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  • Cost analysis of Tommy John surgery for Major League Baseball teams

    BACKGROUND: The economic loss following ulnar collateral ligament reconstruction (UCLR) in Major League Baseball (MLB) pitchers has not been evaluated. The purpose of this study is to quantify the financial impact of UCLR on MLB teams. We hypothesize that MLB teams incur significant losses annually as a result of salaries paid to injured players following reconstruction.
    METHODS: Public records were accessed to identify MLB pitchers from January 1, 2004, to December 31, 2014, who had undergone UCLR. Contract terms and time away from competition were used to approximate economic loss. Successful return was considered when a pitcher returned to play in at least 1 Minor League Baseball (MiLB) or MLB game.

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  • How Should We Define Clinically Significant Improvement on Patient-Reported Outcomes Measurement Information System Test for Patients Undergoing Knee Meniscal Surgery?

    PURPOSE: The purpose of the study was to define the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) thresholds for the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) computerized adaptive test (CAT) instrument in patients undergoing arthroscopic meniscal surgery.
    METHODS: The PROMIS PF CAT was administered preoperatively and postoperatively to patients undergoing arthroscopic meniscal surgery. At 6 months postoperatively, patients graded their knee function based on a domain-specific anchor question. A satisfaction anchor question was used to indicate achievement of the PASS. Receiver operating characteristic analysis determined the relevant psychometric values. Cutoff analysis was performed to find preoperative patient-reported outcome scores predicting achievement of clinically significant outcomes (CSOs).

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  • Fatigue Increases Dynamic Knee Valgus in Youth Athletes: Results From a Field-Based Drop-Jump Test

    PURPOSE: To determine whether fatigue increases dynamic knee valgus in adolescent athletes, as measured after a standardized exercise protocol and video-based drop-jump test. A secondary aim was to determine whether individual risk factors place certain athletes at increased risk for dynamic knee valgus.

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  • Effect of Fatigue Protocols on Upper Extremity Neuromuscular Function and Implications for Ulnar Collateral Ligament Injury Prevention

    BACKGROUND: As the incidence of overuse injuries to the medial elbow in overhead athletes continues to rise, recent evidence suggests a link between these injuries and alterations in biomechanics produced by athlete fatigue. Previous studies have evaluated the effect of fatigue on elbow injuries using a wide array of fatigue protocols/athletic tasks, and, as a consequence, the results have been heterogeneous.
    PURPOSE: To determine whether there is a uniform alteration in neuromuscular function or biomechanics as the overhead athlete fatigues. Furthermore, this study sought to determine whether player fatigue should be accounted for in ulnar collateral ligament (UCL) injury prevention programs.

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  • Defining Minimal Clinically Important Difference and Patient Acceptable Symptom State After Isolated Endoscopic Gluteus Medius Repair

    BACKGROUND: Endoscopic surgical repair has become a common procedure for treating patients with gluteus medius tears. However, meaningful clinical outcomes after the procedure have not been defined.
    PURPOSE: To (1) define the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) in patients undergoing endoscopic gluteus medius repair and (2) determine correlations between preoperative patient characteristics and achievement of MCID/PASS.

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  • Arthroscopic Femoral Osteochondroplasty With Capsular Plication for Osteochondroma of the Femoral Neck

    Abstract Osteochondromas of the femoral neck are a rare but challenging problem because of their distal location, which is difficult to access arthroscopically. Traditional methods of osteochondroma resection used invasive open approaches to manage these lesions. More recently, advances in hip arthroscopy have allowed expanded treatment of extra-articular hip conditions with a minimally invasive approach.

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  • Do anatomic changes found in the throwing arm after a season of pitching resolve with off-season rest? A dynamic ultrasound study

    HYPOTHESIS: Our hypothesis was that seasonal adaptive changes in the ulnar collateral ligament (UCL), ulnohumeral joint space (UHJS), and glenohumeral internal rotation deficit (GIRD) of the pitching extremity would subsequently resolve with off-season rest.
    METHODS: Eleven collegiate pitchers underwent preseason, postseason, and off-season evaluations including physical examination; dynamic ultrasound imaging of the UCL and UHJS; and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Ultrasound images were evaluated by 2 fellowship-trained musculoskeletal radiologists.

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  • Osteochondral Allograft Transplantation in the Patellofemoral Joint: A Systematic Review

    BACKGROUND: The initial focus of cartilage restoration algorithms has been on the femur; however, the patellofemoral compartment accounts for 20% to 30% of significant symptomatic chondral pathologies. While patellofemoral compartment treatment involves a completely unique subset of comorbidities, with a comprehensive and thoughtful approach many patients may benefit from osteochondral allograft treatment.
    PURPOSE: To perform a systematic review of clinical outcomes and failure rates after osteochondral allograft transplantation (OCA) of the patellofemoral joint at a minimum 18-month follow-up.

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  • The Impact of Workers' Compensation on Patient-Reported Outcomes Measurement Information System Upper Extremity and Legacy Outcome Measures in Patients Undergoing Arthroscopic Rotator Cuff Repair

    PURPOSE: To examine the preoperative performance of the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Computer Adaptive Test (CAT) with respect to legacy scores in patients receiving rotator cuff repair (RCR). In addition, to define the impact of Workers' Compensation (WC) status on both performance and floor and ceiling effects.
    METHODS: The PROMIS UE CAT was administered preoperatively alongside legacy patient-reported outcome measures (PROMs) to patients undergoing isolated arthroscopic RCR from November 2017 to September 2018. Performance was assessed using Spearman correlation coefficients, and floor and ceiling effects were examined.

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  • Superior Gluteal Reconstruction for Severe Hip Abductor Deficiency

    Abstract Abductor tendon tears are one of the common causes of recalcitrant laterally based hip pain and dysfunction. In most cases, abductor tendon tears are associated with chronic nontraumatic tearing of the gluteus medius tendon. Restoring abductor function of the hip by primary repair of the gluteus medius tendon has been reported to have good and excellent outcomes. However, primary repair might not be as effective for chronic detachment of the gluteus medius tendon with a wide separation from the femoral footprint or severe tendon loss.

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