Jan 29, 2015
Validation for Reconstruction

By Abigail Funk

Recent research shows a rise in long-term satisfaction in patients recovering from anterior cruciate ligament (ACL) and ulnar collateral ligament reconstruction (Tommy John) surgeries. The studies were among the highlights of the 2010 American Academy of Orthopaedic Surgeons (AAOS) annual meeting held in New Orleans.

Surgeries Proving Successful
The AAOS meeting’s specialty day featured scientific works from organizations like the American Orthopaedic Society for Sports Medicine. Two recent studies showed evidence of a rise in patient satisfaction after two common reconstruction procedures.

The first study had researchers checking in with 90 male patients 15 years after they underwent ACL reconstruction. It was found that 84 percent of the patients who underwent surgery that used a patellar tendon graft were still very active in athletics 15 years post-procedure.

“We have done this procedure for many years and this study looks at patients as far back as 17 years,” Leo Pinczewski, MD, told Medical News Today. “The results of this technique, which was new almost 20 years ago, were excellent at five years, outstanding at 10 years and still very, very good at 15 years. Patients went back to sport quickly, had an easy rehabilitation with no brace and were frequently walking straight away.”

In a smaller study, 20 high school baseball pitchers who underwent Tommy John elbow reconstruction were asked about their satisfaction level post-surgery, and 19 of them said they were either “very satisfied” or “somewhat satisfied” with the outcome. Eighteen of the 19 surveyed pitchers also returned to play at the high school, collegiate, or minor league level.

“High school kids have been a grey zone for this surgery,” Michael Angel, MD, told Medical News Today. “Obviously, surgeons would avoid surgery on young patients whose growth plates had not closed. But this study can give surgeons the confidence to recommend this surgery to teenage skeletally mature athletes. It also gives teens and their parents assurance that the surgery should go well.”

Youth Arm Injuries On The Rise
Though surgeons were pleased to hear the Tommy John procedure get rave reviews, they continue to try to find ways to combat arm injuries seen in young baseball players. One research study presented over the weekend showed evidence that a quarter of youth (eight to 12 year-old) players experience elbow pain–the majority of them being pitchers.

“… And nearly 15 percent sustain osteochodral lesions per year and pitchers have the highest rate of osteochondral lesions,” Tetsuya Matsuura, MD, told PR Newswire. “If overuse injuries such as osteochrondral lesions occur, prompt diagnosis and treatment can prevent this injury from causing long-term damage. Better awareness and education among parents, players and especially coaches about risk factors can help prevent these injuries.”

One tactic thought to prevent arm injuries is stretching. An orthopaedic surgeon from Houston found that the posterior capsular stretch helped almost 97 percent of the 1,267 youth baseball players in his study see improvements in shoulder pain. Many surgeons also support current youth league pitch count limits, and encourage parents and coaches to review them regularly.

“A young athlete should never throw through pain or continue to pitch when he or she is obviously fatigued,” George Paletta, Jr., MD, told PR Newswire. “Additionally, parents should familiarize themselves with the recommended single game, weekly and season total pitch counts, suggested recovery times, and recommended ages for learning various pitches.”

Surgery vs. No Surgery
Just because the AAOS is comprised of orthopaedic surgeons doesn’t mean the society always presents surgery as the best option to its patients. The latest case in point: Achilles tendon treatments.

A randomized trial presented at the meeting showed that both surgical and non-surgical treatments were similarly effective in Achilles tendon injury recovery.

Ninety-seven patients with first-time midsubstance ruptures either had surgery within 72 hours of their injury or did not. Both groups had their injured feet put in a cast for two weeks, then spent another six weeks in an adjustable brace that allowed some movement of the foot. Finally, all the patients participated in rehabilitation programs.

Within one year post-injury, 12 percent of the injured patients who did not have surgery experienced re-rupture, and four percent of the patients who did have surgery had a re-rupture, which was determined to be an insignificant difference between the two groups. Though the patients who had surgery saw improved function faster than those who did not, at one year post-injury, both groups of patients had similar function.

Understanding Ankle Sprains
In what presenters said is the largest completed U.S. study examining ankle sprains, new clues shed a light on this injury that affects people of all ages and lifestyles, including thousands of competitive athletes. Researchers studied over 80,000 emergency room ankle sprains from 2002 to 2006, and found following themes:

•Two in every 1,000 people were treated in emergency rooms for ankle sprains each year.
•The risk varied greatly by age, reaching a peak of seven in 1,000 among 15 to 19 year-olds.
•Forty-nine percent of sprains occurred during athletic activities.
•Forty percent of those were linked to basketball.
•Males and females had almost identical sprain rates, but males under age 30 were at a higher risk than females of the same age, while females over age 30 were at a higher risk than males of the same age.

Researchers said that while ankle sprains can vary greatly in seriousness, no matter how little it hurts, it’s worth resting. They also noted that other studies have shown evidence of just one ankle sprain setting the body up for long-term weakness, pain, and repeat injury.

Abigail Funk is an Assistant Editor at Training & Conditioning.

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