The OJSM Hot Corner

Controversy exists regarding the correct treatment for type III-V acromioclavicular (AC) joint dislocations. While more recent data has shown equivalence between operative and non-operative management of Rockwood type III AC joint injuries, historical gestalt has suggested that AC separations with greater deformity, the type Vs, may best be treated surgically. This, however, is not backed by strong data. Of note, type IVs are exceedingly rare. Dr. Darius Lamiere, MD and Dr. Daniel Whelan, MD, MSc join us from the University of Toronto to share their meta-analysis and systematic review of randomized controlled trials comparing surgical and non-surgical treatment for these injuries.

Sports Specialization remains one of the most debated topics in Sports Medicine today. While the idea of having a youth athlete focus year-round on a single sport to maximize his/her potential in that particular sport sounds reasonable, it has not been shown to be an effective strategy at accomplishing its goal and may come at a cost of mental and physical injury to the athlete. Dr. Rachel Meyers, PT, DPT & Dr. Gregory Walker, MD from Children's Hospital Colorado join us to discuss their study further exploring the connection between Sports Specialization and mental health using a recently validated tool designed to identify a highly specialized athlete, the Wisconsin Sport Specialization Questionnaire (WISSQ).

Achilles tendon ruptures have historically been an injury of 40-50 year olds. The recent uptick in Achilles ruptures in younger athletes has been a point of concern in the Sports Medicine community, particularly when some of the NBA's brightest stars have sustained this devastating injury in their 20-30s. Dr. Nirav Pandya, MD, Pediatric Sports Medicine Specialist from UCSF joins us to discuss his group's findings as well as the viral response to his study.

The advent of Name, Image, and Likeness (NIL) legislation has changed college sports profoundly. NIL now extends beyond the collegiate ranks to high school athletes and younger. While the financial stakes now in play for young athletes have had obvious impacts on the sports they play, what may be less obvious are the ramifications for Sports Medicine providers caring for these athletes. We welcome Dr. George Richard, MD from Rothman Orthopaedics Florida & Dr. Kevin Farmer, MD from University of Florida to discuss the changing landscape for those of us caring for youth athletes in this age of NIL.

Calcific tendinitis is a common, painful condition that can cause intense pain and dysfunction of the shoulder. However, in spite of its commonality, there is much we do not understand about it including why it occurs. One thing we do know is that, in most cases, the calcium will just go away, however we do not have any way to predict how long that may take to occur. A variety of treatment options are available to treat calcific tendinitis including several non-surgical options such as physical therapy, cortisone injections, and barbotage, as well as surgery. Because the natural history of calcific tendinitis is one of self-resolution, surgery is typically reserved for long-standing cases where non-surgical treatments have been tried and failed. Authors Ryan Gilbert, BA & Dr. Albert Lin, MD from University of Pittsburgh Medical Center join us to discuss their study looking at success rates of these 3 non-surgical options as well as the success rates for patients who opted for surgery as an initial treatment or after failing at least one non-surgical option. If you've failed one of the non-operative treatment, should you try another one or just go to surgery?

Lateral Extra-Articular Tenodesis (LET) has become an accepted adjunct to standard anterior cruciate ligament reconstruction to help provide additional rotational stability to the knee and lower the risk of re-tears. The classic situation to perform this surgery would be at the same time as an ACL reconstruction in a patient with a high degree of rotational instability or in a patient who has already had ACL surgery and re-torn. However, might there be a role for LET performed as a standalone procedure? A subset of patients following ACL surgery will have a knee that is very stable in the anterior-to-posterior (front-to-back) direction but continues to demonstrate some degree of rotational instability. Could an LET performed in isolation provide these patients with that additional rotational stability and thus lower their risk of another injury, or is that a crazy idea? Click here to read the article.

The importance of the mind-body connection in Sports Medicine is well-established and continues to be a hot topic of study and conversation. This connection between psychological and physical is especially noted with ACL injuries, surgery, and rehabilitation. Dr. Brian M. Devitt, MD, PhD from UPMC Sports Surgery Clinic in Dublin, Ireland joins us to discuss his team's work examining psychological readiness and return to play rates in elite versus nonelite athletes. One might assume that the elite athlete, perhaps with more personal athletic identity and rehab resources would outperform the nonelite athlete, but does that actually play out?

The correct treatment for rotator cuff tears remains a matter of debate. The varying characteristics of cuff tears – symptomatic versus asymptomatic, tear size, tendon quality, the presence of fatty atrophy, etc. – makes generalizations about the best treatment approach difficult. One thing shoulder specialists agree on is that tear enlargement is problematic. A cuff tear that enlarges may turn a once fixable tear into an unfixable one.  Predicting which tears will enlarge and the rate at which they will is not an exact science. We welcome Dr. James Irrgang, PT, PhD, FAPTA & Dr. Luke Mattar, PhD from the University of Pittsburgh to discuss their study looking at tear propagation trends in patients with a symptomatic, isolated supraspinatus tears after 3 month of an initial trial of physical therapy.

Shoulder and elbow injuries in pitchers are as old as baseball itself. Measures to lower the risk of these injuries have been evolving for decades, with a nationalized though heterogenous effort from state to state implemented in the mid-2010s. Adherence to pitch counts and mandatory days of rest in between outings, for example, are common restrictions placed upon pitchers to try and keep them safe. Dr. Peter Kriz, MD and his team from Boston Children's Hospital look back to see if these policies made any impact. Have the pitching restriction regulations designed to keep pitchers safe actually worked?

Sleep disruption is a hallmark symptom of rotator cuff pathology. Poor sleep can result in profound detriment to one's health and wellbeing. One of the greatest rewards of rotator cuff surgery is the ability to correct this. However, recovery from rotator cuff repair surgery can be long, upwards of 6+ months, with each individual's recovery pathway unique to him/herself. So when should a patient expect, on average, to see improvement in sleep after shoulder surgery? Drs. Mohammad Daher, MD and Joseph Abboud, MD from the famed Rothman Institute in Philadelphia, PA join us to share their findings on this topic.