No abstract

Acellular dermal matrices (ADMs) are tissue grafts that have been specially processed to remove all cellular components. These machined biological scaffolds have become popular in a variety of surgical settings due to their rapid incorporation into living tissue. As ADMs are highly malleable and cause minimal inflammation, they have come to serve as a useful tool in implant-based breast reconstruction procedures. The major benefits of using an ADM in this setting include superior initial breast contouring, decreased risk of capsular contracture after implant insertion, and consistent sustained positioning of the reconstructed breast. Despite these advantages, these tissue grafts are foreign to the host, and postoperative complications following ADM insertion, including infection and seroma, have been well documented. When considering using ADMs in this setting, it is important to first consider patient-specific factors that could preclude their use, such as low body mass index, small breasts, or a history of radiation exposure to the breast tissue. ADM grafts are also expensive, which may present another barrier to their use. Review of the literature ultimately suggests a continued role for ADMs in implant-based breast reconstruction, and continued research in this field is warranted.

Many studies have focused on the long-term impact of concussions in professional sports, but few have investigated short-term effects. This study examines concussion effects on individual players in the National Hockey League (NHL) by assessing career length, performance, and salary. Contracts, transactions, injury reports, and performance statistics from 2008-17 were obtained from the official NHL online publication. Players who sustained a concussion were compared with the 2008-17 non-concussed player pool. Career length was analyzed using Kaplan-Meier survival curves and stratification of player age, experience, and longevity. Player performance and salary changes were evaluated between the years before versus after concussion. Performance and salary changes were compared against non-concussed NHL athletes before/after their career midpoints. Of the 2194 eligible NHL players in the 9-year period, 309 sustained 399 concussions resulting in injury protocol. The probability of playing a full NHL season post-concussion was significantly decreased compared with the non-concussed pool (p < 0.05), specifically 65.0% versus 81.2% at 1 year into a player's career, 49.8% versus 67.4% at 2 years, and 14.6% versus 43.7% at 5 years. Performance was reduced at all non-goalie positions post-concussion (p < 0.05). Players scored 2.5 points/year less following a concussion. The total annualized financial impact from salary reductions after 1 concussion was $57.0 million, with a decrease of $292,000 per year in contract value per athlete. This retrospective study demonstrates that NHL concussions resulting in injury protocol activation lead to shorter career lengths, earnings reductions, and decreased performance when compared with non-concussed controls.

Background:The short-term outcomes of concussions within Major League Baseball (MLB) warrant further consideration beyond a medical standpoint given that performance, career, and financial data remain unknown. The perception of this injury directly affects decision making from the perspective of both player and franchise.Purpose:To evaluate the effect of concussion on MLB players by (1) establishing return-to-play (RTP) time after concussion; (2) comparing the career length and performance of players with concussion versus those who took nonmedical leave; and (3) analyzing player financial impact after concussion.Study Design:Cohort study; Level of evidence, 3.Methods:Contracts, transactions, injury reports, and performance statistics from 2005 to 2017 were analyzed by comparing matched players who sustained a concussion versus those who took nonmedical leave. Of the 4186 eligible MLB players, 145 sustained concussions resulting in the activation of concussion protocol and 538 took nonmedical leave. RTP time was recorded. Career length was analyzed in reference to an experience-based stratification of full seasons remaining after the concussion. Changes in player performance and salary before and after concussion were compared with the same parameters for players who took nonmedical leave.Results:The mean RTP time was 26 days (95% CI, 20-32 days) for athletes with concussion and 8 days (95% CI, 6-10 days) for those who took nonmedical leave. Athletes with concussion had a mean of 2.8 full seasons remaining, whereas athletes who took nonmedical leave had 3.1 seasons remaining (P = .493). The probability of playing in the MLB after concussion compared with the nonmedical leave pool was not significantly lower (P = .534, log-rank test; hazard ratio, 1.108). Postconcussion performance decreased significantly in position players, including a lower batting average and decreased on-base percentage in the players with concussion compared with those returning from nonmedical leave. Players who sustained a concussion lost a mean of US$654,990 annually compared with players who took nonmedical leave.Conclusion:This study of the short-term outcomes after concussion in limited-contact MLB athletes demonstrates that concussions may not decrease career spans but may result in decreased performance in addition to financial loss when compared with matched controls who took nonmedical leave. In sports such as baseball that are not subject to repetitive head trauma, career spans may not decrease after a single concussive event. However, sentinel concussions have deleterious short-term effects on performance and compensation among MLB players.