scholarly journals There is a high return to sport rate but with reduced career lengths after Achilles tendon repair in Major League Soccer players

2019 ◽  
Vol 4 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Kyle R Sochacki ◽  
Robert A Jack II ◽  
Takashi Hirase ◽  
Patrick C McCulloch ◽  
David M Lintner ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Repair ◽  
Return To Sport ◽  
Level Of Evidence ◽  
Postoperative Performance ◽  
Achilles Tendon Repair ◽  
Major League Soccer ◽  
Major League ◽  
And Performance

ObjectivesTo determine (1) return to sport (RTS) rate in Major League Soccer (MLS) players following Achilles tendon repair, (2) postoperative career length and games per season, (3) preoperative and postoperative performance, and (4) postoperative performance compared with control players matched by position, age, body mass index, sex, years of experience and performance.MethodsPublicly available records were used to identify MLS players who underwent Achilles tendon repair with a minimum of 1 year follow-up. Demographic and performance data were collected for each player. Matched controls were identified. RTS was defined as playing in one or more MLS games after surgery. Comparisons between case and control groups and preoperative and postoperative time points were made using paired sample Student’s t-tests.ResultsTwenty-two players (mean age 28.4±4.0 years; mean 3.0±2.2 years follow-up) and 23 Achilles tendon repairs (one bilateral repair) were analysed. Seventeen players (18 Achilles tendon repairs; 77.3%) were able to RTS in the MLS at mean 306.6±199.2 days. Players who RTS after repair had shorter careers than matched controls (2.5±2.2 vs 4.5±3.0 seasons, respectively; p=0.021). Additionally, players who RTS after repair played in fewer games per season than matched controls (13.4±8.4 vs 23.2±6.5, respectively; p<0.001). There was no significant decrease in performance postsurgery compared with presurgery.ConclusionThere is a 77.3% RTS rate in the MLS following Achilles tendon repair. Following repair, players had shorter careers and played fewer games per season than matched controls. There was no significant decrease in performance postsurgery compared with presurgery nor in postsurgery compared with postindex. A significantly greater number of Achilles tendon tears occurred in the left versus the right lower extremity.Level of evidenceLevel III.

scholarly journals Performance and Return to Sport After Hip Arthroscopic Surgery in Major League Baseball Players

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982583 ◽  
Author(s):  
Robert A. Jack ◽  
Kyle R. Sochacki ◽  
Takashi Hirase ◽  
Justin Vickery ◽  
Patrick C. McCulloch ◽  
...  
Keyword(s):  
Major League Baseball ◽  
Statistical Significance ◽  
Arthroscopic Surgery ◽  
Return To Sport ◽  
Control Group ◽  
P Value ◽  
Postoperative Performance ◽  
Significant Difference ◽  
Major League ◽  
And Performance

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain that may lead to decreased performance in Major League Baseball (MLB) players. Purpose: To determine the (1) return-to-sport (RTS) rate in MLB players after hip arthroscopic surgery for FAI; (2) postoperative career length, innings pitched (IP) (pitchers), and plate appearances (PA) (position players); (3) preoperative and postoperative performance; and (4) postoperative performance compared with control players matched by position, age, years of experience, and performance. Study Design: Cohort study; Level of evidence, 3. Methods: MLB athletes who underwent hip arthroscopic surgery for FAI and matched controls were identified. Demographic and performance data were collected. RTS was defined as playing in at least 1 MLB game after surgery. Continuous variables of each group were compared using a 2-tailed paired-samples Student t test for normally distributed data. The chi-square test was used to analyze categorical data. The Bonferroni correction was used to control for multiple comparisons, with statistical significance defined by a P value of ≤.007. Results: A total of 50 players (57 surgeries) were analyzed (mean age, 30.4 ± 3.9 years; mean MLB experience at the time of surgery, 7.0 ± 4.6 years). Pitchers (31 surgeries; 54.4%) represented the largest proportion of players analyzed. Of these players, 42 (47 surgeries; 82.5%) were able to RTS at a mean of 8.3 ± 4.1 months. The overall 1-year MLB career survival rate of players undergoing FAI surgery was 78.9%. Players in the control group were in MLB a similar number of years (4.0 ± 2.9 years) to players who underwent surgery (3.3 ± 2.4 years) ( P > .007). There was no significant decrease in IP or PA per season after surgery ( P > .007). There was no significant difference in performance for pitchers and nonpitchers compared with matched controls after surgery ( P > .007). Conclusion: The RTS rate for MLB athletes after hip arthroscopic surgery for FAI was high. There were similar IP, PA, and career lengths postoperatively compared with preoperatively and with matched controls. There was no significant difference in performance for pitchers and nonpitchers compared with matched controls after surgery.

Letter Regarding: Performance and Return to Sport After Achilles Tendon Repair in National Football League Players

2018 ◽  
Vol 39 (1) ◽  
pp. 130-130 ◽  
Author(s):  
Robert Anderson ◽  
Michael Coughlin ◽  
James Jastifer ◽  
Kirk McCullough
Keyword(s):  
Achilles Tendon ◽  
National Football League ◽  
Tendon Repair ◽  
Return To Sport ◽  
Achilles Tendon Repair

Performance and Return to Sport After Tommy John Surgery Among Major League Baseball Position Players

2018 ◽  
Vol 46 (7) ◽  
pp. 1720-1726 ◽  
Author(s):  
Robert A. Jack ◽  
Matthew B. Burn ◽  
Kyle R. Sochacki ◽  
Patrick C. McCulloch ◽  
David M. Lintner ◽  
...  
Keyword(s):  
Major League Baseball ◽  
Return To Sport ◽  
High Rate ◽  
Position Change ◽  
Level Of Evidence ◽  
Valgus Stress ◽  
Postoperative Performance ◽  
Career Length ◽  
Major League ◽  
Tommy John

Background: The anterior bundle of the medial ulnar collateral ligament (UCL) is the primary restraint to valgus stress at the elbow and is often injured among overhead throwing athletes. Despite prevention strategies, injuries to the elbow UCL are on the rise. Purpose: To determine (1) the return-to-sport (RTS) rate of Major League Baseball (MLB) position players after elbow medial UCL reconstruction, (2) postoperative career length and games per season, (3) pre- and postoperative performance, (4) postoperative performance versus matched control players, and (5) whether position players changed positions after UCL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: MLB players who underwent elbow UCL reconstruction were identified (cases). Demographic and performance data were collected for each player. Matched controls were identified. RTS in MLB was defined as playing in at least 1 MLB game after UCL reconstruction. Comparisons between case and control groups and pre- and postoperative time points were made via paired samples Student t tests. Results: Thirty-three players (34 surgical procedures) were identified with a mean ± SD age of 30.2 ± 4.2 years and a mean experience in the MLB of 6.3 ± 3.9 years at the time of surgery. Twenty-eight players (84.8%) were able to RTS in MLB at a mean 336.9 ± 121.8 days. However, players ≥30 years old demonstrated a significantly lower RTS rate (53.3%) than players <30 years old (89.4%; P < .05). Catchers had a significantly shorter postoperative career length (2.8 ± 1.8 years) versus matched controls (6.1 ± 1.9 years; P < .05). Outfielders had a significantly lower wins above replacement postoperatively (0.8 ± 0.7) versus preoperatively (1.5 ± 1.1; P < .05). There were no performance differences between cases and matched controls. Twelve players (48%) returned to a different position postoperatively. Conclusion: The RTS rate for MLB position players after elbow UCL reconstruction is similar to that of pitchers. Catchers had a significantly shorter career length than that of matched controls. Outfielders performed worse postoperatively versus preoperatively. There is a high rate of position change after Tommy John surgery for infielders and outfielders.

scholarly journals Electromyographic Evidence of Excessive Achilles Tendon Elongation During Isometric Contractions After Achilles Tendon Repair

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988335
Author(s):  
Malachy P. McHugh ◽  
Karl F. Orishimo ◽  
Ian J. Kremenic ◽  
Julia Adelman ◽  
Stephen J. Nicholas
Keyword(s):  
Achilles Tendon ◽  
Muscle Fiber ◽  
Fourier Transforms ◽  
Maximum Voluntary Contraction ◽  
Tendon Repair ◽  
Case Series ◽  
Medial Gastrocnemius ◽  
Level Of Evidence ◽  
Achilles Tendon Repair ◽  
Tendon Elongation

Background: Weakness in end-range plantarflexion has been demonstrated after Achilles tendon repair and may be because of excessive tendon elongation. The mean frequency (MNF) of surface electromyogram (EMG) data during isometric maximum voluntary contraction (MVC) increases with muscle fiber shortening. Hypothesis: During isometric plantarflexion, MNF during MVCs will be higher on the involved side compared with the uninvolved side after Achilles tendon repair because of excessive tendon elongation and greater muscle fiber shortening. Study Design: Case series; Level of evidence, 4. Methods: Isometric plantarflexion MVC torque was measured at 20° and 10° dorsiflexion, neutral, and 10° and 20° plantarflexion in 17 patients (15 men, 2 women; mean age, 39 ± 9 years) at a mean 43 ± 26 months after surgery. Surface EMG signals were recorded during strength tests. MNF was calculated from fast Fourier transforms of medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) EMG signals. Results: Patients had marked weakness on the involved side versus the uninvolved side in 20° plantarflexion (deficit, 28% ± 18%; P < .001) but no significant weakness in 20° dorsiflexion (deficit, 8% ± 15%; P = .195). MNF increased when moving from dorsiflexion to plantarflexion ( P < .001), but overall, it was not different between the involved and uninvolved sides ( P = .195). However, differences in MNF between the involved and uninvolved sides were apparent in patients with marked weakness. At 10° plantarflexion, 8 of 17 patients had marked weakness (>20% deficit). MNF at 10° plantarflexion was significantly higher on the involved side versus the uninvolved side in patients with weakness, but this was not apparent in patients with no weakness (side by group, P = .012). Mean MNF at 10° plantarflexion across the 3 muscles was 13% higher on the involved side versus the uninvolved side in patients with weakness ( P = .012) versus 3% lower in patients with no weakness ( P = .522). Conclusion: Higher MNF on the involved side versus the uninvolved side in patients with significant plantarflexion weakness is consistent with greater muscle fiber shortening. This indicates that weakness was primarily because of excessive lengthening of the repaired Achilles tendon. If weakness was simply because of atrophy, a lower MNF would have been expected and patients would have had weakness throughout the range of motion. Surgical and rehabilitative strategies are needed to prevent excessive tendon elongation and weakness in end-range plantarflexion after Achilles repair.

scholarly journals Functional Outcomes and MRI Results Following Knotless Repair of Acute Achilles Tendon Ruptures

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Brian D. Steginsky ◽  
Mallory Suhling ◽  
Eric Giza ◽  
Christopher D. Kreulen ◽  
B. Dale Sharpe ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Achilles Tendon ◽  
Functional Outcomes ◽  
Tendon Repair ◽  
Surgical Techniques ◽  
Wound Complications ◽  
Distal Stump ◽  
Achilles Tendon Repair ◽  
Tendon Ruptures

Category: Ankle; Sports Introduction/Purpose: The surgical techniques for primary repair of acute Achilles tendon ruptures have evolved from large open incisions to mini-open and percutaneous techniques. Studies have demonstrated that lesser invasive surgical techniques may reduce the risk of post-operative wound complications. Knotless surgical repair of acute Achilles tendon ruptures can be performed through a mini-incision, but still permits a robust re-approximation of the tendon stumps and decreases suture burden through distal anchor fixation in the calcaneus. However, stress shielding and subsequent tendinosis of the distal tendon stump is a theoretical concern with this surgical technique. We hypothesize that our surgical technique allows for a durable repair through a minimally invasive approach, permitting a safe and accelerated rehabilitation protocol, excellent functional outcomes, and absence of distal stump tendinosis. Methods: A multicenter retrospective chart review was performed to identify all patients that underwent primary Achilles tendon repair using a knotless surgical technique with a minimum of one-year follow-up from three orthopedic foot and ankle surgeons’ practices. Exclusion criteria included: age <18, chronic Achilles tendon ruptures (>4 weeks), insertional Achilles tendon ruptures, revision Achilles surgery, peripheral neuropathy, and systemic inflammatory disease. All patients were contacted by phone and asked to return to the office for an MRI, clinical examination, and completion of functional outcome questionnaires. The primary outcome measure was the validated Achilles Tendon Total Rupture Score (ATRS). Secondary outcomes included the Visual Analog Score (VAS), postoperative complications, ankle range of motion, calf circumference, and single-heel rise. MRI was used to assess tendon continuity and healing, tendinosis, muscle atrophy, and bone marrow edema/stress fracture associated with anchor fixation in the calcaneus. MRI interpretation was performed by a single, blinded musculoskeletal radiologist. Results: Forty-three patients were identified with acute Achilles tendon ruptures. There were 36 patients (36/43, 84%) who underwent knotless Achilles tendon repair and agreed to participate in the study. The average time to clinical follow-up was 23.5 months (SD±16.3). The mean postoperative ATRS was 84.6 (SD±19.7). There was no significant difference in calf circumference (p=0.22), dorsiflexion (p=0.07), and plantarflexion (p=0.11) between the unaffected and surgical extremity at latest follow-up. One patient (1/36, 2.8%) experienced a re-rupture. There were no wound complications or neuritis. MRI was obtained in 26 patients (26/36, 72.2%) at an average of 17.5 months (SD±10.1). There were no MRI findings of distal stump tendinosis or calcaneal stress fractures. Thirty-two patients (32/36, 88.8%) returned to the same athletic activities one-year after surgery. Conclusion: There is paucity in the literature on functional outcomes following knotless Achilles tendon repair. In this multicenter study, we found that validated functional outcome scores and return to activity were similar to historical controls, with a low rate of surgical complications. MRI obtained in twenty-six patients (72.2%) at 17.5 months demonstrated an intact tendon without distal tendon stump stress shielding or calcaneal stress fracture. The knotless Achilles tendon repair is a unique surgical technique, minimizing suture burden and postoperative complications, while offering excellent functional outcomes and return to activity at two-year follow-up. The excellent clinical outcomes are corroborated by MRI.

Retrospective Analysis of Mini-Open Repair Versus Open Repair for Acute Achilles Tendon Ruptures

2012 ◽  
Vol 6 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Erin E. Klein ◽  
Lowell Weil ◽  
Jeffrey R. Baker ◽  
Lowell Scott Weil ◽  
Wenjay Sung ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Open Repair ◽  
Surgical Intervention ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Level Of Evidence ◽  
Tendon Ruptures ◽  
Return To Activity ◽  
Mini Open

Purpose: Debate exists over optimal treatment for acute Achilles tendon ruptures. Recent literature suggests the mini-open technique may provide the reliability of the open repair with the decreased complication rate of non-operative treatment. This retrospective review compares acute tendon ruptures treated with one of two techniques: open repair (TO) or mini-open repair (MOA). Methods & Results: Records were reviewed and 34 patients were found to meet the inclusion criteria for open or mini-open repair of an acute Achilles tendon rupture with follow up of at least 12 months. TO (n=16) and MOA (n=18) had no statistically significant differences in age at time of injury [TO: 41 + 2.5 years (range 20 – 68); MOA: 46 + 2.5 years (range 33 – 73)] or time between injury and surgical repair [TO: 15 + 2 days (range 2 – 30); MOA: 15 + 2 days (range 2 – 30)]. Post-operative VISA-A scores were 82 + 10 (range 42 – 98) and 92 + 5 (range 66 – 100) for TO and MOA, respectively. Significant differences were found in the time between surgical intervention and beginning of rehabilitation [TO: Post op day 37 + 5 (range 21 – 46); MOA: Post op day 19 + 2 (range 7 – 32)] and the time between surgical intervention and full return to activity [TO: Post op month 7 + 1 (range 4 – 11); MOA: Post op month 5 + 0.6 (range 4 – 11)]. Conclusion: These results suggest that the mini-open repair provides acceptable surgical outcomes while optimizing patient function after Achilles tendon repair. Level of Evidence: Therapeutic, Level III: Retrospective Comparative

scholarly journals Clinical Outcomes and Cadaveric Biomechanical Analysis of Endoscopic Percutaneous Achilles Tendon Rupture Repair With Absorbable Suture

2020 ◽  
Vol 5 (4) ◽  
pp. 247301142096596
Author(s):  
Daniel Carpenter ◽  
Katherine Dederer ◽  
Paul Weinhold ◽  
Joshua N. Tennant
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Return To Sport ◽  
Biomechanical Analysis ◽  
Absorbable Suture ◽  
Operative Repair ◽  
Repair Technique ◽  
Achilles Tendon Repair

Background: Percutaneous repair of acute Achilles tendon rupture (ATR) continues to gain in popularity. The primary aim of the study was to review the outcomes of a patient cohort undergoing a novel technique of endoscopic percutaneous Achilles tendon repair with absorbable suture. A secondary purpose of this study was to evaluate the basic biomechanical properties of the technique. Methods: A cohort of 30 patients who underwent percutaneous ATR repair was retrospectively analyzed with Achilles Tendon Rupture Scores (ATRS), complications, and additional outcome measures. For a biomechanical analysis portion of the study, 12 cadaveric specimens were paired and randomized to either novel percutaneous repair or open Kessler repair with absorbable suture. These specimens were subjected to 2 phases of cyclical testing (100 cycles 10-43 N followed by 200 cycles 10-86 N) and ultimate strength testing. Results: In the clinical portion of the study we report excellent patient reported outcomes (mean ATRS 94.1), high level of return to sport, and high patient satisfaction. One partial re-rupture was reported but with no major wound or neurologic complications. In the biomechanical portion of the study we found no significant difference in tendon gapping between percutaneous and open repairs in phase 1 of testing. In phase 2, increased gapping occurred between percutaneous (17.8 mm [range 10.7-24.1, SD 6.4]) and open repairs (10.8 mm [range 7.6-14.9, SD 2.7, P = .037]). The ultimate load at failure was not statistically different between the 2 repairs. Conclusions: A percutaneous ATR repair technique using endoscopic assistance and absorbable suture demonstrated low complications and good outcomes in a cohort of patients, with high satisfaction, and excellent functional outcomes including high rates of return to sport. Cadaveric biomechanical testing demonstrated excellent survival during testing and minimal increase in gapping compared with open repair technique, representing sufficient strength to withstand forces seen in early rehabilitation. A percutaneous Achilles tendon repair technique with absorbable suture may minimize risks associated with operative repair while still maintaining the benefit of operative repair. Level of Evidence: Level IV, retrospective case series.

scholarly journals Value of Supine Positioning in Repair of Achilles Tendon Ruptures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0040
Author(s):  
Ryan Rogero ◽  
David Beck ◽  
Kristen Nicholson ◽  
Rachel Shakked ◽  
David Pedowitz ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Operating Room ◽  
Functional Outcomes ◽  
Short Form ◽  
Tendon Repair ◽  
Optimal Method ◽  
Achilles Tendon Repair ◽  
Procedure Cost ◽  
Tendon Ruptures

Category: Hindfoot Introduction/Purpose: The optimal method of Achilles tendon repair remains undefined. Few previous studies have quantified the financial expenses of Achilles tendon repairs in relation to functional outcomes in order to assess the overall value of the accepted repair techniques. The purpose of this study is to demonstrate the value of supine positioning during open repair (OS) of acute Achilles tendon ruptures through the quantification of operative times, costs, and outcomes in comparison to the commonly performed percutaneous prone (PP) repair technique. Methods: A retrospective review was conducted on 67 patients undergoing OS and 67 patients undergoing PP primary Achilles tendon repair with two surgeons at four surgical locations. Total operating room usage times and operating times were collected from surgical site records. Total operating room times were used to estimate the costs of room usage and anesthesia, while costs of repair equipment were collected from the respective manufacturers. Patients undergoing OS repair completed the Foot and Ankle Ability Measure (FAAM) questionnaire, with activities of daily living (ADL) and sports subscales, Short Form-12 (SF-12), with mental (MCS) and physical (PCS) health subcategories, and the visual analog scale (VAS) for pain preoperatively and at final follow-up. Results: Even with a significantly longer mean surgical time (P=.035), OS repairs had a shorter duration of total operating room time when compared to that of PP repairs (58.4 versus 69.7 minutes, P<.001). Estimated time-dependent costs were lower in OS repairs ($739 versus $861 per procedure, P<.001), while the estimated average total per procedure cost was also lower for OS repairs ($801 versus $1,910 per procedure, P<.001). For patients undergoing OS repair, FAAM-ADL (P<.001), FAAM-Sports (P<.001), SF-12-PCS (P<.001) all increased and VAS grades (P<0.001) decreased from time of initial encounter to final follow-up and were comparable to reported outcomes in the current literature. The complication rate in OS repairs (6.0%) was lower than PP repairs (11.9%), with revisions only occurring in the latter technique. Conclusion: Performing open Achilles tendon repair in the supine position offers substantial value, or “health outcomes achieved per dollar spent”, to providers due to decreased total operating room times and costs with satisfactory functional outcomes.

Return-to-Sport Time and Postoperative Performance in MLB Players Undergoing Wrist Arthroscopy

Hand ◽  
2021 ◽  
pp. 155894472110289
Author(s):  
Erin I. Orozco ◽  
Andrea E. Guloy ◽  
Michael O. Cotton ◽  
Robert A. Jack ◽  
Shari R. Liberman
Keyword(s):  
Major League Baseball ◽  
Return To Sport ◽  
Wrist Arthroscopy ◽  
Baseball Players ◽  
Postoperative Performance ◽  
Paired Samples ◽  
Significant Difference ◽  
Major League ◽  
Performance Statistics ◽  
And Performance

Background: Wrist injuries are common in sports and can result in prolonged time missed from playing. This study aimed to determine in Major League Baseball-players after arthroscopic wrist surgery the return-to-sport (RTS) rate, postoperative career length, and changes in performance compared with preoperative statistics and matched controls. Methods: Major League Baseball players who underwent arthroscopic wrist surgery from 1990 to 2019 were identified. Demographic and performance data were collected for each player, and matched controls were identified. Comparisons were made via paired samples Student t tests. Results: Twenty-six players (27 surgeries) were identified. The average age of included players was 28.9 ± 2.9 years with an average professional experience of 5.2 ± 3.4 years. Eighty-four percent of players returned to sport, with an average RTS time of 5.0 ± 2.7 months. A statistically significant ( P < .05) decrease was seen in preoperative and postoperative runs scored per season (95.6 ± 91.3 vs 41.0 ± 29.5), batting average (BA) (0.270 ± 0.024 vs 0.240 ± 0.036), and average wins above replacement (WAR) (1.5 ± 1.1 vs 0.8 ± 0.9). Conclusion: Major League Baseball players who underwent arthroscopic wrist surgery had an RTS rate of 84% at a mean time of 5.0 months. There was no significant difference in performance statistics between cases postoperatively and matched controls overall, with some differences in performance found when categorized by position. However, a significant decrease in performance among case players was observed between preoperative and postoperative performance, including runs per season, BA, and WAR.

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