Background: Elbow injuries are exceedingly common in baseball players. Previous studies have identified that upper extremity strength and range of motion deficits pose a risk for these injuries, but few studies have examined the effect of lower extremity deficits. Given the role of the lower extremity in the kinetic chain of the baseball throwing motion, lower body deficits may affect the kinematics of the upper extremity and play a role in the elbow injury of baseball players. Purpose: To systematically review the current literature investigating the association of trunk and lower extremity deficits with elbow pain or injury in baseball players. Study Design: Systematic review. Methods: A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines to identify and analyze all previous studies focused on the association of elbow pain and/or injury with functional deficits of the trunk and lower extremities. Results: A total of 14 studies met inclusion criteria, examining a range of baseball players extending from youth to professional athletes. One of the 14 studies examined other types of overhead throwing athletes alongside baseball players. Lower extremity–related risk factors for elbow pain and injury in these athletes were found and stratified per level of play. Factors included specific hip range of motion, lower extremity injury or pain, balance, and foot arch posture. Associations were also found with lower extremity injury and noncompliance with primary prevention programs. Conclusion: Specific lower extremity deficits were found to be independent risk factors for elbow pain and injury in throwing athletes at certain levels of play. Additionally, prevention programs designed to correct deficits in identified risk factors were effective in reducing the incidence of elbow injury in youth athletes. These results highlight the potential of screening and subsequent intervention to reduce the incidence of elbow injury in certain subsets of baseball players.
At the present time, there is a paucity of literature regarding medial meniscal posterior root repair and outcomes. This review seeks to examine the currently available data to further elucidate the clinical risks and benefits and any associated risks of medial meniscal posterior root repair. A systematic literature search was performed up to July 2018 in the databases of Medline via PubMed, EBSCOhost, and EMBASE. The results were reviewed independently by two authors and appropriate articles were reviewed and eligibility determined based on established criteria. The best-evidence synthesis was subsequently used. Thirteen studies (324 patients) were included in this review with a mean patient age of 54 years. There were no control studies with nonoperative treatment of medial meniscal posterior root tears. All studies included a minimum of 10 patients in a case series or case-control manner. Of patients treated with medial meniscal posterior root repair, 62.43% demonstrated complete healing on follow-up magnetic resonance imaging (MRI) or second-look arthroscopy. Among them, 32.60% demonstrated incomplete healing, loosening of the construct, or excessive scar tissues formation. Also, 4.97% demonstrated complete failure or retearing of the construction. At a mean follow-up period of 33 months, patients demonstrated a mean improvement in Lysholm's score of 30.5 (p < 0.00001), International Knee Documentation Committee (IKDC) score of 31.9 (p < 0.00001), and HSS Knee Score of 38.3 (p < .00001). Surgical repair of medial meniscus posterior root tears appears to result in highly satisfying subjective outcomes. Patients included in this review meet criteria for both statistically and clinically significant improvement, based on published guidelines for minimal clinically important difference. Despite this, however, postoperative MRI and second-look arthroscopy demonstrate a relatively high rate of incomplete healing (32.60%) or retearing and failure of the construct (4.97%). More highly powered studies are required to confirm these findings.
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