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Purpose The purpose of this study is to investigate the trends concerning ulnar collateral ligament (UCL) reconstruction (UCLR) for athletic injuries within the United States over the years 2003 to 2014. Methods A retrospective review of the Truven Health Marketscan® Commercial Database was conducted for patients undergoing UCLR. Data was reviewed for patients treated between 2003 and 2014, and the cohort of patients undergoing UCLR was queried using Common Procedural Terminology code 24346. Patients ages 11 to 40 years were included and divided into 6 different age groups, with the rate of UCLR calculated for each group. Results The overall rate of UCLR increased from 4.4 per million in 2003 to 11.9 per million in 2014 ( p < .01). Throughout the same time period, the rate per million increased from 3.3 to 22.1 in 11- to 15-year-olds ( p < .01), from 105.4 to 293.2 in 16- to 20-year-olds ( p < .01), from 23.1 to 67.0 in 21- to 25-year-olds ( p < .01), and from 2.1 to 5.7 in 31- to 35-year-olds ( p < .01). There was no significant increase in the rate of UCLR in the age groups of 26 to 30 and 36 to 40 years. Conclusion UCLR was mostly performed in patients aged 11 to 25 years (96.6%), and specifically most common in those patients aged 16 to 20 years (67.4%). The rate of UCLR procedures increased over time for younger age groups significantly more than for their older counterparts. Clinical Relevance UCLR rates are increasing in young patients despite efforts addressing injury risk reduction strategies and education for coaches, players, and parents regarding risk factors for UCL injury.

Background: Concussion injuries are common in professional hockey; however, their effect on player performance remains unclear. Purpose: To quantify the effect of concussions on the performance of position players in the National Hockey League (NHL). Study Design: Cohort study; Level of evidence, 3. Methods: Concussion data from the NHL were collected using publicly available databases for the seasons between 2009-2010 and 2015-2016, coinciding with new NHL concussion rules. Age, body mass index, position, number of concussions during a player’s NHL career, games played, and time on ice were recorded. Basic and advanced performance metrics were collected for 1 season pre- and postconcussion (short-term period) and 3 seasons before and after concussion (long-term period) to assess short- and long-term changes in performance. A control group of players without an identified concussion who competed during the study period was assembled for comparison. Wilcoxon signed rank tests were used to evaluate pre- to postconcussion data in the short- and long-term settings as well as to compare the cohorts at each time point. Results: Overall, 48 players were identified as having a concussion during the study period. Players missed 17.2 ± 15.1 days (mean ± standard deviation) and 7.5 ± 6.9 games postconcussion. There were no significant differences in any metric when pre- and postconcussion intraseason performance was assessed. Athletes who were concussed demonstrated significantly deceased performance metrics (assists per 60 minutes, points per 60 minutes, Corsi percentage, and Fenwick percentage) in the 3 years after the concussion as compared with the year before injury ( P < .05). However, no difference was found between the concussed group and matched control group in the short- or long-term period. Players with concussion played fewer career games (856.4 ± 287.4 vs 725.7 ± 215.0; P < .05) than did controls. Conclusion: A high rate of NHL players were able to return to play after a concussion injury. Players with concussion did not experience a reduction in performance metrics in the short- or long-term setting when compared with matched controls. The concussed cohort maintained a similar workload up to 3 seasons postconcussion but played in fewer career games when compared with matched controls.

The purpose of this study is to evaluate differences in game utilization or performance following primary anterior cruciate ligament (ACL) reconstruction between National Football League (NFL) players with and without a second ACL injury. Methods: NFL players who underwent ACL reconstruction between 2013 and 2017 were identified. Players were classified as having one injury ("tear") or having later sustained a subsequent second (reinjury or contralateral) ACL injury ("retear"). Players were excluded if they tore their ACL prior to the NFL, did not return to play (RTP), did not play the season before injury, or had concomitant injuries. Demographic characteristics, game utilization statistics, and season approximate value (SAV) performance metrics were recorded. Statistical analysis compared data after RTP from primary ACL reconstruction (seasons þ1, þ2, and þ3) relative to the season before injury (season À1) between cohorts using mean differences and relative percentages. Results: Analysis included a total of 45 players, 32 in the "tear" group and 13 in the "retear" group. Demographics, level of play, and time to RTP after primary ACL reconstruction did not differ between the groups (P > .05). Tear and retear groups demonstrated similar utilization and performance metrics the season prior to injury (À1) and the 3 seasons following RTP (season of injury is "0"). Both groups had a similar decrease (relative percentage) in games played and started, snap counts, and SAV during the 3 seasons following RTP compared to baseline (P > .05). The draft pick position was correlated with the relative percentage of games started the first season after RTP (r ¼ .6, P ¼ .02). Conclusions: Game utilization and performance metrics following ACL reconstruction were not associated with a subsequent second ACL injury. Players with a higher draft pick position were more likely to return to the starting lineup following primary ACL reconstruction. Ultimately, player game utilization and performance following primary ACL reconstruction is not predictive of a subsequent second ACL injury. Level of Evidence: Level III, retrospective case-control study

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Objectives:To examine the early rates of revision surgery for common knee cartilage restoration procedures performed in the United States, and subsequent conversion to total or unicondylar knee arthroplasty within five years.Methods:Using the MarketScan Research Databases (Truven Health Analytics), we examined all patients who underwent knee microfracture (CPT 29879), autologous chondrocyte implantation (ACI) (CPT 27412) or osteochondral grafting (CPT 27415, 27416, 29866, 29867), within the encompassed timeframe (2003-2014), and who remained tracked within the system for two contiguous years post-operatively to assess rate of revision surgery for complications and five contiguous years to assess revision to either total or unicondylar knee arthroplasty.Results:Although microfracture remains the most common articular cartilage restorative procedure, its rates have been slowly declining since 2009, where as rates of ACI and osteochondral grafting have remained relatively stable (Image). 76,304 microfracture patients, average age 48.3 (SD=13.6), with minimum follow-up of 2 years were examined. 6,366 patients (8.3%) underwent at least one revision cartilage procedure within two years. 93% of these patients had either repeat microfracture or chondroplasty, 4.7% underwent osteochondral grafting, and 2.3% underwent ACI. 1,030 patients (1.3%) required repeat surgery secondary to stiffness or infection: 94% of these patients required manipulation under anesthesia (MUA) and the remaining 6% required open or arthroscopic incision and drainage (I&D). 24,892 patients who underwent microfracture were enrolled for at least 5 years. 428 (1.7%) of these patients subsequently underwent knee arthroplasty within 5 years. Of the 868 patients who underwent ACI as the index procedure, 139 patients (16.0%) underwent a revision cartilage procedure within two years; most commonly chondroplasty (77.8%). Average age of ACI patients was 34.5 (SD=13.5). 46 ACI patients (2.1%) returned to the OR for complications; most commonly MUA for stiffness (98.3%). Of the 233 ACI patients who were enrolled for 5 years, 16 (6.9%) of patients underwent knee arthroplasty. 2,151 patients underwent osteochondral grafting as the index procedure, with the average age being 34.5 (SD=14.1). 331 (15.4%) patients underwent revision cartilage surgery, most commonly arthroscopic chondroplasty (52.6%). 107 (5%) of patients underwent surgery for complications, most commonly MUA (80.3%). Of the 741 patients who underwent osteochondral grafting that were enrolled for 5 years, 16 (2.2%) subsequently underwent conversion to knee arthroplasty.Conclusion:While the incidence of arthroscopic microfracture has been slowly decreasing since 2009, it remains the most common cartilage restorative procedure performed in the USA. Of the procedures examined, those undergoing ACI were more likely to require subsequent chondroplasty, where as patients undergoing osteochondral grafting were more likely to require MUA for stiffness. Conversion to arthroplasty within five years was lowest ...