scholarly journals Return to Preinjury Levels of Participation After Superior Labral Repair in Overhead Athletes: A Systematic Review

2015 ◽  
Vol 50 (7) ◽  
pp. 767-777 ◽  
Author(s):  
Aaron Sciascia ◽  
Natalie Myers ◽  
W. Ben Kibler ◽  
Timothy L. Uhl
Keyword(s):  
Soft Tissue ◽  
Surgical Procedures ◽  
Shoulder Surgery ◽  
Labral Repair ◽  
Odds Ratios ◽  
Rates Of Return ◽  
Overhead Athletes ◽  
Full Participation ◽  
Overhead Throwing ◽  
Labral Injury

Context Athletes often preoperatively weigh the risks and benefits of electing to undergo an orthopaedic procedure to repair damaged tissue. A common concern for athletes is being able to return to their maximum levels of competition after shoulder surgery, whereas clinicians struggle with the ability to provide a consistent prognosis of successful return to participation after surgery. The variation in study details and rates of return in the existing literature have not supplied clinicians with enough evidence to give overhead athletes adequate information regarding successful return to participation when deciding to undergo shoulder surgery. Objective To investigate the odds of overhead athletes returning to preinjury levels of participation after arthroscopic superior labral repair. Data Sources The CINAHL, MEDLINE, and SPORTDiscus databases from 1972 to 2013. Study Selection The criteria for article selection were (1) The study was written in English. (2) The study reported surgical repair of an isolated superior labral injury or a superior labral injury with soft tissue debridement. (3) The study involved overhead athletes equal to or less than 40 years of age. (4) The study assessed return to the preinjury level of participation. Data Extraction We critically reviewed articles for quality and bias and calculated and compared odds ratios for return to full participation for dichotomous populations or surgical procedures. Data Synthesis Of 215 identified articles, 11 were retained: 5 articles about isolated superior labral repair and 6 articles about labral repair with soft tissue debridement. The quality range was 11 to 17 (42% to 70%) of a possible 24 points. Odds ratios could be generated for 8 of 11 studies. Nonbaseball, nonoverhead, and nonthrowing athletes had a 2.3 to 5.8 times greater chance of full return to participation than overhead/throwing athletes after isolated superior labral repair. Similarly, nonoverhead athletes had 1.5 to 3.5 times greater odds for full return than overhead athletes after labral repair with soft tissue debridement. In 1 study, researchers compared surgical procedures and found that overhead athletes who underwent isolated superior labral repair were 28 times more likely to return to full participation than those who underwent concurrent labral repair and soft tissue debridement (P < .05). Conclusions The rate of return to participation after shoulder surgery within the literature is inconsistent. Odds of returning to preinjury levels of participation after arthroscopic superior labral repair with or without soft tissue debridement are consistently lower in overhead/throwing athletes than in nonoverhead/nonthrowing athletes. The variable rates of return within each group could be due to multiple confounding variables not consistently accounted for in the articles.

Epidemiology of Shoulder Surgery Among Professional Baseball Players

2019 ◽  
Vol 47 (5) ◽  
pp. 1068-1073 ◽  
Author(s):  
Peter N. Chalmers ◽  
Brandon J. Erickson ◽  
John D’Angelo ◽  
Kevin Ma ◽  
Anthony A. Romeo
Keyword(s):  
Rotator Cuff ◽  
Surgical Procedures ◽  
Return To Sport ◽  
Shoulder Surgery ◽  
Rotator Cuff Tears ◽  
Labral Repair ◽  
Professional Baseball ◽  
Baseball Players ◽  
Minor League ◽  
Major League

Background: Injuries remain a significant problem for professional baseball players. There is little information regarding the incidence and outcomes of shoulder surgical procedures among these athletes. Purpose/Hypothesis: To report the incidence, pathology, procedure type, demographics, and return-to-sport (RTS) rate of shoulder surgery among Major League Baseball (MLB) players. Most shoulder procedures would be performed on pitchers with a history of injury; the labrum would be the most commonly involved; and that the RTS rate would be >50%. Study Design: Descriptive epidemiology study. Methods: All MLB players who underwent surgery between 2012 and 2016 were identified from a database prospectively maintained by MLB. Demographic information and details regarding the procedure were recorded and RTS rates determined. Only those players with a minimum 2-year follow-up were included. Results: There were 581 shoulder procedures performed (542 players; pitchers, 60%; incidence, 1.48%). Overall, 19% of surgical procedures were performed on major league players and 81% on minor league players. Most players were between 20 and 25 years old. The majority of procedures were performed on the posterior and anterior labrum. Of these, 67% involved labral repair. Within rotator cuff surgery, 84% involved debridement; most tears were articular sided (87%); and 75% involved the supraspinatus. Overall, 11% of players had prior shoulder surgery, and 76% spent time on the disabled list before surgery. The overall rate of RTS was 63%. Of those who returned, 86% returned to at least the same level of play or higher as before surgery. Of those who returned to their prior level of play, 73% later ascended to a higher level of play or could not ascend to a higher level because they were already in the majors. Conclusion: Shoulder surgery is uncommon among professional baseball players. Of those players who require surgery, the majority are pitchers and minor league players. Most procedures involve the labrum. Rotator cuff tears are mostly articular-sided supraspinatus tears. The overall RTS rate is 63%. Of those who return, 86% are able to return to the same or higher level of play as before surgery.

Orthodontic Pre Grafting Closure of Large Alveolar Bony and Soft Tissue Gaps: A Novel Nonsurgical Protraction of the Lesser Segments in Growing Patients With Cleft Lip and Palate

2021 ◽  
pp. 105566562110076
Author(s):  
Maria Costanza Meazzini ◽  
Noah Cohen ◽  
Valeria Marinella Augusta Battista ◽  
Cristina Incorvati ◽  
Federico Biglioli ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Procedures ◽  
Efficient Method ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Soft Tissues ◽  
Cleft Lip And Palate ◽  
Face Mask ◽  
Younger Patients ◽  
Good Healing

Background: Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the dentoalveolar defect are challenging for the surgeon. Some authors successfully used interdental segmental distraction, which requires an additional surgical procedure. Objective: This study evaluates the effectiveness of tooth borne devices utilized to orthopedically advance the lesser segments, with a complete approximation of the soft tissue of the alveolar stumps, allowing traditional simultaneous soft tissue closure and bone grafting, and avoiding the need for supplementary surgery. Methods: Eight growing patients, 2 with unilateral complete cleft lip and palate (UCLP) and 6 with bilateral complete cleft lip and palate (BCLP), with large soft tissue and bony alveolar defects prior to bone grafting were prospectively selected. A banded rapid palatal expander (RPE) in BCLP and a modified RPE in UCLP combined with protraction face mask in younger patients or a modified Alt-Ramec in patients older than 12 years were applied. Radiographic and photographic records were available at T0, at the end of protraction (T1) and at least 1 year after bone grafting (T2). Results: Patients with large gaps showed a significant reduction in the bony cleft area and approximation of the soft tissues at T1. All patients received bone grafting with good healing and ossification at T2. Conclusion: In growing patients with UCLP and BCLP with large gaps, presurgical orthodontic protraction seems to be an efficient method to reduce the cleft defect, minimizing the risk of post grafting fistulas, reducing the need for supplementary surgical procedures.

Soft-tissue changes associated with different surgical procedures for treating class III patients

2014 ◽  
Vol 75 (4) ◽  
pp. 299-307 ◽  
Author(s):  
M. Ghassemi ◽  
A. Jamilian ◽  
J.R. Becker ◽  
A. Modabber ◽  
U. Fritz ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Procedures ◽  
Class Iii ◽  
Tissue Changes ◽  
Soft Tissue Changes

scholarly journals Ulnar Collateral Ligament Repair with Internal Brace Augmentation in Amateur Overhead Throwing Athletes

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0008 ◽  
Author(s):  
Jeffrey R. Dugas ◽  
Christopher A. Looze ◽  
Christopher Michael Jones ◽  
Brian L. Walters ◽  
Marcus A. Rothermich ◽  
...  
Keyword(s):  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Time Frame ◽  
Return To Play ◽  
Overhead Athletes ◽  
Late Failure ◽  
Internal Brace ◽  
Overhead Throwing ◽  
A Prospective Study

Objectives: There has been a renewed interest in UCL repair in overhead athletes. This is largely due to greater understanding of UCL pathology, improvement in fixation technology and the extensive rehab required to return from UCL reconstruction. Initial data regarding UCL repair in overhead athletes was poor and therefore UCL repair was largely abandoned in favor of reconstruction. However, recent literature examining UCL repair with anchor only fixation demonstrated an excellent rate of return to play, reduced time to return to play and a low complication rate. Based on this promising data, we have developed a novel technique of UCL repair with internal brace augmentation that we have used in overhead throwing athletes. We performed a prospective study evaluating the outcomes of this procedure with respect to return to play, time to return to play, functional outcome score and complications. Methods: Overhead athletes undergoing UCL repair with internal brace augmentation were prospectively followed for a minimum of one year. Patients were carefully selected from those who would traditionally be considered for UCL reconstruction. Initially, patients were considered if they had an avulsion of the UCL with otherwise healthy UCL tissue and had a vested interest in shortened rehab. As the study progressed, interest in shortened rehab became a less stringent criteria. Demographic and operative data were collected at the time surgery. This data was compiled for both desciption and comparison between subgroups. Patients were then contacted 1 year postoperatively and assessed for return to play, time to return to play and KJOC scores. Complications were documented and patients having complications were detailed. Results: 66 overhead athletes underwent UCL repair with internal brace augmentation during the study period. 8 were lost to follow up, leaving 58 athletes included in the study. Average age at the time of surgery was 17.9 years old. There were 43 baseball pitchers, 8 baseball position players, 4 softball players, 2 football quaterbacks, and 1 javelin thrower. 96% (54/56) of those who desired to return to the same or higher level of competition were able to do so at an average time of 6.1 months (range 3.2-12 months). 65% of these were able to return in less than 6 months. Many of those who took longer than 6 months did so due to timing within the season. Average KJOC score was 90.2 at 1-year follow-up. 3 patients required return to the operating room, 2 of which were eventually able to return to their previous level of play. There was 1 late failure over 3 years from the index procedure. Comparative subgroup data is presented in table 1. Conclusion: UCL repair with internal brace augmentation is a viable option for overhead throwers with selected UCL pathology who wish to return to sport in a shorter time frame than allowed by traditional UCL reconstruction. [Table: see text]

scholarly journals The sub-supraspinatus recess and superior labral motion: an arthroscopic analysis

2018 ◽  
Vol 11 (3) ◽  
pp. 199-203
Author(s):  
Martin Bouliane ◽  
Ryan Paul ◽  
Anelise Silveira ◽  
Rob Balyk ◽  
Lauren Beaupre ◽  
...  
Keyword(s):  
Range Of Motion ◽  
External Rotation ◽  
Labral Repair ◽  
Successful Outcome ◽  
Clinical Implications ◽  
Average Depth ◽  
Overhead Athletes ◽  
Static Measurement ◽  
Shoulder Motion ◽  
Minimal Information

Background Minimal information exists regarding the sub-supraspinatus recess superior to the labrum and inferior to the supraspinatus. Furthermore, movement of the superior labrum during glenohumeral range of motion has not previously been defined. The objectives of this arthroscopic study were to describe the (i) sub-supraspinatus recess dimensions and (ii) superior labral motion. Methods Forty-four patients were enrolled and underwent standardized arthroscopic assessment. Analysis consisted of static measurement of the sub-supraspinatus recess depth, as well as the amount of labral motion during passive shoulder motion. Labral movement was categorized relative to the glenoid rim (lateral to the rim, to the rim, or medial to the rim). Results All patients had a well-defined sub-supraspinatus recess varying from a depth of 0 mm to 5 mm ( n = 10; 22.7%), 5 mm to 10 mm ( n = 23; 52.3%) or >10 mm ( n = 11; 25%). External rotation in abduction demonstrated the greatest labral movement ( p < 0.001) with 28 (80%) shoulders moving medial to the rim. Conclusions The sub-supraspinatus recess is consistently present with an average depth of 5 mm to 10 mm. Superior labral motion is present in most patients and is most pronounced in external rotation in abduction. This finding likely has clinical implications for superior labral repair surgery, especially for overhead athletes and laborers who require external rotation in an abducted position for a successful outcome.

scholarly journals Incidence and Return to Play after Biceps Tenodesis in Major League Baseball Players

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0011 ◽  
Author(s):  
Peter Nissen Chalmers ◽  
Brandon J. Erickson ◽  
Nikhil N. Verma ◽  
Anthony A. Romeo
Keyword(s):  
Major League Baseball ◽  
Small Sample ◽  
Shoulder Surgery ◽  
Return To Play ◽  
Rate Of Return ◽  
Labral Repair ◽  
Professional Baseball ◽  
Biceps Tenodesis ◽  
Baseball Players ◽  
Major League

Objectives: Superior labral anterior-posterior (SLAP) tears are a common source of inability to play among baseball players of all levels. SLAP repair is unpredictable and thus biceps tenodesis (BT) has been proposed as an alternative. Furthermore, tenodesis may be indicated for pain isolated to the biceps tendon. The incidence of BT among professional baseball players is unknown, as are the rates of return to play (RTP). The purpose of this study was to determine RTP rates after BT among professional baseball players. Methods: Major League Baseball (MLB) has maintained a prospective database containing all major and minor league baseball players who have undergone shoulder surgery since 2010. Using this database we determined the incidence, demographics, position, prior surgical history, concomitant procedures, RTP rates, time to RTP, and performance upon RTP for professional baseball players following BT. Minimum follow-up was 2 years. Results: Between 2010 and 2013, 17 professional baseball players underwent BT, of which 71% were pitchers, and 29% were in the major league. Forty-seven percent had a history of prior shoulder surgery and 47% underwent concomitant labral repair. Overall RTP after BT was 35%. RTP for isolated BT was 44% in 0.8±0.5 years while RTP for those who underwent both BT and labral repair was 25% (p=0.620). All players who RTP were able to return to at least ten games at their pre-operative level of play. Return to professional play was significantly more common among position players than pitchers (80% vs. 17%, p=0.028). RTP was less common among players with prior shoulder surgery, but this was not statistically significant (56% vs. 13%, p=0.131). For those players who did RTP, pre-operative and post-operative performance was unchanged. Conclusion: Professional baseball players who undergo biceps tenodesis have a 35% rate of return to their prior level of play. While pitchers have only a 16% rate of return to play, position players have an 80% rate of return to play. Furthermore, 100% of those who returned to baseball played at least 10 games at their pre-operative level with no significant change in performance statistics. Professional baseball players who choose to undergo biceps tenodesis should be counseled regarding the low rates or return to play. Pitchers in particular may have a poor prognosis following tenodesis. However, given the small sample size and concomitant procedures, further study is needed before definitive conclusions can be made.

A Newly Designed Template Device for Use With the Insertion of Immediately Loaded Implants

2004 ◽  
Vol 30 (5) ◽  
pp. 325-329 ◽  
Author(s):  
Marco A. B. Pontual ◽  
JoséN. O. Freire ◽  
Dircilene C. Souza ◽  
Cimara F. Ferreira ◽  
Marco A. Bianchini ◽  
...  
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Bone Loss ◽  
Surgical Procedures ◽  
Therapeutic Approach ◽  
Soft Tissue Healing ◽  
Implant Placement ◽  
Tissue Healing ◽  
Edentulous Mandible ◽  
Fixed Prosthesis

Abstract This article describes a newly designed surgical template that was used to facilitate dental implant placement. The implants were planned to function by loading them immediately. A case report describing the device and the benefits of its use for a patient with an edentulous mandible is presented. Four implants were placed in the anterior region of the mandible to support an immediately fixed prosthesis. Clinical and radiographic analyses were conducted postoperatively to evaluate bone loss and peri-implant soft-tissue healing. The salutary results demonstrated the positive value of this therapeutic approach and presented the advantages of shorter treatment times, fewer patient visits, lower costs, and elimination of secondary surgical procedures.

scholarly journals The Comparison of Instrument-Assisted Soft Tissue Mobilization and Self-Stretch Measures to Increase Shoulder Range of Motion in Overhead Athletes: A Critically Appraised Topic

2018 ◽  
Vol 27 (4) ◽  
pp. 385-389 ◽  
Author(s):  
Matthew J. Hussey ◽  
Alex E. Boron-Magulick ◽  
Tamara C. Valovich McLeod ◽  
Cailee E. Welch Bacon
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Internal Rotation ◽  
Proper Function ◽  
Clinical Question ◽  
Bottom Line ◽  
Overhead Athletes ◽  
Shoulder Range Of Motion ◽  
Soft Tissue Mobilization ◽  
Shoulder Range

Clinical Scenario: Shoulder range of motion (ROM) in throwing athletes relies on a balance of mobility and stability to maintain proper function and health that, if disrupted, can lead to shoulder injury. There have been several studies that address the relationship between ROM deficits and overhead injuries; however, it may be unclear to clinicians which interventions are most effective for increasing ROM in the glenohumeral joints of overhead athletes. Clinical Question: In overhead athletes who have deficient shoulder ROM, is instrument-assisted soft tissue mobilization (IASTM) more effective at acutely increasing ROM over the course of a patient’s treatment when compared with self-stretching? Summary of Key Findings: A thorough literature review yielded 3 studies relevant to the clinical question, and all 3 studies were included. Two articles found a significant increase in acute ROM when compared with a self-stretch measure. All 3 articles showed increases in internal rotation and horizontal adduction, and 1 study reported an increase in total arc of shoulder ROM. Clinical Bottom Line: There is moderate evidence to support the use of IASTM to acutely increase ROM in the glenohumeral joint of overhead athletes. Clinicians should be aware of the variability with recommended treatment times; however, positive results have been seen with treatments lasting 5 to 6 minutes per treatment region. There is no consensus for treatment intensity, and certain IASTM tools require certification. Strength of Recommendation: Grade B evidence exists that IASTM is more effective at increasing shoulder ROM (ie, internal rotation, horizontal adduction, external rotation, total arc of motion) in overhead athletes than self-stretching measures.

Surgical procedures and prognostic factors for local recurrence of soft tissue sarcomas

2014 ◽  
Vol 19 (1) ◽  
pp. 141-149 ◽  
Author(s):  
Hideshi Sugiura ◽  
Yoshihiro Nishida ◽  
Hiroatsu Nakashima ◽  
Yoshihisa Yamada ◽  
Satoshi Tsukushi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Surgical Procedures ◽  
Soft Tissue Sarcomas

Soft tissue surgery using radiowave techniques

1997 ◽  
Vol 87 (3) ◽  
pp. 131-135 ◽  
Author(s):  
DF Hettinger
Keyword(s):  
Soft Tissue ◽  
Surgical Procedures ◽  
Electrical Current ◽  
Electromagnetic Spectrum ◽  
Surgical Instrument ◽  
Soft Tissue Surgery

Numerous types of soft tissue surgical procedures can be performed using radiowave techniques. The Ellman International Surgitron is a versatile surgical instrument capable of making incisions, excisions, dessication, and coagulation. It converts electrical current into controlled energy in the radiowave frequency of the electromagnetic spectrum. Surgeons can then choose from three surgical currents based on the results they desire.

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