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Dragoo JL, Meadows MC. The use of biologics for the elbow: a critical analysis review. J Shoulder Elbow Surg 2019; 28:2053-2060. [PMID: 31585783 DOI: 10.1016/j.jse.2019.07.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/28/2019] [Indexed: 02/01/2023]
Abstract
There is significant interest in biologic treatment options to improve the healing environment and more rapidly decrease symptoms in many conditions around the elbow. Despite fairly widespread use of biologic agents such as platelet-rich plasma (PRP) in the elbow, there is a lack of clear evidence in the literature to support its use. The potential impact of these biologic agents must be evaluated with evidence from high-quality studies, particularly considering the high financial burden these treatments often impose on patients. The aim of this review is to provide an evidence-based summary of the biologic augmentation options available for use by the physician treating painful conditions of the elbow and to identify areas where further research is warranted.
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Affiliation(s)
- Jason L Dragoo
- Department of Orthopaedic Surgery, University of Colorado, Denver, CO, USA.
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Raducha JE, Gil JA, Harris AP, Owens BD. Ulnar Collateral Ligament Injuries of the Elbow in the Throwing Athlete. JBJS Rev 2019; 6:e1. [PMID: 29406433 DOI: 10.2106/jbjs.rvw.17.00061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UPDATE This article was updated on February 26, 2018, because of a previous error. On pages 1 and 7, in the author byline section, the authors' names that had read "Andrew Harris" and "Brett Owens" now reads "Andrew P. Harris" and "Brett D. Owens."
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Affiliation(s)
- Jeremy E Raducha
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Dubin JM, Rojas JL, Borade AU, Familiari F, McFarland EG. Isolated complete ulnar collateral ligament tear of the elbow in a gymnast: does it need surgery? PHYSICIAN SPORTSMED 2019; 47:242-246. [PMID: 30827129 DOI: 10.1080/00913847.2019.1589104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ulnar collateral ligament (UCL) tears can occur from trauma or chronic overuse, and the treatment depends on the type of sport the patient plays and the severity of symptoms. Overuse UCL injuries are most commonly due to micro-trauma in overhead athletes such as baseball players, softball players, and tennis players. Acute complete UCL tears in athletes due to trauma are less common but generally operative treatment is recommended. In gymnastics, elbow dislocations are more common than isolated UCL injuries, and there is sparse literature on the success of non-operative treatment of isolated UCL injuries in this group of athletes. In this case report, we report a high-level competitive gymnast with an UCL tear and a partial tear of the forearm flexor mass, which was confirmed by a thorough careful physical examination and magnetic resonance imaging. The patient was treated non-operatively and successfully returned to gymnastics without symptoms. This case supports the suggestion that UCL tears of the elbow can be treated successfully in some gymnasts without surgery, and that treatment should be individualized in this group of athletes.
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Affiliation(s)
- Justin M Dubin
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University , Baltimore , MD , USA
| | - Jorge L Rojas
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University , Baltimore , MD , USA
| | - Amrut U Borade
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University , Baltimore , MD , USA
| | - Filippo Familiari
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University , Baltimore , MD , USA
| | - Edward G McFarland
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University , Baltimore , MD , USA
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Return to Play Following Nonoperative Treatment of Partial Ulnar Collateral Ligament Injuries in Professional Baseball Players: A Critically Appraised Topic. J Sport Rehabil 2019; 28:660-664. [PMID: 30040021 DOI: 10.1123/jsr.2018-0110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/21/2018] [Accepted: 06/10/2018] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Ulnar collateral ligament (UCL) injuries are highly prevalent in professional baseball players with the success of operative management being well known in the literature. Return to play (RTP) rates following nonoperative management of partial UCL injuries in professional baseball players are not well established in the literature. With a UCL tear being a potential career-ending injury, it is imperative that the best treatment option is provided to these throwing athletes. There is an increase in the incidence of UCL surgical rates and a lack of general agreement on nonoperative treatment of partial UCL injuries as reported by the American Shoulder and Elbow Surgeons in 2017. There is also a lack of clarity on when to initiate rehabilitation, which may be due to the limited amount of studies reporting success of RTP rates and time to RTP following conservative interventions of partial UCL injuries. Evidence on the RTP rates seen following conservative management of partial UCL tears injuries can help guide health care providers in deciding on the best treatment option for professional baseball athletes who desire to return to their athletic careers. These rates of RTP will add valuable objective input when determining if conservative management is the best choice. To determine the current evidence, inclusion criteria for the literature search consisted of RTP rates following conservative treatment in professional baseball players between inception and 2018. Clinical Question: Is there evidence for successful RTP rates in professional baseball players following conservative treatment of a UCL injury? Summary of Key Findings: Three retrospective studies met the inclusion criteria and were included. Of those, 2 reported RTP rates following a nonoperative rehabilitation program of a UCL injury, whereas 1 reported RTP rates after injection therapy in subjects who attempted a trial of conservative treatment. All 3 studies considered location and grade of UCL tear. Successful RTP rates (66%-100%) were reported in professional baseball players following nonoperative treatment of partial UCL injuries. Clinical Bottom Line: Current evidence supports high success with RTP rates up to 100% after nonoperative treatment of grade 1 UCL injuries in professional baseball players and between 66% and 94% for a grade 2 and above. Strength of Recommendation: There is level C evidence for high RTP rates following nonoperative treatment of partial UCL injuries in professional baseball players.
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Milano G, Sánchez M, Jo CH, Saccomanno MF, Thampatty BP, Wang JHC. Platelet-rich plasma in orthopaedic sports medicine: state of the art. J ISAKOS 2019. [DOI: 10.1136/jisakos-2019-000274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Cascia N, Picha K, Hettrich CM, Uhl TL. Considerations of Conservative Treatment After a Partial Ulnar Collateral Ligament Injury in Overhead Athletes: A Systematic Review. Sports Health 2019; 11:367-374. [PMID: 31194648 DOI: 10.1177/1941738119853589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
CONTEXT Ulnar collateral ligament (UCL) reconstructions continue to increase without consensus on an evidence-based treatment protocol for nonoperative management. Currently, there is no consensus on an effective nonoperative protocol for partial UCL injuries that uses return-to-play (RTP) rates in determining the outcome of conservative treatment. OBJECTIVE To systematically review RTP rates after conservative treatment of partial UCL injuries in overhead athletes along with descriptive components of each conservative intervention to identify an effective evidence-based nonoperative rehabilitation protocol. DATA SOURCES Articles in PubMed, CINAHL, MEDLINE, Academic Search Complete, and SPORTDiscus were identified in October 2018 based on the following terms: overhead athlete, ulnar collateral ligament, nonoperative treatment, and return to play. STUDY SELECTION Seven retrospective, level 4 studies (n = 196) qualified for analysis. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Study design, level of evidence, demographics, sample size, sports involved, level of competition, grade or type of UCL diagnosis, conservative treatment components, and percentage RTP were extracted. RESULTS Overall, RTP rates after conservative treatment ranged between 42% and 100% (mean, 78% ± 20%). The most frequently reported components of rehabilitation protocols were (1) a period of rest, (2) stretching, (3) strengthening, and (4) a throwing program. Platelet-rich plasma injections were included in 5 (71%) of the 7 protocols with a rehabilitation period. CONCLUSION Conservative treatment is a viable option for partial UCL tears in overhead athletes. A successful rehabilitation protocol includes the use of patient-reported outcomes, a sport-specific tailored treatment plan, kinetic chain strengthening, and an interval throwing program. Factors such as age, grading of tear, level of play, sport, and athlete's perceived well-being should all be considered during treatment decisions.
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Affiliation(s)
- Nicole Cascia
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
| | | | - Carolyn M Hettrich
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Tim L Uhl
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
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Kato Y, Yamada S, Chavez J. Can platelet-rich plasma therapy save patients with ulnar collateral ligament tears from surgery? Regen Ther 2019; 10:123-126. [PMID: 30963080 PMCID: PMC6434065 DOI: 10.1016/j.reth.2019.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/25/2019] [Accepted: 02/27/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction Platelet-rich plasma (PRP) has been shown to be effective in treating partial tears of the ulnar collateral ligament (UCL) of the elbow in overhead throwing athletes, but it is still unknown whether it has a role in complete tears. The aim of this study was to assess the effectiveness of PRP in treating complete as well as partial UCL tears. We hypothesized that trephination of the injured UCL followed by injection with PRP can promote healing of both partial and complete tears. Methods Thirty-four baseball players with partial or complete UCL tears confirmed by magnetic resonance imaging (MRI) were included in the study. They were all recalcitrant to more than two months of rest and physical therapy. Under ultrasound guidance, trephination of the UCL was performed using an 18-gauge needle, followed by PRP injection. Visual analog scale (VAS) scores, Disabilities of the Arm, Shoulder, and Hand (DASH) sports module scores, and sonographic ulnohumeral joint space measurements with valgus stress were all obtained prior to the procedure and six months after. Results Twenty-six of 30 athletes were able to return to sport with pre-injury level of play within six months after the procedure, at an average time of 12.4 weeks (range: 10-18). Four subjects needed surgical treatment for persistent UCL insufficiency. The average follow-up was 54.2 weeks (range: 26-148). The average VAS and DASH scores improved from 53.5 to 17.2 (p < 0.0001) and from 81.7 to 24.2 (p < 0.0001), respectively. The average ulnohumeral joint space opening with valgus stress decreased from 3.81 mm to 3.45 mm (p = 0.018). Subgroup analysis by injury location revealed that the average VAS score improved from 48.2 to 8.6 (p < 0.0001) and from 64.0 to 34.5 (p = 0.0023) in proximal and distal tears, respectively. The average DASH score improved from 83.8 to 17.8 (p = 0.0001) and from 77.5 to 36.7 (p < 0.0001) in proximal and distal tears, respectively. The average ulnohumeral joint space opening with valgus stress decreased from 3.64 to 3.21 mm (p = 0.003) and from 4.14 to 3.92 mm (p = 0.0023) in proximal and distal tears, respectively. There was one case with a proximal tear that needed surgical management for failure of treatment, while there were three cases needing surgery in those with distal tears. Conclusion Ultrasound-guided PRP injection following trephination can be an effective treatment option for both partial and complete UCL tears of the elbow, especially proximal tears. The use of this technique for complete UCL tears may allow more athletes to avoid surgery and enable them to return to play faster.
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Affiliation(s)
- Yuki Kato
- Department of Sports Medicine, Kameda Medical Center, Japan
| | - Shin Yamada
- Department of Sports Medicine, Kameda Medical Center, Japan
| | - Jover Chavez
- Global Care Medical Center of Canlubang, Laguna, Philippines
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Buckley PS, Morris ER, Robbins CM, Kemler BR, Frangiamore SJ, Ciccotti MG, Huard J, LaPrade RF, Hackett TR. Variations in Blood Supply From Proximal to Distal in the Ulnar Collateral Ligament of the Elbow: A Qualitative Descriptive Cadaveric Study. Am J Sports Med 2019; 47:1117-1123. [PMID: 30896969 DOI: 10.1177/0363546519831693] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The vascular supply of the ulnar collateral ligament (UCL) is unknown. Previous studies reported varying success in return-to-play rates after nonoperative management of partial UCL tears and suggested a varying healing capacity as possibly related to the location of the UCL injury. PURPOSE To analyze the macroscopic vascular anatomy of the UCL of the elbow. STUDY DESIGN Descriptive laboratory study. METHODS Eighteen fresh-frozen male cadaveric elbows from 9 donors were sharply dissected 15 cm proximal to the medial epicondyle. Sixty milliliters of India ink was injected through the brachial artery of each elbow. Arms were then frozen at -10°C, radial side down, in 15° to 20° of elbow flexion. A band saw was used to section the frozen elbows into 5-mm coronal or sagittal sections. Sections were cleared for visualization with the modified Spalteholz technique. Images of the specimens were taken, and qualitative description of UCL vascularity was undertaken. RESULTS The authors consistently found a dense blood supply to the proximal UCL, while the distal UCL was hypovascular. They also observed a possible osseous contribution to the proximal UCL from the medial epicondyle in addition to an artery from the flexor/pronator musculature that consistently appeared to provide vascularity to the proximal UCL. The degree of vascular penetration from proximal to distal in the UCL ranged from 39% to 68% of the overall UCL length, with a 49% mean length of vascular penetration of the UCL. CONCLUSION This study found a difference in the vascular supply of the UCL. The proximal UCL was well vascularized, while the distal UCL was hypovascular. This difference in vascular supply may be a factor in the differential healing capacities of the UCL based on the location of injury. CLINICAL RELEVANCE An improved understanding of the macroscopic vascular supply of the UCL may aid in the clinical management of partial UCL tears and suggests an indication for these treatments with respect to location of UCL injuries.
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Affiliation(s)
- Patrick S Buckley
- The Steadman Clinic, Vail, Colorado, USA.,The Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Colin M Robbins
- The Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Bryson R Kemler
- The Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Michael G Ciccotti
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Johnny Huard
- The Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Robert F LaPrade
- The Steadman Clinic, Vail, Colorado, USA.,The Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Thomas R Hackett
- The Steadman Clinic, Vail, Colorado, USA.,The Steadman Philippon Research Institute, Vail, Colorado, USA
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Repair of the Ulnar Collateral Ligament of the Elbow: Rehabilitation Following Internal Brace Surgery. J Orthop Sports Phys Ther 2019; 49:253-261. [PMID: 30862273 DOI: 10.2519/jospt.2019.8215] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Injuries to the elbow in athletes who play overhead sports, especially in baseball pitchers, continue to increase in frequency. The anterior band of the ulnar collateral ligament (UCL), the primary restraint to valgus stress, is commonly injured from throwing. Historically, such injuries have been treated with surgical reconstruction techniques, using a tendon autograft. A recently developed UCL repair procedure with an internal brace, utilizing collagen tape, is gaining popularity. The primary goal of this surgery is to enhance elbow joint stability while the ligament is healing and to allow earlier return to sport after UCL reconstruction. The rehabilitation program following UCL repair with internal brace progresses through a different time frame than after UCL reconstruction. The purpose of this commentary, based on our experience with more than 350 cases, including 79 patients with at least a 1-year postsurgical follow-up, was to describe and provide the rationale for the rehabilitation process following UCL repair with internal brace. J Orthop Sports Phys Ther 2019;49(4):253-261. doi:10.2519/jospt.2019.8215.
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Marshall NE, Keller R, Limpisvasti O, Schulz B, ElAttrache N. Major League Baseball Pitching Performance After Tommy John Surgery and the Effect of Tear Characteristics, Technique, and Graft Type. Am J Sports Med 2019; 47:713-720. [PMID: 30624958 DOI: 10.1177/0363546518817750] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Return to play and player satisfaction have been quite high after ulnar collateral ligament reconstruction (UCLR); however, there has been little reported on how outcomes are affected by surgical technique, graft type, and tear characteristics. PURPOSE To evaluate surgical techniques, graft type, and tear characteristics on Major League Baseball (MLB) performance after UCLR. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS MLB pitchers who underwent primary UCLR at a single institution were included. Tear characteristics included tear location, tear grade, and acuity. Surgical technique and graft type were also collected. Pitching performance statistics, including earned run average (ERA), walks and hits per innings pitched (WHIP), innings pitched, and fastball velocity were evaluated 3 years before and after UCLR. RESULTS Forty-six MLB pitchers were identified as having primary UCLR. Return to play was 96%, with 82% returning to MLB play. Technique performed showed no difference in performance. As compared with pitchers with gracilis grafts, pitchers with palmaris grafts were younger ( P = .043), played longer after surgery ( P = .012), and returned to play at 100% (35 of 35) versus 82% (9 of 11, P = .010). When compared with pitchers with proximal tears, pitchers with distal tears pitched at higher velocity (93.0 vs 90.6 mph, P = .023) and had better performance before surgery (ERA, P = .003; WHIP, P = .021); however, those with proximal tears improved to match this performance and velocity after reconstruction. As compared with those having partial tears, pitchers with complete tears played longer after surgery (5.9 vs 4.0 years, P = .033), had a better ERA before injury ( P = .041), and had better WHIP ( P = .037) and strikeouts per 9 innings ( P = .025) after reconstruction. Pitchers with chronic tears had a significant improvement in postoperative ERA, from 4.49 to 3.80 ( P = .040). CONCLUSION Technique performed and graft type used did not affect performance; however, pitchers with palmaris grafts returned at a higher rate than those with gracilis grafts. Distal tears occurred in pitchers with greater velocity and better performance before injury, yet pitchers with proximal tears matched this performance after reconstruction. Pitchers with complete tears played longer after reconstruction. Pitchers who had partial tears had worse performance before injury and after reconstruction, and those with chronic tears saw a significant improvement in ERA with reconstruction.
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Affiliation(s)
| | | | - Orr Limpisvasti
- Kerlan Jobe Orthopaedic Clinic, Los Angeles, California, USA
| | - Brian Schulz
- Kerlan Jobe Orthopaedic Clinic, Los Angeles, California, USA
| | - Neal ElAttrache
- Kerlan Jobe Orthopaedic Clinic, Los Angeles, California, USA
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Abstract
PURPOSE OF REVIEW Injury to the ulnar collateral ligament is the most common, significant injury affecting the medial elbow of the overhead athlete. However, there are many other significant sources of pathology that should be considered. This review seeks to present a broad range of conditions that providers should consider when evaluating the overhead athlete with medial elbow pain. RECENT FINDINGS Recent biomechanical studies have deepened understanding of the anatomy and function of the anterior bundle of the ulnar collateral ligament germane to the overhead athlete. Orthobiologics hold potential for expanding the role of non-operative treatment for ulnar collateral ligament injuries. In addition to injury to the ulnar collateral ligament, providers should be prepared to diagnose and treat valgus extension overload, proximal olecranon stress fracture, ulnar nerve pathology, common flexor - pronator mass injury, and, in adolescents, medial epicondylar avulsion, when managing medial elbow pain in the overhead athlete.
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Affiliation(s)
- L Pearce McCarty
- Sports & Orthopaedic Specialists, part of Allina Health, 8100 W 78th Street, Suite 225, Edina, MN, 55439, USA.
- Department of Orthopaedic Surgery, Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN, 55407, USA.
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Kadri OM, Okoroha KR, Patel RB, Berguson J, Makhni EC, Moutzouros V. Nonoperative Treatment of Medial Ulnar Collateral Ligament Injuries in the Throwing Athlete. JBJS Rev 2019; 7:e6. [DOI: 10.2106/jbjs.rvw.18.00031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Image guided injection therapies in athletes-Do they work and what should we be using? Eur J Radiol 2018; 110:193-202. [PMID: 30599860 DOI: 10.1016/j.ejrad.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 12/01/2018] [Indexed: 12/18/2022]
Abstract
In the modern management of the injured elite athlete, the goals of guided injection therapies have extended beyond simple reduction of pain to enhancement of tissue healing and accelerated return to competition, faster than natural healing can allow. This article will review the injection therapies which are frequently used in elite sports injury management and describe other less commonly used injection therapies that are available to the treating clinician and athlete. The evidence base, where available, for each treatment option will be summarised.
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Kia C, Baldino J, Bell R, Ramji A, Uyeki C, Mazzocca A. Platelet-Rich Plasma: Review of Current Literature on its Use for Tendon and Ligament Pathology. Curr Rev Musculoskelet Med 2018; 11:566-572. [PMID: 30203334 PMCID: PMC6220011 DOI: 10.1007/s12178-018-9515-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Platelet-rich plasma (PRP) contains numerous growth factors and cytokines that potentially offer an alternative treatment modality to assist in the healing of multiple musculoskeletal issues. The purpose of this review was to examine the latest literature on the use of PRP for various ligament and tendon pathologies. RECENT FINDINGS Recent literature has shown moderate- to high-quality evidence that PRP can have positive clinical effects in certain conditions such as lateral epicondylitis and rotator cuff tendinopathy. Prospective studies have shown that it can also be useful in the treatment of patella tendinopathy. In summary, we found PRP to have variable success in ligament and tendon pathology; however, it should be considered a viable option in chronic musculoskeletal disease that has failed other treatments. Patient selection, duration of symptoms, and combining with other modalities such as physical therapy should all be taken into consideration in treatment with PRP.
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Affiliation(s)
- Cameron Kia
- University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, USA.
| | - Joshua Baldino
- University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, USA
| | - Ryan Bell
- University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, USA
| | - Alim Ramji
- University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, USA
| | - Colin Uyeki
- University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, USA
| | - Augustus Mazzocca
- University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, USA
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Kwapisz A, Prabhakar S, Compagnoni R, Sibilska A, Randelli P. Platelet-Rich Plasma for Elbow Pathologies: a Descriptive Review of Current Literature. Curr Rev Musculoskelet Med 2018; 11:598-606. [PMID: 30255288 PMCID: PMC6220004 DOI: 10.1007/s12178-018-9520-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Platelet-rich plasma is used in many orthopedic pathologies such as tendinopathies and ligament injuries. The clinical results reported in the scientific literature are, however, confusing. The aim of this manuscript is to provide a narrative literature review regarding the role of PRP in the most common elbow soft tissue pathologies. RECENT FINDINGS The response to PRP seems to be favorable when compared to steroid injection for pain management and for patient-reported outcomes in lateral epicondylitis. PRP injection does not seem to have the potential complications associated with a steroid injection such as skin atrophy, discoloration, and secondary tendon tears. Only a few manuscripts comparing the results of PRP treatment with either extracorporeal shockwave (ESW), dry needling, or even surgical treatments in lateral epicondylitis exist. The use of PRP in other elbow pathologies such as golfer's elbow, ulnar collateral ligament injury, and distal biceps and triceps pathology is examined in few studies, with unclear recommendations. Regarding elbow pathologies, PRP injections in tennis elbow seems to be the best-studied intervention. A major limitation in these studies is the significant heterogeneity in the methods used for preparing PRP, for example employing leukocyte-rich, leukocyte-poor preparations, PRP with or without activation, which makes the results of the studies difficult to compare. Results of this review show that more studies on larger cohorts, with comparable formulations, and with longer follow-up are required to give optimal suggestions concerning the use of PRP in elbow pathologies.
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Affiliation(s)
- Adam Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland.
| | - Sharad Prabhakar
- Department of Orthopedics Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Riccardo Compagnoni
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, UniversitàdegliStudi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- 1 Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Aleksandra Sibilska
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland
| | - Pietro Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, UniversitàdegliStudi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- 1 Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
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Santos SC, Sigurjonsson ÓE, Custódio CA, Mano JF. Blood Plasma Derivatives for Tissue Engineering and Regenerative Medicine Therapies. TISSUE ENGINEERING. PART B, REVIEWS 2018; 24:454-462. [PMID: 29737237 PMCID: PMC6443031 DOI: 10.1089/ten.teb.2018.0008] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Platelet-rich plasma (PRP) and its derivatives have been investigated and applied in regenerative medicine. The use of PRP as a supplement of cell culture media has consistently shown to potentiate stem cell proliferation, migration, and differentiation. In addition, the clinical utility of PRP is supported by evidence that PRP contains high concentrations of growth factors (GFs) and proteins which contribute to the regenerative process. PRP based therapies are cost effective and also benefit from the accessibility and safety of using the patient's own GFs. In the last years, a great development has been witnessed on PRP based biomaterials, with both structural and functional purposes. In this study we overview the most relevant PRP applications encompassing PRP based materials for tissue engineering and regenerative medicine. This review also summarizes the challenges in the fields of tissue engineering and regenerative medicine and provides a perspective on future directions.
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Affiliation(s)
- SC Santos
- Department of Chemistry, CICECO – Aveiro Institute of Materials, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - Ólafur Eysteinn Sigurjonsson
- 1) The Blood Bank, Landspitali University Hospital, Snorrabraut 60, 101 Reykjavik, Iceland 2) School of Science and Engineering, University of Reykjavik, Menntavegur 1, 101 Reykjavik
| | - Catarina Almeida Custódio
- Department of Chemistry, CICECO – Aveiro Institute of Materials, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - João Filipe Mano
- Department of Chemistry, CICECO – Aveiro Institute of Materials, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
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Abstract
Injuries and disorders of the elbow in athletes are common especially among throwing athletes. Common injuries encountered in the throwing athlete include ulnar collateral ligament injuries, ulnar neuritis, capitellar osteochondritis dissecans, valgus extension overload with posterior olecranon impingement, olecranon stress fracture, and loose bodies. A thorough knowledge of both the functional anatomy as well as throwing biomechanics are required to properly diagnosis and treat these problems. Nonoperative and surgical techniques have continued to advance over the last 25 years allowing for improved prognosis and return to play for athletes affected with elbow pathology.
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Kerlan-Jobe Orthopaedic Clinic (KJOC) score and scapular dyskinesis test in collegiate baseball players. J Shoulder Elbow Surg 2018; 27:1830-1836. [PMID: 30139685 DOI: 10.1016/j.jse.2018.06.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/13/2018] [Accepted: 06/23/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Kerlan-Jobe Orthopaedic Clinic (KJOC) score has been used to describe various parameters of throwing shoulder and elbow function for the return to play after a long period of rehabilitation, such as after ulnar collateral ligament reconstruction. No study has yet to identify how scapular dyskinesis (SD) in baseball players affects the KJOC score. This study investigated the relationship of the KJOC score to SD evaluated in collegiate baseball players with and without upper extremity injury. MATERIALS AND METHODS The study participants were 30 male collegiate baseball players (13 pitchers) belonging to the National Collegiate Athletic Association D-I conference. Participants were assessed with the KJOC instrument in the beginning (PRE) and end (POST) of the season. The SD test was conducted (PRE) in shoulder flexion to identify SD RESULTS: The mean value of KJOC score was significantly less in POST than that of PRE for the pitchers with SD (89.3 and 60.5, respectively; P = .001), whereas no difference was found in the KJOC score between PRE and POST for the pitchers without SD. For the position players, no difference in the mean value of KJOC score was found between PRE and POST, regardless of SD. CONCLUSION The results of this study provide evidence that collegiate baseball pitchers with mild SD may have lower KJOC scores, particularly setup or relief pitchers.
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71
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McCrum CL, Costello J, Onishi K, Stewart C, Vyas D. Return to Play After PRP and Rehabilitation of 3 Elite Ice Hockey Players With Ulnar Collateral Ligament Injuries of the Elbow. Orthop J Sports Med 2018; 6:2325967118790760. [PMID: 30148179 PMCID: PMC6100131 DOI: 10.1177/2325967118790760] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Ulnar collateral ligament (UCL) injury is a well-described etiology of pain and decreased performance for the overhead athlete. Despite a growing volume of literature regarding the treatment of these injuries for overhead athletes, there is a paucity of such data regarding stickhandling collision sport athletes, such as ice hockey players. Purpose/Hypothesis: The purpose of this study was to characterize this injury among 3 elite ice hockey players and to describe the ability of these athletes to return to play, as well as to review the unique sport-specific implications of this injury, evaluation, nonsurgical management, and considerations for return to play. The authors hypothesized that elite ice hockey players will be able to return to play at the same level following nonoperative treatment of UCL injury. Study Design: Case series; Level of evidence, 4. Methods: Data from 3 elite professional ice hockey players who sustained a high-grade injury to the UCL were retrospectively reviewed. All athletes underwent 2 autologous conditioned plasma injections as part of their treatment and were evaluated with ultrasonography and magnetic resonance imaging. Results: Three consecutive elite ice hockey players were included in this study, and no patients were excluded. Players were cleared to full return to play at a mean 36 days postinjury. Follow-up examination at this time point demonstrated full range of motion of the elbow for all athletes, without tenderness to palpation over the UCL, including no tenderness over the humeral insertion site. Stability examination improved as well, demonstrating a soft to moderate endpoint with valgus stress, although this was not symmetric to the contralateral side. All athletes were able to continue to play at the same level of competition as before the injury occurred, without any complaints. No players had repeat injury during the same or following seasons. Conclusion: The authors present 3 elite-level ice hockey players who sustained a high-grade injury to the UCL. Successful return to play was possible after nonoperative treatment with injection of autologous conditioned plasma at a mean 36 days following injury. Athletes who injure either the top or bottom hand can return to play at the same elite level following this injury.
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Affiliation(s)
- Christopher L McCrum
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joanna Costello
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kentaro Onishi
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Dharmesh Vyas
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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72
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Partial Anterior Cruciate Ligament Ruptures: Advantages by Intraligament Autologous Conditioned Plasma Injection and Healing Response Technique-Midterm Outcome Evaluation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3204869. [PMID: 30148163 PMCID: PMC6083554 DOI: 10.1155/2018/3204869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/02/2018] [Indexed: 02/06/2023]
Abstract
The historical treatment options for partial anterior cruciate ligament (ACL) ruptures were conservative therapy or ACL reconstruction by injured bundle or entire ACL replacement. In awareness of the regenerative potential of biologic agents such as mesenchymal stem cells or platelet rich plasma (PRP), the healing response technique was developed to preserve the injured ACL with better outcomes than the conservative therapy. Further improvement of this technique seems to be obtained by the additional application of PRP products. Thus, the aim of this study was to evaluate the midterm outcome after intraligament autologous conditioned plasma (ACP) by a clinical, scoring, and functional performance assessment. 42 patients were evaluated in this study. The failure rate was 9.5%. Outcome evaluation showed good to excellent results. The scores were IKDC subjective 83.2 (SD 14.5), Lysholm 85.5 (SD 15.5), Tegner 4.7 (SD 1.7), and Cincinnati 85.4 (SD 15.5) after a mean follow-up of 33 months. Clinical examination showed stable Lachman test, negative pivot shift phenomenon, and a significant reduction in AP-laxity compared to preoperative status (rolimeter preoperative: 1.9 (SD1.4); postoperative 0.6 (SD1.8), p=0.001) in all patients. Functional performance testing showed no significant differences between the injured and healthy side. Return to sport was achieved after a mean of 5.8 months (SD 3.6) in 71.1% of the included patients. In summary, this new treatment option revealed in midterm follow-up promising results to treat partial ACL lesions with a reduced need for conversion to ACL reconstruction and with a high percentage of return to preinjury sport activity.
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73
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Frangiamore SJ, Morris ER, Scibetta AC, Chahla J, Moatshe G, Civitarese D, Provencher MT, Hackett TR, Schickendantz MS, Huard J, LaPrade RF. Evaluation of Endothelial and Vascular-Derived Progenitor Cell Populations in the Proximal and Distal UCL of the Elbow: A Comparative Study. Orthop J Sports Med 2018; 6:2325967118777825. [PMID: 29977939 PMCID: PMC6024543 DOI: 10.1177/2325967118777825] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Vascular-derived progenitor and endothelial cell populations (CD31, CD34, CD146) are capable of multipotent differentiation at the site of injured ligamentous tissue to aid in the intrinsic healing response. Proximal ulnar collateral ligament (UCL) tears have been reported to have better healing capability when compared with distal UCL tears. Purpose: To compare the vascular composition of the proximal and distal insertions of the anterior bundle of the UCL of the elbow via known markers of endothelial and vascular-derived progenitor cells (CD31, CD34, CD146). Study Design: Descriptive laboratory study. Methods: UCLs were harvested from 10 nonpaired fresh-frozen human cadaveric elbows and transected into proximal and distal portions. Endothelial and vascular-derived progenitor cell densities were assessed with 4 staining groups: CD31 (immunohistochemistry) and CD31/α-smooth muscle actin (α-SMA), CD34/α-SMA, and CD146/α-SMA (immunofluorescence). CD31 immunohistochemistry identified endothelial progenitor cells in the UCL. Later staining of the same slides with α-SMA demonstrated the relationship of progenitor cells to the surrounding vasculature. Fluorescent staining was quantified by calculating the proportion of positively stained nuclei versus the total number of nuclei in the proximal and distal UCL. Results: CD31+ cells were present in the proximal and distal sections of all 10 UCLs. Fluorescent staining revealed no significant differences in the ratio of CD31 to total nuclei between the distal (median, 36% [range, 23%-53%]) and proximal UCL (39% [22%-56%]) (P = .432, Wilcoxon signed-rank test). Similarly, no differences were seen between CD34 distal (39% [24%-64%]) and proximal regions (46% [28%-63%]) (P = .846, Wilcoxon signed-rank test) or CD146 distal (40% [12%-65%]) and proximal regions (40% [22%-51%]) (P ≥ .999, Wilcoxon signed-rank test). Conclusion: Analysis of UCL tissues demonstrated equal distributions of vascular endothelial and vascular-derived progenitor cell markers throughout the proximal and distal UCL. Unlike that of the medial collateral ligament of the knee, the microvascular composition of the proximal and distal UCL insertions was not different, suggesting a well-vascularized ligament throughout its course. Clinical Relevance: These findings investigate one of the possible contributors to UCL healing after injury, which may provide insight into operative and nonoperative management of UCL injuries in the future. This study also indicates that reasons other than differences in progenitor cell density alone may explain the clinical healing differences seen between proximal and distal UCL tears. A better understanding of the microvascular environment and associated blood supply is warranted to understand the healing capability of the UCL.
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Affiliation(s)
| | | | | | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Gilbert Moatshe
- The Steadman Clinic, Vail, Colorado, USA.,Oslo University Hospital, Oslo, Norway.,OSTRC, Norwegian School of Sports Sciences, Oslo, Norway
| | | | | | | | | | - Johnny Huard
- Steadman Philippon Research Institute, Vail, Colorado, USA.,University of Texas Health Science Center, Houston, Texas, USA
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74
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Turgut E, Tunay VB. Cross-cultural adaptation of Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score: Reliability and validity in Turkish-speaking overhead athletes. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:206-210. [PMID: 29530478 PMCID: PMC6136342 DOI: 10.1016/j.aott.2018.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/04/2017] [Accepted: 02/14/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC-SES) is a subjective assessment tool to measure functional status of the upper extremities in overhead athletes. The aim was to translate and culturally adapt the KJOC-SES and to evaluate the psychometric properties of the Turkish version (KJOC-SES-Tr) in overhead athletes. METHODS The forward and back-translation method was followed. One hundred and twenty-three overhead athletes completed the KJOC-SES-Tr, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the American Shoulder and Elbow Surgeons Evaluation Form (ASES). Participants were assigned to one of the following subgroups: asymptomatic (playing without pain) or symptomatic (playing with pain, or not playing due to pain). Internal consistency, reliability, construct validity, discriminant validity, and content validity of the KJOC-SES-Tr were tested. RESULTS The test-retest reliability of the KJOC-SES-Tr was excellent with an interclass coefficient of 0.93. There was a strong correlation between the KJOC-SES-Tr and the DASH and the ASES, indicating that the construct validity was good for all participants. Results of the KJOC-SES-Tr significantly differed between different subgroups and categories of athletes. The floor and ceiling effects were acceptable for symptomatic athletes. CONCLUSION The KJOC-SES-Tr was shown to be valid, reliable tool to monitor the return to sports following injuries in athletes.
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Affiliation(s)
- Elif Turgut
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | - Volga Bayrakci Tunay
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
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75
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Kantrowitz DE, Padaki AS, Ahmad CS, Lynch TS. Defining Platelet-Rich Plasma Usage by Team Physicians in Elite Athletes. Orthop J Sports Med 2018; 6:2325967118767077. [PMID: 29780836 PMCID: PMC5954340 DOI: 10.1177/2325967118767077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: The indications for the use of platelet-rich plasma (PRP) are vaguely defined despite the frequency of its use as a treatment for athletes. While select studies have advocated for its efficacy, the majority of orthopaedic research conducted on the topic has been equivocal. Purpose: To define the use of PRP in elite athletes by team physicians from professional sports leagues. Study Design: Cross-sectional study. Methods: A survey assessing treatment timing, usage patterns, indications, and complications was generated by fellowship-trained sports medicine orthopaedic surgeons. The survey was distributed to team physicians from the National Football League, National Basketball Association, Major League Baseball, National Hockey League, Major League Soccer, and the “Power 5” Division I conferences of the National Collegiate Athletic Association. From a compilation of publicly available email addresses and those available from professional team physician associations, 149 team physicians were sent this PRP assessment tool. Results: Of the 149 professional and collegiate team physicians contacted, 59 started the survey and 46 completed it, resulting in a 39.6% participation rate and a 30.9% completion rate. Approximately 93% of physicians stated that they use PRP in their practices, and 72% use ultrasonography for injection guidance. On average, collegiate team physicians and National Football League physicians treated the most players per season with PRP (69.4 and 60.4 players, respectively), while National Hockey League physicians treated the fewest (18.0 players). The majority of respondents reported no complications from PRP injections (70%), with pain being the most common complication reported (26%). There was no consensus on the most important aspect of PRP formulation, with the top 2 responses being platelet concentration (48%) and white blood cell concentration (39%). When grading the importance of indications to use PRP, physicians found athlete desire on average (7.5 ± 2.2 [SD]; out of 10) to be more important than reimbursement (2.2 ± 2.2) (P < .001). Importantly, physicians stated that they moderately (5.4 ± 2.3) believed in the evidence behind PRP. Physicians listed hamstring injuries as the most common injury treated with PRP. Hamstring injuries were treated with a mean 3.14 PRP injections, as opposed to 2.19 injections for nonhamstring injuries. Conclusion: Professional and collegiate team physicians frequently use PRP despite a lack of consensus regarding the importance of the formulation of the product, the timing of treatment, and the conditions that would most benefit from PRP treatment.
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Affiliation(s)
- David E Kantrowitz
- Department of Orthopedic Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Ajay S Padaki
- Department of Orthopedic Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Christopher S Ahmad
- Department of Orthopedic Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - T Sean Lynch
- Department of Orthopedic Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
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76
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Saper M, Shung J, Pearce S, Bompadre V, Andrews JR. Outcomes and Return to Sport After Ulnar Collateral Ligament Reconstruction in Adolescent Baseball Players. Orthop J Sports Med 2018; 6:2325967118769328. [PMID: 29780844 PMCID: PMC5954308 DOI: 10.1177/2325967118769328] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: The number of ulnar collateral ligament (UCL) reconstructions in adolescent athletes has increased over the past 2 decades. Clinical results in this population have not been well studied. Purpose/Hypothesis: The purpose of this study was to evaluate the outcomes and return to sport after UCL reconstruction in a large group of adolescent baseball players. We hypothesized that excellent clinical outcomes and high rates of return to sport would be observed in this population at a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: We reviewed 140 adolescent (aged ≤19 years) baseball players who underwent UCL reconstruction with the American Sports Medicine Institute (ASMI) technique by a single surgeon. Medical records were reviewed for patient demographics, injury characteristics, operative details, and surgical complications. Patient-reported outcomes were assessed using the Conway scale, the Andrews-Timmerman (A-T) score, the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, and a 0- to 100-point subjective scale for elbow function and satisfaction. Return to sporting activity was assessed using a custom-designed questionnaire. Results: The mean age at the time of surgery was 18.0 years (range, 13-19 years), and the mean follow-up was 57.9 months (range, 32.4-115.4 months). Over half (60%) of patients were high school athletes. The mean duration of symptoms before surgery was 6.9 months (range, 0.5-60.0 months). Partial tears were identified in 57.9% of patients, and 41.3% of patients had preoperative ulnar nerve symptoms. Graft type included the ipsilateral palmaris in 77.1% of patients. Concomitant procedures were performed in 25% of patients. Outcomes on the Conway scale were “excellent” in 86.4% of patients. The mean A-T and KJOC scores were 97.3 ± 6.1 and 85.2 ± 14.6, respectively. Mean patient satisfaction was 94.4. Overall, 97.8% of patients reported returning to sport at a mean of 11.6 months (range, 5-24 months), and 89.9% of patients returned to sport at the same level of competition or higher. A total of 11.6% of patients went on to play professional baseball. Conclusion: UCL reconstruction with the ASMI technique is an effective surgical option in adolescents, with excellent outcome scores. At a minimum of 2-year follow-up, nearly 90% of patients returned to their preinjury level of sport.
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Affiliation(s)
- Michael Saper
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, Washington, USA
| | - Joseph Shung
- Department of Orthopaedic Surgery, University of South Alabama, Mobile, Alabama, USA
| | - Stephanie Pearce
- Department of Orthopaedic Surgery, University of South Alabama, Mobile, Alabama, USA
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, Washington, USA
| | - James R Andrews
- Andrews Institute for Orthopaedics & Sports Medicine, Gulf Breeze, Florida, USA
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77
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Clark NJ, Desai VS, Dines JD, Morrey ME, Camp CL. Nonreconstruction Options for Treating Medial Ulnar Collateral Ligament Injuries of the Elbow in Overhead Athletes. Curr Rev Musculoskelet Med 2018; 11:48-54. [PMID: 29335854 DOI: 10.1007/s12178-018-9458-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW This review aims to describe the nonreconstructive options for treating ulnar collateral ligament (UCL) injuries ranging from nonoperative measures, including physical therapy and biologic injections, to ligament repair with and without augmentation. RECENT FINDINGS Nonoperative options for UCL injuries include guided physical therapy and biologic augmentation with platelet-rich plasma (PRP). In some patients, repair of the UCL has shown promising return to sport rates by using modern suture and suture anchor techniques. Proximal avulsion injuries have shown the best results after repair. Currently, there is growing interest in augmentation of UCL repair with an internal brace. The treatment of UCL injuries involves complex decision making. UCL reconstruction remains the gold standard for attritional injuries and complete tears, which occur commonly in professional athletes. However, nonreconstructive options have shown promising results for simple avulsion or partial thickness UCL injuries. Future research comparing reconstructive versus nonreconstructive options is necessary.
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Affiliation(s)
- Nicholas J Clark
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Vishal S Desai
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Joshua D Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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78
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Molenaars RJ, Hilgersom NFJ, Doornberg JN, van den Bekerom MPJ, Eygendaal D. Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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79
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Deal JB, Smith E, Heard W, O'Brien MJ, Savoie FH. Platelet-Rich Plasma for Primary Treatment of Partial Ulnar Collateral Ligament Tears: MRI Correlation With Results. Orthop J Sports Med 2017; 5:2325967117738238. [PMID: 29164165 PMCID: PMC5686880 DOI: 10.1177/2325967117738238] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Jobe revolutionized the treatment of medial ulnar collateral ligament (MUCL) tears with his reconstruction technique. However, not all MUCL injuries require operative management; Rettig showed that 42% of MUCL injuries respond to conservative management. This was improved by Podesta, who showed that augmentation of nonoperative management with platelet-rich plasma (PRP) and magnetic resonance imaging (MRI) for detecting partial MUCL tears resulted in significantly higher success rates. Their series used a single injection of leukocyte-rich PRP. However, to our knowledge, no study has established optimal dosing and composition of PRP for augmentation of soft tissue healing. We present a series of patients with partial MUCL tears of the elbow treated with a series of 2 leukocyte-rich PRP injections, bracing, physical therapy, and a structured return-to-throwing protocol. Hypothesis: Nonoperative management of acute or subacute partial MUCL tears of the elbow with a formal treatment protocol will allow the injured ligament to heal without surgery and will permit a rapid return to sport. Study Design: Case series; Level of evidence, 4. Methods: Patients with symptomatic MUCL instability and magnetic resonance arthrography demonstrating grade 2 MUCL tears at the proximal or distal aspect were treated with varus-loading elbow bracing, activity restriction, and physical therapy, supplemented by 2 injections of PRP. The injections were separated by 2 weeks. Two weeks after the second injection, a repeat examination and magnetic resonance arthrogram were obtained to evaluate the response to treatment. Results: A total of 25 athletes (23 baseball athletes, 2 softball athletes [1 participant also danced]) underwent PRP injections and guided rehabilitation. Of these patients, 23 were diagnosed with primary grade 2 injuries of the MUCL; 22 patients with primary injuries (96%) demonstrated stability of the MUCL after treatment and returned to play at the same or higher level of competition without further intervention. Repeat MRI demonstrated reconstitution of the ligament in all patients, although 2 patients demonstrated only partial reconstitution. Patients were released to play at 6 weeks; due to vagaries of sports seasons, the mean time to return to competitive play was 82 days. Two of the 25 patients had undergone prior surgery (1 MUCL reconstruction and 1 repair). These patients remained unstable and symptomatic on examination after this treatment regimen, did not show complete reconstitution of the ligament on subsequent MRI, and required MUCL reconstruction. Conclusion: Ouf of 23 primary injury patients who received PRP injections and nonoperative measures, 22 (96%) were able to return to play and demonstrated reconstitution of the MUCL on MRI. Two of the 3 patients for whom PRP therapy failed had undergone previous MUCL surgery. We conclude that a 2-injection regimen of leukocyte-rich PRP is a safe and effective treatment for partial MUCL tears, but it appears to be less effective in patients with previous surgery for MUCL repair or reconstruction.
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Affiliation(s)
| | - Ed Smith
- Tulane University, New Orleans, Louisiana, USA
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80
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Rebolledo BJ, Dugas JR, Bedi A, Ciccotti MG, Altchek DW, Dines JS. Avoiding Tommy John Surgery: What Are the Alternatives? Am J Sports Med 2017; 45:3143-3148. [PMID: 28278401 DOI: 10.1177/0363546517692548] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The number of ulnar collateral ligament (UCL) reconstructions being performed has risen sharply in recent years, most notably in the young amateur athlete. While successful outcomes have been reported with reconstruction, the surgery and the associated rehabilitation timeline may be difficult for the nonelite athlete to incur. Return-to-play expectations, along with level of competition, should help guide surgeons in exploring management options. While reconstruction remains a mainstay, focused research exploring nonreconstructive options has expanded. This review discusses the clinical approach to those with UCL injury, including current support for rehabilitation, biologic strategies, and available repair or augmentation alternatives.
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Affiliation(s)
- Brian J Rebolledo
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Jeffrey R Dugas
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michael G Ciccotti
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David W Altchek
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Joshua S Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
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81
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Hurwit DJ, Garcia GH, Liu J, Altchek DW, Romeo A, Dines J. Management of ulnar collateral ligament injury in throwing athletes: a survey of the American Shoulder and Elbow Surgeons. J Shoulder Elbow Surg 2017; 26:2023-2028. [PMID: 28941974 DOI: 10.1016/j.jse.2017.08.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/30/2017] [Accepted: 08/05/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Amid evidence that the number of ulnar collateral ligament (UCL) reconstructions performed annually is on the rise, there continues to be significant variation among surgeons in the management of UCL injuries. The purpose of this paper was to survey the members of the American Shoulder and Elbow Surgeons (ASES) to assess current trends related to the comprehensive treatment of athletes presenting with UCL injury. METHODS An online survey was distributed to the active members of the ASES. The survey was composed of 3 sections assessing the demographics of the survey-takers, presenting 7 distinct fictional clinical case scenarios of athletes with UCL injury, and posing a series of more general questions about operative and nonoperative management of UCL injuries. RESULTS There were 159 ASES members who responded to the survey (24% of the active membership); 65 respondents (40.9%) reported >15 years of clinical experience. Of the 7 case scenarios presented, a consensus was reached to indicate the patient for surgery in 4 cases. In all 7 cases, when operative management was the preferred option, a consensus was reached to perform UCL reconstruction. The preferred method of UCL reconstruction among respondents was the docking technique (66.0%); 36.3% of respondents used platelet-rich plasma in their treatment of UCL injuries. CONCLUSION The survey presented here shows that an overall experienced and well-trained cohort of surgeons tended to agree and often reached consensus opinions on how to approach UCL injury. Professional athletes and those with complete tears were indicated for surgery by consensus, whereas opinion was more divided on how to treat partial tears or nonprofessionals.
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Affiliation(s)
- Daniel J Hurwit
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
| | - Grant H Garcia
- Sports Medicine and Shoulder Department, Rush University, Chicago, IL, USA
| | - Joseph Liu
- Sports Medicine and Shoulder Department, Rush University, Chicago, IL, USA
| | - David W Altchek
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Anthony Romeo
- Sports Medicine and Shoulder Department, Rush University, Chicago, IL, USA
| | - Joshua Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
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Chahla J, Cinque ME, Piuzzi NS, Mannava S, Geeslin AG, Murray IR, Dornan GJ, Muschler GF, LaPrade RF. A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature. J Bone Joint Surg Am 2017; 99:1769-1779. [PMID: 29040132 DOI: 10.2106/jbjs.16.01374] [Citation(s) in RCA: 332] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP) is a blood-derived preparation whose use has grown exponentially in orthopaedic practice. However, there remains an unclear understanding of the biological properties and effects of PRP on musculoskeletal healing. Heterogeneous processing methods, unstandardized nomenclature, and ambiguous classifications make comparison among studies challenging. A comprehensive assessment of orthopaedic clinical PRP trials is key to unraveling the biological complexity of PRP, while improving standardized communication. Toward this goal, we performed a systematic review of the PRP preparation protocols and PRP composition utilized in clinical trials for the treatment of musculoskeletal diseases. METHODS A systematic review of the literature was performed from 2006 to 2016. Inclusion criteria were human clinical trials, English-language literature, and manuscripts that reported on the use of PRP in musculoskeletal/orthopaedic conditions. Basic-science articles, editorials, surveys, special topics, letters to the editor, personal correspondence, and nonorthopaedic applications (including cosmetic use or dental application studies) were excluded. RESULTS A total of 105 studies (in 104 articles) met the inclusion criteria for analysis. Of these studies, only 11 (10%) provided comprehensive reporting that included a clear description of the preparation protocol that could be used by subsequent investigators to repeat the method. Only 17 studies (16%) provided quantitative metrics on the composition of the final PRP product. CONCLUSIONS Reporting of PRP preparation protocols in clinical studies is highly inconsistent, and the majority of studies did not provide sufficient information to allow the protocol to be reproduced. Furthermore, the current reporting of PRP preparation and composition does not enable comparison of the PRP products being delivered to patients. A detailed, precise, and stepwise description of the PRP preparation protocol is required to allow comparison among studies and provide reproducibility.
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Affiliation(s)
- Jorge Chahla
- 1Steadman Philippon Research Institute, Vail, Colorado 2Department of Orthopaedic Surgery and Bioengineering, The Cleveland Clinic Foundation, Cleveland, Ohio 3Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina 4The Steadman Clinic, Vail, Colorado 5Department of Orthopaedics, University of Edinburgh, Edinburgh, United Kingdom
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Zaremski JL, McClelland J, Vincent HK, Horodyski M. Trends in Sports-Related Elbow Ulnar Collateral Ligament Injuries. Orthop J Sports Med 2017; 5:2325967117731296. [PMID: 29085844 PMCID: PMC5648099 DOI: 10.1177/2325967117731296] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Elbow ulnar collateral ligament (UCL) injuries are common, particularly in adolescent athletes playing overhead sports. While the incidence and outcomes of surgical UCL injuries are well documented, the nonsurgical UCL injury patterns and injury management in this population are not yet known. PURPOSE/HYPOTHESIS The purpose of this study was to retrospectively assess the injury severity and subsequent management of UCL injuries among competitive athletes aged 11 to 22 years. We hypothesized that nonsurgical UCL injuries would occur more frequently in younger athletes compared with older athletes. STUDY DESIGN Descriptive epidemiological study. METHODS Electronic medical records (using International Classification of Diseases, 9th Revision and 10th Revision and Current Procedural Terminology codes) and keyword searches were used to identify all patients with sports-related UCL injuries between January 2000 and April 2016. A total of 136 records were included. Patients were stratified into 3 age brackets (age 11-13 years, n = 17; age 14-16 years, n = 49; age 17-22 years, n = 70). There were no prior elbow surgical interventions. The main outcome measures included the frequency and severity of UCL injuries and injury management (surgical, nonsurgical). Independent variables included age, UCL injuries per year, and sport classification. RESULTS There were 53 surgical and 83 nonsurgical UCL injuries. The number of nonsurgical cases increased 9-fold from 2000-2008 to 2009-2016. The UCL injuries were distributed as follows: 60 sprains, 39 partial tears, 36 ruptures, and 1 rerupture. Moreover, 7% of sprains, 51% of partial tears, and 78% of ruptures underwent UCL reconstruction. Nonsurgical management was most common in the youngest athletes (age 11-13 years, 100.0% of total injuries; age 14-16 years, 71.4% of total injuries; and age 17-22 years, 44.3% of total injuries) (P = .007). UCL injury volume was most commonly associated with javelin (odds ratio, 6.69; 95% CI, 0.72-61.62; P = .07) and baseball (odds ratio, 1.55; 95% CI, 0.69-3.51; P = .32). CONCLUSION Younger athletes sustained less severe UCL injuries more often than older athletes. Participation in javelin and baseball was associated with a greater likelihood of UCL injuries based on our dataset. This is the first study to provide data on the volume of nonsurgical UCL injuries among athletes in various sports.
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Affiliation(s)
- Jason L. Zaremski
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - JoAnna McClelland
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Heather K. Vincent
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - MaryBeth Horodyski
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
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Yoshida M, Goto H, Takenaga T, Tsuchiya A, Sugimoto K, Musahl V, Fu F, Otsuka T. Anterior and posterior bands of the anterior bundle in the elbow ulnar collateral ligament: ultrasound anatomy. J Shoulder Elbow Surg 2017; 26:1803-1809. [PMID: 28735845 DOI: 10.1016/j.jse.2017.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/11/2017] [Accepted: 05/21/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The anterior oblique bundle (AOL) of the ulnar collateral ligament (UCL) is composed of anterior and posterior bands. This study evaluated the anatomy of the anterior and posterior bands in the AOL of the UCL for their separate visualization with ultrasound (US). METHODS We dissected 18 cadaveric elbow joints and recorded the direction of each band from the lateral view to determine the proper position for the US transducer. To determine the proper inclination of the transducer, we measured the inclinations of each band at the proximal and distal insertions from the transverse view. A paired t test was used for comparisons between both bands. Values of P < .05 were considered statistically significant. RESULTS The mean angles of the directions in the anterior and posterior bands were 10° ± 4° and 24° ± 9°, respectively. At the medial epicondyle, the mean inclination angles of both bands were 61° ± 5° and 67° ± 5°, respectively. At the sublime tubercle, the mean inclination angles of both bands were 14° ± 7° and 44° ± 9°, respectively. The inclination angles at the proximal ulna and the directions in both bands were significantly different (P < .001). CONCLUSIONS This study shows that the directions of both bands and inclination angles of the bony attachments in both bands can assist with correct placement of the US transducer and allow for separate visualization of each band.
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Affiliation(s)
- Masahito Yoshida
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Hideyuki Goto
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Tetsuya Takenaga
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Atsushi Tsuchiya
- Department of Orthopedic Surgery, Meitetsu Hospital, Nagoya, Japan
| | | | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Takanobu Otsuka
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
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Smucny M, Westermann RW, Winters M, Schickendantz MS. Non-operative management of ulnar collateral ligament injuries in the throwing athlete. PHYSICIAN SPORTSMED 2017; 45:234-238. [PMID: 28730863 DOI: 10.1080/00913847.2017.1358585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Medial ulnar collateral ligament (UCL) injuries have become increasingly prevalent in overhead athletes. The orthopaedic literature contains a wealth of information on operative management of these injuries. However, there are few high-quality longitudinal studies on non-operative care of UCL injuries. The purpose of this review is to describe the non-operative approach to managing UCL injuries, including recommended rehabilitation strategies and predictors of successful non-operative treatment.
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Affiliation(s)
- Mia Smucny
- a Cleveland Clinic Foundation , Cleveland , OH , USA
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87
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Abstract
OBJECTIVE Competitive bass angling involves sport fishing against other anglers while targeting a species of fish known as the black basses. Due to the rapidly growing popularity of high school competitive bass angling in Alabama and the nature of the casting motion similar to that of overhead athletes, we sought to examine the prevalence of sports type injuries in this population. METHODS In spring 2016, an anonymous survey was distributed across two large scale competitive high school fishing tournaments, allowing for a broad sampling of anglers throughout the state of Alabama. Survey items included demographic information, relevant past medical history, and various pains associated with the shoulder, elbow and wrist. Results were recorded and analyzed electronically using Microsoft Excel and IBM SPSS statistical software. RESULTS A total of 257 surveys were recorded. The response rate was 61%. The mean age of participating anglers was 15 ± 1.61 years. The majority (42%) of anglers fished year round. On average, anglers casted nearly 1,000 more times while competing versus fishing recreationally. Approximately 15% of anglers experienced shoulder, elbow, and wrist pain. The most common factors associated with pain included higher tournament cast counts, number of competitive years, number of tournaments/year, number of tournaments, and use of light weight lures. CONCLUSION A large portion of high school competitive anglers experience upper extremity pain. Knowledge of angling factors associated with pain allow for the creation of a modifiable routine to help reduce pain in affected anglers and prevent pain in healthy anglers.
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Affiliation(s)
- Connor R Read
- a UAB Sports Medicine, Division of Orthopedics, Department of Surgery , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Shawna L Watson
- a UAB Sports Medicine, Division of Orthopedics, Department of Surgery , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Jorge L Perez
- a UAB Sports Medicine, Division of Orthopedics, Department of Surgery , University of Alabama at Birmingham , Birmingham , AL , USA
| | - A Reed Estes
- a UAB Sports Medicine, Division of Orthopedics, Department of Surgery , University of Alabama at Birmingham , Birmingham , AL , USA
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Tisano BK, Estes AR. Overuse Injuries of the Pediatric and Adolescent Throwing Athlete. Med Sci Sports Exerc 2017; 48:1898-905. [PMID: 27254261 DOI: 10.1249/mss.0000000000000998] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the hypercompetitive environment of year round youth baseball, arm pain is commonplace. Although much research has been done about injuries in the overhead throwing athlete, the emphasis has been on the more elite levels, where athletes have reached full development. The anatomy of the skeletally immature athlete, including open physeal plates and increased tissue laxity, raises unique issues in the presentation and treatment of repetitive throwing injuries of the elbow and shoulder. With a focus on "little leaguers," this discussion evaluates five of the most common elbow and shoulder injuries-Little Leaguer's elbow, ulnar collateral ligament sprain or tear, osteochondritis dissecans/Panner's disease, Little Leaguer's shoulder, and multidirectional instability. In the developmentally distinct pediatric athlete, pathogenesis, diagnosis, and treatment may differ from that established for adults. Offering early diagnosis and treatment appropriate to a child's level of development will enable youth to not only continue to play sports but to also maintain full functionality as active adults.
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Affiliation(s)
- Breann K Tisano
- 1University of Alabama at Birmingham School of Medicine, Birmingham, AL; 2Division of Orthopaedic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL
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Abstract
Orthobiologics are biological substances that allow injured muscles, tendons, ligaments, and bone to heal more quickly. They are found naturally in the body; at higher concentrations they can aid in the healing process. These substances include autograft bone, allograft bone, demineralized bone matrix, bone morphogenic proteins, growth factors, stem cells, plasma-rich protein, and ceramic grafts. Their use in sports medicine has exploded in efforts to increase graft incorporation, stimulate healing, and get athletes back to sport with problems including anterior cruciate ligament ruptures, tendon ruptures, cartilage injuries, and fractures. This article reviews orthobiologics and their applications in pediatric sports medicine.
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Affiliation(s)
- Christopher C Bray
- Pediatric Orthopaedic Surgery and Adolescent Sports Medicine, Department of Orthopaedic Surgery, Steadman Hawkins Clinic of the Carolinas, Greenville Health System, 701 Grove Road, Greenville, SC 29605, USA; University of South Carolina School of Medicine - Greenville, Greenville, SC, USA.
| | - Clark M Walker
- Department of Orthopaedic Surgery, Greenville Health System, 701 Grove Road, Greenville, SC 29605, USA
| | - David D Spence
- Department of Orthopaedic Surgery, University of Tennessee - Campbell Clinic, 1400 South Germantown Road, Germantown, Memphis, TN 38138, USA
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Abstract
Damage to the medial collateral ligament of the elbow from an instability
episode usually heals with non-operative treatment. In some cases, residual
instability may occur, leading to functional impairment. Non-operative management can be successful when bracing, taping and therapy
are used to stabilise the elbow. A recent report detailing the efficacy of platelet-rich plasma in
effectively treating ulnar collateral ligament (UCL) injuries in throwers
has shown promise. However, there remain specific groups that should be
considered for repair or reconstruction. These may include throwing
athletes, wrestlers and some individuals involved in highly active physical
activity which demands stability of the elbow. The results of surgical repair and reconstruction allowing a return to
sports are quite good, ranging from 84% to 94%. Complications are generally
low and mostly centred on ulnar nerve injuries. This report represents a review of the literature concerning valgus
instability over the past five years, supplemented by selective older
articles where relevant.
Cite this article: EFORT Open Rev 2017;2:1-6.
DOI:10.1302/2058-5241.2.160037.
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Jena BP, Stemmer PM, Wang S, Mao G, Lewis KT, Walz DA. Human Platelet Vesicles Exhibit Distinct Size and Proteome. J Proteome Res 2017; 16:2333-2338. [PMID: 28587468 DOI: 10.1021/acs.jproteome.7b00309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the past 50 years, isolated blood platelets have had restricted use in wound healing, cancer therapy, and organ and tissue transplant, to name a few. The major obstacle for its unrestricted use has been, among others, the presence of ultrahigh concentrations of growth factors and the presence of both pro-angiogenic and anti-angiogenic proteins. To overcome this problem requires the isolation and separation of the membrane bound secretory vesicles containing the different factors. In the current study, high-resolution imaging of isolated secretory vesicles from human platelets using atomic force microscopy (AFM) and mass spectrometry enabled characterization of the remaining vesicles size and composition following their immunoseparation. The remaining vesicles obtained following osmotic lysis, when subjected to immunoseparation employing antibody to different vesicle-associated membrane proteins (VAMPs), demonstrate for the first time that VAMP-3-, VAMP-7-, and VAMP-8-specific vesicles each possesses distinct size range and composition. These results provide a window into our understanding of the heterogeneous population of vesicles in human platelets and their stability following both physical manipulation using AFM and osmotic lysis of the platelet. This study further provides a platform for isolation and the detailed characterization of platelet granules, with promise for their future use in therapy. Additionally, results from the study demonstrate that secretory vesicles of different size found in cells reflect their unique and specialized composition and function.
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Affiliation(s)
- Bhanu P Jena
- Department of Physiology, School of Medicine, ‡Department of Chemical Engineering & Materials Science, College of Engineering, and §Institute of Environment Health Sciences, Wayne State University , Detroit, Michigan 48201, United States
| | - Paul M Stemmer
- Department of Physiology, School of Medicine, ‡Department of Chemical Engineering & Materials Science, College of Engineering, and §Institute of Environment Health Sciences, Wayne State University , Detroit, Michigan 48201, United States
| | - Sunxi Wang
- Department of Physiology, School of Medicine, ‡Department of Chemical Engineering & Materials Science, College of Engineering, and §Institute of Environment Health Sciences, Wayne State University , Detroit, Michigan 48201, United States
| | - Guangzhao Mao
- Department of Physiology, School of Medicine, ‡Department of Chemical Engineering & Materials Science, College of Engineering, and §Institute of Environment Health Sciences, Wayne State University , Detroit, Michigan 48201, United States
| | - Kenneth T Lewis
- Department of Physiology, School of Medicine, ‡Department of Chemical Engineering & Materials Science, College of Engineering, and §Institute of Environment Health Sciences, Wayne State University , Detroit, Michigan 48201, United States
| | - Daniel A Walz
- Department of Physiology, School of Medicine, ‡Department of Chemical Engineering & Materials Science, College of Engineering, and §Institute of Environment Health Sciences, Wayne State University , Detroit, Michigan 48201, United States
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Oh JH, Kim JY, Limpisvasti O, Lee TQ, Song SH, Kwon KB. Cross-cultural adaptation, validity and reliability of the Korean version of the Kerlan-Jobe Orthopedic Clinic shoulder and elbow score. JSES OPEN ACCESS 2017; 1:39-44. [PMID: 30675538 PMCID: PMC6340835 DOI: 10.1016/j.jses.2017.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background The Kerlan-Jobe Orthopedic Clinic shoulder and elbow score (KJOC score) was developed for assessing performance and function in overhead athletes with shoulder and elbow injury and recently adapted as the standard score for overhead athletes in Major League Baseball. However, the Korean version of the KJOC score was not developed in the literature. The aim of the current study was to adapt the English version of the KJOC score to develop a Korean version (K-KJOC) and to evaluate its validity and reliability. Methods A total of 52 professional baseball players in the Korean Baseball League completed the K-KJOC at two-week intervals during the off-season. The QuickDASH (11-point Disabilities of the Arm, Shoulder and Hand) score was also performed to evaluate the construct validity of the K-KJOC score. The internal consistency of reliability and test–retest reliability were assessed as well. Results The K-KJOC score was correlated with the Quick DASH – disability/symptom (−0.309, ~−0.268, p < 0.05), Quick DASH – work (r = −0.721 to −0.671, p = 0.000) and QuickDASH – sports (r = −0.721 to −0.714, p = 0.000). The internal consistency of the K-KJOC score was excellent (Cronbach's α: 0.917–0.966), and the intra-class correlation coefficients of test–retest reliability for the 10 items for the K-KJOC score were fair to excellent (ICC 0.505–0.937, p < 0.05). Conclusion The K-KJOC score appeared to be a valid and reliable tool for assessing shoulder and elbow injuries in Korean overhead athletes.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, Republic of Korea
| | - Joon Yub Kim
- Department of Orthopedic Surgery, Myongji Hospital, Seonam University College of Medicine, Goyang, Gyeonggi-do, Republic of Korea
| | | | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Long Beach Veterans Affairs Healthcare System, Long Beach, CA, USA.,Department of Orthopaedic Surgery, University of California, Irvine, CA, USA
| | - Seong Hun Song
- Department of Orthopedic Surgery, Myongji Hospital, Seonam University College of Medicine, Goyang, Gyeonggi-do, Republic of Korea
| | - Ki Bum Kwon
- Department of Orthopedic Surgery, Myongji Hospital, Seonam University College of Medicine, Goyang, Gyeonggi-do, Republic of Korea
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A Retrospective Look at Integrating a Novel Regenerative Medicine Approach in Plastic Limb Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1214. [PMID: 28203511 PMCID: PMC5293309 DOI: 10.1097/gox.0000000000001214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 12/02/2016] [Indexed: 11/25/2022]
Abstract
Full-thickness wounds that have rendered patients candidates for amputation may require techniques that may include a combinatorial approach above traditional standard of care. The purpose of this retrospective study was to evaluate the effectiveness of an innovative approach whereby several therapies were combined to avoid amputation. Patients with full-thickness wounds who were previously recommended for amputation and were treated with the combinatorial approach of muscle flap reconstruction and concentrated bone marrow aspirate, platelet-rich plasma, INTEGRA Wound matrix, vacuum-assisted closure, and split-thickness skin grafts were assessed retrospectively. The mean age of the patients identified was 48 years (range, 34–66 years). The average size of the defects was 19.6 cm2. All defects were successfully covered with medial hemisoleus, lateral hemisoleus, or peroneus brevis muscle flaps combined with split-thickness skin grafts, concentrated bone marrow aspirate, and platelet-rich plasma. All flaps healed with an average time to fixator removal of 8.3 weeks; there was 1 above-knee amputation that occurred approximately after successful wound closing and fixator removal. The combinatorial approach described here including several regenerative medicine tools is an effective means of lower limb reconstruction to avoid amputation.
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95
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Dallo I, Chahla J, Mitchell JJ, Pascual-Garrido C, Feagin JA, LaPrade RF. Biologic Approaches for the Treatment of Partial Tears of the Anterior Cruciate Ligament: A Current Concepts Review. Orthop J Sports Med 2017; 5:2325967116681724. [PMID: 28210653 PMCID: PMC5298533 DOI: 10.1177/2325967116681724] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) has been established as the gold standard for treatment of complete ruptures of the anterior cruciate ligament (ACL) in active, symptomatic individuals. In contrast, treatment of partial tears of the ACL remains controversial. Biologically augmented ACL-repair techniques are expanding in an attempt to regenerate and improve healing and outcomes of both the native ACL and the reconstructed graft tissue. PURPOSE To review the biologic treatment options for partial tears of the ACL. STUDY DESIGN Review. METHODS A literature review was performed that included searches of PubMed, Medline, and Cochrane databases using the following keywords: partial tear of the ACL, ACL repair, bone marrow concentrate, growth factors/healing enhancement, platelet-rich plasma (PRP), stem cell therapy. RESULTS The use of novel biologic ACL repair techniques, including growth factors, PRP, stem cells, and bioscaffolds, have been reported to result in promising preclinical and short-term clinical outcomes. CONCLUSION The potential benefits of these biological augmentation approaches for partial ACL tears are improved healing, better proprioception, and a faster return to sport and activities of daily living when compared with standard reconstruction procedures. However, long-term studies with larger cohorts of patients and with technique validation are necessary to assess the real effect of these approaches.
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Affiliation(s)
| | - Jorge Chahla
- The Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - John A Feagin
- The Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Robert F LaPrade
- The Steadman Philippon Research Institute, Vail, Colorado, USA.; The Steadman Clinic, Vail, CO, USA
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96
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Abstract
OBJECTIVE The purpose of this article is to review common elbow injuries found in overhead athletes with focus on mechanism, clinical features, imaging appearance, and treatment options. CONCLUSION The overhead throwing motion subjects the elbow to a variety of complex forces, which places both osseous and soft-tissue structures at high risk for injury.
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Affiliation(s)
- Brandon J Erickson
- 1Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
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98
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Best TM, Caplan A, Coleman M, Goodrich L, Hurd J, Kaplan LD, Noonan B, Schoettle P, Scott C, Stiene H, Huard J. Not Missing the Future. Curr Sports Med Rep 2017; 16:202-210. [DOI: 10.1249/jsr.0000000000000357] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Cain EL, McGonigle O. Return to Play Following Ulnar Collateral Ligament Reconstruction. Clin Sports Med 2016; 35:577-95. [DOI: 10.1016/j.csm.2016.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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