A Case Report on Medial Patellofemoral Ligament Reconstruction Rehabilitation in a Cricket Player Through Targeted Agility Training

The medial patellofemoral ligament (MPFL) serves as a crucial stabilizer, preventing lateral dislocation of the patella. Surgery is usually advised after a second dislocation, with MPFL reconstruction being a common procedure. The primary objective of rehabilitation post-surgery is not just to relieve pain and restore range of motion (ROM), but also to combine proprioceptive neuromuscular training to help patients return to their prior functional level. Agility training is a crucial component in accomplishing this goal. The current case is of a 19-year-old male cricket player with a history of recurrent patellar dislocation who underwent surgery after the latest incident rendered him unable to bear weight. His rehabilitation program included standard protocols alongside the early implementation of agility drills, such as ladder exercises. Compared to traditional approaches, this case demonstrates significant improvement in the patient's functional ability following surgery. This report highlights the importance of comprehensive rehabilitation for patients undergoing MPFL reconstruction. It not only underscores the rationale behind the surgery but also lays the groundwork for comparing recovery times. Notably, this program incorporated early agility exercises from the very beginning, suggesting that such an approach might accelerate recovery compared to standard protocols. Further investigation is warranted to explore the potential benefits of early agility training in this patient population.

Conservative Treatment of Avulsion Injuries of the Lesser Trochanter in Adolescent Athletes

BACKGROUND

 Avulsion injuries of the lesser trochanter apophysis are relatively uncommon injuries and there have been no peer-reviewed case series dedicated to the evaluation and treatment of this injury. The purpose of this study is to characterize avulsion injuries of the lesser trochanter apophysis, review treatment protocols, and time to return to sport.  Methods: We reviewed 30 confirmed avulsion fractures of the lesser trochanter. Clinical data were reviewed to evaluate treatment protocols, duration, and time to return to sport. Radiographs were reviewed to confirm lesser trochanter avulsion and fracture displacement.

RESULTS

There were 26 males and 4 females, with the average age at the time of injury being 14.2 years. Treatment modalities consisted of protective weight-bearing, discontinuation of the patient's sport in all cases, and formal physical therapy in 18 cases. The average treatment duration was 30.7 days. The mean follow-up time was 102 days. The radiographic assessment demonstrated an average fracture displacement of 5.1 mm. The average return to sport was 11 weeks.

CONCLUSION

This is the first large case series studying avulsion injuries of the lesser trochanter. We have shown that these athletes can be managed non-surgically and can successfully return back to sport within three months.

Operative management of ulnar collateral ligament insufficiency in adolescent athletes

BACKGROUND

The incidence of ulnar collateral ligament (UCL) injuries of the elbow has increased in adolescents over the past decade because of widespread participation in athletics and heightened awareness among physicians.

HYPOTHESIS

Ulnar collateral ligament reconstruction using the docking technique would result in a successful return to athletic activity in this age group.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Study participants were 55 skeletally mature adolescent athletes (mean age, 17.6 years; range, 15-18 years) who underwent UCL reconstruction between 2008 and 2010. While the majority of patients were baseball players (n = 47), there were 3 gymnasts and 5 javelin throwers included in the study. Each patient underwent UCL reconstruction utilizing the docking technique after an adequate trial of nonoperative management (mean, 5.8 months). At the latest follow-up, patients were evaluated to determine their ability to return to athletic activity. Clinical outcomes were classified using the Conway scale, the Andrews-Timmerman score, and the Kerlan-Jobe Orthopaedic Clinic (KJOC) score.

RESULTS

At a minimum 2-year follow-up, 87% (48/55) of patients had excellent results using the Conway scale. Overall, there were only 2 poor results (3.6%) that were observed in patients with concomitant osteochondritis dissecans lesions of the capitellum. There were 4 postoperative complications in 4 patients (2 gymnasts and 2 javelin throwers) who developed ulnar neuritis after UCL reconstruction. The mean Andrews-Timmerman score was 83.6 ± 7.2 (range, 30-100), and the mean KJOC score was 88.0 ± 6.0 (range, 40-100).

CONCLUSION

The docking technique results in favorable clinical outcomes in adolescent athletes with UCL insufficiency at a minimum of 2 years postoperatively. Patients with concomitant intra-articular lesions should be cautioned preoperatively that they might experience inferior clinical outcomes. Postoperatively, adolescent gymnasts and javelin throwers may be at an increased risk for transient paresthesia of the ulnar nerve caused by increased stress on the medial elbow.