The Chronister Protocol: Early Experience With Immediate Immobilization in Flexion and Rapid Return to Play After Acute Lateral Patellar Dislocation

2015 ◽  
Vol 20 (4) ◽  
pp. 16-22
Author(s):  
Raymond Chronister ◽  
George C. Balazs ◽  
Adam Pickett ◽  
John-Paul H. Rue ◽  
David J. Keblish
Keyword(s):  
Outcome Measures ◽  
Knee Flexion ◽  
Patellar Dislocation ◽  
Case Series ◽  
Return To Sport ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Full Extension ◽  
Knee Stiffness ◽  
Lateral Patellar Dislocation

Context:Acute lateral patellar dislocation is a common injury sustained by athletes, and often requires several months to recover and return to play.Objective:To describe a novel protocol for the treatment of acute lateral patellar dislocation that returns patients to play far sooner than traditional treatment protocols.Design:Case series and review of the literature.Setting:Division I NCAA institution.Patients:Two collegiate athletes who sustained first-time acute lateral patellar dislocations.Interventions:Traditional standard of care for acute lateral patellar dislocation after reduction involves 1–7 weeks of immobilization in full extension. Knee stiffness commonly results from this method, and return to full activity typically takes 2–4 months. We used a protocol involving immobilization in maximal flexion for 24 hr, with early aggressive range of motion and quadriceps strengthening in the first week after injury.Main Outcome Measures:Time to return to play.Results:Immediate on-site reduction of the patella followed by 24 hr of immobilization in maximal knee flexion was performed. Following an accelerated rehabilitation regimen, patients were able to return to sport an average of 3 days postinjury. Neither patient has experienced a recurrent dislocation.Conclusions:Our protocol is based on anatomic studies demonstrating reduced tension on the medial patellofemoral ligament, reduced hemarthrosis, and reduced soft tissue swelling in maximal knee flexion. This method apparently bypasses the knee stiffness and deconditioning commonly seen with traditional nonoperative regimens, allowing return to sport weeks or months sooner.

scholarly journals Modified Langenskiöld procedure for chronic, recurrent, and congenital patellar dislocation

2020 ◽  
Vol 14 (4) ◽  
pp. 318-329
Author(s):  
Omar Ramos ◽  
Corey Burke ◽  
Molly Lewis ◽  
Martin J. Morrison ◽  
Dror Paley ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Patellar Dislocation ◽  
Case Series ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Full Extension ◽  
Chronic Group ◽  
Patellar Maltracking ◽  
Kujala Score ◽  
One Year

Purpose Langenskiöld described a reconstructive soft-tissue procedure for irreducible lateral congenital patellar dislocations. Paley further detailed the technique in the surgical management of congenital femoral deficiency. The aim of this study was to evaluate the outcomes of patients with congenital, chronic and recurrent patellar dislocations treated with the modified Langenskiöld procedure. Methods This is a retrospective case series. Between 2011 and 2018, 18 knees in 13 patients (mean age 15.8 years (sd 4.4; 12 to 29.9), nine female) with diagnoses of recurrent (six patients, eight knees), chronic (four patients, six knees) and congenital (three patients, four knees) patellar dislocations were treated with the modified Langenskiöld procedure. Results There were no recurrent lateral dislocations in the congenital or recurrent groups. One of the patients in the congenital group had an overcorrection with some medial patellar maltracking but until this time has not required any further surgery. In the chronic group two of the six knees developed further dislocations; these were both on the same patient, who had no dislocations until one year after surgery. Mean Kujala score was 83.7 (sd 17; 47 to 100) for all groups. In spite of preoperative knee flexion contractures of up to 30° in three patients (six knees), all patients had full extension postoperatively. Eight patients reported being satisfied with their outcome, one was somewhat satisfied, two were very dissatisfied, and two did not respond. Conclusion The modified Langenskiöld reconstruction provides a powerful correction for challenging cases of congenital and recurrent patellar dislocations. Re-dislocation as well as overcorrection can occasionally occur. Level of Evidence Level IV

Minimally Invasive Double-Button Fixation of Displaced Lateral Clavicular Fractures in Athletes

2016 ◽  
Vol 45 (2) ◽  
pp. 462-467 ◽  
Author(s):  
Maximiliano Ranalletta ◽  
Luciano A. Rossi ◽  
Hugo Barros ◽  
Francisco Nally ◽  
Ignacio Tanoira ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Closed Reduction ◽  
Functional Outcomes ◽  
Constant Score ◽  
Case Series ◽  
Return To Sport ◽  
Return To Play ◽  
Short Version ◽  
Level Of Evidence ◽  
The Mean

Background: Early union and a rapid return to prior function are the priorities for young athletes with lateral clavicular fractures. Furthermore, it is essential to avoid nonunion in this subgroup of patients, as this is frequently associated with persistent pain, restriction of movement, and loss of strength and endurance of the shoulder. Purpose: To analyze the time to return to sport, functional outcomes, and complications in a group of athletes with displaced lateral clavicular fractures treated using closed reduction and minimally invasive double-button fixation. Study Design: Case series; Level of evidence, 4. Methods: A total of 21 athletes with displaced lateral clavicular fractures were treated with closed reduction and minimally invasive double-button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return to sport and treatment course. Functional outcomes were assessed with the Constant score and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union, malunion, and nonunion. Results: Of the 21 study patients, 20 returned to sport after treatment; 100% returned to the same level. The mean time to return to play was 78 days (range, 41-120 days). Four patients (20%) returned to sport less than 6 weeks after surgery, 14 (70%) returned between 6 and 12 weeks after surgery, and 2 (10%) returned after 12 weeks. The mean Constant score was 89.1 ± 4.2 (range, 79-100), the mean QuickDASH score was 0.4 ± 2.6 (range, 0-7.1), and the mean VAS pain score was 0.4 ± 1.0 (range, 0-3) at final follow-up (mean, 41 months). The only complication was asymptomatic nonunion. Hardware removal was not necessary in any patient. Conclusion: Closed reduction and minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes was successful in terms of returning to the previous level of athletic activity regardless of the type of sport, with excellent clinical results and a low rate of complications.

scholarly journals Noniatrogenic Medial Patellar Dislocations: Case Series and International Patellofemoral Study Group Experience

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098553
Author(s):  
Alexander E. Loeb ◽  
Jack Farr ◽  
Shital N. Parikh ◽  
Andrew J. Cosgarea
Keyword(s):  
Risk Factors ◽  
Patellar Dislocation ◽  
Patellar Instability ◽  
Case Series ◽  
Collegiate Athletes ◽  
Study Group ◽  
Case Review ◽  
Level Of Evidence ◽  
Lateral Direction ◽  
Ehlers Danlos Syndrome

Background:Most patellar dislocations occur in a lateral direction because of a summed lateral force vector and predisposing anatomic risk factors. Medial patellar instability is rare and is a well-recognized iatrogenic complication of an overly aggressive lateral retinacular release. Noniatrogenic medial patellar dislocations are rare. The management of these injuries is not well described.Purpose:To describe the experience of the International Patellofemoral Study Group with patients with noniatrogenic medial patellar dislocation.Study Design:Case series; Level of evidence, 4.Methods:Members of the International Patellofemoral Study Group (N = 64) were surveyed between October 2018 and April 2019. This group was chosen because of its wide referral base and interest in patellar instability. Specialists who had encountered a patient with medial patellar instability were sent a questionnaire inquiring about details of the case, including patient demographics, medical history, level of athletic competition, injury characteristics, and treatment. Cases were confirmed by physical examination records and, in some cases, with findings on advanced radiographic imaging.Results:The survey response rate was 73% (47/64). Three of the 47 specialists (6.4%) reported they had seen a case of noniatrogenic medial patellar dislocation, for a total of 6 cases. Four cases were described as recurrent medial dislocations in the setting of hypermobile Ehlers-Danlos syndrome; 2 were treated nonoperatively, 1 underwent lateral patellofemoral ligament reconstruction, and 1 underwent derotational osteotomies. Two medial-sided patellar dislocations in collegiate athletes were sports-related injuries that required surgical debridement but no ligamentous reconstruction. None of the patients had persistent or recurrent instability at the time of their most recent follow-up.Conclusion:Noniatrogenic medial patellar dislocations are extremely rare. This case review suggests that the treatment of first-time medial patellar instability in patients without known risk factors should follow the same principles as the treatment of lateral instability with no known risk factors, which is nonoperative management. For patients with documented risk factors and recurrence, surgery to address the risk factors may be appropriate.

scholarly journals Is resistance training intensity adequately prescribed to meet the demands of returning to sport following anterior cruciate ligament repair? A systematic review

2021 ◽  
Vol 7 (3) ◽  
pp. e001144
Author(s):  
Zackary William Nichols ◽  
Daniel O'Brien ◽  
Steven Gordon White
Keyword(s):  
Systematic Review ◽  
Resistance Training ◽  
Outcome Measures ◽  
Data Extraction ◽  
Cruciate Ligament ◽  
Case Series ◽  
Return To Sport ◽  
Eligibility Criteria ◽  
Randomised Controlled ◽  
Meta Analyses

ObjectiveTo identify, critique and synthesise the research findings that evaluate the use of resistance training (RT) programmes on return to sport outcome measures for people following ACL repair (ACLR).Design and data sourcesThis systematic review included a comprehensive search of electronic databases (EBSCO health databases (CINAHL, MEDLINE, SPORTDiscus), Scopus and Pedro) performed in June 2020 and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies were appraised using the Downs and Black checklist.Eligibility criteriaRandomised and non-randomised controlled trials, longitudinal cohort studies and case series were considered for inclusion where an adequate description of the RT intervention was provided as a part of the study’s ACLR rehabilitation protocol. Articles that did not include outcome measures related to return to sport criteria were excluded.ResultsEleven articles met the inclusion criteria and were subjected to appraisal and data extraction. Study quality ranged from poor to excellent. RT intensity varied considerably among studies (between 5% and >80% of one repetition maximum). Only one identified study specifically investigated the effect of a low-intensity versus high-intensity RT protocol. The majority of studies reported participant outcomes that would not meet commonly used return to sport criteria.ConclusionThere appears to be considerable variation in the intensity of RT prescribed in research for people following ACLR. Furthermore, in most of the identified studies, RT protocols promoted muscle endurance and hypertrophy without progressing to strength or power-based RT. The findings of this review provide insight into potential factors limiting returning to sport and contributing to reinjury for people following ACLR.

scholarly journals Stretching for Recovery from Groin Pain or Injury in Athletes: A Critical and Systematic Review

2021 ◽  
Vol 6 (3) ◽  
pp. 73
Author(s):  
José Afonso ◽  
João Gustavo Claudino ◽  
Hélder Fonseca ◽  
Daniel Moreira-Gonçalves ◽  
Victor Ferreira ◽  
...  
Keyword(s):  
Groin Pain ◽  
Case Series ◽  
Return To Sport ◽  
Return To Play ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Rehabilitation Protocols ◽  
Recovery Protocols ◽  
Meta Analyses ◽  
Specific Contribution

Stretching is usually used as part of rehabilitation protocols for groin pain or injury, but its specific contribution to and within multimodal recovery protocols is unclear. Our goal was to systematically review the effects of stretching for the recovery from groin pain or injury. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, with eligibility criteria defined according to PICOS: (Participants) athletes with groin pain or injuries; (Interventions) interventions with stretching as the differentiating factor; (Comparators) comparators not applying stretching; (Outcomes) symptom remission or improvement and/or time to return to sport and/or return to play; (Study design) randomized controlled trials. Searches were performed on 26 March 2021, in CINAHL, Cochrane Library, EBSCO, EMBASE, PEDro, PubMed, Scielo, Scopus, SPORTDiscus, and Web of Science, with no limitations regarding language or date, and no filters. Of 117 retrieved results, 65 were duplicates and 49 were excluded at the screening stage. The three articles eligible for full-text analysis failed to comply with one or more inclusion criteria (participants, intervention and/or comparators). We then went beyond the protocol and searched for non-randomized trials and case series, but no intervention was found where stretching was the differentiating factor. We found no trials specifically assessing the effects of stretching on recovery or improvement of groin pain or injury in athletes. Currently, the efficacy of these interventions is unknown, and more research is warranted.

scholarly journals Outcomes after Elbow Ulnar Collateral Ligament Reconstruction with the Docking Plus Technique in 163 Athletes

2020 ◽  
Author(s):  
Marc Lubitz ◽  
Benjamin Donohue ◽  
Vadim Molla ◽  
Timothy Kremchek
Keyword(s):  
Case Series ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
High Volume ◽  
Return To Play ◽  
College Level ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Before And After ◽  
High Level

Abstract Background: This retrospective case series examined 163 athletes who underwent ulnar collateral ligament (UCL) reconstruction (UCLR) from 2015-2018. All cases were by a single surgeon at a high volume center using the Docking Plus Technique. We previously reported outcomes in 324 athletes from 2005-2014 with 88% of patients reporting a Conway score of good or excellent. Purpose/Hypothesis: The purpose of this study was to determine if patients undergoing UCLR with the docking plus technique are able to return to sport and to better characterize the athletes needing this procedure. Our hypothesis was that our cohort would largely be able to return to their previous level of play and be mostly college level pitchers. Methods: Patients who underwent UCLR at our institution from 2015-2018 were identified and surveyed. We were able to reach a total of 163 patients and they were asked for background demographic information and information about their athletic careers before and after UCLR. Results: Our results were largely similar to our previously study with 94.5% of athletes obtaining Conway scores of Good or Excellent. 95% of athletes were male, 91% played baseball, and 83% of baseball players were pitchers. 59% of athletes were in college at the time of their surgery. For 8 athletes, this was a revision procedure, 7 of the revisions were for pitchers. 5 of the 7 pitchers were able to get back to the same level or higher of competition. 98.8% of patients surveyed said they were “satisfied with the outcome of the surgery.” Conclusions: The Docking Plus Technique performed by a single surgeon at a private practice setting leads to reproducible return to play and patient satisfaction. The prototypical patient undergoing UCLR is a high level male baseball pitcher. UCL outcomes data would benefit from more prospective studies and the creation of a nationwide UCLR database to draw conclusions about technique, graft type, risk factors, and many more relevant variables.

scholarly journals Early Return to Play After Intramedullary Screw Fixation of Acute Jones Fractures in Collegiate Athletes: 22-Year Experience

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091242 ◽  
Author(s):  
Scott Watson ◽  
Amy Trammell ◽  
Stephanie Tanner ◽  
Steven Martin ◽  
Larry Bowman
Keyword(s):  
Screw Fixation ◽  
Skin Irritation ◽  
Case Series ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Early Return ◽  
Hardware Complications ◽  
Patient Reported ◽  
Intramedullary Screw

Background: There is disagreement among team physicians, without conclusive evidence, as to when high-level athletes with a Jones fracture should be allowed to return to play after being treated operatively with an intramedullary screw. Purpose: To report our experience of early return to sport in collegiate athletes after intramedullary screw fixation of Jones fractures. Study Design: Case series; Level of evidence, 4. Methods: We identified all collegiate athletes with an acute fracture at the base of the fifth metatarsal treated by 1 of 2 orthopaedic surgeons with intramedullary screw fixation over a 22-year period (1994-2015), and we performed a retrospective review of their records. Fixation consisted of a single intramedullary screw. Athletes were allowed to bear weight as tolerated in a walking boot immediately postoperatively and return to play as soon as they could tolerate activity. Patients were contacted to complete patient-reported outcome scores that included the Foot and Ankle Ability Measure (FAAM) score, a brief survey specific to our study, and follow-up radiographs. Results: A total of 26 acute Jones fractures were treated in 25 collegiate athletes (mean age, 20 years; range, 18-23 years). Overall, the athletes returned to play at an average of 3.6 weeks (range, 1.5-6 weeks). Three screws were removed for symptomatic skin irritation. There was 1 refracture after screw removal that was done after radiographic and clinical documentation of fracture union, which was treated with repeat cannulated percutaneous screw fixation. One screw was observed on radiographs to be broken at 1 year postoperatively, but the fracture was healed and the athlete was playing National Collegiate Athletic Association Division I sports without symptoms and continued to play professionally without symptoms. Of 25 athletes, 19 completed the FAAM at an average follow-up of 8.6 years (range, 1.5-20.0 years). They reported scores of 94.9% (range, 70.2%-100%) for the activities of daily living subscale and 89.1% (range, 42.9%-100%) for the sports subscale. Follow-up radiographs were obtained, and no nonunion, malunion, or additional hardware complications were identified. Conclusion: Athletes with acute Jones fractures can safely be allowed to return to play after intramedullary screw fixation as soon as their symptoms allow, without significant complications. In our experience, this is usually within 4 weeks from injury.

Return to Play in Elite Rugby Union: Application of Global Positioning System Technology in Return-to-Running Programs

2013 ◽  
Vol 22 (2) ◽  
pp. 122-129 ◽  
Author(s):  
Laura C. Reid ◽  
Jason R. Cowman ◽  
Brian S. Green ◽  
Garrett F. Coughlan
Keyword(s):  
Outcome Measures ◽  
Sports Medicine ◽  
Case Series ◽  
Rugby Union ◽  
Return To Play ◽  
Physical Demands ◽  
Positioning Systems ◽  
Global Positioning ◽  
Game Environment ◽  
Gps Devices

Global positioning systems (GPS) are widely used in sport settings to evaluate the physical demands on players in training and competition. The use of these systems in the design and implementation of rehabilitation and return-to-running programs has not yet been elucidated.Objective:To demonstrate the application of GPS technology in the management of return to play in elite-club Rugby Union.Design:Case series.Setting:Professional Rugby Union club team.Participants:8 elite Rugby Union players (age 27.86 ± 4.78 y, height 1.85 ± 0.08 m, weight 99.14 ± 9.96 kg).Intervention:Players wore GPS devices for the entire duration of a club game.Main Outcome Measures:Variables of locomotion speed and distance were measured.Results:Differences in physical demands between playing positions were observed for all variables.Conclusions:An analysis of the position-specific physical demands measured by GPS provides key information regarding the level and volume of loads sustained by a player in a game environment. Using this information, sports-medicine practitioners can develop rehabilitation and return-to-running protocols specific to the player position to optimize safe return to play.

scholarly journals Resumption of sport after spinal fusion for adolescent idiopathic scoliosis: a review of the current literature

2021 ◽  
Author(s):  
Francesca Barile ◽  
Alberto Ruffilli ◽  
Marco Manzetti ◽  
Michele Fiore ◽  
Alessandro Panciera ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Spinal Fusion ◽  
Health Care Providers ◽  
Case Series ◽  
Return To Sport ◽  
Well Being ◽  
Return To Play ◽  
Current Evidence ◽  
Care Providers

Abstract Background Adolescent idiopathic scoliosis (AIS) is a frequent disorder. Since patients with AIS are typically as active as age-matched controls and post-operative reduction in physical activity has detrimental effects on their well-being, return to sport (RTS) is an important perioperative concern. Aim of the present study is to review the literature concerning return to sport after spinal fusion for AIS. Methods This work was carried out in accordance with Preferential Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search was carried out in December 2020. Only peer-reviewed randomized controlled trials (RCTs), retrospective studies (RS), retrospective case series (RCS) and perspective cohort studies (PCS) were considered for inclusion. Results Six studies were included; only one of them was prospective. All the authors reported a time to RTS ranging between 6 and 18 months. Between 28 and 36.6% of all patients changed sport, choosing lower impact activities, mostly due to loss of flexibility of the spine. No complications due to return to play were noted. Conclusion According to current evidence, patients who received spinal arthrodesis for AIS can safely return to any sport, even those that require extreme levels of spinal and pelvic movements such as gymnastics and golf. As there is little evidence, however, of the spinal loading that occurs during such movements, there is a lack of scientific evidence-based recommendations or guidelines surgeons and other health care providers can follow. Prospective comparative studies are needed to investigate these biomechanical and clinical issues. Level of evidence Level III.

scholarly journals Outcomes following surgical management of inguinal-related groin pain in athletes: a case series

2020 ◽  
Vol 7 (1) ◽  
pp. 103-108
Author(s):  
Michael Gerhardt ◽  
Josh Christiansen ◽  
Benjamin Sherman ◽  
Alejandro Miranda ◽  
William Hutchinson ◽  
...  
Keyword(s):  
Groin Pain ◽  
Surgical Intervention ◽  
Case Series ◽  
Return To Sport ◽  
Scar Tissue ◽  
Nerve Entrapment ◽  
Return To Play ◽  
Retrospective Case ◽  
Operative Findings

Abstract To determine the outcomes of a limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement of adhesions based on intraoperative findings. Retrospective case series. Outpatient orthopedic/general surgery clinic. Fifty-one athletes treated surgically for inguinal-related groin pain from 2009 to 2015. Limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement based on intra-operative findings. Ability to return to sport at the same level, time to return to play. Fifty-one athletes were included in the study with an average follow-up of 4.42 years (range 2.02–7.01). The average age was 24.2 years (range 16–49) and consisted of 94.0% males and 6.0% females. Nerve entrapment was demonstrated in 96.2% of cases with involvement of the ilioinguinal in 92.5%, the iliohypogastric in 30.8% and the genitofemoral in 13.2%. Attenuation of the posterior inguinal wall was present and repaired in 79.3% of cases. Scar tissue was present around the adductor origin and required debridement in 56.7% of cases. Forty-nine (96.1%) athletes returned to sport at the same level of play at an average of 5.9 weeks. Two athletes required a revision surgery. High rates of return to sport were achieved after surgery for inguinal-related groin pain that addresses the varying pathology and associated nerve entrapment.

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