• The Sports Medicine blog reviews and adds clinical perspective to sports medicine cases and reviews of recently published case-based studies.

Thursday, June 19, 2014

Stay out of trouble with shoulder stabilization: Don’t miss the HAGL

Sports Medicine

Anterior capsulolabral injury (Bankart lesion) is a common cause of anterior shoulder instability that is frequently treated with excellent outcomes. However, it is important not to miss associated pathology. Humeral avulsion of the glenohumeral ligament (HAGL), occurring in combination with a Bankart lesion, can present with similar findings to an isolated Bankart lesion, but if not recognized and treated will lead to recurrent instability.

Wednesday, April 16, 2014

Should we fix grade III AC joint injuries in athletes?

Sports Medicine

The acromioclavicular joint is a commonly injured joint in sports. Injury typically occurs from direct impact from a collision as in football or hockey or from a fall onto the shoulder with the arm adducted, which is a common occurrence in many recreational sports. Grade I and II injuries are treated non-operatively. Grade IV, V and VI injuries are treated surgically. There is some controversy in the management of grade III injuries as to whether surgical or nonoperative management is best. ...

Monday, December 30, 2013

In-season anterior shoulder instability: What is the risk in returning to play?

Sports Medicine

Shoulder instability is a common injury in contact and collision athletes. While the acute management is relatively straight forward, the controversy arises when considering the risks associated with return to play in athletes.

Shoulder instability encompasses a wide spectrum of injury from microinstability, through subluxations all the way to complete locked dislocations that require a manual reduction. To treat the in-season athlete with shoulder instability, one must understand the subtle differences in the types of anterior shoulder instability, the associated injury patterns, and the recurrence rates that are associated with return to play.

Friday, October 18, 2013

ACL and medial-sided injuries: When should we fix the medial side?

Sports Medicine

ACL and medial collateral ligament injuries are a relatively common injury we see with contact and collision sports. However, objective completely defined criteria for fixing the medial side in addition to the ACL remain controversial and not set in stone.

One must fully understand the anatomy of the medial side as well as appreciate the subtle exam findings of a combined ACL/medial collateral ligament injuries (MCL) injury. The majority of these cases involving the MCL only involve the superficial MCL (often the femoral side and not a tibial avulsion). The important deep fibers of the MCL that anchor the meniscus to the tibia and femur as well as the posterior oblique ligament (POL) are spared.

Friday, September 20, 2013

Allograft use in primary ACL surgery: Who is the ideal candidate?

Sports Medicine

During the past 5 years, the controversy surround graft selection in ACL surgery has clarified a bit. Multiple peer review articles from respected ACL surgeons have documented an increased failure rate in “young” patients using allograft tissue. However, there is much more to the story.

When looking at ACL surgery results and graft selection, one has to compare apples to apples. This is difficult to do in a single study when you have so many different variables that potentially affect outcome. In the ideal world, every ACL study would include the Marx activity level of the patient. How often and intense does the patient “test” the knee, i.e., attempt ACL-dependent activities? This is critically important in that the ACL may not be so important in the majority of activities the average person does. However, it is entirely different if they participate in level 1 sports every day. Most ACL studies include both groups of patients, active and not so active. One would also compare only males to males, females to females, and the exact same “allograft” to form a cohort group. I am unaware of an ideal study that has done such.

Friday, August 16, 2013

Isolated complex lateral meniscal tears: What would you do?

Sports Medicine

Isolated complex tears of the lateral meniscus that extend to the periphery in a radial fashion at the popliteal hiatus represent a true treatment decision enigma for orthopedic sports medicine surgeons. Fortunately for us, it is not a relatively common lesion. However because of its controversial treatment decision, it has garnered much discussion in the literature and sports medicine team physicians’’ locker room during the past 5 years.

Basic science and clinical studies tell us that in the “normal knee” the overall health of the lateral meniscus is more important to that compartment than the medial meniscus. Isolated complete lateral meniscectomy is a recipe for chronic problems and often career-ending for the competitive athlete. Because of this, one would attempt to repair the majority of the complex tears that extend to the periphery, which also involve the avascular portion of the inner meniscus.