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Imaging interpretation of the postoperative shoulder is a challenging and difficult task for both the radiologist and the orthopedic surgeon. The increasing number of shoulder rotator cuff, labrum, and biceps tendon repairs performed in the United States also makes this task a frequent occurrence. Whether treatment is surgical or conservative, imaging plays a crucial role in patient care. Many imaging findings can be used to predict prognosis and functional outcomes, ultimately affecting treatment. In addition, evolving surgical techniques alter the normal anatomy and imaging appearance of the shoulder such that accepted findings proved to be pathologic in the preoperative setting cannot be as readily described as pathologic after surgery. An understanding of common surgical procedures of the shoulder can aid in recognizing normal expected postoperative findings and discerning common complications. Although magnetic resonance (MR) imaging and MR arthrography are widely used, implementing a multimodality imaging approach for evaluation of the postoperative shoulder can provide additional imaging information that may be decisive and vital to diagnosis. The high spatial resolution of both computed tomography with arthrography and ultrasonography makes them additional modalities to consider, especially when dealing with metal artifact. To provide an accurate radiologic interpretation of high clinical value, radiologists should approach the postoperative shoulder comprehensively with knowledge of the anatomy, surgical techniques and complications, clinical outcomes, and imaging pitfalls. RSNA, 2016.

Objectives:Injuries involving fractures of the metacarpals are common among football players of all levels. These injuries are typically treated conservatively with casting or splinting among non-in-season athletes, a method that involves a relatively lengthy recovery time (four weeks). To our knowledge, there are no previous reports documenting return to play in elite football players after operative management of metacarpal fractures. The purpose of this study was to retrospectively review and describe the results of operative treatment of metacarpal shaft fractures in 19 high level football players with respect to return to play. We hypothesized that in-season football players with metacarpal fractures treated surgically would be able to return to play more quickly than the typical recovery time following non-operative treatment.Methods:Surgically treated metacarpal fractures in elite football players were queried over a three-year period (2009-2012) from a database maintained by American Sports Medicine Institute (ASMI) in Birmingham, AL. Over the study period, 19 football players were identified who underwent open reduction internal fixation of metacarpal fractures by one of three attending surgeons. Retrospective chart review and phone interviews with the patient and their athletic trainers were performed to identify player position, level of competition, mechanism of injury, return to play, post-operative bracing, and re-fracture event. Radiographs were used to classify the fractures, and operative reports were reviewed for implant choice. Numerical means were calculated for in-season return to play as well as for brace time.Results:Ten high school players (53%) and nine college players (47%) were injured. The most common injured positions were wide receivers and defensive backs (26% each). Most injuries occurred through player to player contact (63%) at a game (37%) or practice (47%). The long finger (58%) was the most commonly involved metacarpal. Two players (11%) had multiple metacarpal fractures. The most common location was mid-diaphyseal (74%). Twelve patients were stabilized with plates and screws, five of whom underwent lag screw augmentation. Six patients were stabilized with a metacarpal nail and one was stabilized with only lag screws. All athletes were able to return to their pre-injury level of play without recurrence of fracture. Return to play for in-season athletes (N=11) was 6.3 days. The average time to return to play for in-season high school football players (N=6) was 9.2 days and 2.8 days for in-season collegiate football players (N=5). All in-season athletes returned to play with protective equipment in the form of a padded glove, bivalve padded cast, padded club cast, or padded splint. The protective equipment was used for an average of 21 days.Conclusion:This study provides support for the surgical treatment of displaced metacarpal shaft fractures with immediate return to play as tolerated for in-season football players. No re-fractures or complications were identified with the use...

Objectives: Injuries involving fractures of the metacarpals are common among football players of all levels. These injuries are typically treated conservatively with casting or splinting among non-in-season athletes, a method that involves a relatively lengthy recovery time (four weeks). To our knowledge, there are no previous reports documenting return to play in elite football players after operative management of metacarpal fractures. The purpose of this study was to retrospectively review and describe the results of operative treatment of metacarpal shaft fractures in 19 high level football players with respect to return to play. We hypothesized that in-season football players with metacarpal fractures treated surgically would be able to return to play more quickly than the typical recovery time following non-operative treatment. Methods: Surgically treated metacarpal fractures in elite football players were queried over a three-year period (2009)(2010)(2011)(2012)) from a database maintained by American Sports Medicine Institute (ASMI) in Birmingham, AL. Over the study period, 19 football players were identified who underwent open reduction internal fixation of metacarpal fractures by one of three attending surgeons. Retrospective chart review and phone interviews with the patient and their athletic trainers were performed to identify player position, level of competition, mechanism of injury, return to play, post-operative bracing, and re-fracture event. Radiographs were used to classify the fractures, and operative reports were reviewed for implant choice. Numerical means were calculated for in-season return to play as well as for brace time. Results: Ten high school players (53%) and nine college players (47%) were injured. The most common injured positions were wide receivers and defensive backs (26% each). Most injuries occurred through player to player contact (63%) at a game (37%) or practice (47%). The long finger (58%) was the most commonly involved metacarpal. Two players (11%) had multiple metacarpal fractures. The most common location was mid-diaphyseal (74%). Twelve patients were stabilized with plates and screws, five of whom underwent lag screw augmentation. Six patients were stabilized with a metacarpal nail and one was stabilized with only lag screws. All athletes were able to return to their pre-injury level of play without recurrence of fracture. Return to play for in-season athletes (N=11) was 6.3 days. The average time to return to play for in-season high school football players (N=6) was 9.2 days and 2.8 days for in-season collegiate football players (N=5).

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Background:The National Athletic Trainers’ Association (NATA) advocates for cervical spine immobilization on a rigid board or vacuum splint and for removal of athletic equipment before transfer to an emergency medical facility.Purpose:To (1) compare triplanar cervical spine motion using motion capture between a traditional rigid spine board and a full-body vacuum splint in equipped and unequipped athletes, (2) assess cervical spine motion during the removal of a football helmet and shoulder pads, and (3) evaluate the effect of body mass on cervical spine motion.Study Design:Controlled laboratory study.Methods:Twenty healthy male participants volunteered for this study to examine the influence of immobilization type and presence of equipment on triplanar angular cervical spine motion. Three-dimensional cervical spine kinematics was measured using an electromagnetic motion analysis system. Independent variables included testing condition (static lift and hold, 30° tilt, transfer, equipment removal), immobilization type (rigid, vacuum-mattress), and equipment (on, off). Peak sagittal-, frontal-, and transverse-plane angular motions were the primary outcome measures of interest.Results:Subjective ratings of comfort and security did not differ between immobilization types (P > .05). Motion between the rigid board and vacuum splint did not differ by more than 2° under any testing condition, either with or without equipment. In removing equipment, the mean peak motion ranged from 12.5° to 14.0° for the rigid spine board and from 11.4° to 15.4° for the vacuum-mattress splint, and more transverse-plane motion occurred when using the vacuum-mattress splint compared with the rigid spine board (mean difference, 0.14 deg/s [95% CI, 0.05-0.23 deg/s]; P = .002). In patients weighing more than 250 lb, the rigid board provided less motion in the frontal plane (P = .027) and sagittal plane (P = .030) during the tilt condition and transfer condition, respectively.Conclusion:The current study confirms similar motion in the vacuum-mattress splint compared with the rigid backboard in varying sized equipped or nonequipped athletes. Cervical spine motion occurs when removing a football helmet and shoulder pads, at an unknown risk to the injured athlete. In athletes who weighed more than 250 lb, immobilization with the rigid board helped to reduce cervical spine motion.Clinical Relevance:Athletic trainers and team physicians should consider immobilization of athletes who weigh more than 250 lb with a rigid board.

Objectives: After anterior cruciate ligament reconstruction (ACLR), only 60% of patients are able to return to their pre-injury level of sports with nearly 15% experiencing persistent rotatory instability. Young patients returning to pivoting sports experience high rates of graft tear and subsequent need for revision ACLR. Recently, the anterolateral ligament (ALL) has gained attention as an important rotatory stabilizer about the knee in prevention of the pivot shift phenomenon. It is theorized that an ALL tear at initial injury may predispose a patient to failure of primary ACLR due to persistent rotatory instability from a torn ALL. The purpose of this study was to investigate the incidence of primary ALL rupture on magnetic resonance imaging (MRI) in a population that required revision ACLR compared to a matched cohort of patients that did not require revision ACLR. Methods: Using CPT and ICD-9 and 10 codes, a retrospective search was performed within our electronic medical record database for patients who underwent ACLR and revision ACLR. Patients were excluded for a chronic ACL injury greater than 6 months, MRI obtained more than 3 months after initial injury, inability to obtain initial injury MRI, or presence of a multiligament knee injury. Age, sex, and graft type were recorded for every revision ACLR patient, and each revision patient was paired with a matched control that did not require revision ACLR. Two clinically blinded, fellowship trained musculoskeletal radiologists reviewed initial injury MRI scans to assess the integrity of the ALL. Each MRI was given a diagnosis of either an intact ALL, a partially torn ALL, or a completely torn ALL (Figure 1). The incidence of primary ALL rupture between the revision ACLR group and control ACLR group was evaluated for statistical difference using the Pearson Chi Square test. Results: 1967 patients underwent ACLR at our institution between 2009-2015, and 128 patients required revision ACLR. Initial injury knee MRI was available for 55 revision ACLR patients, and 39 of these patients met inclusion criteria. For the revision cohort, the average age at primary ACLR was 21.1 years (range 13-47 years) (Table 1). Time between primary and revision ACLR was an average of 2.2 years (0.23-8.72 years). In the ACLR control cohort, the average age of ACLR was 20.9 years (range 13-47). Average length of follow-up was 0.6 years (0.21-2.8 years). The revision cohort had 17 patients with an intact ALL, 14 patients with a partial ALL tear, and 8 patients with a ALL tear on initial injury MRI. The control cohort had 18 patients with an intact ALL, 13 patients with a partial ALL tear, and 8 patients with a ALL tear. There was no statistically significant difference between the two cohorts in the incidence of primary ALL rupture (Pearson Chi-Square=0.066, p-value=0.968) (Table 1). Conclusion: The incidence of primary ALL rupture in patients undergoing revision ACLR was similar...