Patel, Karan A.

Context The complex, high-energy nature of football puts players at risk for hip injuries. Objective To analyze National Collegiate Athletic Association (NCAA) Injury Surveillance Program data for men's football hip injuries from 2004–2005 through 2013–2014. Design Descriptive epidemiologic study. Setting National Collegiate Athletic Association football teams. Patients or Other Participants Data on collegiate football players was provided by the NCAA Injury Surveillance System from 2004–2005 through 2013–2014. Main Outcome Measure(s) The incidence, risk factors, rates, and distribution of hip injuries over the 10-year period from 2004–2005 through 2013–2014 were determined. Rates and distribution of injuries were analyzed by injury type, time loss, event type, time of season, recurrence, mechanism of injury, player position, and if surgery was required. Injury rate ratios were calculated to compare rates between event types and by time of season. Results A total of 1618 hip injuries occurred during 3 121 380 athlete-exposures (AEs), resulting in an overall hip injury rate of 5.18 per 10 000 AEs. Adductor strains (38.63%) were the most common type, followed by hip-flexor strains (28.55%) and hip contusions (18.23%). Players were 3.56 (95% confidence interval [CI] = 3.19, 3.98) times more likely to sustain a hip injury during competitions compared with practices. They were 2.37 (95% CI = 2.15, 2.62) and 3.56 (95% CI = 2.49, 5.08) times more likely to sustain a hip injury during the preseason than in-season or the postseason, respectively. Conclusions During the 10-year period, NCAA football players sustained higher rates of hip injuries during competitions and the preseason. The majority were noncontact injuries, resulted in time loss of less than 6 days, and did not require surgery. The injuries varied with player position and occurred most often to defensive backs. Muscle strains were the most frequent group of hip injuries, while adductor strains, hip-flexor strains, and hip contusions were the most common injury types.

Abstract Articular cartilage is critical for painless and low‐friction range of motion; however, disruption of articular cartilage, particularly in the knee joint, is common. Treatment options are based on the size and depth of the chondral defect, as well as involvement of subchondral bone. The gold standard for evaluation of articular cartilage is with arthroscopy, but it is limited by its ability to objectively judge the depth and severity of chondral damage. Optical reflection spectroscopy has been introduced to objectively assess the thickness of cartilage. We present a technique to systematically evaluate the articular cartilage of the knee using BioOptico optical reflection spectroscopy (Arthrex) to better evaluate those with visible chondral and subchondral defects. Technique Video video See video under supplementary data.

Study Design. Descriptive epidemiology study. Objective. The purpose of this study was to describe the epidemiology of cervical spine injuries in collegiate football players. Summary of Background Data. The incidence and etiology of cervical spine injuries in National Collegiate Athletic Association (NCAA) football players has not been well defined in recent years. Methods. The incidence and characteristics of cervical spine injuries were identified utilizing the NCAA-ISP database. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition. Results. An estimated 7496 cervical spine injuries were identified. Of these, 85.6% were categorized as new injuries. These occurred at a rate of 2.91 per 10000 AEs. Stingers were most common (1.87 per 10000 AEs) followed by cervical strains (0.80 per 10000 AEs). Injuries were nine times more likely to occur during competition when compared with practice settings. When compared with the regular season, the relative risks of sustaining a cervical spine injury during the preseason and postseason were 0.69 (95% CI 0.52–0.90) and 0.39 (95% CI 0.16–0.94), respectively. The rate of cervical spine injuries was highest in Division I athletes. Direct contact-related injuries were most common, representing 90.8% of all injuries sustained. Injuries were most common in linebackers (20.3%) followed secondarily by defensive linemen (18.2%). Most players returned to play within 24 hours of the initial injury (64.4%), while only 2.8% remained out of play for > 21 days. Conclusion. Fortunately, the rate of significant and disabling cervical spine injuries appears to be low in the NCAA football athlete. The promotion of safer tackling techniques, appropriate modification of protective gear, and preventive rehabilitation in these aforementioned settings is of continued value. Level of Evidence: 4

Background: Lumbar spine injuries in National Collegiate Athletic Association (NCAA) athletes have not been well studied. Purpose: To describe the epidemiology of lumbar spine injuries in NCAA athletes during the 2009/2010 through 2013/2014 academic years utilizing the NCAA Injury Surveillance Program (ISP). Study Design: Descriptive epidemiology study. Methods: A voluntary convenience sample of NCAA varsity teams from 25 sports was examined. Mechanism of injury, injury recurrence, and time lost from sport were recorded. Injury rates were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in 1 NCAA-sanctioned practice or competition. Injury rate ratios and injury proportion ratios were calculated to compare the rates within and between sports by event type, season, patient sex, mechanism, injury recurrence, and time lost from sport. Comparisons between sexes were made utilizing data that had both male and female samples. Results: An estimated 50,834 lumbar spine injuries were identified. The overall rate of injuries was 2.88 per 10,000 AEs. The rate of injuries was 2.60 per 10,000 AEs in men compared with 2.89 per 10,000 AEs in women for sex-comparable sports. Women were 1.11 times more likely than men to suffer a lumbar spine injury. Women's gymnastics (8.02 injuries per 10,000 AEs) and women's tennis (5.73 injuries per 10,000 AEs) had the highest rates of lumbar spine injuries. Athletes were 1.6 and 2.4 times more likely to sustain a lumbar spine injury during the preseason than the regular season or postseason, respectively. Noncontact was the most common mechanism of injury (45%). Injury recurrence was most common in men’s outdoor track (43%). Most injuries resulted in less than 24 hours of time loss from event participation (64%). Conclusion: The rate of lumbar spine injuries was high in NCAA athletes, and injuries commonly recurred (20.73%). In general, women were more likely to sustain a lumbar spine injury compared with men. Higher injury rates occurred during competition and via a noncontact mechanism of injury. In addition to prevention programs, reconditioning programs should be considered to prevent these injuries.

Background: Ankle injury is the most common injury in men’s and women’s basketball, regardless of the level of competition. Purpose: To use the National Collegiate Athletic Association (NCAA) Injury Surveillance Program/System (ISP/ISS) to review the 10-year epidemiology of ankle injuries in men’s and women’s collegiate basketball players. Study Design: Descriptive epidemiology study. Methods: The NCAA ISP was queried for men’s and women’s collegiate basketball ankle injury data from the 2004 through 2014 academic years. Ankle injury rates were calculated based on injuries per athlete-exposure (AE). Injury proportion ratios (IPRs) were determined by comparing variables between sexes. Activity and position of injury were also studied. Results: Over the 10-year study period, most ankle injuries in collegiate basketball occurred in the preseason (female, 1.45/1000 AEs; male, 2.00/1000 AEs), were contact related (female, 50.4%; male, 57.6%), were treated conservatively (female, 98.5%; male, 99.3%), and were new injuries (female, 78.0%; male, 78.9%), resulting in a time loss of less than 7 days (female, 62.7%; male, 65.2%). The most common injury types were lateral ligament complex tears (female, 83.5%; male, 80.0%), deltoid ligament tears (female, 5.6%; male, 7.2%), and high ankle sprains (female, 7.1%; male, 7.0%). Guards experienced the highest rate of ankle injuries in competition (female, 50.1%; male, 43.3%), and rebounding was found to be the most common activity during an injury (female, 30.3%; male, 34.4%). The rate of ankle injuries was significantly lower in women than in men (IPR, 0.81 [95% CI, 0.75-0.88]). Conclusion: This study found that most ankle injuries in collegiate basketball occurred during the preseason, were contact related, were treated conservatively, and were new injuries that resulted in a time loss of less than 7 days.

Abstract Superior capsular reconstruction has emerged as a promising technique in the treatment of massive irreparable rotator cuff tears. The technical aspects of the surgery continue to evolve, and scientific studies to evaluate these techniques are emerging. One such area of interest concerns the appropriate thickness of the graft and its role as a spacer. The original description of the graft was an autograft tensor fascia lata, which was folded to achieve a thickness of around 8 mm. It has been demonstrated that an 8‐mm graft is superior biomechanically to a 4‐mm graft, which exceeds the typical human dermal allograft thickness. Herein we describe a technique in which an acellular human dermal allograft was used to perform a superior capsular reconstruction and the remainder of the graft was used to resurface the undersurface of the acromion. This modification of the technique allows for arthroscopic acromial resurfacing, as well as effectively doubling the thickness of the spacer function of the graft. The technique and justification are described in detail, and this has become the senior author's standard approach to the massive irreparable rotator cuff tear in patients with Hamada stages 2 and 3. Technique Video video See video under supplementary data.

The anterior inferior iliac spine (AIIS) is a newly recognized etiology of extra-articular hip impingement. The purpose of this article is to describe an arthroscopic technique for AIIS decompression causing extra-articular hip impingement. Arthroscopic decompression of subspine impingement is a novel procedure that can be used to successfully relieve hip pain and improve hip function and range of motion cause by AIIS impingement.

Background: Up to 50% of National Collegiate Athletic Association (NCAA) football players have a history of shoulder injuries. The quarterback position has been shown to have a high prevalence of these injuries because of its unique exposures. There is little information regarding the shoulder injury type and mechanism in NCAA quarterbacks. Purpose: To understand the 10-year epidemiology of specific shoulder injury rates in NCAA quarterbacks. Study Design: Descriptive epidemiology study. Methods: Shoulder injury data for collegiate football quarterbacks from the 2004 through 2014 academic years were analyzed using the NCAA Injury Surveillance Program (ISP) data set. Results: Over the 10-year study period, a total of 133 shoulder injuries to collegiate quarterbacks were reported, with 157,288 quarterback exposures. There was approximately 1 shoulder injury per 1221 exposures. The most common injuries noted were acromioclavicular sprains (45.1%, n = 60), followed by shoulder contusions (9.0%, n = 12), clavicular fractures (7.5%, n = 10), and anterior instability (5.3%, n = 7). The majority of injuries were caused by contact with a player (60.2%, n = 80) or contact with a playing surface (28.6%, n = 38), and 88% (n = 117) were deemed nonsurgical in nature. Conclusion: NCAA ISP data analysis suggests that collegiate quarterbacks sustain acute contact injuries 89% of the time and that they typically occur while being tackled, resulting in a time loss of less than 2 weeks. These injuries are commonly treated nonsurgically.

Abstract The medial patellofemoral ligament (MPFL), which is critical for both patellar stability and normal kinematics of the patellofemoral joint, is disrupted in most patellar dislocations. Consequently, MPFL reconstruction is advocated in recurrent dislocations to restore native patellar constraints. Fixation of the MPFL graft to the medial border of the patella can be achieved through various methods, each with its own benefits and drawbacks. We present a technique for MPFL fixation to the patella using all‐soft suture anchors, theoretically decreasing the risk of patellar fracture and articular surface violation. Technique Video video See video under supplementary data.

Abstract Arthroscopy is currently the gold standard for diagnosing intra‐articular knee pathology. Magnetic resonance imaging (MRI) can be a clinical adjunct for diagnosis; however, it is not without its shortcomings. Although highly accurate, even advanced imaging misdiagnoses the condition in 1 in 14 patients with regard to anterior cruciate ligament pathology. Previous studies have indicated that MRI fails to identify meniscal pathology when one exists in 1 of every 10 cases, and diagnoses pathology when pathology truly does not exist in 1 of every 5 patients. In‐office arthroscopy offers an alternative to formal diagnostic arthroscopy, with reduced cost and risk of complications. This is a technique article that discusses the use of small‐bore needle arthroscopy in the office setting. Technique Video video See video under supplementary data.