James Borchers

Activity Level and Graft Type as Risk Factors for Anterior Cruciate Ligament Graft Failure A Case-Control Study

Background Anterior cruciate ligament (ACL) graft failure is an uncommon but devastating event after reconstruction, and risk factors for graft failure are not well understood. Hypothesis Returning to a high activity level after ACL reconstruction and use of an allograft are risk factors for ACL graft failure. Study Design Case-control study; Level of evidence, 3. Methods Twenty-one patients with ACL graft failure were identified over a 2-year period. Forty-two age- and sex-matched controls were identified over the same period. A 1:2 matched case-control design was used to evaluate activity level after reconstruction and graft type as risk factors for ACL graft failure. Logistic regression analysis was used to determine odds ratios for activity level after reconstruction and for graft type among cases and controls. Association (interaction) between activity level after reconstruction and graft type was evaluated comparing stratum-specific odds ratios. Results Univariate logistic regression models showed an increased odds of ACL graft failure for those with high activity level compared with low activity level (odds ratio [OR], 5.53; 95% confidence interval [CI], 1.18–28.61; P = .03) and for allografts compared with autografts (OR, 5.56; 95% CI 1.55–19.98; P = .009). A bivariate logistic regression model showed a 35% change in the odds ratio for activity level (OR, 4.33; 95% CI, 0.89–21.16; P = .07) and a 13% change in the odds ratio for allograft compared with autograft (OR, 4.93; 95% CI, 1.34–18.20; P = .02). Stratum-specific odds ratios between activity level and graft type show a multiplicative interaction between higher activity level and allograft for much greater odds of ACL graft failure. Conclusion Higher activity level after reconstruction and allograft use for reconstruction are risk factors for ACL graft failure. Stratum-specific odds ratios show a multiplicative interaction between higher activity level after ACL reconstruction and allograft use, greatly increasing the odds for ACL graft failure.

Intra-articular Findings in Primary and Revision Anterior Cruciate Ligament Reconstruction Surgery A Comparison of the MOON and MARS Study Groups

Background: At the time of anterior cruciate ligament (ACL) reconstruction, there are usually concurrent meniscal and articular cartilage injuries. It is unclear if there is a significant difference between intra-articular injuries at the time of a primary ACL reconstruction compared with revision ACL reconstruction. Purpose: To compare the meniscal and articular cartilage injuries found at the time of primary and revision ACL reconstruction surgery and to determine associations between primary and revision surgery and specific intra-articular findings. Study Design: Cohort study (prevalence); Level of evidence, 2. Methods: Primary and revision ACL surgeries were identified from the Multicenter Orthopedic Outcomes Network (MOON) and Multicenter ACL Revision Study (MARS) study groups, respectively, from January 1, 2007 to November 1, 2008. Demographic data on individual patients were analyzed including age, body mass index (BMI), and gender. Intra-articular findings including the presence of medial or lateral meniscal tears and chondral damage to articular surfaces were analyzed for each patient. Comparisons of intra-articular findings at the time of surgery for the 2 groups were analyzed. Chondral damage in the medial and lateral compartments was analyzed considering previous meniscal tear as a possible confounder. Results: There were 508 patients undergoing primary ACL reconstruction and 281 patients undergoing revision ACL reconstruction who were identified for inclusion. There were no differences in the mean age, BMI, and gender in the 2 study groups. There was a decreased odds ratio (OR) of new untreated lateral meniscal tears (OR, 0.54; P < .01) but not of medial meniscal tears (OR, 0.86; P = .39) in revision compared with primary ACL reconstruction. There was an increased OR of Outerbridge grade 3 and 4 articular cartilage injury in revision compared with primary ACL reconstruction in the lateral compartment (OR, 1.73; P = .04) and in the patellar-trochlear compartment (OR, 1.70; P = .04) but not in the medial compartment (OR, 1.33; P = .23). There was an increased OR of Outerbridge grade 3 and 4 articular cartilage injury in patients from both groups having a prior medial meniscectomy on the medial femoral condyle (OR, 1.44; P < .01) and on the medial tibial plateau (OR, 1.63; P < .01). There was an increased OR of Outerbridge grade 3 and 4 articular cartilage injury in patients from both groups having a prior lateral meniscectomy on the lateral femoral condyle (OR, 1.65; P < .01) and on the lateral tibial plateau (OR, 1.56; P < .01). Conclusion: Meniscal tears are a common finding in both primary and revision ACL reconstruction. These results show a decreased OR of new untreated lateral meniscal tears in revision compared with primary ACL reconstruction. A previous medial or lateral meniscectomy increases the OR of articular cartilage damage in the medial or lateral compartments, respectively. Even when controlling for meniscus status, there is an increased OR in revision compared with primary ACL reconstruction of significant lateral compartment and patellar-trochlear chondral damage but not medial compartment chondral damage.

A Systematic Review of the Effectiveness of Kinesio Taping for Musculoskeletal Injury

Abstract Objective: Kinesio taping (KT) is used to prevent and treat musculoskeletal injuries. This systematic review examines the evidence for the effectiveness of KT in improving patient outcomes following musculoskeletal injury. Materials and Methods: A literature search (October 2011) was performed using PubMed, CINAHL, Scopus, SportsDiscus, and Cochrane databases. The literature search employed the keywords “kinesio tap*” or “kinesiotap*” or “athletic tap*” and “performance” or “function” or “strength” or “activity” or “pain” or “muscle” and “athlet*” or “sport*.“ These searches yielded a total of 727 articles, which were reviewed thoroughly to identify suitable articles. Results: Six studies met our criteria and were included in this systematic review. Two of these studies examined musculoskeletal injuries in the lower extremity and reported that the use of KT did not affect outcome measures. Two studies examined musculoskeletal injuries involving the spine. Treatment with KT significantly improved pain levels and range of motion in patients with acute whiplash-associated disorders of the cervical spine both immediately and 24 hours after injury; however, the long-term results did not differ between the 2 groups. Subjects with chronic low back pain treated with KT and exercise, KT alone, or exercise alone experienced significant improvement in short-term pain, while the exercise-only group also showed significantly less long-term disability. Two studies examined musculoskeletal injuries in the shoulder. The first of these found insufficient evidence to indicate that KT decreases pain and disability in young patients with shoulder impingement/tendinitis, while the second suggested that KT may provide short-term pain relief for patients with shoulder impingement. This systematic review found insufficient evidence to support the use of KT following musculoskeletal injury, although a perceived benefit cannot be discounted. There are few high-quality studies examining the use of KT following musculoskeletal injury.

Ultrasound versus anatomic guidance for intra-articular and periarticular injection: a systematic review.

Abstract Objective: To investigate the clinical efficacy of ultrasound when compared with anatomic standard injection using palpation/anatomic landmarks. Methods: PubMed, Ovid Medline/Cochrane Reviews, BIOSIS Previews®, and SPORTDiscus™ databases were searched to January 2011. To narrow the search, the following key search terms were used: ultrasound, guided, injection, joint, shoulder, elbow, wrist, hip, knee, and ankle. Fifteen articles were determined to be relevant, and an additional 2 articles were added after bibliography sections of the 15 articles were reviewed, resulting in a total of 17 articles meeting inclusion and exclusion criteria. Results: Accuracy was greater in the ultrasound-guided group, independent of anatomic site. An improvement in time to symptom onset in the short term (< 6 weeks) was greatest with the use of ultrasound-guided intra-articular injection. Long-term outcomes are not proven to be different between intra-articular injection with ultrasound or anatomic guidance. The greatest trends were observed in the knee and shoulder joints, demonstrating improvements in function, pain, intensity, and range of motion, independent of injection technique. In foot/ankle and wrist/hand, small joint space injections showed a greater accuracy with ultrasound-guided injections contrasted to larger joint spaces, in which these joint injections demonstrated equal accuracy independent of injection technique. Conclusion: This systematic review can confirm that accuracy is improved with the use of ultrasound-guided intra-articular injection. We can also confirm that short-term outcome improvements are present using ultrasound-guided injection techniques but can confirm no difference in long-term outcome measures using either technique.

Facial protection and head injuries in ice hockey: a systematic review

Objective: To summarise the best available evidence to determine if facial protection reduces head injury in ice hockey. Data Sources: MEDLINE and Cochrane databases through January 2009. Review Methods: Utilising terms: “head injuries,” “craniocerebral trauma [MeSH]”, “head injuries, closed [MeSH]”, head injuries, penetrating [MeSH]”, “face mask”, “face shield”, “visor” and “hockey”, 24 articles were identified through our systematic literature search. Of these, six studies met the inclusion criteria. Three independent reviewers reviewed the articles. The study results and generated conclusions were extracted and agreed upon. Results: Studies reviewed suggest that facial protection reduces overall head injuries in ice hockey. Facial protection showed a statistically significant (p<0.05) reduction in the number and type of facial injuries. In studies evaluating full facial protection (FFP) versus half facial protection (HFP), FFP offered a significantly higher level of protection against facial injuries and lacerations than HFP (relative risk (RR) 2.31, CI 1.53 to 3.48). There was no significant difference in the rate of concussion (RR 0.97, CI 0.61 to 1.54) or neck injury (CI 0.43 to 3.16) between full and partial protection. In those who sustained concussion players with FFP returned to practice or games sooner than players with partial facial protection (PFP) (1.7 sessions, CI 1.32 to 2.18). Conclusions: There is good evidence that FFP reduces the number and risk of overall head and facial injuries in ice hockey compared with PFP and no facial protection. PFP, while not as protective as FFP, appears to offer more risk reduction than no protection.

Metabolic syndrome and insulin resistance in Division 1 collegiate football players.

PURPOSE To estimate the prevalence of metabolic syndrome and insulin resistance in a cohort of Division 1 collegiate football players. METHODS Ninety football players were evaluated in a cross-sectional study to estimate the prevalence of metabolic syndrome, insulin resistance, and associated risk factors. Obesity was defined as a body fat >or=25% determined by BOD POD measurements. The National Cholesterol Education Program Adult Treatment Panel III criteria were used to estimate prevalence of metabolic syndrome. Quantitative insulin sensitivity check index calculations were performed to estimate prevalence of insulin resistance. Linear regression techniques were used to determine association between body fat percentage and other measured continuous parameters. Fisher exact test was used to determine association between nominal variables, and one-way ANOVA compared the three groups defined by position. RESULTS Summary measures showed a small prevalence of abnormal individual measurements. There was an association between body fat percentage and most evaluated parameters (P < 0.05). The prevalence of obesity, insulin resistance, and metabolic syndrome was 21%, 21%, and 9%, respectively. Obesity is closely associated with metabolic syndrome (P < 0.0001) and insulin resistance (P < 0.0001) in this population. All subjects with metabolic syndrome were obese, and the odds for insulin resistance in the obese group are 10.6 times the odds for the nonobese group. Linemen (n = 29) had 19 of the 19 obese subjects, 13 of the 19 subjects with insulin resistance, and all subjects with metabolic syndrome. CONCLUSIONS There is a strong association between obesity and both metabolic syndrome and insulin resistance in Division 1 collegiate football players. Linemen are at significant risk for metabolic syndrome and insulin resistance compared with other positions. This may be predictive of future health problems in Division 1 collegiate football players, especially linemen.

Lumbopelvic control and pitching performance of professional baseball pitchers.

Chaudhari, AMW, McKenzie, CS, Borchers, JR, and Best, TM. Lumbopelvic control and pitching performance of professional baseball pitchers. J Strength Cond Res 25(8): 2127-2132, 2011—This study assessed the correlation between lumbopelvic control during a single-leg balancing task and in-game pitching performance in Minor-League baseball pitchers. Seventy-five healthy professional baseball pitchers performed a standing lumbopelvic control test during the last week of spring training for the 2008 and 2009 seasons while wearing a custom-designed testing apparatus, the “Level Belt.” With the Level Belt secured to the waist, subjects attempted to transition from a 2-leg to a single-leg pitching stance and balance while maintaining a stable pelvic position. Subjects were graded on the maximum sagittal pelvic tilt from a neutral position during the motion. Pitching performance, number of innings pitched (IP), and injuries were compared for all subjects who pitched at least 50 innings during a season. The median Level Belt score for the study group was 7°. Two-sample t-tests with equal variances were used to determine if pitchers with a Level Belt score <7° or ≥7° were more likely to perform differently during the baseball season, and chi-square analysis was used to compare injuries between groups. Subjects scoring <7° on the Level Belt test had significantly fewer walks plus hits per inning than subjects scoring ≥7° (walks plus hits per inning pitched, 1.352 ± 0.251 vs. 1.584 ± 0.360, p = 0.013) and significantly more IP during the season (IP, 78.89 ± 38.67 vs. 53.38 ± 42.47, p = 0.043). There was no significant difference in the number of pitchers injured between groups. These data suggest that lumbopelvic control influences overall performance for baseball pitchers and that a simple test of lumbopelvic control can potentially identify individuals who have a better chance of pitching success.

The effects of platelet-rich plasma in the treatment of large-joint osteoarthritis: a systematic review.

Abstract Context: Osteoarthritis (OA) is a common and costly condition with both operative and nonoperative treatments available. Platelet-rich plasma (PRP) is emerging as a treatment option for a variety of musculoskeletal pathologies, including OA. Objective: To evaluate the effectiveness of intra-articular PRP injection in the treatment of large-joint OA. Data Sources: PubMed, Web of Knowledge, Scopus, and the Cochrane Database were searched. The references of all articles that met the inclusion criteria were manually searched for additional articles. Study Selection: English studies that enrolled human participants were included, with level of evidence I to IV. Results: Thirteen articles met the inclusion criteria: 12 focused on knee OA, and 1 on hip OA. All studies showed statistically significant improvement in patient outcome scores with PRP. Platelet-rich plasma has a statistically significant benefit in knee OA when compared with hyaluronic acid. The benefit from PRP appears to last between 6 and 12 months. Conclusion: Platelet-rich plasma may be an effective treatment for knee OA. However, because of the low level of evidence, small sample sizes, and wide variability in treatment, no definitive recommendations can be made at this time.

Comparison of Injuries in American Collegiate Football and Club Rugby A Prospective Cohort Study

Background: American football and rugby players are at substantial risk of injury because of the full-contact nature of these sports. Methodological differences between previous epidemiological studies hamper an accurate comparison of injury rates between American football and rugby. Purpose: To directly compare injury rates in American collegiate football and rugby, specified by location, type, mechanism, and severity of injury, as reported by licensed medical professionals. Study Design: Cohort study; Level of evidence, 2. Methods: Licensed medical professionals (athletic trainer or physician) associated with the football and rugby teams of a National Collegiate Athletic Association Division I university reported attendance and injury details over 3 autumn seasons. Injuries were categorized by the location, type, mechanism, and severity of injury, and the injury rate was calculated per 1000 athlete-exposures (AEs). Injury rate ratios (IRRs) were calculated to compare overall, game, and practice injury rates within and between sports. Results: The overall injury rate was 4.9/1000 AEs in football versus 15.2/1000 AEs in rugby: IRR = 3.1 (95% CI, 2.3-4.2). Game injury rates were higher than practice injury rates: IRR = 6.5 (95% CI, 4.5-9.3) in football and IRR = 5.1 (95% CI, 3.0-8.6) in rugby. Injury rates for the shoulder, wrist/hand, and lower leg and for sprains, fractures, and contusions in rugby were >4 times as high as those in football (all P ≤ 0.006). Concussion rates were 1.0/1000 AEs in football versus 2.5/1000 AEs in rugby. Most injuries occurred via direct player contact, especially during games. The rate of season-ending injuries (>3 months of time loss) was 0.8/1000 AEs in football versus 1.0/1000 AEs in rugby: IRR = 1.3 (95% CI, 0.4-3.4). Conclusion: Overall injury rates were substantially higher in collegiate rugby compared with football. Similarities between sports were observed in the most common injury types (sprains and concussions), locations (lower extremity and head), and mechanisms (direct player contact). Upper extremity injuries were more common in rugby, and the rate of season-ending injuries was similar between sports.

Tendon needling for treatment of tendinopathy: A systematic review

Abstract Objective. To summarize the best available evidence to determine if tendon needling is an effective treatment for tendinopathy. Data source. Medline and Cochrane Databases through November 2013. Review methods. Utilizing the search terms tendinopathy, needle, needling, tenotomy, dry needling, needling tendon, needle fenestration, and tendon fenestration, 17 articles were identified through our systematic literature search. Of these, 4 studies met the inclusion criteria. Four independent reviewers reviewed the articles. The study results and generated conclusions were agreed upon. Results. The studies that were included in this review suggest that tendon needling improves patient reported outcomes in patients with tendinopathy. In 2 studies evaluating tendon needling in lateral epicondylosis, one showed an improvement in a subjective visual analogue scale score of 34% (significant change > 25%) from baseline at 6 months. The other showed an improvement of 56.1% in a visual analogue scale score from baseline. In 1 study evaluating tendon needling in addition to eccentric therapy for Achilles tendinosis, the subjective Victorian Institute of Sport Assessment–Achilles (VISA-A) score improved by 19.9 (significant change > 10) (95% CI, 13.6–26.2) from baseline. In 1 study evaluating tendon needling in rotator cuff tendinosis, the subjective shoulder pain and disability index showed statistical significant improvement from baseline at 6 months (P < 0.05). Conclusions. The evidence suggests that tendon needling improves patient-reported outcome measures in patients with tendinopathy. There is a trend that shows that the addition of autologous blood products may further improve theses outcomes.