Andrews Research & Education Foundation

PurposeTo evaluate clinical outcomes of augmenting an anterior cruciate ligament (ACL) allograft with an amnion matrix wrap and injecting bone marrow aspirate concentrate (BMAC).MethodsWe enrolled 10 ACL reconstruction patients aged 22-60 years with hamstring allografts wrapped with an amnion collagen matrix and injected with BMAC in this prospective case series. Participants completed physical therapy and reported outcomes for 2 years. Postoperative magnetic resonance imaging scans were mapped/processed at 3, 6, 9, and 12 months, yielding mean transverse relations time constant (T2∗) and volume values for grafts and bone tunnel integration.ResultsWe assessed the longitudinal outcomes of allograft augmentation using descriptive statistics and confidence intervals, showing significant increases in average Knee Injury and Osteoarthritis Outcome Score (KOOS5) and Single Assessment Numerical Evaluation (SANE) scores (KOOS5: Baseline-24 months [m] = 64.2-84.8, 95% confidence interval [CI] 9.14-32.56, SANE: Baseline-24m = 33.8-87.9, 95% CI 38.71-64.87). Average Veterans RAND 12 Item Health Survey (VR-12) Physical scores significantly increased from baseline to 24 months postoperation (Baseline-24m = 35.1-49.6, 95% CI 8.25-20.30). Average visual analog scale for pain scores significantly decreased from baseline at all time points except 2 weeks postoperation (baseline-2 weeks = 2.7-3.6, 95% CI −0.19 to 2.07) starting at 6 weeks postoperation (baseline-6 weeks = 2.7-1.3, 95% CI −2.52 to −0.26) and remained significantly lower than baseline to 24 months postoperation (baseline-24m = 2.7-0.6, 95% CI− 3.27 to −0.85). Average Max Activity Scale scores were significantly decreased from baseline starting at 12 months postoperation (baseline-12m = 6.3-2.7, 95% CI −6.32 to −0.88) but returned to baseline levels at 24-months postoperation (Baseline-24m = 6.3-5.8, 95% CI −4.45 to 1.45). There were no significant differences in VR-12 mental component scores or magnetic resonance imaging measures. No infections nor reconstruction failures occurred after 2 years.ConclusionsThis case series demonstrated augmenting hamstring allograft ACL reconstruction with an amnion collagen matrix and injecting BMAC appeared to be safe, and clinical outcomes were favorable up to 2 years postoperation despite having no quantifiable effect on graft maturation.Level of EvidenceLevel IV, therapeutic case series.

This cross-sectional study’s objective was to evaluate the primary muscles involved during each phase of a lacrosse shot. The data provided facilitates data-informed recommendations for muscle-targeted injury prevention and performance improvements. We hypothesized a specific subgroup of upper body muscles would be involved in each lacrosse shot phase, as shown by the primary effectiveness endpoint, electromyographic (EMG) muscle activity.

: A growing trend in sports is early sport specialization which involves training in a single sport on a year-round basis. Factors that contribute to an athlete specializing in a sport include: enjoyment of the sport, obtaining a scholarship, professional aspirations, gaining a competitive advantage, lack of enjoyment in other sports, injury risk, lack of time to participate in other sports, and parent/coach pressure. With the growing hyper competitiveness and professionalization of sports and lucrative financial gains that proceed them, more and more young athletes, coaches and parents are looking to gain a competitive edge. Sport specialization may contribute to increased risk of injury and burnout in athletes. Male athletes have garnered most of the attention regarding early sport specialization, particularly in baseball. Female athletes have their own set of risk factors as they tend to specialize earlier in their athletic career and have been shown to accumulate primarily overuse injuries. In addition to contributing to this paper, Dr. James R. Andrews has been one of the leaders in injury prevention and an advocate in cautioning against early sport specialization in all young athletes. The focus of this paper is to highlight the specific risks associated with sport specialization for adolescent female athletes in hopes of developing successful athletes while avoiding injury or burnout along their path. Over the years there has been a trend of increased youth sports participation by female athletes. As female athlete participation continues to increase, we concomitantly have an increase in injury rates. Additionally, the iconic female influences of superstars like Nadia Comaneci and Lindsey Vonn has popularized the notion of sports specialization in young female athletes. Thus, with both the increase in participation as well as the heightened popularity of sport specialization, greater focus needs to be devoted to injury recognition and prevention in youth female athletes. Identifying the at-risk female athlete is prudent for the health and well-being of our youth athletes.

Currently it is hypothesized that increased body mass index may contribute to overuse injuries. Thus, if hip or shoulder range of motion is affected by body mass index, pitchers may be placing additional stress on joints as they seek to pitch at maximal velocity. The purpose of this study was to examine if range of motion at the hips and shoulders were related to body mass index classification. A sample of 147 female softball pitchers (17.0±4.2 years; 167.6±11.8 cm; 70.6±17.5 kg; body mass index=24.8±4.7 kg/m2) participated. Bilateral hip and shoulder range of motion were assessed. Multivariate analysis of variance results indicated body mass index [Wilks’Λ=0.742, F=1.722, p=0.014, η2=0.095] significantly affected range of motion of the shoulder and hip. Post hoc results indicated the underweight group had significantly more range of motion than the obese group in hip internal range of motion on both the throwing side (mean difference=12.39, p=0.005) and glove side (mean difference=11.98, p=0.004). Although body composition is not overly emphasized among softball pitchers, the current study reveals excess weight may inhibit proper mechanics. Coaches, athletic trainers, strength and conditioning personnel, and athletes should acknowledge the role that body composition can play in affecting pitch outcomes.

Background:There is a paucity of research regarding the relationship between fastpitchsoftball pitching mechanics and reported pain. Thus, understanding thepitching mechanics of athletes pitching with upper extremity pain and thosepain free is paramount.Purpose:To examine lower extremity pitching mechanics, upper extremity kinetics, andupper extremity pain in National Collegiate Athletic Association (NCAA)Division I female softball pitchers.Study Design:Descriptive laboratory study.Methods:A total of 37 NCAA Division I female softball pitchers (mean age, 19.84 ±1.28 years; mean height, 173.67 ± 7.77 cm; mean weight, 78.98 ± 12.40 kg)from across the United States were recruited to participate. Participantswere divided into 2 groups: upper extremity pain (n = 13; mean age, 19.69 ±1.18 years; mean height, 172.60 ± 11.49 cm; mean weight, 86.75 ± 13.02 kg)and pain free (n = 24; mean age, 19.91 ± 1.35 years; mean height, 174.26 ±4.96 cm; mean weight, 74.78 ± 9.97 kg). An electromagnetic tracking systemwas used to obtain kinematic and kinetic data during the riseball softballpitch.Results:At foot contact (F3,33 = 7.01, P = .001), backward eliminationregression revealed that stride length, trunk rotation, and center of mass(COM) significantly explained about 33% of variance with softball pitchersexperiencing upper extremity pain (adjusted R2 = 0.33).Conclusion:At foot contact, the kinematic variables of increased trunk rotation towardthe pitching arm side, increased stride length, and a posteriorly shiftedCOM were associated with upper extremity pain in collegiate softballpitchers. Variables early in the pitching motion that do not set a workingand constructive proximal kinetic chain foundation for the rest of the pitchto follow could be associated with breakdowns more distal in the kineticchain, possibly increasing the susceptibility to upper extremity pain.Clinical Relevance:The identification of pitching mechanics associated with pain allowsclinicians to develop exercises to avoid such mechanics. Avoiding mechanicsassociated with pain may help reduce the prevalence of pain in windmillsoftball pitchers as well as help coaches incorporate quantitativebiomechanics into their instruction.

Hematopoetic stem cells (HSC) have recently been studied to improve healing and rehabilitation from musculoskeletal injury. HSC are currently collected using invasive bone marrow aspiration and peripheral harvest after pharmaceutical mobilization. Animal studies show environmental stresses including heat, hypoxia, and cold mobilize HSC. HSC have also been mobilized to peripheral circulation (PC) with exercise. We hypothesized that the combination of environmental stress and exercise can mobilize HSC to PC. Mechanisms for environmental mobilization will aid in understanding healing and rehabilitation mechanisms and may provide a more convenient method to harvest HSC. PURPOSE: To determine if the combination of compression and cooling during exercise can mobilize HSC in PC. METHODS: Ten healthy, active males (height 1.78 ± .06 m, weight 85.1 ± 13.3 kg, age 30.4 ± 4.7 y) completed a 20-min exercise protocol on the VasperTM recumbent cross trainer. The protocol entailed a 7-min warm up and 6 sprints alternating between 30s and 60s in duration with 90s recoveries. Compression cuffs were placed around the upper arms and thighs and inflated to 40 and 65 mmHg, respectively. Subjects sat on a cooling pad and wore a cooling vest to decrease body temperature. Blood samples were collected via forearm vein access prior to exercise and at 20 (T20), 30, 60, 90, 120, 150, 180 min and 24h post exercise. A complete blood count with differential and flow cytometry was performed on each sample. A linear mixed model analysis was used to evaluate differences in each variable. RESULTS: A spike in white blood cell (WBC) count was seen between baseline and T20 (Mdiff = 1.740, SE = .48, p = .004). The WBC differential revealed a decrease in neutrophils (Mdiff = 4.13, SE = 1.52, p = .015) and eosinophils (Mdiff = .42, SE = .13, p = .009), and an increase in lymphocytes (Mdiff = 4.51, SE = 1.62, p = .014) from baseline to T20, with no change in basophils, monocytes, or immature granulocytes. Flow cytometry indicated an increase in CD34(+), a cell surface marker for HSC, from baseline to T20 (Mdiff = 1.25, SE = .48, p = .028) with no change in the viability of the WBCs. CONCLUSION: The VasperTM consistently mobilizes HSC to PC when used to a high level of exertion. Further study is required to determine if these cells can be consistently harvested from PC after mobilization.

ABSTRACTChronic ankle instability (CAI) is a common condition following ankle injury that is associated with compromised balance. Whole body vibration training (WBVT) programmes are linked with improved balance and function in athletic and non-athletic populations and may improve balance in CAI. Twelve healthy and seven CAI participants completed two randomly assigned interventions. Two Power Plate® platforms were attached back to back using a Theraband®. Participants stood on the active plate and inactive plate for WBVT and sham interventions, respectively. Each intervention included vibration of the active plate. Centre of pressure (COP) and the star excursion balance test (SEBT) were measured before and at 3, 15 and 30 min following the interventions. Significant improvements were found in the anterior direction of the SEBT following both interventions in CAI and varying patterns of improvement were observed for COP measurements in all participants. Therefore, WBVT does not appear to acutely improve balance in CAI.

In many orthopaedic operating rooms, anaesthesia providers routinely wear lead aprons for protection from radiation, but some studies have questioned whether this is needed. We conducted a systematic review to identify studies that measured the amount of radiation that anaesthetists were exposed to in the orthopaedic operating room. Multiple studies have shown that at 1.5 m from the source of radiation, anaesthetists received no radiation, or amounts so small that a person would have to be present in an unreasonable number of operations to receive cumulative doses of any significance. Radiation doses at this distance were often at the limits of the sensitivity of the measuring dosimeter. We question the need to wear lead protection for anaesthesia providers who are routinely at 1.5 m or a greater distance from standard fluoroscopy units.

Peroneal nerve palsy is the most common entrapment neuropathy of the lower extremity. Numerous etiologies have been identified; however, compression remains the most common cause. Although injury to the nerve may occur anywhere along its course from the sciatic origin to the terminal branches in the foot and ankle, the most common site of compressive pathology is at the level of the fibular head. The most common presentation is acute complete or partial foot drop. Associated numbness in the foot or leg may be present, as well. Neurodiagnostic studies may be helpful for identifying the site of a lesion and determining the appropriate treatment and prognosis. Management varies based on the etiology or site of compression. Many patients benefit from nonsurgical measures, including activity modification, bracing, physical therapy, and medication. Surgical decompression should be considered for refractory cases and those with compressive masses, acute lacerations, or severe conduction changes. Results of surgical decompression are typically favorable. Tendon and nerve transfers can be used in the setting of failed decompression or for patients with a poor prognosis for nerve recovery.

Background: A relatively high number of active professional baseball pitchers have a history of ulnar collateral ligament reconstruction (UCLr) on their throwing elbow. Controversy exists in the literature about whether professional baseball pitchers regain optimal performance after return from UCLr. It has been suggested that pitchers may have different biomechanics after UCLr, but this has not been previously tested. Hypothesis: It was hypothesized that, compared with a control group without a history of UCLr, professional pitchers with a history of UCLr would have (1) significantly different throwing elbow and shoulder biomechanics; (2) a shortened stride, insufficient trunk forward tilt, and excessive shoulder horizontal adduction, characteristics associated with “holding back” or being tentative; (3) late shoulder rotation; and (4) improper shoulder abduction and trunk lateral tilt. Study Design: Controlled laboratory study. Methods: A total of 80 active minor league baseball pitchers (and their 8 Major League Baseball organizations) agreed to participate in this study. Participants included 40 pitchers with a history of UCLr and a matched control group of 40 pitchers with no history of elbow or shoulder surgery. Passive ranges of motion were measured for each pitcher’s elbows and shoulders, and then 23 reflective markers were attached to his body. The pitcher took as many warm-up pitches as desired and then threw 10 full-effort fastballs for data collection. Ball speed was recorded with a radar gun. The reflective markers were tracked with a 10-camera, 240-Hz automated motion analysis system. Eleven biomechanical parameters were computed for each pitch and then averaged for each participant. Demographic, range of motion, and biomechanical parameters were compared between the UCLr group and the control group by use of Student t tests (significance set at P < .05). Results: All hypotheses were rejected, as there were no differences in pitching biomechanics between the UCLr group and the control group. There were also no differences in passive range of motion between the 2 groups. Conclusion: Compared with a control group, active professional pitchers with a history of UCLr displayed no significant differences in shoulder and elbow passive range of motion and no significant differences in elbow and shoulder biomechanics. Clinical Relevance: Clinical studies have previously shown that 10% to 33% of professional pitchers do not return to their preinjury level; however, the current study showed that those pitchers who successfully return to professional baseball after UCLr pitch with biomechanics similar to that of noninjured professionals.