Hassebrock, Jeffrey D

Purpose To use the National Collegiate Athletic Association Injury Surveillance Program (NCAA‐ISP) from the 2009‐2010 through the 2014‐2015 seasons to report lumbar spine injury rates, characteristics, and time lost from sport in soccer players. Methods Characteristics of lumbar spine injuries by season, competition/practice, and time lost from sport were determined using the NCAA‐ISP database. Rates of injury were calculated as the number of injuries divided by the number of athlete exposures (AEs). AEs are any athlete participation in a competition or practice. Incidence rate ratios (IRRs) were calculated to compare rates between event types and time of season. Injury proportion ratios (IPRs) were used to evaluate differences in injury rates between men and women. Results The NCAA‐ISP estimated 4,464 LSIs over 5 years. The rate of LSI in men was 2.1/10,000 AEs and 3.0/10,000 AEs in women. Women were 1.43 times more likely to suffer an LSI compared to men. Women were 2.15 times as likely to suffer an LSI in competition compared to in practice while men were 1.10 times as likely. Women were 2.15 times as likely to be injured in the preseason compared to the regular season, while men were 3.76 times as likely. Non‐contact injuries were the most common cause of lumbar spine injuries (LSIs) in men (35%); however, contact injuries were more common in women (33%). Most athletes both male (57%) and female (59%) returned to play within 24 hours. Conclusion This study provides information on the characteristics of LSIs in NCAA soccer. The overall injury rate to the lumbar spine is relatively low. Injury rates are highest in the preseason and in competition. Women suffer from more recurrent LSI’s than men, and men acquired more injuries through non‐contact mechanisms. More than one‐half of athletes returned to sport within 24 hours.

Purpose To systematically review the literature to examine current understanding of the meniscofemoral ligaments (MFLs), their function, their importance in clinical management, and known anatomical variants. Methods A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines using PubMed, EMBASE, and Cochrane databases. Studies were included if they reported on the biomechanical, radiographic, or arthroscopic evaluation of human MFLs, or if they reported on an anatomical variant. These were then categorized as cadaveric, radiographic, or clinical. Biomechanical, radiographic, patient‐reported, and functional outcomes data were recorded. Results Forty‐seven studies were included in the qualitative analysis, and 26 of them were included in the quantitative analysis. Of these, there were 15 cadaveric, 3 arthroscopic, and 9 radiographic studies that reported on the prevalence of MFLs. Overall, when looking at all modalities, the presence of either the anterior or posterior MFL (aMFL, pMFL) has been noted to be 70.8%, with it being the aMFL 17.4% and the pMFL 40.6%. The presence of both ligaments occurs in approximately 17.6% of individuals. Eleven reported on mean MFL length and thickness. When evaluating mean length in both men and women, the aMFL has been reported between 21.6 and 28.3 mm and the pMFL length in this population is between 23.4 and 31.2 mm. Five reported on cross‐sectional area. Nine additional papers report anatomical variants. Conclusions This review shows that there continues to be a variable incidence of MFLs reported in the literature, but our understanding of their function continues to broaden. A growing number of anatomic and biomechanical studies have demonstrated the importance of the MFLs in supporting knee stability. Specifically, the MFLs serve an important role in protecting the lateral meniscus and augmenting the function of the posterior cruciate ligament. Clinical Relevance Our findings will aid the clinician in both identifying and treating pathologies of the meniscofemoral ligaments.

Background: Recent literature has suggested that capsular closure following hip arthroscopy restores native hip-joint kinematics and may lead to better patient-reported outcomes, especially in high-level athletes 1–4 . Description: Capsular closure of the hip occurs following standard hip arthroscopy, which typically includes labral repair and osteoplasty of the femoral neck and/or acetabulum accessed through an interportal capsulotomy. Viewing through an anterolateral portal with use of a 70° scope, a suture-passing device loaded with a #2 FiberWire (Arthrex) is passed down into the mid-anterior portal. The suture is then passed through the anterior aspect of the proximal leaflet of the capsulotomy. The suture-passing device is then passed through the distal leaflet, and the previously passed suture is grasped and brought out of the cannula. The capsular bites are typically made 1 cm from the edge of the capsule. This process is repeated 1.5 cm posteriorly to the initially placed suture. Typical capsular closure takes 2 to 3 sutures for complete closure. Once the sutures are passed, they are tied with use of half-hitches and excess suture is cut. Alternatives: Alternatives include capsular plication, which is more frequently performed in the setting of capsular laxity preoperatively or connective-tissue disorders 5,6 . Additionally, there is evidence suggesting that leaving the capsulotomy unrepaired may lead to similar results in select populations 7 . Rationale: This procedure is performed largely secondary to the restoration of native anatomy and kinematics of the hip joint 3,8 . Arthroscopy of the hip requires a capsulotomy in order to access the joint, unlike other, more superficial joints such as the shoulder. Capsular closure is often technically challenging and adds length to the procedure. However, recent literature has shown improved patient-reported outcomes with routine capsular closure specifically among high-level athletes 9,10 . Expected Outcomes: Routine capsular closure has been associated with good mid-term patient-reported outcomes 10 . Patients who undergo hip arthroscopy and routine capsular closure can expect to meet the minimal clinically important difference and the patient acceptable symptomatic state for the modified Harris hip score and the Hip Outcome Score Activities of Daily Living component. Patients who participate in high-level sports activities may experience a quicker return to play and more normal kinematics with routine capsular closure. Important Tips: Clear off the capsule immediately following the capsulotomy. Utilize an over-the-top view to better visualize the capsule. Place the sutures from anterior to posterior.

Purpose To describe and compare the epidemiology of lumbar spine injuries (LSIs) in women’s and men’s ice hockey during the 2009‐2010 to 2013‐2014 academic years and to investigate sex‐specific differences, using data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) database. Methods The incidence and characteristics of LSIs were identified utilizing the NCAA ISP. Rates of injury were calculated as number of injuries divided by total number of athlete exposures (AEs). AEs were defined as any student participation in one NCAA‐sanctioned practice or competition. Incidence rate ratios (IRRs) were calculated to compare rates of injury between season, event type, mechanism, injury recurrence, and time lost from sport, and injury proportion ratios (IPRs) were calculated to examine the differences in injury rates between men and women. Results There were a total of 165 LSIs from an average of 10 and 19 women’s and men’s teams, respectively, calculated to 1,254 LSIs nationally. Women were 2.48 times more likely to suffer a noncontact injury than men (95% CI: 1.33‐4.61), whereas men were more likely than women to suffer contact LSIs (IPR: .51 [95% CI: .28‐.92]). In Divisions II and III, women were 6.64 (95% CI: 4.14‐10.64) and 1.28 (95% CI: 1.12‐1.46) times more likely to suffer LSIs than men, respectively. Conclusions Women and men were similarly likely to suffer an LSI, but sex‐specific differences existed in a mechanism of injury and likelihood of injury within NCAA Divisions.

Purpose To determine the degree of correlation of radiographic measurements, degree of correlation of intraoperative pathology, and difference in outcomes between sides of patients requiring staged bilateral hip arthroscopy. Methods Two high‐volume hip preservation centers retrospectively reviewed hip preservation databases for staged bilateral hip arthroscopies conducted between 2008 and 2015. Patients were separated into those who presented with bilateral hip pain and those that presented with unilateral pain and developed contralateral pain >2 years later. Patients were analyzed for radiographic correlation (alpha angle, lateral center edge angle, anterior center edge angle, magnetic resonance imaging alpha angle, Tönnis grade) and correlation of intraoperative pathology (acetabular labrum articular disruption grade, Outerbridge grade/location, Villar class ligamentum teres tears, labral tear location, symmetry of Seldes tear types, and the differences between operative procedures). Patient‐reported outcomes were analyzed (modified Harris Hip Score, Non‐Arthritic Hip Score, International Hip Outcome Tool‐12, hip outcome score‐sport specific subscale, visual analog scale, patient satisfaction). Correlative tests included Pearson and Spearman; univariate and multivariate analysis for differences included χ‐square test and Student t tests for ordinal and continuous variables respectively. Results A total of 133 of 2,705 patients (4.6%) underwent bilateral hip arthroscopy. Radiographic alpha angle, magnetic resonance imaging alpha angle, lateral center edge angle, and anterior center edge angle demonstrated strong correlation (Pearson's coefficients 0.651, 0.648, 0.644, 0.667, respectively, P < .0001). Tönnis grade was weakly correlated (Pearson's coefficient 0.286, P = .001). Intraoperative pathology was moderately correlated (Pearson's coefficients for acetabular Outerbridge location, 0.300, P = .0170; acetabular labrum articular disruption, 0.490, P < .0001; acetabular Outerbridge; 0.530; P < .0001; femoral head Outerbridge, 0.459, P < .0001; Villar class, 0.393, P < .0001; and labral tear location, 0.468, P < .0001). Labral tear Seldes type was compared with Bowker's symmetry test and there was no significant difference between sides. There were no significant differences in surgical interventions performed between sides. Patients with bilateral hip arthroscopies significantly improved in all measured patient‐reported outcomes and had a high patient satisfaction after both procedures. Final patient‐reported outcomes and change in patient‐reported outcomes were not different between procedures; follow up ranged from 3 months to 8 years. Conclusions This study demonstrated an incidence of 4.6% of patients who require bilateral hip arthroscopy. These patients can expect significant improvement after surgical intervention. Patients that had 1 side done gained similar improvement when the contralateral side was performed. Preoperative radiographic, intraoperative pathology, and procedures performed were similar between hips. Level of Evidence Level III, retrospective cohort study.