Background:The majority of Achilles tendon ruptures are sports related; however, no investigation has examined the impact of surgical repair for complete ruptures on professional soccer players.Purpose:To examine the return to play, playing time, and performance of professional soccer players following Achilles tendon repair.Study Design:Cohort study; Level of evidence, 3.Methods:Union of European Football Associations (UEFA) and Major League Soccer (MLS) athletes who sustained a primary complete Achilles tendon rupture and were treated surgically between 1988 and 2014 were identified via public injury reports. Demographic information and performance-related statistics for the identified athletes were recorded for the season before surgery and 2 seasons after surgery and were compared with information for matched controls. Statistical analyses were used to assess differences in recorded metrics.Results:A total of 24 athletes with Achilles ruptures met inclusion criteria, 17 (70.8%) of whom were able to return to play. On average, players had 8.3 years of professional-level experience prior to sustaining an Achilles rupture. Among athletes who returned to play, no differences were found in the number of games played or started, minutes played, or goals scored 1 year postoperatively compared with the year prior to injury. However, 2 years postoperatively, these athletes played 28.3% (P = .028) fewer minutes compared with their preoperative season, despite starting and playing in an equivalent number of games. Matched controls had baseline playing time and performance statistics similar to those of players. However, controls played and started in significantly more games and played more minutes at 1 and 2 years compared with players (P < .05). No differences were found in goals scored at any time point.Conclusion:This is the first investigation examining the effect of an Achilles repair on the career of professional soccer players. This is a difficult injury that most commonly occurs in veteran players and prevents 29.2% of players from returning to play despite surgical management. Additionally, athletes able to return to play were found to play fewer minutes 2 years postoperatively compared with their baseline as well as playing less at 1 and 2 years postoperatively compared with uninjured matched controls. The reduction in playing time following an Achilles repair has significant implications for professional players and teams.

The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is the most commonly used instrument to assess outcomes of basal joint arthritis (BJA). However, the DASH is subject to influence by the entire upper extremity. This study aims to develop and validate a disease-specific questionnaire for BJA that would be more sensitive to changes in thumb function and pain, and correlate better with objective and subjective metrics. The thumb disability examination (TDX) was developed and 80 patients presenting with BJA at one of the two hospital-based hand clinics were enrolled in the validation study. At enrollment, subjects were given the TDX, DASH, and visual analog pain scale with activity (A-VAS) surveys. The strength was assessed. Patients receiving corticosteroid injection were seen for follow-up at 6 weeks and those who underwent surgery were seen between 3 and 6 months postoperatively. Both the groups were given the TDX, DASH, and A-VAS scales at follow-up. In total, 65 subjects were included in the analysis. Average TDX completion time was 134.3 seconds. The TDX correlated more strongly with A-VAS scores at baseline than the DASH, but less strongly with tip-pinch measures. The TDX was more responsive to injection and surgical treatments for BJA than the DASH, yielding a larger effect size and standardized response mean, and was the only instrument to significantly correlate with changes in A-VAS. The TDX is a reliable instrument for assessing BJA treatment outcomes. It bears less of a burden on patients, is more responsive to symptomatic changes, and correlates better with most objective and subjective measures than the DASH. II, diagnostic.

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Objectives:Patients are attempting to access healthcare content online at a precipitously increasing rate given the efficiency and ease of modern search engines. The purpose of this study was to assess the quality and variability found across isolated meniscal repair rehabilitation protocols published online. Methods: Web-based meniscal repair physical therapy protocols from U.S. academic orthopaedic programs available online were included for review. The first 10 protocols identified by the Google search engine for the term "meniscal repair physical therapy protocol" were also included as these will be the most commonly encountered by patient searches. Exclusion criteria comprised treatment of concomitant injuries and protocols aimed at pediatric patients. A comprehensive custom scoring rubric was created to assess each protocol for presence or absence of various rehabilitation components, as well as their timing. Results: Twenty protocols were included from 155 U.S. academic orthopaedic programs for a total of 30 protocols. Only one protocol (5%) recommended a pre-operative rehabilitation program and no protocol recommended continuous passive motion post-operatively. Twenty-six protocols (86.6%) recommended immediate post-operative bracing with an average 5.0 (range 3 to 8) weeks of brace use. Twenty-three of these protocols (88.5%) specifically mentioned locking of the brace during ambulation. Twelve (40.0%) protocols permitted immediate weight bearing as tolerated (WBAT) post-operatively, while the remaining protocols permitted WBAT at an average 4.0 (range 1 to 7) weeks post-operatively. There was considerable variation in range of motion (ROM) goals with most protocols (73.3%) initiating immediate PROM to 90°. Full ROM was mentioned in 22 (73.3%) protocols and permitted at an average of 5.2 (range 1 to 7) weeks. The types of strength and proprioception exercises specifically recommended in each protocol were extremely diverse. In regard to modalities recommended for return to basic activity, stationary biking was the most commonly employed (90.0%) at an average 4.6 (range 1 to 7) weeks post-operatively. Agility and pivot training were permitted at an average of 12.5 (range 7 to 28) and 19.3 (range 11 to 28) weeks, respectively. Only five protocols (16.7%) employed functional testing during the rehabilitation process as a marker for return to athletic activities, with 14 (46.7%) protocols failing to mention return to practice or competition as a goal for meniscal repair rehabilitation. Conclusion: There is a paucity of evidence-based treatment modalities employed during physical therapy following isolated meniscal repair. The results of this study indicate that only a minority of academic orthopaedic programs publish meniscal repair physical therapy protocols online and that within these protocols there are significant disparities. These variations reflect the lack of consensus regarding the best-practice components of meniscal repair rehabilitation which can lead to confusion among patients, therapists and...