Effect of Achilles Tendon Rupture on Player Performance and Longevity in Women\u27s National Basketball Association Players

Background: Women\u27s National Basketball Association (WNBA) players have a greater incidence of lower extremity injury compared with male players, yet no data exist on functional outcomes after Achilles tendon rupture (ATR). Purpose: To evaluate the effect of Achilles tendon repair on game utilization, player performance, and career longevity in WNBA athletes. Study Design: Cohort study; Level of evidence, 3. Methods: WNBA players from 1997 to 2019 with a history of ATR (n = 12) were matched 1:2 to a healthy control group. Player characteristics, game utilization, and in-game performance data were collected for each athlete, from which the player efficiency rating (PER) was calculated. Statistical analysis was performed comparing postinjury data to preinjury baseline as well as cumulative career data. Changes at each time point relative to the preinjury baseline were also compared between groups. Results: Of the 12 players with ATR, 10 (83.3%) returned to play at the WNBA level at a mean (+/- SD) of 12.5 +/- 3.3 months. Four players participated in only 1 WNBA season after injury. There were no differences in characteristics between the 10 players who returned to play after injury and the control group. After return to play, the WNBA players demonstrated a significant decrease in game utilization compared with preinjury, playing in 6.0 +/- 6.9 fewer games, starting in 12.7 +/- 15.4 fewer games, and playing 10.2 +/- 9.1 fewer minutes per game (P \u3c .05 for all). After the index date of injury, the players with Achilles repair played 2.1 +/- 1.2 more years in the WNBA, while control players played 5.35 +/- 3.2 years (P \u3c .01) Additionally, the players with Achilles repair had a significant decrease in PER in the year after injury compared with preinjury (7.1 +/- 5.3 vs 11.0 +/- 4.4; P = .02). The reduction in game utilization and decrease in PER in these players was maintained when compared with the matched controls (P \u3c .05 for both). Conclusion: The majority of WNBA players who sustained ATR were able to return to sport after their injury; however, their career longevity was shorter than that of healthy controls. There was a significant decrease in game utilization and performance in the year after return to play compared with healthy controls

Pain Assessment After Anterior Cruciate Ligament Reconstruction: Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autograft.

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction is a common outpatient procedure that is accompanied by significant postoperative pain. PURPOSE: To determine differences in acute pain levels between patients undergoing ACL reconstruction with bone-patellar tendon-bone (BTB) versus hamstring tendon (HS) autograft. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 70 patients who underwent primary ACL reconstruction using either BTB or HS autografts consented to participate. The primary outcome of the study was postoperative pain levels (visual analog scale), which were collected immediately after surgery and for 3 days postoperatively. Secondary outcome measures included opioid consumption (intravenous morphine equivalents), hours slept, patient satisfaction, reported breakthrough pain, and calls to the physician. RESULTS: Patients treated with BTB had increased pain when compared with those treated with HS in the acute postoperative period (mean ± SD: day 0, 6.0 ± 1.7 vs 5.2 ± 2.0 [P = .066]; day 1, 5.9 ± 1.7 vs 4.9 ±1.7 [P = .024]; day 2, 5.2 ± 1.9 vs 4.1 ± 2.0 [P = .032]; day 3, 4.8 ± 2.1 vs 3.9 ± 2.3 [P = .151]). There were also significant increases in reported breakthrough pain (day 0, 76% vs 43% [P = .009]; day 1, 64% vs 35% [P = .003]) and calls to the physician due to pain (day 1, 19% vs 0% [P = .041]) in the BTB group. There were no significant differences in narcotic requirements or sleep disturbances. Overall, the BTB group reported significantly less satisfaction with pain management on days 0 and 1 (P = .024 and .027, respectively). CONCLUSION: A significant increase in acute postoperative pain was found when performing ACL reconstruction with BTB compared with HS. Patients treated with BTB were more likely to have breakthrough pain, decreased satisfaction with their pain management, and to contact their physician due to pain. These findings suggest a difference in early postoperative pain between the 2 most common graft options for ACL reconstruction. Patients should be informed of the differences in acute postoperative pain when deciding on graft choice with their physician

Acute patellar tendon ruptures: The diagnostic utility of sonography for tear detection and characterization in the emergent setting.

Purpose To determine the accuracy of ultrasound for diagnosing and characterizing acute patellar tendon ruptures, as well as to investigate secondary sonographic signs that may aide in identifying tear location, using surgical findings as the reference standard. Methods The sonographic findings of 46 consecutive knee ultrasounds obtained for clinically-suspected extensor mechanism injury (23 cases reporting a torn patellar tendon and 23 cases reporting an intact patellar tendon) were compared with intra-operative findings in those patients who underwent patellar tendon surgery. Twomusculoskeletal radiologists blindly and retrospectively reviewed all 46 cases to indicate the presence or absence of a patellar tendon tear, to identify suspected tear location, and to comment on refraction artifact and peritendinous fluid, which were also correlated with intraoperative findings. Results The sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for diagnosing patellar tendon rupture were 100%. Further, ultrasound correctly identified tear location in 94% of surgically-proven cases. The presence of refraction artifact (P \u3c 0.05) and increasing amount of peritendinous fluid (P \u3c 0.05) were associated with higher likelihood of tear. Relying solely on refraction artifact to identify tear location proved less accurate (P \u3c 0.05, P = 0.08) than using all sonographic signs available. There was no difference in tear location accuracy with varying amount of peritendinous fluid (P \u3e 0.24) or conspicuity of refraction artifact (P = 1.0). Conclusions Ultrasound is highly accurate for diagnosing and characterizing acute patellar tendon ruptures. Because acute repair is preferred in order to avoid long-term morbidity, and missed clinical diagnosis reportedly ranges from 10-50%, we advocate for an increasing role of ultrasound in the emergency setting to rapidly and effectively evaluate the integrity of the patellar tendon

Acute patellar tendon ruptures: The diagnostic utility of sonography for tear detection and characterization in the emergent setting

Purpose To determine the accuracy of ultrasound for diagnosing and characterizing acute patellar tendon ruptures, as well as to investigate secondary sonographic signs that may aide in identifying tear location, using surgical findings as the reference standard. Methods The sonographic findings of 46 consecutive knee ultrasounds obtained for clinically-suspected extensor mechanism injury (23 cases reporting a torn patellar tendon and 23 cases reporting an intact patellar tendon) were compared with intra-operative findings in those patients who underwent patellar tendon surgery. Twomusculoskeletal radiologists blindly and retrospectively reviewed all 46 cases to indicate the presence or absence of a patellar tendon tear, to identify suspected tear location, and to comment on refraction artifact and peritendinous fluid, which were also correlated with intraoperative findings. Results The sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for diagnosing patellar tendon rupture were 100%. Further, ultrasound correctly identified tear location in 94% of surgically-proven cases. The presence of refraction artifact (P \u3c 0.05) and increasing amount of peritendinous fluid (P \u3c 0.05) were associated with higher likelihood of tear. Relying solely on refraction artifact to identify tear location proved less accurate (P \u3c 0.05, P = 0.08) than using all sonographic signs available. There was no difference in tear location accuracy with varying amount of peritendinous fluid (P \u3e 0.24) or conspicuity of refraction artifact (P = 1.0). Conclusions Ultrasound is highly accurate for diagnosing and characterizing acute patellar tendon ruptures. Because acute repair is preferred in order to avoid long-term morbidity, and missed clinical diagnosis reportedly ranges from 10-50%, we advocate for an increasing role of ultrasound in the emergency setting to rapidly and effectively evaluate the integrity of the patellar tendo

Inguinal Hernia in Athletes: Role of Dynamic Ultrasound

BACKGROUND: Inguinal hernia is a commonly encountered cause of pain in athletes. Because of the anatomic complexity, lack of standard imaging, and the dynamic condition, there is no unified opinion explaining its underlying pathology. HYPOTHESIS: Athletes with persistent groin pain would have a high prevalence of inguinal hernia with dynamic ultrasound, and herniorrhaphy would successfully return athletes to activity. STUDY DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 3. METHODS: Forty-seven amateur and professional athletes with sports-related groin pain who underwent ultrasound were selected based on history and examination. Patients with prior groin surgery or hip pathology were excluded. Clinical and surgical documentation were correlated with imaging. The study group was compared with 41 age-matched asymptomatic athletes. RESULTS: Ultrasound was positive for hernia with movement of bowel, bladder, or omental tissue anterior to the inferior epigastric vessels during Valsalva maneuver. The 47-patient symptomatic study group included 41 patients with direct inguinal hernias, 1 with indirect inguinal hernia, and 5 with negative ultrasound. Of 42 patients with hernia, 39 significantly improved with herniorrhaphy, 2 failed to improve after surgery and were diagnosed with adductor longus tears, and 1 improved with physical therapy. Five patients with negative ultrasound underwent magnetic resonance imaging and were diagnosed with hip labral tear or osteitis pubis. The 41-patient asymptomatic control group included 3 patients with direct inguinal hernias, 2 with indirect inguinal hernias, and 3 with femoral hernias. CONCLUSION: Inguinal hernias are a major component of groin pain in athletes. Prevalence of direct inguinal hernia in symptomatic athletes was greater than that for controls ( P \u3c 0.001). Surgery was successful in returning these athletes to sport: 39 of 42 (93%) athletes with groin pain and inguinal hernia became asymptomatic. CLINICAL RELEVANCE: Persistent groin pain in the athlete may relate to inguinal hernia, which can be diagnosed with dynamic ultrasound imaging. Herniorrhaphy is successful at returning athletes to sports activity

Diagnostic Accuracy of Ultrasound for Rotator Cuff Tears

Ultrasonography (US) is an inexpensive, convenient, and effective tool that can be used to evaluate the shoulder. It does not expose the patient to harmful radiation and can be used to evaluate the musculoskeletal system dynamically. Additionally, US is not subject to metal artifacts when evaluating patients with previously placed hardware. Over the years, US has been found to be reliable and accurate for diagnosing rotator cuff tears (RCTs), despite its operatordependence. The usage of US for diagnosing RCTs in orthopedic practice varies depending on practitioners\u27 familiarity with the exam and the availability of experienced technicians. The purpose of this article is to review the diagnostic accuracy of US for identifying RCTs

Inguinal Hernia in Athletes: Role of Dynamic Ultrasound

BACKGROUND: Inguinal hernia is a commonly encountered cause of pain in athletes. Because of the anatomic complexity, lack of standard imaging, and the dynamic condition, there is no unified opinion explaining its underlying pathology. HYPOTHESIS: Athletes with persistent groin pain would have a high prevalence of inguinal hernia with dynamic ultrasound, and herniorrhaphy would successfully return athletes to activity. STUDY DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 3. METHODS: Forty-seven amateur and professional athletes with sports-related groin pain who underwent ultrasound were selected based on history and examination. Patients with prior groin surgery or hip pathology were excluded. Clinical and surgical documentation were correlated with imaging. The study group was compared with 41 age-matched asymptomatic athletes. RESULTS: Ultrasound was positive for hernia with movement of bowel, bladder, or omental tissue anterior to the inferior epigastric vessels during Valsalva maneuver. The 47-patient symptomatic study group included 41 patients with direct inguinal hernias, 1 with indirect inguinal hernia, and 5 with negative ultrasound. Of 42 patients with hernia, 39 significantly improved with herniorrhaphy, 2 failed to improve after surgery and were diagnosed with adductor longus tears, and 1 improved with physical therapy. Five patients with negative ultrasound underwent magnetic resonance imaging and were diagnosed with hip labral tear or osteitis pubis. The 41-patient asymptomatic control group included 3 patients with direct inguinal hernias, 2 with indirect inguinal hernias, and 3 with femoral hernias. CONCLUSION: Inguinal hernias are a major component of groin pain in athletes. Prevalence of direct inguinal hernia in symptomatic athletes was greater than that for controls ( P \u3c 0.001). Surgery was successful in returning these athletes to sport: 39 of 42 (93%) athletes with groin pain and inguinal hernia became asymptomatic. CLINICAL RELEVANCE: Persistent groin pain in the athlete may relate to inguinal hernia, which can be diagnosed with dynamic ultrasound imaging. Herniorrhaphy is successful at returning athletes to sports activity

Inguinal Hernia in Athletes: Role of Dynamic Ultrasound.

BACKGROUND: Inguinal hernia is a commonly encountered cause of pain in athletes. Because of the anatomic complexity, lack of standard imaging, and the dynamic condition, there is no unified opinion explaining its underlying pathology. HYPOTHESIS: Athletes with persistent groin pain would have a high prevalence of inguinal hernia with dynamic ultrasound, and herniorrhaphy would successfully return athletes to activity. STUDY DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 3. METHODS: Forty-seven amateur and professional athletes with sports-related groin pain who underwent ultrasound were selected based on history and examination. Patients with prior groin surgery or hip pathology were excluded. Clinical and surgical documentation were correlated with imaging. The study group was compared with 41 age-matched asymptomatic athletes. RESULTS: Ultrasound was positive for hernia with movement of bowel, bladder, or omental tissue anterior to the inferior epigastric vessels during Valsalva maneuver. The 47-patient symptomatic study group included 41 patients with direct inguinal hernias, 1 with indirect inguinal hernia, and 5 with negative ultrasound. Of 42 patients with hernia, 39 significantly improved with herniorrhaphy, 2 failed to improve after surgery and were diagnosed with adductor longus tears, and 1 improved with physical therapy. Five patients with negative ultrasound underwent magnetic resonance imaging and were diagnosed with hip labral tear or osteitis pubis. The 41-patient asymptomatic control group included 3 patients with direct inguinal hernias, 2 with indirect inguinal hernias, and 3 with femoral hernias. CONCLUSION: Inguinal hernias are a major component of groin pain in athletes. Prevalence of direct inguinal hernia in symptomatic athletes was greater than that for controls ( P \u3c 0.001). Surgery was successful in returning these athletes to sport: 39 of 42 (93%) athletes with groin pain and inguinal hernia became asymptomatic. CLINICAL RELEVANCE: Persistent groin pain in the athlete may relate to inguinal hernia, which can be diagnosed with dynamic ultrasound imaging. Herniorrhaphy is successful at returning athletes to sports activity