Return to Play Criteria Following Operative Management of Acromioclavicular Joint Separation: A Systematic Review

Introduction: Acromioclavicular (AC) joint separation is a leading cause of shoulder injury among athletes. High grade injuries may require operative fixation, and comprehensive return to play guidelines have not yet been established. The purpose of this investigation is to summarize return to play criteria following operative management of AC joint separation. Methods: A systematic review of the literature was performed to evaluate clinical evidence regarding return to play following operative management of isolated AC joint separation. Studies satisfying inclusion criteria were analyzed for return to play timeline and other factors used to guide return to play following surgery. Results: Sixty-three studies with at least 1 explicitly stated return to play criterion were identified out of an initial database search of 1,253 published articles. Eight separate categories of return to play criteria were identified, the most common of which was time from surgery (95.2%). Return to play timelines ranged from 2 – 12 months, the most common timeline being 6 months (37.8%). Only 4 (6.3%) studies utilized conditional criteria to guide return to play, among which included range of motion, strength, clinical stability, radiographic stability, functional assessment, safety assessment, and hardware removal. Discussion: Most published studies utilize only time-based return to play criteria, and only a small number of studies employ patient-centered conditional criteria. While this systematic review helps provide a foundation for developing a comprehensive return to play checklist, further investigation is needed to establish safe and effective guidelines that will enable athletes to safely return to sport and minimize the recurrence of injury

Radiologic Measurements in the Assessment of Patellar Instability: A Systematic Review and Meta-analysis.

Background: Numerous diagnostic imaging measurements related to patellar instability have been evaluated in the literature; however, little has been done to compare these findings across multiple studies. Purpose: To review the different imaging measurements used to evaluate patellar instability and to assess the prevalence of each measure and its utility in predicting instability. We focused on reliability across imaging modalities and between patients with and without patellar instability. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a systematic review of the literature using the PubMed, SCOPUS, and Cochrane databases. Each database was searched for variations of the terms patellar instability, patellar dislocation, trochlear dysplasia, radiographic measures, computed tomography, and magnetic resonance imaging. Studies were included if they were published after May 1, 2009, and before May 1, 2019. A meta-analysis using a random effects model was performed on several measurements, comparing instability and control groups to generate pooled values. Results: A total of 813 articles were identified, and 96 articles comprising 7912 patients and 106 unique metrics were included in the analysis. The mean patient age was 23.1 years (95% CI, 21.1-24.5), and 41% were male. The tibial tubercle–trochlear groove (TT-TG) distance was the most frequently included metric (59 studies), followed by the Insall-Salvati ratio and Caton-Deschamps index (both 26 studies). The interobserver intraclass correlation coefficients were excellent or good for the TT-TG distance and Insall-Salvati ratio in 100% of studies reporting them; however, for the Caton-Deschamps index and Blackburne-Peel ratio, they were excellent or good in only 43% and 40% of studies. Pooled magnetic resonance imaging values for TT-TG distance (P \u3c .01), Insall-Salvati ratio (P = .01), and femoral sulcus angle (P = .02) were significantly different between the instability and control groups. Values for tibial tubercle–posterior cruciate ligament distance (P = .36) and Caton-Deschamps index (P = .09) were not significantly different between groups. Conclusion: The most commonly reported measurements for evaluating patellar instability assessed patellar tracking and trochlear morphology. The TT-TG distance was the most common measurement and was greater in the patellar instability group as compared with the control group. In addition, the TT-TG, tibial tubercle-posterior cruciate ligament, and patellar tendon-trochlear groove distances were highly reproducible measurements for patellar tracking, and the Insall-Salvati ratio had superior reproducibility for assessing patellar height