The American journal of sports medicine
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Randomized Controlled Trial
Ten-year follow-up of a prospective, randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint of athletes.
Various techniques have proven to be effective for treating articular cartilage defect (ACD) and osteochondral defect (OCD) of the knee joint, but knowledge regarding which method is best still remains uncertain. ⋯ The OAT technique for ACD or OCD repair in the athletic population allows for a higher rate of return to and maintenance of sports at the preinjury level compared with MF.
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Patients usually return to pivoting sports between 6 months and 1 year after anterior cruciate ligament (ACL) reconstruction, but no matched study has so far examined 1-year return to sport rates in nonoperatively and operatively treated ACL-injured patients. ⋯ Anterior cruciate ligament-injured patients following a nonoperative treatment course, including recommendations of activity modifications, and operatively treated patients did not have significantly different rates of returning to pivoting sports after 1 year in this pair-matched cohort study. Clinicians should be aware of a potentially high level of noncompliance to recommendations of activity modifications. Although these results show that it is possible for nonoperatively treated patients to return to sport after rehabilitation, future follow-ups are needed to examine whether these patients maintain sports participation over time, and what long-term consequences they may suffer regarding subsequent injuries and knee osteoarthritis.
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Scapulothoracic dyskinesis is an important consequence of acromioclavicular joint dislocations. However, no reports have described changes in 3-dimensional motions of the scapula and clavicle with respect to the thorax caused by acromioclavicular joint dislocation. ⋯ The results of this cadaveric study revealed that AC and CC ligament disruption could cause dyskinesis of the scapula and clavicle. The kinematic changes could be a potential source of pain and dysfunction in the shoulder with AC joint dislocation, and therefore surgical reconstruction may be indicated in certain patients.
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The overhead-throwing athlete is a unique patient, requiring an elite, precise functional ability. Superior labral tears are quite common, and the percentage of athletes who return to play after superior labrum anterior-posterior (SLAP) repair has been variable. A tear of the infraspinatus caused by either internal impingement or tension overload may compromise this return. ⋯ A significant (>50%) tear of the infraspinatus in combination with glenohumeral internal rotation deficit (GIRD) and SLAP tears in the throwing athlete results in a guarded prognosis in return to play at the same level. While the rates of return to play in overhead-throwing athletes with an isolated SLAP tear have historically been encouraging, the prognosis for an athlete with both a SLAP and infraspinatus tear is more guarded. These patients are not likely to return to their preinjury level of play.
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Internal fixation is advocated as the primary treatment for fifth metatarsal Jones fractures in athletes; however, screw insertion site discomfort and refracture can occur especially in competitive athletes. The ideal implant has not been determined. ⋯ Headless compression screw fixation of fifth metatarsal Jones fractures provided excellent results, allowing athletes to return to full activity without both screw insertion site irritation and clinical refracture.