Projection of Patient Condition Code Distributions Based on Mechanism of Injury

Background: There has been minimal research investigating injury and pitching performance differences between Major League Baseball (MLB) and other professional leagues. Purpose/Hypothesis: This 2-team comparison between MLB and Japan’s Nippon Professional Baseball (NPB) involved affiliated players over 5 years. We hypothesized that teams would differ in the injury incidence, mechanism of injury, pitch velocity, and pitch type usage. Study Design: Descriptive epidemiology study. Methods: Between 2015 and 2019, pitching data as well as injury statistics for the highest level and minor league affiliates of the Los Angeles Angels (MLB) and the Hiroshima Toyo Carp (NPB) were reviewed for significant differences in the injury prevalence, injury type, mechanism of injury, and days missed. In total, 3781 MLB and 371 NPB injuries were studied. Results: MLB-affiliated players were significantly younger, taller, and heavier ( P < .001) than were NPB-affiliated players. MLB-affiliated pitchers threw faster than did their NPB counterparts ( P = .026). MLB minor league pitchers threw more curveballs than did NPB minor league pitchers ( P = .004), and MLB minor league relief pitchers threw more sliders than did NPB minor league relief pitchers ( P = .02). The MLB team had a 3.7-fold higher incidence of injuries versus the NPB team (0.030 vs 0.008 injuries per player-game, respectively) as well as more repeat injuries, with fewer days missed per injury (15.8 ± 54.7 vs 36.2 ± 55.1 days, respectively; P < .001). The MLB team also had a higher percentage of injuries that were throwing related ( P < .001), were contact related ( P < .001), and occurred outside of competition ( P < .001) compared with the NPB team. Conclusion: This is the first empirical study examining injury trends and pitching characteristics between MLB and NPB athletes. MLB-affiliated pitchers threw faster and relied more on breaking pitches in comparison with NPB-affiliated pitchers. From injury data, MLB players were younger, taller, and heavier with a higher percentage of throwing-related injuries, contact injuries, and injuries sustained outside of competition. Overall, the MLB team indicated a 3.7-fold higher rate of reported injuries with fewer days missed per injury than did the NPB team. Competitive conditions are distinctly different between MLB and NPB, and thus, more extensive research collaborations in the future can identify best practices to advance health and performance for both leagues.

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Is Edema at the Posterior Medial Tibial Plateau Indicative of Ramp Lesion? An Examination of 852 Patients with Anterior Cruciate Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00132 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0013

Author(s):

Neil Kumar ◽

Tiahna Spencer ◽

Edward Hochman ◽

Mark P. Cote ◽

Robert A. Arciero ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Tibial Plateau ◽

Cruciate Ligament ◽

Mechanism Of Injury ◽

Medial Tibial Plateau ◽

Meniscal Tears ◽

Ramp Lesion ◽

Anterior Cruciate ◽

Operative Notes

Objectives: Meniscal injuries are commonly observed with anterior cruciate ligament (ACL) deficiency. A subset of these injuries includes tears of the medial meniscus at the posterior meniscocapsular junction, or ramp lesions. Biomechanical studies have indicated that ramp injuries may compromise anterior stability of the knee, even after ACL reconstruction (ACLR). These lesions are not consistently diagnosed with magnetic resonance imaging (MRI). One criterion that shows promise is the presence of posterior medial tibial plateau (PMTP) edema. A correlation of PMTP edema and peripheral posterior horn medial meniscal injuries has been observed in the literature. We evaluated a consecutive series of patients who underwent ACLR for incidence of ramp tears. These patients were then compared to patients with non-ramp (meniscal body) medial meniscal tears. The utility of PMTP edema on preoperative MRI for ramp tear diagnosis was then determined. Methods: A retrospective chart review via an institutional database search identified 892 patients who underwent ACLR by one of two senior authors (R.A.A., C.E.) between January 2006 and June 2016. Operative notes identified patients diagnosed arthroscopically with medial meniscal lesions, including ramp lesions. Arthroscopic identification was the gold standard for diagnosis of both ramp and non-ramp (meniscal body) tears. Demographic information such as age, sex, laterality, mechanism of injury (contact/noncontact), sport, revision procedure, multi-ligament procedure, time to MRI, and time to surgery were recorded. Patients without available operative records were excluded. Preoperative MRIs were obtained for all patients and reviewed by an orthopaedic sports medicine fellow for PMTP edema. Axial, coronal, and sagittal T2 and proton-density sequences were utilized. A MRI was considered positive if edema was detected in 2 different planes of sequences. Differences between groups were analyzed with two-sample t test or Chi square test Univariate and multivariate logistic regression models analyzed the relationships among patient factors, MRI findings, and ramp lesions. Results: 852 patients met the inclusion criteria for analysis. 307 patients were diagnosed with medial meniscal tear at the time of ACLR, 127 of which were ramp lesions. The overall incidence of ramp tear was 14.9% and consisted of 41.4% of all medial meniscal tears. Patients with ramp tears were mean 7.5 years younger than patients with meniscal body tears ( p<0.01). There was no difference between the groups in regard to mechanism of injury, revision surgery, or multi-ligamentous injury. Patients with delayed ACLR were at 3.3x greater odds ( p<0.01) of having meniscal body tear compared to ramp lesion. MRI was available for review in 178 patients, 97 of whom had positive MRI for PMTP edema. Sensitivity and specificity of PMTP edema for ramp tear was 66.3% and 55.1%, respectively. Of patients with PMTP edema, 54.6% had ramp lesions and 45.4% had non-ramp tears ( p<0.01). Patients with preoperative MRI positive for PMTP edema were at 2.1 times greater odds ( p<0.01) of having sustained a ramp tear compared to a meniscal body tear. Conclusion: The incidence of ramp tear was 14.9% and was more prevalent in younger patients. Delayed ACLR resulted in 3.3x greater odds of meniscal body tears compared to ramp tears. Patients with PMTP edema on preoperative MRI were at 2.1x greater odds to have ramp lesions compared to a meniscal body tears at the time of ACL reconstruction.

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Stenosing Tenosynovitis of the Flexor Hallucis Longus Tendon and Posterior Impingement upon the Os Trigonum in Ballet Dancers

Foot & Ankle ◽

10.1177/107110078200300204 ◽

1982 ◽

Vol 3 (2) ◽

pp. 74-80 ◽

Cited By ~ 126

Author(s):

William G. Hamilton

Keyword(s):

Lateral Approach ◽

Flexor Hallucis Longus ◽

Mechanism Of Injury ◽

Dance Class ◽

Os Trigonum ◽

Ballet Dancers ◽

Longus Tendon ◽

Surgical Access ◽

Posterior Impingement ◽

Stenosing Tenosynovitis

The problems of flexor hallucis tendonitis and os trigonum syndrome in dancers are presented. The mechanism of injury, diagnosis, treatment, and rehabilitation are outlined. Pitfalls in diagnosis are discussed as well as prognosis for return to dance class and the stage. The best surgical access to the os trigonum is a lateral approach.

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