Bedi worked with senior mentors Dr. David W. Altchek and Dr. Riley J. Williams on studying the anatomy and stability of ACL reconstructions using transtibial versus anteromedial portal drilling techniques on 19 cadaveric knees. Femoral socket position was characterized using high-resolution 3D-fluoroscopy with transtibial and anteromedial portal drilling. "While anteromedial portal drilling allows for excellent access and restoration of the femoral ACL footprint, there is a significant learning curve. There can be an increased risk of shorter femoral tunnels and wall blow-out intraoperatively" says Dr. Riley Williams, the senior author and Associate Attending Surgeon at the Hospital for Special Surgery.
Follow-up studies have evaluated the biomechanical stability of ACL reconstructions completed with transtibial and anteromedial portal techniques. "The anteromedial portal drilling technique allowed for better restoration of native ACL anatomy and knee stability compared to conventional transtibial techniques. We also found that re-reaming of the tibial tunnel is a bigger issue than has been previously recognized with transtibial drilling" says Dr. David Altchek, senior author and Co-Chief of the Sports Medicine Service at the Hospital for Special Surgery.
Bedi and Altchek will be presenting the second part of their study at the 2009 AOSSM Annual Meeting in Keystone, CO. "Continued research into the best techniques for ACL stabilization are ongoing and a vital part of getting athlete's back into play at a quicker rate. We are working to define these techniques in the lab and have them translated into the operating room" says Altchek.
Elbow ligament reconstruction appears not to effect future professional advancement in baseball
New research presented at the 2009 American Orthopaedic Society of Sports Medicine Specialty Day in Las Vegas suggests that elbow ulnar collateral ligament (UCL) reconstruction prior to selection in the Major League Baseball (MLB) draft does not increase the risk of future injury or affect the rate of professional advancement. "Our study showed no statistical difference between athletes who had undergone UCL reconstruction prior to the draft and a matched control group in terms of advancement in professional baseball" said Gregory F. Carolan, MD, lead author and Director of Orthopaedic Sports Medicine at St. Luke's Hospital in Bethlehem, PA. Dr. Carolan is a former fellow at the San Diego Arthroscopy & Sports Medicine Program and The Scripps Clinic, San Diego, CA where the research was conducted in conjunction with the San Diego Padres Baseball Club.
The researchers reviewed the medical records of all players selected during the five MLB drafts held from 1999 through 2003 and identified 30 players (all but 3 were pitchers) who had undergone UCL reconstruction (RUCL) prior to entering the draft. The data analyzed included the highest level of professional advancement, the number of times players were placed on the disabled list (DL), the type of injury responsible for placement on the DL and game statistics for those players that advanced to the Major Leagues. There was no statistically significant difference in any of these areas between the RUCL group and the control group.
"Our data shows that UCL reconstruction prior to selection in the MLB draft does not appear to increase the chances of a future injury to the throwing arm or impact a player's professional prospects when compared to a matched control group. Our analysis is sufficiently powered to detect large differences between the two groups; however our ongoing research will continue to add confidence that we are not missing more subtle differences. As more athletes undergo the procedure and enter the MLB draft, we hope to be able to accomplish this goal. With the increase in UCL reconstructions being performed, it is heartening to see that the procedure can be successful in allowing future professional athletes to the reach the highest level of competition on par with their peers," said Carolan.
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