Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz Specialty Update summaries.

This month, OrthoBuzz asked Warren Dunn, MD, a co-author of the April 20, 2016 Specialty Update on sports medicine, to select the five most clinically compelling findings from among the more than 30 studies cited in the article.

Shoulder

–What happens to asymptomatic rotator cuff tears over time?  According to a long-term prospective study of patients who had an asymptomatic tear in one shoulder and a symptomatic contralateral rotator cuff tear, the asymptomatic tears enlarged in almost one-half of the patients over a median of three years. Those patients who experienced tear enlargement tended to have an onset of new pain and progressive degenerative changes within the supraspinatus and infraspinatus muscles. The authors concluded that many formerly asymptomatic tears will progress to become symptomatic.

–Does tendon repair yield better outcomes than physical therapy (PT) when treating rotator cuff tears? A randomized trial of 103 patients with tears not exceeding 3 cm found that 12 of 51 patients (24%) in the PT group subsequently underwent secondary cuff repair over a 5-year follow-up period. Statistically, patients in the primary repair group had significantly better group-mean improvements on the Constant score, ASES score, and VAS for pain and patient satisfaction than those who underwent secondary repair, but the authors noted that these differences “may be below clinical importance.” Thirty-seven percent of those treated with PT only experienced a >5 mm increase in tear size, which was associated with inferior outcomes.

–Are estimates of Propionibacterium acnes colonization rates in surgical shoulder wounds accurate? A controlled diagnostic study examined P. acnes colonization in 117 open shoulder surgeries that utilized the deltopectoral approach. In 20.5% of the procedures, at least one surgical specimen was positive for P. acnes growth, but 13% of cultures from sterile-sponge control samples also had positive growth. This led the authors to surmise that prior estimates of P. acnes incidence may be higher than actual because of frequent culture contamination. Male sex and preoperative corticosteroid injections were associated with a higher likelihood of bacterial growth.

Knee/ACL

–Most people who undergo ACL reconstruction experience significant improvement in physical quality of life and quality-adjusted life years, but who is more or less likely to benefit? A 2- and 6-year longitudinal analysis of a multicenter cohort found that those who underwent revision, smoked cigarettes, had lateral tibial plateau chondromalacia, or had less education were more likely to score lower on the Physical Component Summary of the Short Form-36. Those who tended to have higher postoperative functional scores were those with higher baseline function, younger age, lower BMI, and either no lateral meniscal treatment or >50% lateral meniscectomy.

Hamstring Injuries

–Hamstring injuries are common among soccer players. A Level I randomized controlled trial among 579 high-level amateur soccer players found that 13 weeks of participation in Nordic hamstring exercises significantly reduced injury incidence and risk for injury compared with a control group over a 1-year period. No differences in injury severity were found.¹

Reference

1. van der Horst N, Smits DW, Petersen J, Goedhart EA, Backx FJG. The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players: a randomized controlled trial. Am J Sports Med. 2015 Jun;43(6):1316-23. Epub 2015 Mar 20.