Keeping you up to date on recent headlines in orthopedic healthcare:

Specific injuries predict odds for NFL careers ....

College defensive backs who suffer meniscal tears will probably have to turn pro in something other than football, researchers have found. A study based on data from elite college players collected during the National Football League's annual scouting "combine" found significant associations between particular injuries, a player's position, and the chances of landing an NFL contract or having a long career. Conducted by Robert H. Brophy, MD, of Washington University (St. Louis), and colleagues, the study was reported in the April issue of the American Journal of Sports Medicine. It examined injury data on 5,004 promising college players who participated in NFL combines from 1987 to 2000, along with follow-up on their subsequent pro careers. Some 56% of the players went on to play in at least one NFL game. Brophy and colleagues found that players with histories of meniscal tears, shoulder instability, and anterior cruciate ligament (ACL) injuries and reconstructions were less likely to play in the NFL – but in some positions more than others. For example, meniscal tears or knee ligament reconstructions had little apparent effect on a college kicker's chances of playing professionally: Some 25% of those who suffered these injuries made it to the NFL, compared with 26% of those who had not received such injuries. But only 48% of college cornerbacks and safeties with meniscal tears went on to play in the NFL, vs. 62% of those without meniscal injury (P=0.049). Meniscal tears did not significantly predict the likelihood of playing professionally at any other position. ACL injuries significantly affected NFL prospects for defensive linemen and linebackers (P<0.05), though there were trends suggesting an effect on running backs, tight ends, and offensive linemen, too. Analyzed separately, reconstruction of knee ligament tears significantly worsened chances of playing in the NFL for linebackers and linemen on both sides of the ball. Shoulder instability and procedures to correct it, also broken out separately, appeared to affect the NFL prospects at most positions. But it was statistically significant only for linemen, and only for shoulder instability, not stabilization surgery. College shoulder problems appeared to make no difference at all on the prospects of pro quarterbacks or linebackers. Other injuries and reconstructions that were a significant (P<0.05) obstacle to pro careers at certain positions included the following:

• Running backs: spondylosis

• Offensive linemen: carpal fractures, rotator cuff repair, knee articular cartilage surgery

• Quarterbacks: forearm fracture, medial collateral ligament injury

• Defensive linemen: rotator cuff injury

• Linebacker: acromioclavicular joint injury

The findings for knee articular cartilage surgery were particularly sobering, the researchers indicated. Not a single offensive lineman in the study with such a history ever played in an NFL game, and fewer than half of players at other positions played professionally after the procedure. "Cartilage lesions remain a difficult clinical problem, particularly in high-demand, high-performance athletes such as those in the NFL," the researchers wrote. Brophy and colleagues also found that certain injuries in college players predicted the duration of pro careers. In particular, defensive backs who suffered meniscal tears has significantly shorter careers. About 10% who went to the NFL with a history of meniscal tear played 100 professional games, compared with 30% of those without such history. Similarly, shoulder instability and stabilization procedures shortened the pro careers for receivers and defensive linemen. Anterior cruciate ligament injury and reconstruction had the same effect on offensive linemen. Receivers who underwent shoulder stabilization in college were particularly likely to have short careers. Only about 5% who played one NFL game went on to play 100 games vs. about 25% of those without such history. In general, the relationships between specific injuries and positions were consistent with the demands of those positions, the researchers said. American Journal of Sports Medicine Source reference: Brophy R, et al "Predictive value of prior injury on career in professional American football is affected by player position" Am J Sports Med 2009; 37: 768-75.

MRI identifies five causes of complications from ACL reconstructive surgery .... MRI has identified five possible causes of patient complications from anterior cruciate ligament (ACL) reconstructive surgery, according to a study performed at Emory University Hospital (Atlanta) and Sahlgrenska-Molndal University Hospital (Gothenborg, Sweden). Sixteen patients with symptoms suggesting ACL reconstruction failure underwent MR imaging three weeks to three years following surgery to possibly determine the cause(s) of their complications. "Persistent pain is the most consistent patient complaint. Others complain of instability, joint swelling and infection," said Claude Pierre-Jerome, MD, lead author of the study. The study found that there were five possible causes of reconstruction failure and patient complication: graft discontinuity (a tear or impingement in the graft, 5 knees), inappropriate position of the femoral and/or tibial tunnel (graft will not function properly without proper tunnel positioning, 2 knees) hardware failure (screws may not be in the right position, 3 knees), infection (1 knee) and intra-articular arthrofibrosis (affecting movement of the joint, 4 knees). "These are only preliminary results for a much larger study," said Pierre-Jerome. "ACL reconstructive surgery is very common. In fact, ACL injuries account for every one in 3,000 injuries. We see many patients with a history of ACL surgery and it is our goal to make radiology more focused on the findings of pain in the knee," he said. Pierre-Jerome and his co-workers believe that "MRI can accurately detect the causes of surgical failure and persistent pain. MRI allows us to see all of the structures of the knee very well. If the graft is not normal, we can make a note of it and tell the surgeon right away that something is wrong," he said.
Source: American Roentgen Ray Society

Increased risk of fractures and cardiovascular-related death following prostate cancer therapy .... Prostate cancer patients who undergo therapy to decrease testosterone levels increase their risk of developing bone- and heart-related side effects compared to patients who do not take these medications, according to a new analysis. Published in the June 1, 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society (Washington), the study indicates that preventive measures and careful scrutiny of patients' health can keep men from experiencing these potentially serious consequences. While medical treatments that decrease testosterone levels – called androgen deprivation therapy (ADT) – are important and effective therapies for men with prostate cancer, they can cause a variety of side effects including skeletal and cardiovascular complications, sexual dysfunction, periodontal disease, and mood disorders. Bone and heart complications are among the most serious side effects associated with ADT, but the actual risk patients have of developing these effects is unknown. Lockwood Taylor, MPH, of the University of Texas Health Science Center (Houston) and colleagues conducted a study to assess this risk by analyzing all of the literature related to side effects from ADT published between 1996 and mid-2008. They found 14 studies (8 bone-related, 6 heart-related) that were suitable for analysis. The researchers' review revealed that men treated with ADT for prostate cancer had an increased risk of bone fractures and heart-related death, although the absolute risk for both was still low. For bone fractures, there was a 23% increased risk compared to prostate cancer patients who did not undergo the treatment. The absolute risk of fracture among ADT-exposed men was still only 7.2 per 100 person years. For heart-related death, the increased risk among ADT-exposed men was 17% higher compared to other prostate cancer patients. However, because the baseline risk is low, the increase translated to an additional one-to-two deaths per 1,000 men who received ADT. Two large studies also documented significant increases in diabetes risk associated with the therapy.

Article: "Review of Major Adverse Effects of Androgen-deprivation Therapy in Men With Prostate Cancer." Lockwood G. Taylor, Steven E. Canfield, and Xianglin L. Du. CANCER; Published Online: April 27, 2009 (DOI: 10.1002/cncr.24283); Print Issue Date: June 1, 2009.

— Compiled by Holland Johnson, MDD

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