Sports Medicine and Arthroscopy Review最新文献

Purpose: One of the most frequent concerns of the increasing number of patients undergoing shoulder arthroplasty is the possibility to resume sport after surgery. This systematic review determined the rate of return to sport after total shoulder arthroplasty (TSA) and hemiarthroplasty (HA).

Materials and methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review. A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE, and Cochrane Library databases. All the studies analyzing the rates of reverse shoulder arthroplasties were pooled; data were extracted and statistically analyzed. Only studies with at least 10 adult patients recruited were considered. All studies had to relate return to sport after TSA or HA.

Results: A total of 76 studies were included for a total of 694 patients. The mean age and average follow-up were, respectively, 64.5 years (range: 24 to 92 y) and 4.5 years (range: 0.5 to 12 y). The mean rate of return to sport ranged from 49.3% to 96.4%. The mean time to resume sports was 8.1 months. The overall rate of return to sport after the procedures, according to a random effect model, was 83%. The mean level of sports at the time of the survey was worsened in 9.4% (±2.82%), improved or reported from good to excellent in 55.6% (±13.6%), and did not change in 40% (±1.4) of patients.

Conclusions: On the basis of current available data, return to sports after TSA and HA is possible and is highly frequent. The subjective level of practice does not change or improve in most patients. More studies and better designed trials are needed to enrich the evidence on specific sport recovery after the procedure.

Basketball presents several characteristics that distinguishes it from other contact sports and can influence the manner by which a Team Physician and Hand Surgery Consultant interact. An abbreviated list of pathologies that affect the basketball athlete and the approach to their evaluation and treatment by a Hand Surgeon are described in context of return-to-play.

Golf is unique in this compendium of sports-related hand and wrist injury management. It is the only sport where the ball is stationary and there is no opponent against whom the player is defending. This distinctive sport dates to the 15th century in Scotland and is one of the oldest sports, but it is one where technology has changed many of the fundamental elements-from the "playing field (through advanced in agronomy) and the equipment (club and ball technology).

Ice hockey is a high-speed sport played on a slippery ice surface, using sharp skate blades, rigid sticks with a hard rubber puck, and allowing full-force physical contact that includes body checking and fighting. Although many of the same injuries to the hand and wrist occur that are seen in other sports, there is a higher frequency of certain injuries in the hockey athlete due to the forces involved, the way the hockey stick is gripped, torqued, and used, and the fact that players can slash one another with their sticks. Beyond timely and accurate management of the injury itself, the role of the consultant hand surgeon in hockey encompasses mastery of the intangible skills in the art and humanity of medical care. Injury to the hockey athlete sets in motion a dynamic process that involves many stakeholders who each require your knowledge of how this will affect the hockey athlete's immediate and long-term health, how long they may be out of competition, and the kind of treatments, splints and equipment modifications that could help foster the earliest return-to-play in a safe manner. The consultant hand surgeon needs the ability to communicate information at a high level to team physicians and trainers while remaining nimble enough to simplify that information for general managers, coaches, agents, and athletes. The role demands commitment in time and flexibility, remaining open to gray areas in treatment options, possessing a creative mindset for problem-solving, and the ability to quickly assimilate vast amounts of information to provide a risk assessment of short and long-term implications the injury presents to both the player and the team.

The role of an experienced Hand Surgery Consultant within the complete care matrix for a professional sports organization has evolved in my 3-decade career. Granted, hand injuries may have been demoted in this population where ACL tears, shoulder dislocations, and Lisfranc injuries seem to have much greater visibility, but our experience has told us that Hand injuries often contribute to the most surgeries per team/per season and can result in significant man-game loss of service. In my 30 years as a Consultant, Team Physician and/or Medical Director in all 4 major North American-based Leagues (as well as for "itinerant" independent contractor sports of golf, tennis, and motorsports), we have cared for well over 2000 athletes. This privilege has provided us with unparalleled exposure to the locker rooms, training rooms, and clubhouses for almost every team in professional-level competition and many elite-level collegiate programs. My goal in assembling this volume was to highlight the skilled and experienced colleagues who have contributed so much to the surgical science of caring for the hand and wrist in the professional athlete and furthering the logic of having a Hand Surgeon on "speed dial" for our fellow Team Physicians who want to provide optimal care for their athletes. Regrettably, until recently, the limited number of us who had significant involvement in this cohort probably fell short of engaging in scientific inquiry and publishing our observations or series. I will accept more than my share of that shortcoming, but as these practices have expanded in number and the exposure went from anecdotal to voluminous, our community started to communicate within Hand Surgery ranks, but now we want to share our knowledge with all professional involved in elite athlete care. This collection is not meant to be an exhaustive review of individual pathologies. Fortunately, valued colleagues have done a laudable job of chronicling the common-to-complex pathologies that we see in sports coverage This publication is styled less from the "what" and "how" standpoint, aimed instead at providing Team Physicians with the "when" and "why" of optimizing their player's outcomes through collaboration with their Hand Specialist.

The approach to the care of baseball athletes and organizations is influenced by 2 factors that distinguish it from other sports: the number of contests and the number of players. America's pastime is a marathon that can (if successful in the regular season and postseason play) stretch over a 10-months, 162+-game schedule. In addition, unlike other major North American sports, baseball's "feeder system" is the highly-structured Minor League Baseball. This is in contradistinction to caring for 15 basketball players who arrive at the professional level through collegiate (or even high school) play or 20 hockey players that may have had an NCAA experience or come through the Junior Leagues in Canada. Even though a 53-man football roster can keep a Hand Surgery Consultant busy, it is still a limited professional level cohort that is one-third to one-fourth of the size of baseball's and is played across less than 20 contests. Granted, every sport has its own culture-which is why we have developed this format for this publication-but planning for the scope of baseball care is also influenced by the unique pace and intensity of the interactions, that is why it is called a "clubhouse," rather than a "locker room". With these fundamentals shared, let us expand on what our experience has taught us about the care for athletes that are engaged in batting, throwing, receiving, and colliding on the diamond.