Arthroscopic Repair of Humeral Avulsion of the Glenohumeral Ligament Lesion With Capsular Plication in the Lateral Decubitus Position

Humeral avulsion of the glenohumeral ligament (HAGL) lesions can lead to persistent shoulder instability. While rare, HAGL lesions may present as a concomitant injury following shoulder dislocation events. Traditionally, an open approach has been used to repair the inferior glenohumeral ligament and restore shoulder stability. Modern arthroscopic techniques and instrumentation have permitted a minimally invasive approach for treating HAGL lesions. While technically demanding, arthroscopic repair of HAGL lesions has demonstrated favorable outcomes with less soft-tissue disruption. The following Technical Note describes a safe and effective method for the arthroscopic repair of HAGL lesions. Our technique highlights the use of the lateral decubitus position, a 70° arthroscope, a curved anchor device, and a 90° SutureLasso device

Percutaneous Achilles Tendon Repair Using Ultrasound Guidance: An Intraoperative Ultrasound Technique

Rupture of the Achilles tendon is a common injury seen in patients of varying ages and activity levels. There are many considerations for treatment of these injuries, with both operative and nonoperative management providing satisfactory outcomes in the literature. The decision to proceed with surgical intervention should be individualized for each patient, including the patient\u27s age, future athletic goals, and comorbidities. Recently, a minimally invasive percutaneous approach to repair the Achilles tendon has been proposed as an equivalent alternative to the traditional open repair, while avoiding wound complications associated with larger incisions. However, many surgeons have been hesitant to adopt these approaches due to poor visualization, concern that suture capture in the tendon is not as robust, and the potential for iatrogenic sural nerve injury. The purpose of this Technical Note is to describe a technique using high-resolution ultrasound guidance intraoperatively during minimally invasive repair of the Achilles tendon. This technique minimizes the drawbacks of poor visualization associated with percutaneous repair, while providing the benefit of a minimally invasive approach

Multimodal Nonopioid Pain Protocol Provides Equivalent Pain Versus Opioid Control Following Meniscus Surgery: A Prospective Randomized Controlled Trial

PURPOSE: To assess the effectiveness of a nonopioid pain regimen in controlling postoperative pain as compared with a traditional opioid pain control following primary meniscectomy or meniscal repair. METHODS: Ninety-nine patients undergoing primary meniscectomy or meniscal repair were assessed for participation. A prospective randomized control trial was performed in accordance with the Consolidated Standards of Reporting Trials 2010 statement. The 2 arms of the study included a multimodal nonopioid analgesic protocol and a standard opioid regimen with a primary outcome of postoperative pain level (visual analog scale) for the first 10 days postoperatively. Secondary outcomes included patient-reported outcomes, complications, and patient satisfaction. Randomization was achieved using a random-number generator. Patients were not blinded. Data collection was done by a blinded observer. RESULTS: Eleven patients did not meet the inclusion criteria, and 27 declined participation. A total of 61 patients were analyzed with 30 randomized to the opioid regimen and 31 randomized to the nonopioid regimen. Patients receiving the nonopioid regimen demonstrated noninferior visual analog scale scores compared with patients who received opioid pain medication (P \u3e .05). No significant differences were found in preoperative (opioid: 58.9 ± 7.0; nonopioid: 58.2 ± 5.5, P = .724) or postoperative (opioid: 59.8 ± 6.5; nonopioid: 54.9 ± 7.1, P = .064) Patient-Reported Outcomes Measurement and Information System Pain Interference Short Form scores. No difference was found in recorded side effects between both groups at any given time point: constipation, nausea, diarrhea, upset stomach, and drowsiness (P \u3e .05). CONCLUSIONS: This study found that a multimodal nonopioid pain protocol provided equivalent pain control and patient outcomes following primary meniscus surgery while having an equivalent side effect profile. All patients reported satisfaction with their pain management without requiring emergency opioid analgesia. LEVEL OF EVIDENCE: Level I, prospective randomized controlled trial

Older, Male Orthopaedic Surgeons From Southern Geographies Prescribe Higher Doses of Post-Operative Narcotics Than do their Counterparts: A Medicare Population Study

Purpose: We wanted to evaluate opioid prescribing patterns among orthopaedic surgeons and to identify demographics that may be associated with more extensive opioid prescribing habits that could be candidates for targeted education policies. Methods: Medicare Part D prescriber and prescription information for the most recent available year, 2017, was accessed via a publicly available database offered by the Centers for Medicare and Medicaid. Number of total prescriptions, number of opioid prescriptions, and the total days\u27 supply of opioids prescribed were analyzed for each of 19,219 orthopaedic surgeons. Demographics and board certification status were also recorded. Results: Orthopaedic surgeons who wrote the most opioid prescriptions (\u3e400 per year) also wrote the longest prescription durations (14.1 days/prescription, P \u3c .05 for all comparisons). Surgeons with more than 30 years of experience wrote the longest prescriptions (11.8 days/prescription; P \u3c .001). Male surgeons wrote more opioid prescriptions than female surgeons (151 vs 95, respectively; P \u3c .001). However, female surgeons wrote longer prescriptions than male surgeons (7.5 days/prescription vs 6.1 days/prescription, respectively; P = .01). Surgeons from southern states wrote the most opioid prescriptions (1,386,897) and the longest prescriptions, with an average of 13.0 days per prescription, whereas western states wrote the shortest prescriptions at 10.4 days per prescription (P = .004). Conclusion: There are demographic correlations between orthopaedic surgeons and opioid prescribing patterns. In particular, male, older southern surgeons prescribe the highest volumes of opioids. This provides an opportunity for targeted education versus overarching, general policies. Potential directions for future investigation can focus on assessing recent trends in opioid prescriptions among orthopaedic providers. Level of Evidence: Level III, retrospective cohort study

Effects of Multi-ingredient Pre-workout Supplements on Repetitions-in-Reserve and Subjective Measures of Energy, Fatigue, and Focus during Lower-Body Resistance Exercise

Approximately 50% of the U.S. population regularly consumes dietary supplements to enhance their health and well-being. One popular category of dietary supplements is called “pre-workout” supplements, which claims to increase subjective feelings of energy and exercise performance. PURPOSE: The purpose of the study was to examine whether two commercially available pre-workout supplements could beneficially modify resistance exercise-specific perceived exertion and subjective measures of energy, focus, and fatigue during an acute bout of lower-body resistance exercise. METHODS: This was a counterbalanced, double blind, placebo-controlled trial. Resistance-trained (i.e. 2+ hours per week of weight training over the past 6 months) females and males who regularly consumed caffeine (100+ mg/d) were recruited for participation. Each subject completed 3 sessions in a counterbalanced order: placebo (P), non-caffeinated pre-workout (NC; Carbon Prep), and caffeinated pre-workout (C; Jym Supplement Science Pre-Jym). At each session, identical testing was conducted using an isokinetic squat machine. One initial maximum test of 3 repetitions was completed, followed by 5 sets of 6 repetitions using 80% of the maximal force measured during the initial set of 3 repetitions. Within a 2-minute rest between each set, subjective measurements of difficulty were obtained (i.e. estimated repetitions in reserve [RIR] and 10-cm visual analog scales [VAS] for energy, focus, and fatigue). RIR ratings were converted to resistance exercise-specific ratings of perceived exertion (RPE). VAS data was analyzed using two-way repeated measures ANOVA and RIR/RPE data was analyzed for males and females separately using two-way repeated measures ANOVA. RESULTS: Twenty-one participants completed the study (12 F, 9 M). Subjective measures of energy were acutely increased by ingestion of each supplement, including placebo, but decreased as the workout progressed (time main effect; p \u3c .001). Fatigue progressively increased throughout the exercise session (time main effect; p \u3c .001). Fatigue was higher during the NC condition than the C and P conditions (supplement main effect; p = .019). A significant supplement*time interaction was present for RPE in females, but not in males. In females, the caffeinated and non-caffeinated pre-workout supplements delayed the increase in RPE as compared to placebo. CONCLUSION: The studied commercially available pre-workout supplements may beneficially delay the increase in RPE observed during acute lower-body resistance exercise in trained females. However, the results of subjective measurements should be interpreted in the context of the corresponding exercise performance

Effects of Pre-Workout Supplements on Maximal Concentric and Eccentric Force Production During Lower Body Resistance Exercise

Due to claims of increased sport performance and decreased fatigue, “pre-workouts” are some of the most popular dietary supplements being sold today. PURPOSE: The purpose of this study was to determine if two commercially available pre-workout supplements are effective at increasing peak concentric and eccentric force production during lower-body resistance exercise on a mechanized squat device. METHODS: Three conditions were implemented: caffeinated pre-workout (C; Pre-Jym), non-caffeinated pre-workout (NC; Carbon Prep), and placebo (P). Participants served as their own control in a counterbalanced fashion, and the study was double blind (i.e. the participants and researchers were blind to the supplement being taken). Thirty minutes after supplement ingestion, each participant completed one 3-repetition maximal effort test (first repetition at 50% maximal effort, and the last two repetitions at maximal voluntary effort), along with five sets of six repetitions on an isokinetic squat machine (Exerbotics eSq, Tulsa, OK) with attached force analysis system. The maximal concentric forces produced during the second and third repetitions were averaged and one-way repeated measures ANOVA was performed to compare the three supplement conditions. Identical procedures were followed to analyze the peak eccentric forces. RESULTS: Twenty-one participants completed the study (12 F, 9 M). There were no statistically significant effects of supplementation on concentric and eccentric force production during the maximal force production test (p= .323 and p= .631). However, maximal concentric force production was 4.4% and 7.9% higher than placebo in the NC and C conditions, respectively. Additionally, maximal eccentric force production was 3.8% and 4.0% higher in the NC and C conditions. Corresponding Cohen’s d effect sizes for force production, representing the effect of the supplement as compared to placebo, ranged from d= .13 to d= .28.CONCLUSIONS: There were not any deleterious effects of the pre-workout supplements used in this study on peak power output on a mechanized squat machine. Although it cannot be definitively concluded that the pre-workout supplements utilized in this study have a positive effect on improving peak power output (eccentric and concentric) during lower-body resistance training, average force production during the supplementation conditions was 4 to 8% higher than placebo. The largest effect was seen with the caffeinated supplement during concentric muscle action. Additional research is needed to determine the potential of commercially available pre-workouts to increase exercise performance

The Effect of the Crow Hop on Elbow Stress During an Interval Throwing Program

BACKGROUND: Postoperative rehabilitation protocols after ulnar collateral ligament (UCL) reconstruction typically involve a structured interval throwing program. In an effort to minimize torque placed on the UCL, athletes are often instructed to throw with a crow hop, even at short throwing distances. However, the effect of the crow hop on medial elbow stress is unknown. PURPOSE/HYPOTHESIS: The purpose was to determine whether elbow stress differs with and without a crow hop across the throwing distances of a typical interval throwing program. We hypothesized that crow hop throws would generate lower torque on the elbow than standing throws at each distance of the interval throwing program. STUDY DESIGN: Controlled laboratory study. METHODS: Healthy high school and collegiate pitchers and position players were recruited from the surrounding area. Each player was outfitted with a wearable athletic sleeve and device that recorded elbow torque (Newton-meters), arm slot (degrees), arm speed (revolutions per minute), and shoulder rotation (degrees). Ball velocity (miles per hour) was measured using a radar gun. Players were instructed to perform 3 crow hop throws and 3 standing throws at distances of 30, 45, 60, 90, 120, 150, and 180 feet. A repeated measures analysis of variance was used to compare ball velocity, elbow torque, arm slot, arm speed, and shoulder rotation between crow hop and standing throws at each throwing distance. RESULTS: Twenty athletes participated in this study (average age, 17.8 years; range, 15-25 years). The average medial elbow torque increased at each distance for both crow hop and standing throws at distances of 30, 45, 60, and 90 feet (P \u3c .05), after which there were no significant increases in elbow torque (P \u3e .05). The average torque was higher for crow hop throws than standing throws at distances of 30 feet (13.9 N·m vs 12.0 N·m; P = .002), 45 feet (21.8 N·m vs 19.3 N·m; P = .005), and 60 feet (28.0 N·m vs 24.5 N·m; P = .02). CONCLUSION: Crow hop throws generated greater medial elbow torque than standing throws at distances up to 60 feet; however, there were no differences in elbow torque at distances greater than 60 feet between the 2 throw types. For both crow hop and standing throws, elbow stress increased at each distance interval up to 90 feet before plateauing at distances greater than 90 feet. The crow hop throwing technique does not reduce medial elbow stress during a simulated interval throwing program, and it may actually increase torque at shorter throwing distances. CLINICAL RELEVANCE: The results of our study indicate that it would be prudent for players to initially perform standing throws at shorter distances and only later be allowed to employ a natural crow hop at greater distances to minimize torque placed on the medial elbow during UCL rehabilitation protocols

High-Precision Measurement of the 19Ne Half-Life and Implications for Right-Handed Weak Currents

We report a precise determination of the 19Ne half-life to be $T_{1/2} = 17.262 \pm 0.007$ s. This result disagrees with the most recent precision measurements and is important for placing bounds on predicted right-handed interactions that are absent in the current Standard Model. We are able to identify and disentangle two competing systematic effects that influence the accuracy of such measurements. Our findings prompt a reassessment of results from previous high-precision lifetime measurements that used similar equipment and methods.Comment: 5 pages and 5 figures. Paper accepted for publication in Phys. Rev. Let

Athletes Perceive Weighted Baseballs to Carry a Notable Injury Risk, yet Still Use Them Frequently: A Multicenter Survey Study

INTRODUCTION: Weighted baseball use in throwing programs is widespread; however, their use remains controversial. Prior research shows that weighted baseball programs can increase ball velocity but potentially increase throwing arm injuries. This study aims to ascertain perceptions of weighted baseballs among elite baseball players. METHODS: A created online survey questioned common practices, throwing regimens, injury risk factors, and weighted baseball program use. The questions were modeled to ascertain the perceptions of elite baseball players to understand their experience with weighted baseballs. Descriptive statistical analysis was conducted. RESULTS: Three hundred seventy-six baseball players with a mean age of 20 ± 2 years completed the survey; 64% of the players (239/376) were pitchers. 71% (267/376) reported the use of weighted baseballs. Of those, 75% (199/267) thought it made them a better player. Overall, 73% (275/377) thought weighted baseballs are a risk for injury. 17% (46/267) attributed their injury to using weighted baseballs. Overall, participants reported a mean 72% ± 30% likelihood of future weighted baseball use. CONCLUSION: Most of the participating elite adult baseball players reported prior weighted baseball use with a corresponding improvement in pitching performance despite a perceived increased injury risk. Nearly 20% of the players attributed pain or injury to weighted baseball use. Moreover, the players surveyed intend to continue using weighted baseballs because of the perceived performance benefit