Venous Thromboembolism Within Professional American Sport Leagues.

Background: Numerous reports have described players in professional American sports leagues who have been sidelined with a deep vein thrombosis (DVT) or a pulmonary embolism (PE), but little is known about the clinical implications of these events in professional athletes. Purpose: To conduct a retrospective review of injury reports from the National Hockey League (NHL), Major League Baseball (MLB), the National Basketball Association (NBA), and the National Football League (NFL) to take a closer look at the incidence of DVT/PE, current treatment approaches, and estimated time to return to play in professional athletes. Study Design: Descriptive epidemiology study. Methods: An online search of all team injury and media reports of DVT/PE in NHL, MLB, NBA, and NFL players available for public record was conducted by use of Google, PubMed, and SPORTDiscus. Searches were conducted using the professional team name combined with blood clot, pulmonary embolism, and deep vein thrombosis. Results: A total of 55 venous thromboembolism (VTE) events were identified from 1999 through 2016 (NHL, n = 22; MLB, n = 16; NFL, n = 12; NBA, n = 5). Nineteen athletes were reported to have an upper extremity DVT, 15 had a lower extremity DVT, 15 had a PE, and 6 had DVT with PE. Six athletes sustained more than 1 VTE. The mean age at time of VTE was 29.3 years (range, 19-42 years). Mean (±SD) time lost from play was 6.7 ± 4.9 months (range, 3 days to career end). Seven athletes did not return to play. Players with upper extremity DVT had a faster return to play (mean ± SD, 4.3 ± 2.7 months) than those with lower extremity DVT (5.9 ± 3.8 months), PE (10.8 ± 6.8 months), or DVT with PE (8.2 ± 2.6 months) (F = 5.69, P = .002). No significant difference was found regarding time of return to play between sports. Conclusion: VTE in professional athletes led to an average of 6.7 months lost from play. The majority of athletes were able to return to play after a period of anticoagulation or surgery. Those with an upper extremity DVT returned to play faster than those with other types of VTE. Further study is needed to look into modifiable risk factors for these events and to establish treatment and return-to-play guidelines to ensure the safety of these athletes

Slave to Freewoman and Back Again: Kitty Payne and Antebellum Kidnapping

Indiana University-Purdue University Indianapolis (IUPUI)In 1843, an African-American woman known as Kitty Payne and her three children arrived in Adams County, Pennsylvania, newly manumitted by their mistress, Mary Maddox of Virginia. Two years later, in July of 1845, a gang of men burst into the Paynes’ home and kidnapped the family, dragging them back south to slavery. The story of Kitty Payne and her children echoed and replayed itself thousands of times in the years before the end of the Civil War. Between 1620 and 1860, a race-based system of slavery developed in America. Not all persons of African descent came to America as slaves, however, and slaves sometimes obtained freedom through manumission or escape. This created opportunities for corrupt individuals to kidnap free black Americans and sell them as slaves, regardless of their previous status. The abduction of free blacks into slavery is an extremely significant and far-reaching part of the antebellum African-American experience that many historians have previously overlooked

Comparison of Patient Outcomes in Female Patients Undergoing SLAP Repair or Biceps Tenodesis for the Treatment of SLAP Lesions

Background: There is no consensus on whether SLAP repair (SR) or biceps tenodesis (BT) yields superior long-term outcomes in managing superior labrum anterior to posterior (SLAP) tears. No previous study has examined outcomes of these procedures in female patients. Hypothesis/Purpose: The purpose of this study was to compare outcomes following SR and BT for SLAP tears in females. The authors hypothesized there would be no difference in outcomes between patients who underwent SR or BT. Study Design: Retrospective Cohort (level III) Methods: Female patients who underwent SR or BT for treatment of SLAP tears between 1/1/2014 and 9/1/2019 were retrospectively reviewed. Patients undergoing a concomitant procedure were excluded. Patients completed American Shoulder and Elbow Surgeons (ASES), single assessment numerical evaluation (SANE), and visual analog scale (VAS), and a custom return to activity surveys at a minimum 2 years post-operatively. Results: The study included 65 female patients; 38 (58.4%) underwent arthroscopic SR and 27 (41.5%) underwent open- or arthroscopic-BT. There was no significant difference in laterality of procedure but patients in the SR group were significantly younger (36.7±8.44 years vs. 44.4±10.4 years, P = .003). At minimum 2-year follow-up, there was no significant difference in ASES scores (SLAP: 78.3 vs BT: 80.0, P = .591), SANE scores (77.0 vs 80.1, P = .722) or VAS scores (26.4 vs 24.4, P = .530). Furthermore, rates of participation in sports prior to surgery (58.8%vs 37.0%, P = .152) and rates of return-to-sport after surgery (75.0% vs 80.0%, P = 1.000) did not significantly differ. Conclusion: Female patients undergoing surgical treatment of SLAP lesions with either SR or BT show comparable subjective outcomes and return to sport at minimum 2 years. These results are comparable to those seen in prior studies focusing on predominantly male cohorts. Further research is necessary to define precise treatment indications for this pathology in this specific female patient population

Management of Elbow Dislocations in the National Football League.

Background: Although much literature exists regarding the treatment and management of elbow dislocations in the general population, little information is available regarding management in the athletic population. Furthermore, no literature is available regarding the postinjury treatment and timing of return to play in the contact or professional athlete. Purpose: To review the clinical course of elbow dislocations in professional football players and determine the timing of return to full participation. Study Design: Case series; Level of evidence, 4. Methods: All National Football League (NFL) athletes with elbow dislocations from 2000 through 2011 who returned to play during the season were identified from the NFL Injury Surveillance System (NFL ISS). Roster position, player activity, use of external bracing, and clinical course were reviewed. Mean number of days lost until full return to play was determined for players with elbow dislocations who returned in the same season. Results: From 2000 to 2011, a total of 62 elbow dislocations out of 35,324 injuries were recorded (0.17%); 40 (64.5%) dislocations occurred in defensive players, 12 (19.4%) were in offensive players; and 10 (16.1%) were during special teams play. Over half of the injuries (33/62, 53.2%) were sustained while tackling, and 4 (6.5%) patients required surgery. A total of 47 (75.8%) players who sustained this injury were able to return in the same season. For this group, the mean number of days lost in players treated conservatively (45/47) was 25.1 days (median, 23.0 days; range, 0.0-118 days), while that for players treated operatively (2/47) was 46.5 days (median, 46.5 days; range, 29-64 days). Mean return to play based on player position was 25.8 days for defensive players (n = 28; median, 21.5 days; range, 3.0-118 days), 24.1 days for offensive players (n = 11; median, 19 days; range, 2.0-59 days), and 25.6 days for special teams players (n = 8; median, 25.5 days; range, 0-44 days). Conclusion: Elbow dislocations comprise less than a half of a percent of all injuries sustained in the NFL. Most injuries occur during the act of tackling, with the majority of injured athletes playing a defensive position. Players treated nonoperatively missed a mean of 25.1 days, whereas those managed operatively missed a mean of 46.5 days

Evaluation of Rotator Cuff Repair with Concomitant Biceps Tenodesis

Introduction: Surgical rotator cuff repair (RCR) has proven to be an effective treatment for rotator cuff tears. Commonly, rotator cuff tears are associated with concomitant biceps pathology, which are often treated by biceps tenodesis (BT). We hypothesize that patient outcomes will be similar in those that have undergone RCR with concomitant BT and isolated RCR. Methods: This is a retrospective cohort study comparing patients who underwent arthroscopic RCR with arthroscopic or open BT to patients who underwent isolated RCR at a multisurgeon orthopaedic practice during the time period of November 2016 to December 2016. The outcome for comparison is the American Shoulder and Elbow Surgeons score (ASES). Patients with postoperative scores of at least 6 months after surgery were included. The data was collected from the Rothman Institute registry and OBERD. It was analyzed via independent t-test. Results: A total of 53 patients (37 = M; 16 = F) were in the isolated RCR group and 34 patients (27 = M; 7 = F) were in the RCR with BT group. The average age in the isolated RCR group was 58.6 years vs. 58.9 years in the RCR with BT group. There was no statistical difference between postoperative ASES scores (83.69 and 79.43, P = .40) and difference in preoperative and postoperative ASES scores (34.26 and 35.30, P = .85) in the isolated RCR and RCR with BT groups, respectively. Conclusion: There was no significant difference in postoperative ASES scores as well as difference in preoperative and postoperative ASES scores in patients undergoing isolated RCR and RCR with BT. This supports the hypothesis that patients undergoing RCR with BT will have similar outcomes to those undergoing isolated RCR

Youth Single-Sport Specialization in Professional Baseball Players.

Background: An increasing number of youth baseball athletes are specializing in playing baseball at younger ages. Purpose: The purpose of our study was to describe the age and prevalence of single-sport specialization in a cohort of current professional baseball athletes. In addition, we sought to understand the trends surrounding single-sport specialization in professional baseball players raised within and outside the United States (US). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A survey was distributed to male professional baseball athletes via individual team athletic trainers. Athletes were asked if and at what age they had chosen to specialize in playing baseball at the exclusion of other sports, and data were then collected pertaining to this decision. We analyzed the rate and age of specialization, the reasons for specialization, and the athlete\u27s perception of injuries related to specialization. Results: A total of 1673 professional baseball athletes completed the survey, representing 26 of the 30 Major League Baseball (MLB) organizations. Less than half (44.5%) of professional athletes specialized in playing a single sport during their childhood/adolescence. Those who reported specializing in their youth did so at a mean age of 14.09 ± 2.79 years. MLB players who grew up outside the US specialized at a significantly earlier age than MLB players native to the US (12.30 ± 3.07 vs 14.89 ± 2.24 years, respectively; Conclusion: This study challenges the current trends toward early youth sport specialization, finding that the majority of professional baseball athletes studied did not specialize as youth and that those who did specialize did so at a mean age of 14 years. With the potential cumulative effects of pitching and overhead throwing on an athlete\u27s arm, the trend identified in this study toward earlier specialization within baseball is concerning

Latarjet Surgery Leads to Decreased Rates of Subjective Instability Compared to Bankart Repair with Concomitant Remplissage

Background: Predictive factors for performing remplissage concomitantly with arthroscopic Bankart repair include the presence of humeral or glenoid defects \u3e11% and/or revision surgery. International and societal consensus statements support these findings, as surgeons recommend the Latarjet procedure for patients with significant glenoid bone loss (\u3e15-20%) while remplissage is recommended for patients with off-track or engaging Hill-Sachs lesions without significant glenoid bone loss. While several studies have compared outcomes between Latarjet surgery and remplissage, these studies have only evaluated patients with engaging Hill-Sachs lesions, not consecutive patient cohorts indicated for each surgery. Purpose: To compare rates of recurrent instability, re-operation, revision, and return to play (RTP), as well as patient-reported outcomes including the American Shoulder and Elbow Surgeon Score (ASES), Single Assessment Numeric Evaluation (SANE), and Oxford Shoulder Instability Score (OSI) between Latarjet surgery and arthroscopic labral repair plus remplissage surgery (Remplissage) patients

Maintenance of Weight Loss in Adolescents: Current Status and Future Directions

There is a dearth of research on the long-term efficacy and safety of treatments for adolescent obesity. This narrative review examined several approaches to treatment, focusing on long-term effectiveness data in adolescents, as well as relevant findings from studies of adults. The available research suggests that lifestyle modification has promise in obese adolescents, although it is not clear that any particular dietary or physical activity approach is more effective than another. Meal replacements are quite effective in adults and deserve further research in adolescents. Extending the length of treatment to teach weight loss maintenance skills is likely to improve long-term outcomes in adolescents, and delivering treatment via the Internet or telephone is a novel way of doing so. Treatment that combines lifestyle modification with the medication orlistat generally appears to be safe but only marginally superior to lifestyle modification alone. More research is needed on the management of adolescent obesity, which has been overlooked when compared with research on the treatment of obesity in children and adults

Outcomes of Arthroscopic vs. Open Biceps Tenodesis for Treatment of SLAP Lesion in Female Patients

Background: Biceps tenodesis (BT) is one alternative treatment to repair of superior labrum anterior to posterior (SLAP) tears. It can be performed as an arthroscopy or open procedure. While there have been studies comparing the outcomes of SLAP repair procedures with BT for the treatment of SLAP tears, literature comparing arthroscopic and open BT for the treatment of SLAP tears is limited. Additionally, no previous study has specifically examined the outcomes of these procedures in female patients. Hypothesis/Purpose: The purpose of this study was to compare outcomes following Arthroscopic BT and Open BT for SLAP tears in females. The authors hypothesized there would be no difference in outcomes between patients who underwent arthroscopic or open procedures. Study Design: Retrospective Cohort (level III) Methods: Female patients who underwent arthroscopic or open BT for treatment of SLAP tears between 1/1/2014 and 9/1/2019 were retrospectively reviewed. Patients undergoing a concomitant procedure were excluded. A minimum of 2 years postoperatively patients completed American Shoulder and Elbow Surgeons (ASES), single assessment numerical evaluation (SANE), and visual analog scale (VAS), and a custom return to activity surveys. Results: This study included 27 female patients; 14 (51.9%) underwent arthroscopic BT and 13 (48.1%) underwent open BT. There was no significant difference between cohorts in terms of age (P = .679), BMI (P = .382), Height (P = .989), Weight (P = .452), laterality of procedure (P = .678), or rate of surgery taking place on the dominant side (P = 1.000). Groups had similar post-operative ASES scores (85.9 vs 73.6, P = .238), SANE scores (81.4 vs 78.6, P = .922), VAS (16.8 vs 32.5, P = .248). Furthermore, rates of participation in sport prior to surgery (P = .236), rate of return to sport following surgery (P = 1.000), and time it took to return to sport (P = .915) were similar between groups. Conclusion: Female patients undergoing surgical treatment of SLAP lesions with either arthroscopic or open BT show comparable subjective outcomes and return to sport at minimum 2 years. Further research is necessary to define precise treatment indications for this pathology in this specific female patient population

Multidirectional instability in female athletes

Multidirectional instability (MDI) of the shoulder is characterized by generalized shoulder capsular laxity and symptomatic shoulder instability in more than one direction with one direction of instability as inferior. Generalized ligamentous laxity and specifically shoulder laxity, has been associated with female athletes. While males are at a higher risk of shoulder instability due to a number of extrinsic risk factors including participation in higher risk contact/collision activities, females are particularly susceptible to MDI due to their association with increased joint laxity. Patients with MDI often have a loose patulous capsule and display altered glenohumeral and scapulothoracic mechanics. The mainstay of treatment is physical therapy focusing on strengthening the dynamic stabilizers of the shoulder. In cases of failed rehabilitation, operative management most frequently includes either open or arthroscopic capsular shift with reasonably good outcomes and return to sport. Sex-related differences concerning shoulder instability risk and pathophysiology may influence treatment decisions and outcome measures. An understanding of the factors concerning shoulder instability specific to the female athlete is important in management and prevention of injury