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Purpose: To assess the use of anterior cruciate ligament (ACL) reconstruction in older adults and to compare postoperative complication and revision surgery rates between patients older than and younger than 50 years old. Methods: Retrospective data were obtained using the PearlDiver database for patients who underwent arthroscopic ACL reconstruction from January 2010 to December 2017. Trends in the annual performance of ACL reconstruction were determined using nonparametric test of trends of ranks. Patients in each age group were matched based on sex and the Charlson Comorbidity Index. The incidence of postoperative complications within 90 days and subsequent knee surgery within 2 years of ACL reconstruction was collected. Postoperative complication rates were compared between matched age groups using the c 2 test. Results: A total of 20,993 patients aged 50 years and older and 154,817 patients younger than 50 years underwent ACL reconstruction between 2010 and 2017. The use of ACL reconstruction in patients aged 50 years or older decreased over time (P ¼ .044). Patients aged 50 years or older were more likely to experience at least 1 postoperative complication within 90 days compared to patients younger than 50 years (2.5% vs 2.1%, P ¼ .007). Older patients were 1.3 times as likely to experience deep vein thrombosis (P ¼ .002) and 1.8 times as likely to experience pulmonary embolism (P < .001). Younger patients were more likely to undergo subsequent ACL reconstruction and experience knee pain, stiffness, and wound infection postoperatively (P < .001, P < .001, P ¼ .041). 1.6% of patients aged 50 years or older underwent total knee arthroplasty within 2 years. Conclusions: ACL reconstruction in patients aged 50 years or older is associated with greater complication rates but lower rates of subsequent knee surgery relative to patients younger than 50 years of age. Younger patients were more prone to surgical complications whereas older patients experienced more medical complications. The increased incidence of VTE in this population suggests that thrombotic prophylaxis may be considered.

Purpose of Review This review examines the relationship between the baseball pitching motion and the kinetic chain. The goal was to determine the underlying causes of a deficiency in throwing mechanics throughout a throwing motion, and to provide an evidence-based approach on how to prevent injuries caused by a lack of proper mechanics. In doing so, we sought to provide a warm-up strategy that can be added to every baseball player’s daily on-field routine that is tailored to each phase of the throwing motion. Recent Findings To help minimize the risk of injury to overhead throwing athletes, a thorough understanding of the throwing motion is critical. Throwing a ball places extreme stress on the body, notably the shoulder and elbow joints. With a clear understanding of the biomechanics of throwing, we can develop an injury prevention routine to minimize unnecessary stresses throughout the kinetic chain. Summary The throwing cycle is a complex motion that places various stresses throughout the thrower’s body, from the ankle to the core, and from the back to the shoulder and elbow. A thorough understanding of the mechanics of this motion, along with specific exercises to target the specific actions of each phase, may allow for throwers, regardless of their age and experience, to minimize injury risk.

Background: Depression and related psychiatric diagnoses are common in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). The effects of depression on postoperative complications, readmissions, and additional ipsilateral hip surgery are not well studied. Hypothesis: Patients with preoperative depression who undergo hip arthroscopy for FAIS would experience higher rates of 90-day postoperative complications and readmissions, with an increased risk of additional ipsilateral hip procedures, as compared with patients without depression. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study between 2010 and 2019 was performed using the Mariner/PearlDiver database. Current Procedural Terminology and International Classification of Diseases codes were used to compare patients with and without preexisting depression who underwent hip arthroscopy for FAIS. Patients were matched at a 1:1 ratio based on age, sex, Charlson Comorbidity Index, body mass index, and tobacco use. Patients undergoing shoulder or knee arthroscopy were also identified to compare lifetime preoperative depression prevalence amongst groups. Results: The lifetime preoperative depression prevalence was significantly higher in patients undergoing hip arthroscopy as compared with patients undergoing shoulder or knee arthroscopy (25.4% vs 22.2% vs 19.8%; P < .001). When compared with the patients without depression, patients with preoperative depression had higher rates of 90-day readmissions (2.4% vs 1.5%) and complications, including urinary tract infection (36.2% vs 28.9%), pneumonia (12.9% vs 9.1%), hematoma formation (3.1% vs 1.9%), acute kidney injury (4.0% vs 2.6%), deep venous thrombosis/pulmonary embolism (2.6% vs 1.7%), and superficial infection (4.9% vs 2.8%; P < .01 for all comparisons). Preoperative depression was associated with significantly higher odds of undergoing revision hip arthroscopy within 2 years (6.3% vs 2.4%; P < .001). Conclusion: Patients with preexisting depression experienced higher rates of 90-day postoperative complications and hospital readmissions after elective hip arthroscopy for FAIS and were more likely to undergo revision hip arthroscopy within 2 years of the index procedure.

Background:There is no standard method for the surgical treatment of acromioclavicular (AC) joint separations. Current techniques have associated complications, including need for device removal, coracoid fracture, and inadequate reduction.Purpose:To evaluate the clinical outcomes of an internal splint technique without graft augmentation or rigid fixation to treat acute Rockwood type IV and V AC joint injuries.Study Design:Case series; Level of evidence, 4.Methods:A retrospective analysis was performed of 26 patients who underwent a novel internal splint fixation technique between 2011 and 2016. Patients had type IV (n = 2) and type V (n = 24) acute AC separations. The mean time to surgery was 13.7 days (range, 1-28 days). The surgical technique included an open approach with coracoclavicular suture and tape fixation and AC suture fixation. Range of motion, strength, and radiographs were evaluated after surgery. Patient follow-up included the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire at a mean 3.3 years postoperatively (range, 6 months–8.6 years). DASH questionnaires were obtained for all patients via email. Patients were also surveyed on cosmetic appearance and willingness to undergo the operation again.Results:All patients regained full strength and range of motion following surgery. All postoperative radiographs demonstrated well-maintained reduction of the AC joint. The mean DASH score was 3.4 at final follow-up, and 23 of 26 respondents were satisfied with their postoperative shoulder appearance. There were no reoperations, and all patients stated that they would have the operation again given the same circumstances.Conclusion:The results of this study demonstrate a reliable new technique for acute fixation of type IV or V AC joint injuries via an internal splint construct. This technique enables reduction in the coronal and sagittal planes without the need for graft augmentation or a rigid implant, allowing healing of the coracoclavicular and AC ligaments.