Arthroscopic Bankart repair using suture anchors in athletes: patient selection and postoperative sports activity

PURPOSE: The purpose of this study was to evaluate the results in selected high-risk patients who underwent arthroscopic stabilization of shoulders with recurrent anterior instability. HYPOTHESIS: Arthroscopic stabilization using suture anchors is useful for athletes younger than 25 years or for contact athletes without a large bone loss of glenohumeral articulation. STUDY DESIGN: Prospective cohort study. METHODS: The study group comprised 55 patients, with a mean follow-up of 42 months (range, 25-72 months). Thirty-two patients had recurrent dislocations, 14 had recurrent subluxations, and 9 had recurrent subluxations after a single dislocation. Rowe score, range of motion, recurrence, and sports activities were evaluated. RESULTS: Mean Rowe score improved from 30.1 to 92.3 points; 45 scores (82%) were excellent, 5 (9%) good, 1 fair (2%), and 4 (7%) poor. Patients had lost a mean of 4 degrees of external rotation in adduction. Four (7%) had recurrence. The recurrence rate in contact athletes (9.5%, 2 of 21) was not statistically different from that in noncontact athletes (6%, 2 of 34). Forty-four (80%) returned at the same levels. The complete return rate in overhead-throwing athletes (68%, 17 of 25) was lower than that in nonoverhead athletes (90%, 27 of 30) (P = .0423). Five patients had unsatisfactory results. CONCLUSION: Arthroscopic stabilization is a reliable procedure in selected high-risk patients.     

Anterior shoulder stabilization in collision athletes: arthroscopic versus open Bankart repair

BACKGROUND: Collision athletes are reported to be at high risk for redislocation after anterior stabilization of shoulder instability. Some authors have suggested that arthroscopic stabilization produces results similar to those of open stabilization. PURPOSE: To evaluate the results of anterior shoulder stabilization in collision athletes and to compare the clinical results between the arthroscopic and open methods. HYPOTHESIS: Open stabilization might produce better results than does arthroscopic stabilization in collision athletes. STUDY DESIGN: Cohort study; Level of evidence, 4. METHODS: Forty-eight shoulders of 46 collision athletes were enrolled for this study. The mean age of the patients at the time of surgery was 20 years, and the mean follow-up period was 72 months (range, 30-136 months). Sixteen shoulders underwent arthroscopic stabilization; 32 shoulders had open repairs. RESULTS: Visual analog scale, Rowe, and Constant scores improved after surgery, but no statistically significant difference was found between the arthroscopic and open repair groups. Thirty-seven athletes (83%) returned to near-preinjury sports activity levels (>/= 90% recovery) after operation. Two patients (4%) had subluxation and 6 (12.5%) had redislocation after surgery. The number of shoulders with postoperative subluxation or dislocation was 4 (25%) in the arthroscopic group and 4 (12.5%) in the open group (P = .041). Revision surgery was performed on 5 shoulders (10.4%). CONCLUSIONS: There were 8 (16.5%) instances of postoperative instability among the collision athletes studied. The arthroscopic group yielded a higher failure rate than did the open group. The authors believe open stabilization to be a more reliable method for anterior shoulder instability in collision athletes.     

Arthroscopic anterior shoulder stabilization of collision and contact athletes

BACKGROUND: Repair of the anterior labrum (Bankart lesion) with tightening of the ligaments (capsulorrhaphy) is the recommended treatment for recurrent anterior glenohumeral dislocations. Current evidence suggests that arthroscopic anterior stabilization methods yield similar failure rates for resubluxation and redislocation when compared to open techniques. STUDY DESIGN: Case series; Level of evidence, 4 PURPOSE: To examine the results of arthroscopic anterior shoulder stabilization of high-demand collision and contact athletes. METHODS: Thirteen collision and 5 contact athletes were identified from the senior surgeon's case registry. Analysis was limited to patients younger than 20 years who were involved in collision (football) or contact (wrestling, soccer) athletics. Objective testing included preoperative and postoperative range of motion and stability. Outcome measures included the American Shoulder and Elbow Society shoulder score, Simple Shoulder Test, SF-36, and Rowe scores. The surgical procedure was performed in a consistent manner: suture anchor repair of the displaced labrum, capsulorrhaphy with suture placement supplemented with thermal treatment of the capsule when indicated, and occasional rotator interval closure. Average follow-up was 37 months (range, 24-66 months). RESULTS: Two of 18 contact and collision athletes (11%) experienced recurrent dislocations after the procedure; both were collision athletes. One returned to play 3 years of high school football but failed after diving into a pool. One patient failed in his second season after his stabilization (>2 years) when making a tackle. None of the contact athletes experienced a recurrent dislocation, with all of them returning to high school or college athletics. CONCLUSIONS: One hundred percent of all collision and contact athletes returned to organized high school or college sports. Fifteen percent of those collision athletes had a recurrence, which has not required treatment. Participation in collision and contact athletics is not a contraindication for arthroscopic anterior shoulder stabilization using suture anchors, proper suture placement, capsulorrhaphy, and occasional rotator interval plication.     

Closed kinetic chain alone compared to combined open and closed kinetic chain exercises for quadriceps strengthening after anterior cruciate ligament reconstruction with respect to return to sports: a prospective matched follow-up study

Rehabilitation after anterior cruciate ligament (ACL) reconstruction has focused over the past decade on closed kinetic chain (CKC) exercises due to presumably less strain on the graft than with isokinetic open kinetic chain exercises (OKC); however, recent reports suggest that there are only minor differences in ACL strain values between some CKC and OKC exercises. We studied anterior knee laxity, thigh muscle torque, and return to preinjury sports level in 44 patients with unilateral ACL; group 1 carried out quadriceps strengthening only with CKC while group 2 trained with CKC plus OKC exercises starting from week 6 after surgery. Anterior knee laxity was determined with a KT-1000 arthrometer; isokinetic concentric and eccentric quadriceps and hamstring muscle torque were studied with a Kin-Com dynamometer before and 6 months after surgery. At an average of 31 months after surgery the patients answered a questionnaire regarding their current knee function and physical activity/sports to determine the extent and timing of their recovery. No significant differences in anterior knee laxity were noted between the groups 6 months postsurgery. Patients in group 2 increased their quadriceps torque significantly more than those in group 1, but no differences were found in hamstring torque between the groups. A significantly higher number of patients in group 2 (n=12) than in group 1 (n=5) returned to sports at the same level as before the injury (P<0.05). Patients from group 2 who returned to sports at the same level did so 2 months earlier than those in group 1. Thus the addition of OKC quadriceps training after ACL reconstruction results in a significantly better improvement in quadriceps torque without reducing knee joint stability at 6 months and also leads to a significantly higher number of athletes returning to their previous activity earlier and at the same level as before injury.     

Two minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg

Chronic exertional compartment syndrome (CECS) of the leg is a pathological condition often related to overuse in subject who engage repetitive physical activities. Fascial release is the mainstay of surgical management. The purpose of this study was to evaluate the results obtained with a double incision decompressive fasciotomy. Eighteen consecutive athletes with a diagnosis of anterior and/or lateral CECS of the leg were operated on with a minimal double incision fascial release after a mean period of 4 months after onset of symptoms. In 11 cases (61%) CECS was bilateral. Surgery was performed without tourniquet and active mobilization was starting immediately. Sports activities were resumed gradually at a mean period of 25 days. The athletes were followed until 2 years. All resumed pre-injury level sports activity. Two patients (18%) of the 11 who underwent to bilateral fasciotomy referred a sensation of leg weakness for an average period of 3 months. The surgical technique presented in this paper seems to be a good mean to treat anterior and lateral leg CECS. The use of tourniquet is deconselled to obtain an accurate intraoperative haemostasis so reducing the risk of post-operative haematoma.     

Fear of re-injury in people who have returned to sport following anterior cruciate ligament reconstruction surgery

ObjectivesTo examine fear of re-injury in athletes who had returned to regular sports participation following anterior cruciate ligament reconstruction surgery.DesignCross-sectional case series.MethodsA self-report questionnaire was used to collect data 2–7 years following surgery. Key inclusion criteria were regular participation in sport prior to injury and participation in sport at the time of the study.ResultsA sample of 209 (88 females, 121 males) at a mean of 39.6 ± 13.8 months post surgery participated. Overall, participants did not express fear of re-injury, scoring >6/10 (where 10 was the most positive response) on all questions. In terms of the total score and for six out of eight questions, participants who returned to their pre-injury sports level had significantly less fear of re-injury than those who had not returned to their pre-injury level. Females had significantly more concern than males about the environmental conditions experienced while playing (mean 6.1 compared to 7.5). On three out of eight questions, individuals who had surgery more than 3 months after injury had a greater fear of re-injury than those who had their surgery closer to the time of injury.ConclusionsAthletes participating in sport 2–7 years following their anterior cruciate ligament reconstruction generally appear to do so without fear of re-injury. However, gender, the timing of surgery following injury and the level of sport the athletes returned to may be associated with fear of re-injury following surgery.     

Limb asymmetries in landing and jumping 2 years following anterior cruciate ligament reconstruction.

OBJECTIVE: Female athletes who are at increased risk for anterior cruciate ligament (ACL) injury demonstrate biomechanical differences between limbs during athletic tasks that may persist following anterior cruciate ligament reconstruction (ACLR). This may limit an athlete's potential for safe return to sports competition. The purpose of this study was to determine if female athletes demonstrate lower limb asymmetries in landing and takeoff force following ACLR and clearance for return to competitive sports participation. We hypothesized that females following ACLR would demonstrate side-to-side differences in landing and jumping kinetics after their return to sport (2+ years) that would not be observed in a group of healthy female controls. DESIGN: Case control study. SETTING: The Sports Medicine Biodynamics Center at Cincinnati Children's Hospital Medical Center. PATIENTS: Fourteen female athletes at a mean of 27 months following ACLR and 18 healthy female athletes participated in the study. ASSESSMENT: All subjects executed a drop vertical jump (DVJ) task onto 2 force plates. Vertical ground reaction force (VGRF) was measured during landing and takeoff and was used to calculate landing phase loading rates. A 2-way analysis of variance was used to determine differences between the involved, uninvolved, and control limbs. RESULTS: Females who had undergone ACLR demonstrated increased VGRF (P = 0.001) and loading rate (P < 0.001) on the uninvolved limb during landing when compared with the involved limb and the control group. During takeoff, the involved limb showed significantly less ability to generate force (P = 0.03) than the uninvolved limb and the control limbs. CONCLUSIONS: Female athletes who have undergone ACLR and returned to sport may continue to demonstrate biomechanical limb asymmetries 2 years or more after reconstruction that can be identified during landing.     

Clinical, functional, and radiologic outcome in team handball players 6 to 11 years after anterior cruciate ligament injury: a follow-up study

BACKGROUND: Long-term outcome after anterior cruciate ligament injury among top-level pivoting athletes is unknown. PURPOSE: To evaluate outcome among competitive team handball players after anterior cruciate ligament injury. STUDY DESIGN: Prospective cohort study. METHODS: A previously studied group of 86 elite players who had an anterior cruciate ligament rupture were invited to participate in follow-up evaluations a mean of 7.8 years later. RESULTS: Among the 57 operatively treated patients who returned for follow-up, 33 (58%) returned to team handball at their preinjury level, compared with 18 of 22 (82%) in the nonoperative group. Eleven of the 50 players (22%) who continued playing reinjured their anterior cruciate ligament when playing team handball. The overall Lysholm score was 85 +/- 13 in both groups, but the five players classified as poor were all operatively treated. Nearly half of the players had an International Knee Documentation Committee classification of abnormal or severely abnormal. There were significant differences between the injured and uninjured leg in functional (2.5% to 8%), strength (3.8% to 10.1%), and KT-1000 arthrometer tests (27%). In the operatively treated group, 11 developed radiologic gonarthrosis, compared with 6 in the nonoperatively treated group. There was no correlation between radiologic findings and pain scores. CONCLUSION: A more restrictive attitude regarding return to competitive pivoting sports after anterior cruciate ligament injury may be warranted.     

Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes.

Eighteen tenotomies of the adductor longus tendon were performed in 16 consecutive male athletes (aged 20 to 42) as treatment for chronic groin pain. The criteria for surgery was a history of long-standing (range, 2.5 to 48 months) and distinct pain at the origin of the adductor longus muscle, refractory to conservative treatment. At followup 35 months (range, 4 to 84) after surgery, all patients were improved or free of symptoms. All but 1 of the athletes returned to the same sport within a mean of 6.6 weeks, and 12 of 16 returned to competitive sports within a mean of 14 weeks after surgery. A majority of the patients (10 of 16) returned to full athletic activity, whereas 5 of 16 performed at a reduced level. One patient discontinued his sports activity due to other causes. In conclusion, when conservative treatment fails, tenotomy of the adductor longus tendon gives good long-term functional results in the treatment of chronic groin pain that is localized at the origin of the adductor longus muscle. A decreased muscle strength was observed in this study and did not seem to influence participation in sports.     

Sports ability after Bankart procedure in professional athletes

Recurrent anterior shoulder instability and the restoration of sports ability after surgery are common problems, especially among professional athletes. The purpose of this study was to evaluate the rate, level and time of returning to sports activity after Bankart procedure in anterior shoulder instability in high level atheletes. From 1992–1994 61 patients suffering from recurrent anterior shoulder instability were operated on open Bankart procedure. 44 out of 61 were professional athletes. There were 7 handball, 7 basketball, 6 football, 2 waterpolo and 1 base-ball player and 4 wrestlers, 2 weightlifters, 2 boxers, 3 bicyclists, 2 motorists, 2 swimmers, 2 sailors, 2 kayakers and 2 skiers. The mean duration of instability was 19.1 months (3–72) before operation. 29 patients had posttraumatic recurrent anterior dislocation and 15 patients had posttraumatic anterior subluxations. The average number of redislocations was 4.4, ranging from 2 to 11. At the follow-up examination the patients were tested clinically for instability using the special score created by Walch and Duplay and the Constant functional score. We measured the strength of the rotator cuff by Kintrex isokinetic device from the 10th postoperative week. 35 out of 44 professional athletes could be fellowed-up. The average follow-up period was 14.2 months, from 6 to 31. 88% of the patients were able to return to sports participation, 66% on the previous levels and 22% on a lower level. 12% of the patients finished their professional sports career. The mean rehabilitation period was 5.8 months, the average period of full restoration of sports ability was 9.3 months. Similar results were documented with the Constant score and the Walch-Duplay test (88% excellent or good, 12% fair). The main reason for the inability to continue sports activity was some pain during extreme abduction and extrnal rotation of the arm and recurrent sensations of subluxation (3 cases). Based on the results of the follow-up examinations an early diagnosis is paramount followed by timely surgical intervention to restore anatomical integrity in proven cases of shoulder instability in professional athletes. The open Bankart procedure is preferred giving excellent functional results and providing good chances for the atheletes to return to their previous sports level.     

Anterior capsulolabral reconstruction of the shoulder in athletes in overhand sports

From April 1, 1985, through June 30, 1987, 25 skilled athletes with shoulder pain secondary to anterior glenohumeral instability that had failed to improve with conservative therapy had an anterior capsulolabral reconstruction. All but one athlete completed a formal rehabilitation program with an average followup of 39 months. The results at followup were rated excellent in 68%, good in 24%, fair in 4%, and poor in 4%. Seventeen patients returned to their prior competitive level for at least 1 year. This operation and rehabilitation program may allow many athletes who participate in overhand activities or throwing sports to return to their prior level of competition.     

Hemathrosis treated by aspiration and casting. How to condemn the knee

Eighty-eight athletes treated for an acute hemarthrosis of the knee without any demonstrable ligament tear were evaluated. Analysis of the clinical data from these cases, all treated between 1970 and 1975 with aspiration and casting, revealed that the injury was apparently worse than had been thought at the time of first treatment. Surgery was subsequently performed in 32 (37%) because of meniscus tear, and 28 demonstrated anterior cruciate ligament insufficiency. In the 56 who did not have surgical treatment, 38 (43% of the entire group) had significant symptoms and disability causing them to decrease sports participation, and only 18 (20% of the overall group) returned to sports without symptoms or disability. Objective findings at followup suggested that in 70% of the patients injury of the anterior cruciate ligament occurred during the original trauma. A precise diagnosis is needed in every knee ligament sprain with hemarthrosis before one decides upon conservative treatment such as aspiration and casting.     

Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts

We reviewed the results in 13 patients who underwent simultaneous allograft reconstruction of both the anterior and posterior cruciate ligaments after a knee dislocation (nine acute and four chronic injuries). Seven patients sustained related medial collateral ligament injuries and six patients had posterolateral complex injuries. Ligament reconstructions were performed using fresh-frozen Achilles or patellar tendon allografts. At follow-up evaluation (mean of 38 months), only one patient described the reconstructed knee as normal. Six patients had returned to unrestricted sports activities and four had returned to modified sports. The average extension loss was 3 degrees (range, 0 degree to 10 degrees) and average flexion loss was 5 degrees (range, 0 degree to 15 degrees). The KT-1000 arthrometer measurements at 133 N anterior-posterior tibial load showed a mean side-to-side difference of 4.5 mm (range, 0 to 10) at 20 degrees and 5.0 mm (range, 0 to 9) at 70 degrees. The mean Lysholm score was 88 (range, 42 to 100). International Knee Documentation Committee ratings were six nearly normal, five abnormal, and one grossly abnormal. Two patients required manipulations for knee stiffness. This study demonstrates that reconstruction of both cruciate ligaments can restore stability sufficient to allow sports activity in most patients with knee dislocations, but "normal" results are difficult to achieve.     

Inferior capsular shift operation for multidirectional instability of the shoulder in players of contact sports

OBJECTIVES: To assess the results of inferior capsular shift for multidirectional instability of the shoulder in athletes. METHODS: Multidirectional instability was surgically corrected in 53 shoulders in 47 athletes who engaged in contact sports. A history of major trauma was found in eight patients, the others having had minor episodes. Before surgery, all patients had complex combinations of instabilities. The surgical approach was selected according to the predominant direction of instability. RESULTS: Anterior inferior capsular shift was carried out in 37 shoulders, and anterior dislocation recurred in three. In one of these, it was anterior alone, one was anterior and inferior, and one was unstable in all three directions. After posterior inferior capsular shift in 16 shoulders, one dislocation occurred anteriorly and one posteriorly. With the anterior approach, four athletes could not return to sport. Two patients treated with the posterior approach could not return to sport. Of these six failures, five patients had had bilateral repairs. Successful repair based on the criteria of the American Shoulder and Elbow Association was achieved in 92% of anterior repairs and 81% of posterior repairs. Successful return to sport was noted in 82% of patients with anterior repairs, 75% with posterior repairs, and 17% with bilateral repairs. Overall, there were five subsequent dislocations, three in the anterior repair group (8%), and two in the posterior repair group (12%). CONCLUSIONS: Inferior capsular shift can successfully correct multidirectional instability in most players of contact sports, but the results in bilateral cases are poor.     

Inferior capsular shift procedure in athletes with multidirectional instability based on isolated capsular and ligamentous redundancy

Twenty-five athletes (26 shoulders) who underwent an inferior capsular shift procedure for multidirectional glenohumeral instability based on isolated capsular and ligamentous redundancy were evaluated at a median of 54 months (range, 25 to 113) after the operation. Twenty-one athletes (84%) returned to their preinjury activity level at a median of 5 months after surgery. Of 21 athletes involved in sports using overhead motions, 16 (76%) returned to their previous sport after the operation, and 12 (57%) were still active in this sport at the preinjury level at follow-up. According to the Rowe score, 23 shoulders (88%) were excellent or good. The University of California at Los Angeles score for 24 shoulders (92%) was excellent or good. The operations on two shoulders (8%) failed. One patient had a spontaneous redislocation, and one had recurrent subluxations. Nine contralateral shoulders had a history of significant instability; four of these had undergone Bankart repair. We concluded that athletes who have multidirectional instability based on isolated capsular and ligamentous redundancy can be successfully treated by an inferior capsular shift preserving the subscapularis tendon insertion. We found a high rate of return to demanding upper extremity sports in our patients, range of motion was restored in the majority of shoulders, and the failure rate after a median of 54 months was acceptable.     

Nonoperative management for in-season athletes with anterior shoulder instability

BACKGROUND: Acute or recurrent anterior shoulder instability is a frequent injury for in-season athletes. Treatment options for this injury include shoulder immobilization, rehabilitation, and shoulder stabilization surgery. PURPOSE: To determine if in-season athletes can be returned to their sports quickly and effectively after nonoperative treatment for an anterior instability episode. METHODS: Over a 2-year period, 30 athletes matched the inclusion criteria for this study. Nineteen athletes had experienced anterior dislocations, and 11 had experienced subluxations. All were treated with physical therapy and fitted, if appropriate, with a brace. These athletes were followed for the number of recurrent instability episodes, additional injuries, subjective ability to compete, and ability to complete their season or seasons of choice. RESULTS: Twenty-six of 30 athletes were able to return to their sports for the complete season at an average time missed of 10.2 days (range, 0-30 years). Ten athletes suffered sport-related recurrent instability episodes (range, 0-8 years). An average of 1.4 recurrent instability episodes per season per athlete occurred. There were no further injuries attributable to the shoulder instability. Sixteen athletes underwent surgical stabilization for their shoulders during the subsequent off-season. CONCLUSIONS: Most of the athletes were able to return to their sport and complete their seasons after an episode of anterior shoulder instability, although 37% experienced at least 1 additional episode of instability during the season.     

Factors affecting return to sports after anterior cruciate ligament reconstruction with patellar tendon and hamstring graft: a prospective clinical investigation

In athletes, anterior cruciate ligament (ACL) reconstruction is recommended after injury to restore the normal knee function and allow subsequent return to sport. Successful ACL reconstruction with patellar tendon (PT) and hamstring tendon (HT) grafts combined with a well-structured rehabilitation program could bring athletes back to their previous level of sport activities. We prospectively followed-up 100 athletes who underwent ACL reconstruction with either PT (n=50) or HT grafts (n=50). Evaluation was done pre-operatively and post-operatively (3, 6, 12, and 24 months) using International Knee Documentation Committee (IKDC), Lysholm, Noyes, and Tegner scales. Subjective assessment numeric evaluation (SANE), knee activity rating scale (Marx) and a psychological profile questionnaire (psychovitality) were also utilized. Objective evaluations included isokinetic tests and computerized knee motion analysis. Data gathered were statistically analyzed using the Mann–Whitney non-parametric U-test. Among the 100 patients who have undergone ACL reconstruction, 65% returned to the same level of sports, 24% changed sports and 11% ceased sport activities. No significant difference (P>0.05) in outcome between PT and HT grafts were observed. No significant differences (P>0.05) were noted between athletes who “returned” to their previous sport and those who “did not return” to sports at the same level when using the IKDC, Lysholm, Noyes, and Tegner knee evaluation scales. However, significant difference was observed with the knee scores obtained by those who returned and those who completely ceased participation in sport activities. Computerized laxity test revealed that 90% of these patients have less than 3 mm side-to-side difference with no significant difference between HT and PT groups. Patients who “returned to sports” obtained significantly better scores with the Marx scale (P=0.001) and the psychovitality questionnaire (P=0.001) than those who did not. Conventional knee scales including IKDC, Lysholm, Noyes, and Tegner remain as reliable means of evaluating outcome of ACL reconstruction. However, the data obtained from these are not sufficient to determine which among the patients who had knee reconstruction can successfully return to sport. The use of the Marx knee activity rating scale and the evaluation of the athletes’ psychological profile are additional scales that can be useful in determining which among the patients treated have a better chance of returning to their pre-injury activity levels.     

Functional outcome of knee articular cartilage repair in adolescent athletes

BACKGROUND: Limited information exists about the treatment of full-thickness articular cartilage lesions of the knee in adolescent athletes. PURPOSE: To evaluate the functional outcome and athletic activity after articular cartilage repair in the knees of adolescent athletes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty adolescent athletes with full-thickness articular cartilage lesions of the knee were treated with autologous chondrocyte transplantation. Functional outcome was evaluated by subjective patient outcome rating, knee activity scores, and level of athletic participation. RESULTS: At a mean of 47 months after autologous chondrocyte transplantation, 96% of adolescents reported good or excellent results with significant increases in postoperative Tegner activity scores and Lysholm scores. Ninety-six percent returned to high-impact sports and 60% to an athletic level equal or higher than that before knee injury. Return to preinjury sports correlated with shorter preoperative symptoms and a lower number of prior operations. All adolescents with preoperative symptoms < or =12 months returned to preinjury-level athletics, compared to 33% with preoperative intervals longer than 12 months. CONCLUSION: Treatment of full-thickness articular injuries of the knee in adolescent athletes with autologous chondrocyte transplantation yields a high rate of functional success at a mean follow-up of 47 months. The rate of return to demanding athletic activities is higher in cases in which the preoperative duration of symptoms is 12 months or less.     

Rehabilitation duration and time of starting sport-related activities associated with return to the previous level of sports after anterior cruciate ligament reconstruction

ObjectivesTo determine predictors for return to previous level of sports after anterior cruciate ligament reconstruction (ACLR).DesignCross-sectional;SettingAthletic teams.ParticipantsNinety-one athletes who had ACLR with hamstring-tendon autograft within 1–5 years participated in this study. Athletes indicated their sport participation levels, injury profile, rehabilitation duration, and time to start sport-related activities (running, cutting-pivoting) after ACLR. Athletes answered whether they returned to the same previous level of frequency, duration, and intensity of sports.Main outcome measuresAthletes’ characteristics, injury and surgical factors, duration of post-operative rehabilitation program, and time to start sport-related activities after ACLR were evaluated by univariate logistic regression to determine predictors for return to previous level of sports.ResultsNine athletes (10%) returned to their self-described previous level of sports. Predictors for returning to previous level of sports were rehabilitation duration >4 months (OR:6.78; p = .011), time to start running ≤4 months (OR:8.62; p = .047) and cutting-pivoting <6 months after surgery (OR:5.02; p = .030).ConclusionLonger post-operative rehabilitation duration and time to start sport-related activities after ACLR predicted return to previous level of sports. Spending adequate time in post-operative rehabilitation program and time-based resumption of sports-related activities after ACLR might be key factors for returning to previous sports level.     

Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes

PURPOSE: To evaluate the results of arthroscopic repair of type II superior labral anterior posterior lesions of the shoulder in overhead athletes. HYPOTHESIS: Such repair is useful for overhead athletes in terms of postoperative sports activity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The study group was composed of 40 patients with a mean age of 24 years (range, 15-38 years); mean follow-up was 41 months (range, 24-58 months). They were divided into an overuse (n=22) and a trauma group (n=18). The authors used 2 suture anchors loaded with a nonabsorbable suture at the 11-o'clock and 1-o'clock positions through the anterosuperior and lateral trans-rotator cuff portal. A modified Rowe score and postoperative athletic activities were evaluated. RESULTS: After arthroscopic repair, mean modified Rowe scores improved from 27.5 to 92.1 points (P<.0001). Rated on this scale, the results were excellent in 30 (75%), good in 6 (15%), and fair in 4 (10%) athletes; there were no poor results. Satisfactory outcomes were achieved in 36 (90%) of these patients; 30 (75%) experienced a return to the preinjury level. The complete return rate of baseball players in the overuse group was lower than that of other overhead athletes in the trauma group. CONCLUSION: Arthroscopic superior labral repair is a safe and reliable procedure in overhead athletes.