Medial Patellofemoral Reconstruction With a Hamstring Allograft

Background: Lateral patellar instability is common in young, active patients. Patients who fail conservative treatment may benefit from medial patellofemoral ligament (MPFL) reconstruction. Indications: Recurrent lateral patellar instability. Technique Description: Examination assesses patellar translation, eversion and range of instability. Diagnostic arthroscopy is performed for loose bodies, cartilage damage, trochlear dysplasia, and tracking. A longitudinal incision is made from superomedial to mid-body of the patella. The plane between the capsule and retinaculum is developed for palpation of the medial epicondyle and adductor tubercle. Electrocautery and rongeur are used to create a trough on the patella from centromedially to superomedially. Two suture anchors are placed at the proximal and distal trough. Fluoroscopy is utilized to identify Schöttle point with a perfect lateral radiograph. A 3-centimeter incision is made, and blunt dissection connects the 2 incisions in the developed plane. A guidepin is advanced at Schöttle point, and suture anchor sutures are shuttled through the plane, posterior to the guidepin. There should be loosening of tension with knee flexion. A semitendinosus allograft is whipstitched with terminal tapering. The whipstitched end is tunneled around the guidepin and brought back to the patella, so that both ends have an excess of 20 to 25 millimeters, and excess graft is trimmed from the free end prior to whipstitching. The doubled graft is sized. The midportion of the tendon is tagged and passed through both anchors. The graft is tensioned to the patellar trough and the graft ends are advanced through the developed plane. The femoral tunnel is reamed, and the graft is tensioned into the tunnel after nitinol wire placement with the knee in full extension. Isometry and lateral patellar translation are assessed, aiming for 1 quadrant with firm endpoint. The patella is proximalized and the tensioned graft is secured with an interference screw. Results: MPFL reconstruction is successful for the majority of patients, with 1.2% reporting instability, 3.6% apprehension, and 3.1% reoperation. Possible complications include patellar fracture, patellofemoral pain, and knee stiffness (loss of range of motion). Discussion/Conclusion: Lateral patellar instability is common, and MPFL reconstruction is typically successful for the majority of patients

Multiple Ankle Injuries are Associated with an Increased Risk of Subsequent Concussion in National Football League Players

Category: Sports; Ankle Introduction/Purpose: Ankle injuries are among the most common musculoskeletal injuries in National Football League (NFL) players. Concussions are also concerningly frequent, especially given increasing post-mortem observations of chronic traumatic encephalopathy (CTE) in former NFL players. There is a gap in the literature regarding musculoskeletal risk factors for concussion, which is an avenue that must be explored to promote player safety. The purpose of this study is to observe if ankle injuries, especially multiple ankle injuries, are associated with an increased risk of subsequent concussion in NFL players. Methods: The public online database ProFootballReference.com was utilized to identify ankle injuries and concussions in NFL players, as well as demographic variables such as BMI and age. Multivariable logistic regression for subsequent concussion and ankle injury was performed, adjusting for BMI and player position. For descriptive statistics, unpaired T-tests with unequal variance were performed for continuous variables, including BMI and age. Chi-squared testing was performed for categorical variables, including player position, and whether the position was offensive (quarterback, running back, tight end, wide receiver, offensive line), defensive (defensive back, defensive line, linebacker), or on special teams (kicker, punter, long snapper). Results: 5,538 NFL players from the 2009-2010 to 2019-2020 seasons were included in the study. The mean BMI and age of the cohort was 31.06 (SD 4.55) and 24.41 (SD 3.63), respectively. Of these players, 941 had an ankle injury, 633 had a concussion, and 240 had both an ankle injury and a subsequent concussion. The adjusted odds ratio (aOR) for concussion following a single ankle injury was 0.90 (95% CI 0.72 – 1.14, p = 0.387), however, the aOR for concussion following multiple ankle injuries was 2.88 (95% CI 1.28 – 6.74, p = 0.015). The kicker position was determined to have the lowest risk for concussion following ankle injury, and the positions with comparatively greater risk are outlined in Table 1. Conclusion: Multiple ankle injuries were associated with an increased risk of a subsequent concussion by 188% after adjusting for BMI, player position, and offense/defense/special teams designation. Special teams as a group and by position (kicker, long snapper, punter) had the lowest risk of concussion following ankle injury, likely owing to the lower-impact nature of these positions. These findings can inform injury prevention practices in the National Football League

Multiple Ankle Injuries Are Associated With an Increased Risk of Subsequent Concussion in National Football League Players

Background: There is a gap in the literature regarding musculoskeletal risk factors for concussion within the National Football League (NFL), which is an avenue that must be explored to promote player safety given the high incidence of both injury types. This study aims to observe if ankle injuries are associated with an increased risk of subsequent concussion in NFL players. Methods: The public online database ProFootballReference.com was used to identify ankle injuries and concussions in NFL players from the 2009-2010 to 2019-2020 seasons. Multivariable logistic regression for subsequent concussion and ankle injury was performed, adjusting for body mass index (BMI), age, and player position. For descriptive statistics, unpaired t tests with unequal variance were performed for continuous variables, including BMI and age. χ 2 testing was performed for categorical variables, including player position, and whether the position was offensive, defensive, or on special teams. Results: Of the 5538 NFL players included in the study, 941 had an ankle injury, 633 had a concussion, and 240 had both an ankle injury and a subsequent concussion. The adjusted odds ratio (aOR) for concussion following a single ankle injury was 0.90 (95% CI 0.72-1.14, P  = .387); however, the aOR for concussion following multiple ankle injuries was 2.87 (95% CI 1.23-6.75, P  = .015). Special teams players had the lowest risk for concussion (aOR 0.17, 95% CI 0.069-0.36, P  < .001) following ankle injury, and there was no significant difference in risk between offense and defense (aOR 0.91, 95% CI 0.77-1.08, P  = .295). Conclusion: Multiple ankle injuries were associated with an increased risk of a subsequent concussion after adjusting for BMI; player position; and offense, defense, or special teams designation. These findings can inform injury prevention practices in the National Football League. Level of Evidence: Level III, retrospective comparative study