Brian J. Sennett

Patients who suffer anterior shoulder dislocations are at higher risk of developing glenohumeral arthropathy, but little is known about the initial cartilage damage after a primary shoulder dislocation. T1ρ is a magnetic resonance imaging (MRI) technique that allows quantification of cartilage proteoglycan content and can detect physiologic changes in articular cartilage. This study aimed to establish baseline T1ρ MRI values for glenoid and humeral head cartilage, determine whether T1ρ MRI can detect glenohumeral cartilage damage after traumatic primary shoulder dislocation, and assess for patterns in cartilage damage in anterior shoulder dislocation. Cross-sectional study; Level of evidence, 3. Nine male patients (mean age, 32.0 years; range, 20-59 years) who sustained first-time anterior shoulder dislocations underwent 3T T1ρ MRI. Five healthy controls (mean age, 27.4 years; range, 24-30 years) without prior dislocation or glenohumeral arthritis also underwent 3T T1ρ MRI. The T1ρ relaxation constant was determined for the entire glenoid and humeral head for patients with a dislocation and for healthy controls. The glenoid and humeral head were divided into 9 zones, and T1ρ values were determined for each zone in dislocated and control shoulders to identify patterns in cartilage damage in dislocated shoulders. Average overall T1ρ values for humeral head cartilage in dislocated shoulders were significantly greater than in controls (41.7 ± 3.9 ms vs 38.4 ± 0.6 ms, respectively; P = .03). However, average overall T1ρ values for glenoid cartilage were not significantly different in dislocated shoulders compared with controls (44.0 ± 3.3 ms vs 44.6 ± 2.4 ms, respectively; P = .40), suggesting worse damage to humeral head cartilage. T1ρ values in the posterior-middle humeral head were higher in patients with a dislocation compared with controls (41.5 ± 3.8 ms vs 38.2 ± 2.2 ms, respectively; P = .021) and trended toward significance in the posterior-superior and middle-superior zones (35.2 ± 4.9 ms vs 31.3 ± 1.0 ms and 33.7 ± 5.0 ms vs 30.5 ± 1.3 ms, respectively; P = .056). These 3 humeral head zones are where Hill-Sachs lesions predominate. T1ρ values in the anterior-inferior glenoid zone trended toward significance in patients with a dislocation compared with controls (47.4 ± 5.0 ms vs 43.5 ± 3.5 ms, respectively; P = .073). Humeral head cartilage sustained greater damage than glenoid cartilage in primary dislocation. T1ρ values were higher in glenohumeral zones associated with Bankart and Hill-Sachs lesions. Widespread initial cartilage damage may predispose patients to glenohumeral arthropathy.

Context: Little is known about pitching performance or lack of it among Major League Baseball (MLB) pitchers who undergo operative treatment of rotator cuff tears. Objective: To assess pitching performance outcomes in MLB players who needed operative treatment of rotator cuff tears and to compare performance in these athletes with that in a control group of MLB players. Design: Case-control study. Setting: Publicly available player profiles, press releases, and team injury reports. Patients or Other Participants: Thirty-three MLB pitchers with documented surgery to treat rotator cuff tears and 117 control pitchers who did not have documented rotator cuff tears were identified. Main Outcome Measure(s): Major League Baseball pitching attrition and performance variables. Results: Players who underwent rotator cuff surgery were no more likely not to play than control players. Performance variables of players who underwent surgery improved after surgery but never returned to baseline preoperative status. Players who needed rotator cuff surgery typically were more experienced and had better earned run averages than control players. Conclusions: Pitchers who had symptomatic rotator cuff tears that necessitated operative treatment tended to decline gradually in performance leading up to their operations and to improve gradually over the next 3 seasons. In contrast to what we expected, they did not have a greater attrition rate than their control counterparts; however, their performances did not return to preoperative levels over the course of the study.

Background: Men's intercollegiate lacrosse is played at a fast pace and with significant force. Glove protection is required. However, the thumb is at risk because of contact with opponents’ sticks, the ball, other players, and the ground or artificial surface. Purpose: To characterize patterns of hand injuries in men's intercollegiate lacrosse and to compare them with those in similar intercollegiate stick-handling sports that require gloves. Study Design: Descriptive epidemiology study. Methods: The National Collegiate Athletic Association (NCAA) Injury Surveillance System was utilized to evaluate thumb injuries in intercollegiate stick-handling sports (men's lacrosse, women's lacrosse, and men's ice hockey) during 16 intercollegiate seasons. Injuries were defined as events requiring an athlete to seek medical treatment and miss competition. Data were collected for injuries to the thumb, phalanges, and hand. Descriptive statistics were performed to calculate rates of injury per 1000 athlete-exposures and the relative exposure of the thumb with respect to total hand injuries. χ2 testing with the Yates correction for continuity was performed to determine differences in proportions of injury among the 3 sports studied. Results: During 16 intercollegiate seasons, there were 692 thumb, finger, and hand injuries in 3 038 255 athlete-exposures. Total thumb injuries were significantly higher in men's lacrosse, accounting for 59.4% of total hand injuries, when compared with women's lacrosse (42%) and men's ice hockey (35.8%) (P < .001). Thumb fractures and contusions were each also found to be significantly more prevalent (P < .001) when compared with women's lacrosse and men's ice hockey. Conclusion: Men's intercollegiate lacrosse requires the use of gloves; nonetheless, injury rates of the thumb are significantly elevated in this sport compared with other gloved, stick-handling sports. Recommendations include the development of gloves with improved thumb protection.

Background: Microfracture technique is commonly used to treat symptomatic chondral lesions of the knee. Performance outcomes and attrition rates associated with this injury/surgery in National Basketball Association athletes are unclear. Hypothesis: National Basketball Association players undergoing microfracture for symptomatic chondral lesions of the knee will have demonstrable differences in performance compared with preinjury and with matched controls. Study Design: Case control study; Level of evidence, 3. Methods: We evaluated 24 National Basketball Association players who underwent microfracture between 1997 and 2006. Descriptive data and performance data for the first full season preceding and following the index surgery were collected. Data were obtained from 48 matched controls. Univariate/multivariate statistical methods were used to assess change in performance and return to play. Results: Thirty-three percent (8 of 24) of National Basketball Association athletes who underwent microfracture surgery never returned to play in the National Basketball Association. Fourteen players returned to play in the National Basketball Association for >1 season. Within-group comparisons revealed that points scored (P = .008) and minutes played (P = .045) were reduced postoperatively. No performance variables were significantly different when averaged over 40 minutes of play. When compared with controls, cases experienced a significant decline in points per game (P = .013). Multiple regression analysis revealed that cases were 8.15 times less likely to remain in the National Basketball Association than controls (P = .005) after the index year. Conclusion: Players undergoing microfracture for knee chondral injuries are at risk for not returning to the National Basketball Association postoperatively. With the exception of points per game, athletes returning exhibited similar performance postoperatively compared with matched controls.

Ankle injuries account for the highest percentage of injuries among female collegiate volleyball players. Since 1998, all female volleyball players at the authors’ institution have worn bilateral double-upright padded ankle braces at all times. To review the authors’ experience with this brace in preventing ankle injuries that result in a loss of play. Case series; Level of evidence, 4. Injury data, preparticipation medical histories, and total exposure data were collected prospectively on all female volleyball players at the authors’ institution from 1998 to 2005. Injuries and exposures were defined based on established National Collegiate Athletic Association Injury Surveillance System criteria. Injury rate was calculated as the number of injuries per 1000 exposures. The National Collegiate Athletic Association female volleyball injury data from 1998 to 2005 were used for comparison. During the study period, there were a total of 13 500 exposures and 1 injury in our group yielding an injury rate of 0.07 per 1000 exposures. Nearly half of our athletes had a preparticipation history of ankle sprains, yet only 1 ankle injury occurred during all of our braced exposures. There were 811 710 exposures and 797 injuries in the National Collegiate Athletic Association comparison group with an increased injury rate of 0.98 per 1000 exposures (P = .001). Prophylactic use of a double-upright ankle brace significantly reduced the ankle injury rate compared with that reported by the National Collegiate Athletic Association. From these data, it appears that the use of such a brace is an effective way to decrease the incidence of ankle injuries in this active but vulnerable group of athletes.

Background: Anterior cruciate ligament injuries are common in professional football players, and their career impact is unclear. Purpose: To quantify the affect of anterior cruciate ligament injuries on professional football player performance. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Anterior cruciate ligament injury data from the National Football League were collected during a 5-year period (1998-2002) for running backs and wide receivers. Recorded variables included player age, experience, position, time to return to competition, and yearly total yards and touchdowns. Power ratings (total yards divided by 10 plus touchdowns multiplied by 6) were calculated for the injury season as well as for the 3 seasons before and after injury. A control group consisted of all running backs and wide receivers without an identified anterior cruciate ligament injury who competed in the 2000 season. Results: Data were analyzed for 31 running backs and wide receivers with 33 anterior cruciate ligament injuries. More than one fifth of players never returned to a National Football League game. Returning players first competed in a game 55.8 ± 5.4 weeks (mean ± standard error) after injury. For the 24 anterior cruciate ligament–injured players with a minimum total power rating (sum of all 7 seasons) of 200 points, power rating per game played decreased from 9.9 ± 1.1 preinjury to 6.5 ± 0.9 postinjury. This decline in power rating per game played was statistically significant (P =. 002) when compared with the change for the 146 control players. Conclusion: Nearly four fifths of National Football League running backs and wide receivers who sustain an anterior cruciate ligament injury return to play in a game. On return to competition, player performance of injured players is reduced by one third.