence.

Of the 95 patients (93 males; mean age 13.1 years, range 8-17 years), 13% reported elbow pain, 10% reported shoulder fatigue or weakness, 8% reported mechanical symptoms, and all patients complained of shoulder pain with overhead athletics. “These related symptoms should be recognized as possible identifiers for injured athletes in the future,” said Dr. Heyworth. On physical examination, 30% were reported to have glenohumeral internal rotation deficit (GIRD). Patients with GIRD were 3 times more likely to experience an injury recurrence 6 to 12 months after returning to play. “Not surprisingly, we found 97% of the affected athletes were baseball players, with 50% of the patients being only 12 or 13 years old—a good indicator of the stress being put on young arms,” added Dr. Heyworth.

Treatment recommendations included rest in 98% of cases, physical therapy in 79%, and position change upon return to play in 25%. Average time to resolution of symptoms was 2.6 months, with average time for return to competition was 4.2 months. Recurrent symptoms were reported in 7.4% in the overall population at a mean of 8 months following symptom resolution.

SEATTLE—Proximal humeral epiphysiolysis, or little league shoulder (LLS), is being diagnosed with increasing frequency, according to data presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. Concomitant elbow pain may also be seen in up to 13% of youth athletes diagnosed with LLS. After rest and physical therapy, recurrent symptoms can occur, generally 6 to 12 months after return to sports.  

With rising participation in youth sports such as baseball and tennis, there remains a paucity of literature regarding the causes or outcomes of LLS. Benton E. Heyworth, MD, from Children’s Hospital Boston, Division of Sports Medicine in Boston, Massachusetts, and colleagues examined 95 patients with LLS. The researchers reviewed cases of LLS between 1999 and 2013 at a single pediatric referral center. The study analyzed age, sex, physical examination, radiologic findings, treatment approaches, and rates of recurrence.

Of the 95 patients (93 males; mean age 13.1 years, range 8-17 years), 13% reported elbow pain, 10% reported shoulder fatigue or weakness, 8% reported mechanical symptoms, and all patients complained of shoulder pain with overhead athletics. “These related symptoms should be recognized as possible identifiers for injured athletes in the future,” said Dr. Heyworth. On physical examination, 30% were reported to have glenohumeral internal rotation deficit (GIRD). Patients with GIRD were 3 times more likely to experience an injury recurrence 6 to 12 months after returning to play. “Not surprisingly, we found 97% of the affected athletes were baseball players, with 50% of the patients being only 12 or 13 years old—a good indicator of the stress being put on young arms,” added Dr. Heyworth.

Treatment recommendations included rest in 98% of cases, physical therapy in 79%, and position change upon return to play in 25%. Average time to resolution of symptoms was 2.6 months, with average time for return to competition was 4.2 months. Recurrent symptoms were reported in 7.4% in the overall population at a mean of 8 months following symptom resolution.

SEATTLE—Proximal humeral epiphysiolysis, or little league shoulder (LLS), is being diagnosed with increasing frequency, according to data presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. Concomitant elbow pain may also be seen in up to 13% of youth athletes diagnosed with LLS. After rest and physical therapy, recurrent symptoms can occur, generally 6 to 12 months after return to sports.  

With rising participation in youth sports such as baseball and tennis, there remains a paucity of literature regarding the causes or outcomes of LLS. Benton E. Heyworth, MD, from Children’s Hospital Boston, Division of Sports Medicine in Boston, Massachusetts, and colleagues examined 95 patients with LLS. The researchers reviewed cases of LLS between 1999 and 2013 at a single pediatric referral center. The study analyzed age, sex, physical examination, radiologic findings, treatment approaches, and rates of recurrence.

Of the 95 patients (93 males; mean age 13.1 years, range 8-17 years), 13% reported elbow pain, 10% reported shoulder fatigue or weakness, 8% reported mechanical symptoms, and all patients complained of shoulder pain with overhead athletics. “These related symptoms should be recognized as possible identifiers for injured athletes in the future,” said Dr. Heyworth. On physical examination, 30% were reported to have glenohumeral internal rotation deficit (GIRD). Patients with GIRD were 3 times more likely to experience an injury recurrence 6 to 12 months after returning to play. “Not surprisingly, we found 97% of the affected athletes were baseball players, with 50% of the patients being only 12 or 13 years old—a good indicator of the stress being put on young arms,” added Dr. Heyworth.

Treatment recommendations included rest in 98% of cases, physical therapy in 79%, and position change upon return to play in 25%. Average time to resolution of symptoms was 2.6 months, with average time for return to competition was 4.2 months. Recurrent symptoms were reported in 7.4% in the overall population at a mean of 8 months following symptom resolution.