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Marigi EM, Lamba A, Boos A, Wang A, Okoroha KR, Barlow JD, Krych AJ, Camp CL. Outcomes of Shoulder Instability Surgery in Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 5 Years' Mean Follow-up. Am J Sports Med 2024; 52:586-593. [PMID: 38305257 DOI: 10.1177/03635465231218262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Wrestling is a physically demanding sport with young athletes prone to traumatic shoulder instability and a paucity of data evaluating the results of shoulder instability surgery (SIS). PURPOSE To assess reoperation rates, patient-reported outcomes, and return to wrestling (RTW) after SIS in a cohort of competitive wrestlers. STUDY DESIGN Case series; Level of evidence, 3. METHODS All competitive wrestlers with a history of shoulder instability and subsequent surgery at a single institution between 1996 and 2020 were identified. All directions of shoulder instability (anterior shoulder instability [ASI], posterior shoulder instability [PSI], and traumatic multidirectional shoulder instability [TMDI]) were analyzed. Exclusions included revision SIS and <2 years of follow-up. Athletes were contacted for determination of complications, RTW, and Western Ontario Shoulder Instability Index scores. RESULTS Ultimately, 104 wrestlers were included with a mean age at initial instability of 16.9 years (range, 12.0-22.7 years), mean age at surgery of 18.9 years (range, 14.0-29.0 years), and a mean follow-up of 5.2 years (range, 2.0-22.0 years). A total of 58 (55.8%) wrestlers were evaluated after a single shoulder instability event, while 46 (44.2%) sustained multiple events before evaluation. ASI was the most common direction (n = 79; 76.0%), followed by PSI (n = 14; 13.5%) and TMDI (n = 11; 10.6%). Surgical treatment was most commonly an arthroscopic soft tissue stabilization (n = 88; 84.6%), with open soft tissue repair (n = 13; 12.5%) and open bony augmentation (n = 3; 2.9%) performed less frequently. RTW occurred in 57.3% of wrestlers at a mean of 9.8 months. Recurrent instability was the most common complication, occurring in 18 (17.3%) wrestlers. Revision SIS was performed in 15 (14.4%) wrestlers. Across the entire cohort, survivorship rates free from recurrent instability and revision surgery were 90.4% and 92.5% at 2 years, 71.9% and 70.7% at 5 years, and 71.9% and 66.5% at 10 years, respectively. Preoperative recurrent instability was an independent risk factor for postoperative recurrent instability (hazard ratio, 3.8; 95% CI, 1.33-11.03; P = .012). CONCLUSION Competitive wrestlers with multiple dislocations before initial clinical evaluation were 3.8 times more likely to experience postoperative recurrent instability. Patients should be counseled that despite SIS, only 57.3% returned to wrestling after surgery.
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Affiliation(s)
- Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Boos
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Allen Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Comparing National Collegiate Athletic Association Division II Athletes’ Perceptions of Social Support Following Injury, Illness, and Other Identified Stressors. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2022. [DOI: 10.1123/jcsp.2021-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Collegiate athletes have demonstrated a need for social support to help cope with their daily responsibilities. The purpose of this research was to explore National Collegiate Athletic Association Division II athletes’ perception of social support from friends, teammates, family, coaches, significant others, and athletic trainers following injury, illness, or other identified life stressors. There were 546 participants who completed a five-part survey using the University Stress Scale, the Multidimensional Scale of Perceived Social Support, the Athletic Multidimensional Scale of Perceived Social Support, the Perceived Stress Scale, and a demographic section. Of the participants, 352 (64.5%) stated that they experienced moderate stress levels, and all participants indicated experiencing an identified life stressor within the last 12 months. The results indicated statistically significant differences when comparing providers of social support: females preferred the support of friends, significant others, and athletic trainers, and freshmen and sophomores perceived more social support from friends than did juniors and seniors.
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THE NONOPERATIVE REHABILITATION OF A TRAUMATIC COMPLETE ULNAR COLLATERAL LIGAMENT TEAR OF THE ELBOW IN A HIGH SCHOOL WRESTLER: A CASE REPORT. Int J Sports Phys Ther 2020; 15:1211-1221. [PMID: 33344036 DOI: 10.26603/ijspt20201211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Injuries frequently occur in competitive wrestling, with the elbow joint representing about 25% of all injuries. Specific to the elbow, the ulnar collateral ligament (UCL) can be injured traumatically from takedowns in wrestling. In athletes with complete UCL tears, surgical management is often recommended with nonoperative management resulting in less favorable outcomes. The purpose of this case report is to present a nonoperative criterion-based rehabilitation program for a high school wrestler with a complete UCL tear of the elbow. Case Description A 17-year-old male wrestler presented to outpatient physical therapy with a complete UCL tear sustained from falling on an outstretched hand during a wrestling match. He presented with limited elbow range of motion (ROM), medial elbow instability, and weakness of the involved shoulder and forearm musculature. A three staged criterion-based rehabilitation protocol was developed for this subject based on specific criteria, including pain, elbow ROM, arm strength, and functional outcomes. Outcomes The subject was treated for nine visits over six weeks, and demonstrated improvements in all strength tests of the involved upper extremity, with elbow flexion strength improving the most by 58%. Return to sport (RTS) tests were used to assess the subject's ability to return to practice. At approximately eight weeks after initial injury, the subject was able to return to full participation in competitive wrestling with no reports of elbow pain or instability. Discussion Through the utilization of a criterion-based rehabilitation protocol for the nonoperative management of an UCL injury, this high school wrestler was able to safely progress back to wrestling without pain or instability in an accelerated time frame. Previously, no detailed rehabilitation guidelines for nonoperative management of UCL injuries in contact sports have been described. Additionally, few studies exist which report on the inclusion of RTS testing following an injury to the UCL of the elbow, as RTS testing is optimal for determining readiness for sport. Level of Evidence 4, Case Report.
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Molnár S, Hunya Z, Pavlik A, Bozsik A, Shadgan B, Maffulli N. SLAP Lesion and Injury of the Proximal Portion of Long Head of Biceps Tendon in Elite Amateur Wrestlers. Indian J Orthop 2020; 54:310-316. [PMID: 32399150 PMCID: PMC7205930 DOI: 10.1007/s43465-020-00041-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 01/07/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Injuries to the proximal portion of the tendon of the long head of the biceps are challenging, and often only diagnosed at arthroscopy. However, it is important to be able to formulate a preoperative plan based on physical examination and imaging studies, so as to inform patients correctly, plan the likely procedure, and give indication to length and modalities of rehabilitation. MATERIALS AND METHODS Eleven elite wrestlers who suffered their injury between 2008 and 2018 were investigated retrospectively. We aimed to identify an association between the mechanism and the symptoms of the biceps-labral complex injury. RESULTS The injury was sustained at a mean age of 20.63 years, and most wrestlers were middle or light weight. All injuries occurred during shoulder movements in closed kinetic chain with the elbow extended, the forearm pronated and the shoulder slightly elevated. The surgical procedures performed were tenodesis in three wrestlers, reinsertion in seven wrestlers, and one tenotomy of the tendon of the long head of the biceps. The postoperative rehabilitation was shorter (1-3 month) in case of tenodesis or tenotomy, and markedly longer after reinsertion (6-9 months). CONCLUSIONS Injuries to the proximal part of long head of biceps tendon are relatively frequent in elite wrestlers, reflecting the high functional demands imposed on the upper limb. Though necessitating surgery, in these athletes, such injuries are not career ending, and most of our elite athletes returned to high performance levels after surgery.
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Affiliation(s)
- Szabolcs Molnár
- Department of Traumatology, Medical Centre Hungarian Defence Forces, Budapest, Hungary
- University of Physical Education, Budapest, Hungary
| | - Zsolt Hunya
- Department of Orthopedics, University of Debrecen, Debrecen, Hungary
| | - Attila Pavlik
- Department of Sports Surgery, National Institute for Sports Medicine, Budapest, Hungary
| | - Attila Bozsik
- Department of Traumatology, Medical Centre Hungarian Defence Forces, Budapest, Hungary
| | - Babak Shadgan
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Nicola Maffulli
- Department of Musculoskeletal Disorder, Faculty of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK
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Hassebrock JD, Patel KA, Makovicka JL, Chung AS, Tummala SV, Hydrick TC, Ginn JE, Hartigan DE, Chhabra A. Elbow Injuries in National Collegiate Athletic Association Athletes: A 5-Season Epidemiological Study. Orthop J Sports Med 2019; 7:2325967119861959. [PMID: 31448298 PMCID: PMC6688148 DOI: 10.1177/2325967119861959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Little research has focused on the rates and patterns of elbow injuries in
National Collegiate Athletic Association (NCAA) student-athletes. Purpose: To describe the epidemiological patterns of elbow injuries in NCAA athletes
during 5 seasons over the academic years 2009 through 2014 using the NCAA
Injury Surveillance Program (NCAA-ISP) database. Study Design: Descriptive epidemiology study. Methods: A voluntary convenience sample of NCAA varsity teams from 11 sports was
examined to determine the rates and patterns of elbow injuries. Rates and
distributions of elbow injuries were identified within the context of sport,
event type, time in season, mechanism, time lost from sport, surgical
treatment, and injury type. Rates of injury were calculated as the number of
injuries divided by the total number of athlete-exposures (AEs). An AE was
defined as any student participation in 1 NCAA-sanctioned practice or
competition with an inherent risk of exposure to potential injury. Injury
rate ratios (IRRs) and injury proportion ratios (IPRs) were then calculated
to compare the rates within and between sports by event type, season, sex,
mechanism, surgical treatment, and time lost from sport. Comparisons between
sexes were made using only sports data that had both male and female
samples. Results: Overall, 373 elbow injuries were reported in the NCAA-ISP data set during the
2009-2010 through 2013-2014 academic years among 11 varsity sports. The
overall rate of injury was 1.76 per 10,000 AEs. The rate of elbow injuries
in men was 0.74 per 10,000 AEs, while women experienced injuries at a rate
of 0.63 per 10,000 AEs. In sex-comparable sports, men were 1.17 times more
likely to experience an elbow injury compared with women. Men’s wrestling
(6.00/10,000 AEs) and women’s tennis (1.86/10,000 AEs) were the sports with
the highest rates of elbow injuries by sex, respectively. The top 3 highest
injury rates overall occurred in men’s wrestling, baseball, and tennis.
Elbow injuries were 3.5 times more likely to occur during competition
compared with practice. Athletes were 0.76 times less likely to sustain an
elbow injury during the preseason compared with in-season. Contact events
were the most common mechanism of injury (67%). For sex-comparable sports,
men were 2.41 times more likely than women to have contact as their injury
mechanism (95% CI, 0.78-7.38). The majority of athletes missed less than 24
hours of participation time (67%), and only a minority (3%) of patients with
elbow injuries went on to have surgical intervention. Elbow ulnar collateral
ligament injuries were most common (26% of total injuries). Conclusion: Analysis of the study data demonstrated a significant rate of elbow injuries,
1.76 injuries per 10,000 AEs in NCAA collegiate athletes. Higher injury
rates can be expected in males within sex-comparable sports. Elbow injuries
are most common in the setting of competitions and most commonly occur
secondary to contact-type mechanisms. Injuries were more likely to occur
during in-season play. The majority of injuries required less than 24 hours
of time away from sport and did not require surgical intervention.
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Affiliation(s)
| | - Karan A Patel
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Andrew S Chung
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona, USA
| | | | | | | | | | - Anikar Chhabra
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona, USA
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Abstract
BACKGROUND Sports specialization is becoming an increasingly common training strategy in young athletes. Very little research currently exists examining the occurrence of serious injury (>3 months off sport or loss of season) in elite-level wrestlers who specialize early (before age 12 years). HYPOTHESIS Wrestlers who specialize early will sustain more serious injuries than wrestlers who specialize at age 12 years or older. STUDY DESIGN Descriptive epidemiological study. METHODS We sent an anonymous online survey to a total of 312 elite-level wrestlers (National Collegiate Athletic Association Division I athletes and World/Olympic team members) containing questions documenting age of specialization and number of serious injuries sustained. The number of serious injuries both before and after starting college were compared between wrestlers specializing at <12 years old and ≥12 years old using an independent-samples t test. Respondents' opinions on the necessity of early specialization and their primary source of encouragement to specialize were also reported. RESULTS A total of 143 wrestlers completed the survey, for a total response rate of 46%. Thirty-six (25%) wrestlers specialized at <12 years old. The early specialization group sustained significantly more serious injuries than the late specialization group (1.14 vs 0.60; P = 0.035). Sixty-two (43%) believed early specialization was necessary to achieve elite-level status. The decision to specialize was encouraged primarily by the athlete (78/143; 55%), parents (37/143; 26%), and coaches (22/143; 15%). CONCLUSION Elite wrestlers who specialize prior to age 12 years sustain a greater number of serious injuries before starting college than those who specialize at or after the age of 12 years. CLINICAL RELEVANCE Athletes, coaches, and parents should consider the risk of injury before adopting a wrestling-specialized training strategy at a young age.
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