Return to sport following shoulder surgery in the elite pitcher: a systematic review

Abstract

CONTEXT:

The ability to return to elite pitching, performance, and clinical outcomes of shoulder surgery in elite baseball pitchers are not definitively established.

OBJECTIVE:

To determine (1) the rate of return to sport (RTS) in elite pitchers following shoulder surgery, (2) postoperative clinical outcomes upon RTS, and (3) performance upon RTS and to compare RTS rates in different types of shoulder surgery.

DATA SOURCES:

Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist, Medline, SciVerse Scopus, SportDiscus, and Cochrane Central Register of Controlled Trials were searched.

STUDY SELECTION:

Levels I-IV evidence were eligible for inclusion if performance-based (eg, RTS) and/or clinical outcome-based reporting of outcomes were reported following surgical treatment of shoulder pathology in elite pitchers (major or minor league or collegiate).

DATA EXTRACTION:

Subject, shoulder, and pre- and postoperative performance-based variables of interest were extracted. All shoulder surgery types were potentially inclusive (eg, open, arthroscopic, rotator cuff, labrum, biceps, acromioclavicular joint, fracture). Study methodological quality was analyzed using the Modified Coleman Methodology Score (MCMS).

RESULTS:

Six studies were analyzed (287 elite male pitchers [mean age, 27 years] who underwent shoulder surgery, with 99% on the dominant, throwing shoulder). MCMS was 38 (poor). Most pitchers were professional, with a mean career length of 6.58 years and postoperative clinical follow-up of 3.62 years. In 5 of 6 studies, multiple diagnoses were addressed concomitantly at surgery. Rate of RTS was 68% at mean 12 months following surgery. Twenty-two percent of Major League Baseball (MLB) pitchers never RTS in MLB. Overall performance did improve following surgery; however, this did not improve to pre-injurylevels.

CONCLUSION:

In this systematic review, the rate of return to elite baseball pitching following surgery was established. Performance tended to decrease prior to surgery and gradually improve postoperatively, though not reaching pre-injury levels of pitching.

LEVEL OF EVIDENCE:

IV (systematic review of studies level I-IV evidence), therapeutic.

KEYWORDS:

Major League Baseball, arthroscopy, pitcher, shoulder, surgery

PMID:

 

24459557

 

[PubMed] 

PMCID:

 

PMC3899910

 [Available on 2014/7/1]

Perioperative characteristics and complications in obese patients undergoing anterior cervical fusion surgery

Abstract

In the USA, obesity rates have significantly increased in the last 15years. Mirroring this trend, a large proportion of patients undergoing spinal surgery are obese. Concern exists for increased complications due to surgical challenges posed by obese patients and their often-prevalent comorbidities. Studies have shown associations between body mass index (BMI) and perioperative complications in lumbar and thoracolumbar fusion surgeries; however, few studies have evaluated the impact of obesity on anterior cervical fusion surgery. As such, this study aimed to evaluate complications and perioperative characteristics in obese patients undergoing anterior cervical fusion. We queried medical records to identify patients with BMI >30 who underwent anterior cervical fusion surgery. A total of 69 patients were included and subdivided based on obesity class: Class 1 (BMI 30-35), Class 2 (BMI 35-40), and Class 3 (BMI >40). Subgroup analysis included comorbidities, diagnosis, procedure, levels treated, and length of hospital stay. Overall mean BMI was 35.1, mean age was 54.3years, and 43 (63.3%) were men. Disc herniation was the most common diagnosis. Length of stay differed significantly among obesity subgroups (p=0.02). Mean length of stay was 2.8, 3.5, and 4.0days for Classes 1, 2, and 3, respectively. Three (4.3%) complications were observed, comprising of urinary tract infection, wound dehiscence, and neck hematoma. Complication rates by class were 5.5%, 0%, and 16.6% for Classes 1, 2, and 3, respectively (p=0.17). We found that obese patients undergoing anterior cervical spine surgery experience relatively few complications. Hospital stay, however, appears to lengthen with increased BMI.

Copyright © 2013 Elsevier Ltd. All rights reserved.

KEYWORDS:

Cervical spine, Complications, Obesity, Surgery

Reliability of Gadolinium-enhanced MRI findings and their correlation with clinical outcome in patients with sciatica

Abstract

BACKGROUND CONTEXT:

Gadolinium-enhanced Magnetic resonance imaging (Gd-MRI) is often performed in the evaluation of patients with persistent sciatica after lumbar discsurgery. However, correlation between enhancement findings and clinical findings is debated and limited data is available regarding the reliability of enhancement findings.

PURPOSE:

To evaluate the reliability of Gd-MRI findings and their correlation with clinical findings in patients with sciatica.

STUDY DESIGN/SETTING:

Prospective observational evaluation of patients who were enrolled in a randomized trial with one year follow-up.

PATIENTS SAMPLE:

Patients with 6-12 weeks sciatica who participated in a multicentre randomized clinical trial comparing an early surgery strategy to prolonged conservative care with surgery if needed. In total 204 patients underwent Gd-MRI at baseline and after one year.

OUTCOME MEASURES:

Patients were assessed by means of the Roland Disability Questionnaire (RDQ) for Sciatica, visual-analogue scale (VAS) for leg pain and patient-reported perceived recovery at one year. Kappa coefficients were used to assess interobserver reliability.

METHODS:

In total 204 patients underwent Gd-MRI at baseline and after one year. MRI findings were correlated to the outcome measures using The Mann-Whitney U test for continuous data and Fisher's exact tests for categorical data. This study was supported by a grant from the Netherlands Organisation for Health Research and Development (ZonMW) and the Hoelen Foundation, The Hague. None of the authors of this study has any conflict of interest.

RESULTS:

Poor to moderate agreement was observed regarding gadolinium enhancement of the herniated disc and compressed nerve root (kappa <0.41) which was in contrast with excellent interobserver agreement about the disc level of the herniated disc and compressed nerve root (kappa >0.95). Of the 59 patients with an enhancing herniated disc at one year, 86% reported recovery compared to 100% of the 12 patients with non-enhancing herniated discs (P=0.34). Of the 12 patients with enhancement of the most affected nerve root at one year 83% reported recovery compared to 85% of the 192 patients with no enhancement (P=0.69). Patients with and without enhancing herniated discs or nerve roots at one year reported comparable outcomes on RDQ and VAS-leg pain.

CONCLUSION:

Reliability of Gd-enhanced MRI findings was poor to moderate and no correlation was observed between enhancement findings and clinical findings at one year follow-up.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS:

Sciatica, clinical outcome, conservative treatment, disc herniation, follow-up, gadolinium-enhanced MRI findings, surgery

PMID:

 

24561397

 

[PubMed - as supplied by publisher]