Background: Prior biomechanical analyses have grouped minor and major league professional pitchers as a single entity even though there are many levels within the professional group (ie, rookie (ROK), low A (A–), high A (A+), AA, AAA). To date, no study has compared pitching kinematics between pitchers of varying playing levels within the professional cohort. Purpose: To compare anthropometrics, kinematics, kinetics, and prior injury history among pitchers within varying levels of Minor League Baseball (MiLB). Study Design: Controlled laboratory study. Methods: A total of 137 professional MiLB pitchers were instructed to throw 8 to 12 fastball pitches and were evaluated with 3-dimensional motion capture (480 Hz). Pitchers were grouped into competition levels within the MiLB (ROK, A–, A+, AA, and AAA). One-way analysis of variance (ANOVA) was used to compare anthropometrics, kinematics, throwing arm kinetics, and ball velocity among groups. Multivariate logistic regression models examined the association of playing level and age (independent variables) with incidence of prior injury (dependent variables). Results: MiLB pitchers were distributed as follows: ROK (n = 15), A– (n = 47), A+ (n = 33), AA (n = 31), AAA (n = 11). MiLB pitchers at higher levels were older in age (ANOVA P < .001), demonstrated increased arm slot (A vs AA: 53°± 9° vs 60°± 15°; P = .02) and delayed timing of maximal shoulder internal rotational velocity (AAA vs ROK: 101 ± 6 vs 90 ± 2; A– vs A+ vs AA: 99% ± 2% vs 99% ± 1% vs 99% ± 2% pitch time; P = .04), while also demonstrating significantly diminished throwing arm kinetics including shoulder superior force (percentage body weight [%BW]: 22.0% ± 8.4% vs 12.9% ± 4.8%; P = .04) and shoulder internal rotational torque (%BW × body height: 5.6 ± 0.9 vs 4.7 ± 0.7; P = .03), with similar ball velocity. Though being younger, lower competition level –A was associated with having incurred a prior upper extremity injury (coefficient, 0.308; β, 0.297; P = .03). Conclusion: MiLB pitchers in lower levels of play appear to demonstrate kinematic differences of the shoulder and trunk as well as increased throwing arm kinetics. In addition, playing level A- was predictive of prior upper extremity injury. The implications of this are unclear, but may suggest lower-level pitchers are at a higher risk for throwing arm injury among MiLB pitchers. Clinical Relevance: Playing level A– was predictive of prior upper extremity injury. The implications of this are unclear but may suggest lower level pitchers are at a higher risk for throwing arm injury among MiLB pitchers.
Background: Partial anterior cruciate ligament (ACL) tears are increasingly recognized, but management is complex. A prior survey of international expert surgeons from the ACL Study Group (ACLSG) found most favored nonoperative management of a case of a partial ACL injury with return to sport after 3 months and passing functional assessment. Purpose: To present the results of a follow-up survey of the ACLSG regarding their treatment of partial ACL injury with more pronounced clinical and imaging findings. Study Design: Cross-sectional study. Methods: A case of a 17-year-old male with a partial ACL injury was presented to the ACLSG members via electronic survey. Questions addressed nonoperative and operative management of the injury, as well as weightbearing restrictions, bracing, and return to sport. Demographic data were also collected. Responses were compared between demographic groups. Statistical significance was defined as P < .05. Results: Of the 132 total active and associate surgeons in the ACLSG, 123 (91%) completed the survey. Of these, 91 (74%) selected nonoperative management for the partial ACL injury. Of the nonoperative group, 21 (23%) recommended limiting weightbearing, and 50 (55%) would utilize a brace. Bracing was more common among North American surgeons ( P = .05). Only 8 among the nonoperative group selected the use of biologics (9%). For those who chose nonoperative management, return-to-sport decisions were primarily based on functional and performance testing (67%; 83/123) with international surgeons more likely to rely on imaging ( P = .04). Among the entire set of respondents, episodes of knee giving way (92%; 113/123) were the leading factor for transitioning to surgery. Conclusion: This study presents the results of a survey of international experts regarding their preferred management of a case of partial ACL injury. Most respondents selected nonoperative management for this partial ACL injury. Further, weightbearing restrictions and bracing were more commonly selected for the scenario presented than the prior survey of an athlete with a normal physical examination and subtle magnetic resonance imaging findings. Thus, while severity of partial ACL injuries is on a spectrum, nonoperative treatment remains the most frequent choice for management. Weightbearing restrictions, bracing, and return-to-sport criteria should be personalized to each patient and his or her injury.
Background: Long head of the biceps tendon pathology frequently accompanies rotator cuff tears, and tenotomy and tenodesis are commonly performed during arthroscopic rotator cuff repair (RCR). Although previous studies have reported no consistent evidence of superiority regarding patient-reported outcomes between these procedures, limited evidence exists regarding their effects on objective shoulder muscle strength and proprioception. Purpose/Hypothesis: The purpose of this study was to compare the effects of biceps tenotomy and tenodesis performed concomitantly with arthroscopic RCR on isokinetic shoulder muscle strength and proprioception. The authors hypothesized that the 2 techniques would result in differences in postoperative muscle strength and proprioceptive function. Study Design: Cohort study; Level of evidence, 3. Methods: Surgical and baseline data for patients who underwent arthroscopic RCR with concomitant biceps tenotomy or tenodesis between February 2019 and May 2023 were retrospectively obtained from institutional records. Muscle strength and proprioception were evaluated using an isokinetic dynamometer. Strength and endurance in internal/external rotation and abduction/adduction were recorded as peak torque and total work. Joint position sense was assessed under eyes-closed conditions using the mean absolute repositioning error at 15° of internal rotation, 75° of external rotation, and 25° and 75° of abduction. Operated and contralateral asymptomatic shoulders were tested. Clinical outcomes were evaluated by American Shoulder and Elbow Surgeons and Constant scores. All inferential analyses were considered exploratory. Results: This study included 84 patients (50 tenotomy and 34 tenodesis; mean ± SD age, 62.8 ± 9.0 years). No between-group comparison of clinical scores, endurance, peak torque, or proprioception remained statistically significant after Holm correction. At 75° of external rotation, the operated-shoulder repositioning error was lower in the tenodesis group than in the tenotomy group in the unadjusted analysis (1.00°± 0.89° vs 3.48°± 2.55°; mean difference, −2.48° [95% CI, −3.26° to −1.70°]; Hedges g = −1.20; unadjusted P = .017), but this finding did not remain statistically significant after Holm correction (adjusted P = .136). Conclusion: After correction for multiple comparisons, no statistically significant between-group differences were detected in clinical outcomes, endurance, peak torque, or proprioception. The isolated unadjusted finding at 75° of external rotation should be regarded as exploratory and hypothesis generating.
Background: Labral yellow fatty-like degeneration, marked by yellow changes and tissue hypertrophy, has been observed during hip arthroscopy. While labral pathologies are well known, this specific yellow fatty-like degeneration with myxoid and lipid changes has not been histopathologically characterized, requiring further investigation into its histopathological features and surgical outcomes. Purpose: To investigate the pathological features and clinical diagnosis of acetabular labral yellow fatty-like degeneration through retrospective clinical analysis and histopathological examination and to evaluate its short-term results of arthroscopic surgical treatment. Study Design: Cohort study; Level of evidence, 3. Methods: This cohort study included patients with femoroacetabular impingement (FAI) with yellow fatty-like labral changes from 3 centers (January 2021-June 2024). All underwent arthroscopy (labral repair or partial resection). Histopathological analysis was performed and included hematoxylin and eosin, alcian blue and periodic acid–Schiff, and oil red O. Clinical outcomes were compared between debridement and suture repair groups at 24 months. Statistical analysis was done using SPSS. Results: Of 999 eligible patients, 37 with acetabular labral yellow fatty-like changes were included. The cohort included 21 females and 16 males. When compared with patients with conventional femoroacetabular impingement (n = 962), this group (n = 37) was significantly older (mean ± SD, 54.37 ± 13.50 vs 36.83 ± 13.38 years; P < .001) and had a higher proportion of females (56.8% [21/37] vs 34.6% [336/962]; P = .007), but no significant differences were observed in bony morphological parameters, including center-edge angle, alpha angle, or body mass index ( P > .05). Histopathological analysis revealed the following: grossly, degenerated labral tissue with a yellow resilient texture; microscopically, chondrocyte necrosis, disordered collagen fiber arrangement, abnormal accumulation of mucopolysaccharides, and fatty infiltration. No inflammatory cell infiltration was observed. Based on these findings, this degeneration was defined as labral myxoid degeneration. Significant clinical improvements were observed in the debridement group (n = 20) and suture repair group (n = 17) (visual analog scale, 6.33 ± 1.17 → 1.60 ± 1.55 vs 5.83 ± 1.11 → 1.42 ± 1.31; modified Harris Hip Score, 41.20 ± 13.50 → 78.33 ± 14.50 vs 47.33 ± 16.58 → 83.33 ± 9.21), with the suture repair group showing slightly greater improvements ( P < .001). Conclusion: Labral myxoid degeneration is a noninflammatory condition characterized by mucoid-lipid degeneration, often associated with mechanical loading and microtrauma. Arthroscopic treatment offers significant improvement in clinical results and comparable short-term improvements in symptoms and function.
Background: Patellofemoral instability (PFI) is a common condition in the pediatric population, requiring accurate assessment of patellofemoral joint morphology. While magnetic resonance imaging (MRI) offers detailed visualization of osseous, chondral, and soft tissue structures, Merchant view radiographs (M-XR) are widely used given their accessibility and cost-effectiveness and for detection of small patellar or condylar fragments that are not well-depicted on MRI. Agreement of key patellofemoral parameters between the 2 imaging modalities remains unclear. Purpose: To assess the agreement between sulcus angle, lateral patellofemoral angle (LPFA), and patellar tilt in pediatric patients with PFI, both before and after medial patellofemoral ligament (MPFL) reconstruction, on MRI and M-XR. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A retrospective cohort study was conducted on 84 pediatric patients ≤18 years who underwent MPFL reconstruction. Of these, 74 patients had preoperative MRI and M-XR and 44 had postoperative imaging. Sulcus angle, LPFA, and patellar tilt were measured, agreement between imaging modalities was assessed using single-measure, 2-way random-effects intraclass correlation coefficients (ICC[2,1]). Threshold values were applied to classify normal or abnormal measurements; agreement was assessed using Cohen kappa. Subgroup analyses were performed in patients with and without patella alta. Correlation was analyzed using Spearman coefficients, and paired t tests were used to evaluate differences in mean values of paired images. Results: The cohort had a mean age of 15 ± 2 years and included 51 (60.7%) female patients. Across all parameters, MRI and M-XR demonstrated poor intermodality agreement (ICC < 0.50) and weak positive correlations (Spearman rho, 0.27 to 0.42). Agreement between MRI and M-XR binary classification was poor for pre- and postoperative sulcus angle (kappa, 0.117 and 0.095, respectively), pre- and postoperative patella tilt (kappa, 0.421 and −0.044, respectively) and preoperative LPFA (kappa, 0.132), though postoperative LPFA demonstrated excellent agreement (kappa, 1.00). In 32 patients with preoperative patella alta (CDI ≥ 1.3), agreement in preoperative sulcus angle and LPFA on MRI and M-XR remained poor. Conclusion: Our study demonstrated that MRI and M-XR yield significantly different measurements of patellofemoral morphology in pediatric patients with PFI, with poor statistical agreement. These modalities should not be used interchangeably for clinical decision making or postoperative follow-up. Establishing novel cutoff values for radiographic-derived measurements applied to MRI is warranted.
