James E. Voos

Differences in Medial and Lateral Posterior Tibial Slope An Osteological Review of 1090 Tibiae Comparing Age, Sex, and Race

Background: Injuries to the anterior cruciate ligament (ACL) are common, and a number of knee morphological variables have been identified as risk factors for an ACL injury, including the posterior tibial slope (TS). However, limited data exist regarding innate population differences in the TS. Purpose: To (1) establish normative values for the medial and lateral posterior TS; (2) determine what differences exist between ages, sexes, and races; and (3) determine how internal or external tibial rotation (as occurs during sagittal knee motion) influences the stereotactic perception of the TS. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 545 cadaveric specimens (1090 tibiae) were obtained from the Hamann-Todd osteological collection. Specimens were leveled in the coronal, sagittal, and axial planes using a digital laser. Virtual representations of each bone were created with a 3-dimensional digitizer apparatus. The TS of the medial and lateral tibial plateaus were measured using techniques adapted from previous radiographic protocols. Medial and lateral TS were then again measured on 200 tibiae that were internally and externally rotated by 10° (axially). Results: The mean (±SD) medial TS was 6.9° ± 3.7° posterior, which was greater than the mean lateral TS of 4.7° ± 3.6° posterior (P < .001). Neither the medial nor lateral TS changed with age. Women had a greater mean TS compared with men on both the medial (7.5° ± 3.8° vs 6.8° ± 3.7°, respectively; P = .03) and lateral (5.2° ± 3.5° vs 4.6° ± 3.5°, respectively; P = .04) sides. Black specimens had a greater mean medial TS (8.7° ± 3.6° vs 5.8° ± 3.3°, respectively; P < .001) and lateral TS (5.9° ± 3.3° vs 3.8° ± 3.5°, respectively; P < .001) compared with white specimens. Axial rotation was shown to increase the perception of the medial and lateral TS (P < .001). Conclusion: The medial TS was shown to be greater than the lateral TS. Important sex- and race-based differences exist in the TS. This study also highlights the role of axial rotation in measuring the TS.

Wearable Devices for Sports: New Integrated Technologies Allow Coaches, Physicians, and Trainers to Better Understand the Physical Demands of Athletes in Real time

Elite-level athletes and professional sports teams are continually searching for opportunities to improve athletic performance and gain a competitive advantage on the field. Advances in technology have provided new avenues to maximize player health and safety. Over the last decade, time?motion analysis systems, such as video recording and computer digitization, have been used to measure human locomotion and improve sports performance. While these techniques were state of the art at the time, their usefulness is inhibited by the questionable validity of the acquired data, the labor-intensive nature of collecting data with manual hand-notation techniques, and their inability to track athlete position, movement, displacement, and velocity.

Prevalence and impact of glenoid augmentation in American football athletes participating in the national football league scouting combine

Background: Bony augmentation of the anterior glenoid is used in athletes with recurrent shoulder instability and bone loss; however, the prevalence and impact of repair in elite American football athletes are unknown. Purpose: To evaluate the prevalence and impact of glenoid augmentation in athletes invited to the National Football League (NFL) Scouting Combine from 2012 to 2015. Study Design: Case series; Level of evidence, 4. Methods: A total of 1311 athletes invited to the NFL Combine from 2012 to 2015 were evaluated for history of either Bristow or Latarjet surgery for recurrent anterior shoulder instability. Athlete demographics, surgical history, imaging, and physical examination results were recorded using the NFL Combine database. Prospective participation data with regard to draft status, games played, games started, and status after the athletes’ first season in the NFL were gathered using publicly available databases. Results: Surgical repair was performed on 10 shoulders in 10 athletes (0.76%), with the highest prevalence in defensive backs (30%; n = 3). Deficits in shoulder motion were exhibited in 70% (n = 7) of athletes, while 40% (n = 4) had evidence of mild glenohumeral arthritis and 80% demonstrated imaging findings consistent with a prior instability episode (8 labral tears, 2 Hill-Sachs lesions). Prospectively, 40% (n = 4) of athletes were drafted into the NFL. In the first season after the combine, athletes with a history of glenoid augmentation were not found to be at significant risk for diminished participation with regard to games played or started when compared with athletes with no history of glenoid augmentation or athletes undergoing isolated shoulder soft tissue repair. After the conclusion of the first NFL season, 60% (n = 6 athletes) were on an active NFL roster. Conclusion: Despite being drafted at a lower rate than their peers, there were no significant limitations in NFL participation for athletes with a history of glenoid augmentation when compared with athletes without a history of shoulder surgery or those with isolated soft tissue shoulder repair. Glenohumeral arthritis and advanced imaging findings of labral tearing and Hill-Sachs lesions in elite American football players with a history of glenoid augmentation did not significantly affect NFL participation 1 year after the combine.

Conservative management for stable high ankle injuries in professional football players

Context: High ankle “syndesmosis” injuries are common in American football players relative to the general population. At the professional level, syndesmotic sprains represent a challenging and unique injury lacking a standardized rehabilitation protocol during conservative management. Evidence Acquisition: PubMed, Biosis Preview, SPORTDiscus, PEDro, and EMBASE databases were searched using the terms syndesmotic injuries, American football, conservative management, and rehabilitation. Study Design: Clinical review. Level of Evidence: Level 3. Results: When compared with lateral ankle sprains, syndesmosis injuries result in significantly prolonged recovery times and games lost. For stable syndesmotic injuries, conservative management features a brief period of immobilization and protected weightbearing followed by progressive strengthening exercises and running, and athletes can expect to return to competition in 2 to 6 weeks. Further research investigating the efficacy of dry needling and blood flow restriction therapy is necessary to evaluate the benefit of these techniques in the rehabilitation process. Conclusion: Successful conservative management of stable syndesmotic injuries in professional American football athletes requires a thorough understanding of the anatomy, injury mechanisms, diagnosis, and rehabilitation strategies utilized in elite athletes.

Hyoid Dislocation Following Subacute Fracture in an American High School Football Athlete

Musculoskeletal injuries are exceedingly common in American football because of the contact-and-collision nature of the sport. More than 350,000 injuries are documented in the >1 million high school athletes participating in American football annually. Injuries to the neck are largely uncommon, composing only *6% of the injury total; however, if they are not properly diagnosed and treated, they can lead to severe, potentially fatal consequences. Lying in the anterior midline of the neck and well protected by the mandible superiorly, the cervical spine posteriorly, and thyroid cartilage anteriorly is the U-shaped hyoid bone. As the only bone in the body not articulating with any other bone, the hyoid functions to maintain patency of the pharynx for swallowing and respiration while serving as an attachment point for the middle pharynx. The hyoid is rarely susceptible to direct trauma, with fracture rates accounting for only 0.002% to 1% of all fractures and with dislocations being even less common. However, hyoid injuries with resultant bony penetration into the pharyngeal mucosa may compromise the patency of the airway, injure the external carotid artery, or cause infection. The majority of documented hyoid injuries occur in victims of strangulation, hanging, or motor vehicle accidents. Reported hyoid fractures following sports-related trauma are exceedingly infrequent, with only 6 total cases documented in the literature: football (n 1⁄4 2), basketball (n 1⁄4 2), hockey (n 1⁄4 1), and karate (n1⁄4 1). There are currently no reports of hyoid dislocation secondary to sport-related trauma. In this case report, we present a high school football player presenting with an acute hyoid dislocation in the setting of a subacute fracture sustained 6 weeks prior.

Prevalence of Jones Fracture Repair and Impact on Short-Term NFL Participation:

Background: Elite American football athletes are at high risk for Jones fractures. Fixation is recommended to minimize nonunion and allow early return to play. The purpose of this investigation was to evaluate the prevalence of Jones fracture repair in athletes invited to the National Football League (NFL) Combine and the impact of fracture repair on short-term NFL participation compared to athletes with no history of repair. Methods: A total of 1311 athletes participating in the Combine from 2012 to 2015 were evaluated. Athletes with history of Jones fracture repair were identified. Athlete demographic information was collected while physical examination findings were recorded. Radiographs were evaluated to determine fixation type and the presence of nonunion. Future participation in the NFL was evaluated based on draft status, games played, and games started in the athlete’s first season following the Combine. Results: Fixation was performed for 41 Jones fractures in 40 athletes (3.1%). The highest prevalence was in defensive linemen (n = 10 athletes), with the greatest rate in tight ends (5.1%, n = 4 of 79 athletes). Intramedullary screw fixation was used for all fractures. Incomplete bony union was present in 3 (8%) fractures. Athletes with a history of repair were not at significant risk for going undrafted (P = .61), playing (P = .23), or starting (P = .76) fewer NFL games compared to athletes with no history of repair during athletes’ first NFL season. Conclusion: Athletes with a history of Jones fracture repair were not at significant risk of going undrafted or for diminished participation during their first season in the NFL. Level of Evidence: Level IV, case series.

Magnetic Resonance Imaging and Arthroscopic Correlation in Shoulder Instability

The shoulder is the most inherently unstable joint in the body, prone to high rates of anterior dislocations with subsequent injuries to soft tissue and bony stabilizing structures, resulting in recurrent shoulder instability. Advanced imaging utilizing magnetic resonance (MR) imaging and MR arthrography allows for thorough evaluation of lesions present in the unstable shoulder and is critical for preoperative planning. Arthroscopic shoulder stabilization in the appropriately selected patient can help restore stability and function. This review highlights correlations between MR imaging and arthroscopy of the most commonly reported soft tissue and bony injuries present in patients with shoulder instability.

A review of wearable technology: Moving beyond the hype: From need through sensor implementation

Wearable devices have garnered increased attention over the past years by the sports industry, military, and general public for everyday use. Technological advancements have enabled athletes, sports teams, soldiers, and physicians to track functional movements, workload, biometric and bio-vital markers to maximize performance and safety while minimizing the potential for injury or accidents. Wearable monitoring systems can provide continuous physiological data thus enabling accurate treatment plans and specific recovery programs. Herein, we present a review of the wearable sensors field in sports and emergency medicine and highlight our current work and collaborations which bridge academia, healthcare professionals, sports team physicians, Life Flight operations, and ED/trauma operations. A key outcome of this work is the identification of crosscutting themes that indicate critical path items for future research.

Role of the remaining rotator cuff following reverse total shoulder arthroplasty

Rotator cuff degeneration and cuff tear arthropathy result from chronic degeneration and wear, representing a significant clinical and financial burden in the elderly population. Reverse shoulder arthroplasty (RSA) has proven to be superior in restoring clinical and functional outcomes in patients not amendable to direct rotator cuff repair when compared with total shoulder arthroplasty. However, the design of the reverse shoulder prosthesis fails to restore external rotation in the setting of massive posterior rotator cuff tears with a dislocation rates as high as 9%. This necessitates a review of the role of the remaining posterior rotator cuff (infraspinatus and teres minor) and subscapularis on postoperative clinical and functional outcomes after RSA. On the basis of the available literature, the health of the posterior rotator cuff, reflected in the degree of fatty infiltration and tearing, is essential for maintenance and restoration of external rotation postoperatively, with the integrity of the teres minor being more critical. Proper tensioning of the posterior cuff using increased offset designs is necessary to achieve optimal outcomes. However, tendon transfers using the latissimus dorsi, with or without the teres major, make the contribution of the remaining posterior rotator cuff on postoperative outcomes negligible. Meanwhile, subscapularis repair and integrity are not critical to postoperative stability of the prosthesis or internal rotation. Further investigations are warranted to determine the amount of remaining rotator cuff and the extent of degeneration necessary to impact postoperative outcomes after RSA.