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  1. Article: Determining the True Incidence of Glenohumeral Instability Among Players in the National Football League: An Epidemiological Study of Non-Missed Time Shoulder Instability Injuries.

    Anderson, Matthew J J / Confino, Jamie E / Mack, Christina D / Herzog, Mackenzie M / Levine, William N

    Orthopaedic journal of sports medicine

    2023  Volume 11, Issue 10, Page(s) 23259671231198025

    Abstract: Background: Shoulder instability encompasses a spectrum of glenohumeral pathology ranging from subluxation to dislocation. While dislocation frequently leads to removal from play, athletes are often able to play through subluxation. Previous research on ...

    Abstract Background: Shoulder instability encompasses a spectrum of glenohumeral pathology ranging from subluxation to dislocation. While dislocation frequently leads to removal from play, athletes are often able to play through subluxation. Previous research on glenohumeral instability among athletes has largely focused on missed-time injuries, which has likely disproportionately excluded subluxation injuries and underestimated the overall incidence of shoulder instability.
    Purpose: To describe the epidemiology of shoulder instability injuries resulting in no missed time beyond the date of injury (non-missed time injuries) among athletes in the National Football League (NFL).
    Study design: Descriptive epidemiology study.
    Methods: The NFL's electronic medical record was retrospectively reviewed to identify non-missed time shoulder instability injuries during the 2015 through 2019 seasons. For each injury, player age, player position, shoulder laterality, instability type, instability direction, injury timing, injury setting, and injury mechanism were recorded. For injuries that occurred during games, incidence rates were calculated based on time during the season as well as player position. The influence of player position on instability direction was also investigated.
    Results: Of the 546 shoulder instability injuries documented during the study period, 162 were non-missed time injuries. The majority of non-missed time injuries were subluxations (97.4%), occurred during games (70.7%), and resulted from a contact mechanism (91.2%). The overall incidence rate of game-related instability was 1.6 injuries per 100,000 player-plays and was highest during the postseason (3.5 per 100,000 player-plays). The greatest proportion of non-missed time injuries occurred in defensive secondary players (28.4%) and offensive linemen (19.8%), while kickers/punters and defensive secondary players had the highest game incidence rates (5.5 and 2.1 per 100,000 player-plays, respectively). In terms of direction, 54.3% of instability events were posterior, 31.9% anterior, 8.5% multidirectional, and 5.3% inferior. Instability events were most often anterior among linebackers and wide receivers (50% and 100%, respectively), while posterior instability was most common in defensive linemen (66.7%), defensive secondary players (58.6%), quarterbacks (100.0%), running backs (55.6%), and tight ends (75.0%).
    Conclusion: The majority of non-missed time shoulder instability injuries (97.4%) were subluxations, which were likely excluded from or underreported in previous shoulder instability studies due to the inherent difficulty of detecting and diagnosing shoulder subluxation.
    Language English
    Publishing date 2023-10-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2706251-X
    ISSN 2325-9671
    ISSN 2325-9671
    DOI 10.1177/23259671231198025
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: MRI Findings Associated With Anterior Cruciate Ligament Tears in National Football League Athletes.

    Brophy, Robert H / Baker, Jon C / Crain, Jana M / Herzog, Mackenzie M / Stollberg, Ben / Wojtys, Edward M / Mack, Christina D

    Orthopaedic journal of sports medicine

    2023  Volume 11, Issue 6, Page(s) 23259671231169190

    Abstract: Background: Anterior cruciate ligament (ACL) tears are a high-frequency injury requiring a lengthy recovery in professional American football players. Concomitant pathology associated with ACL tears as identified on magnetic resonance imaging (MRI) is ... ...

    Abstract Background: Anterior cruciate ligament (ACL) tears are a high-frequency injury requiring a lengthy recovery in professional American football players. Concomitant pathology associated with ACL tears as identified on magnetic resonance imaging (MRI) is not well understood in these athletes.
    Purpose: To describe the MRI findings of concomitant injuries associated with ACL tears among athletes in the National Football League (NFL).
    Study design: Cross-sectional study; Level of evidence, 3.
    Methods: Of 314 ACL injuries in NFL athletes from 2015 through 2019, 191 complete MRI scans from the time of primary ACL injury were identified and reviewed by 2 fellowship-trained musculoskeletal radiologists. Data were collected on ACL tear type and location, as well as presence and location of bone bruises, meniscal tears, articular cartilage pathology, and concomitant ligament pathology. Mechanism data from video review were linked with imaging data to assess association between injury mechanism (contact vs noncontact) and presence of concomitant pathology.
    Results: Bone bruises were evident in 94.8% of ACL tears in this cohort, most often in the lateral tibial plateau (81%). Meniscal, additional ligamentous, and/or cartilage injury was present in 89% of these knees. Meniscal tears were present in 70% of knees, lateral (59%) more than medial (41%). Additional ligamentous injury was present in 71% of all MRI scans, more often a grade 1/2 sprain (67%) rather than a grade 3 tear (33%), and most often involving the medial collateral ligament (MCL) (57%) and least often the posterior cruciate ligament (10%). Chondral damage was evident in 49% of all MRI scans, with ≥1 full-thickness defect in 25% of all MRI scans, most often lateral. Most (79%) ACL tears did not involve direct contact to the injured lower extremity. Direct contact injuries (21%) were more likely to have a concomitant MCL tear and/or medial patellofemoral ligament injury and less likely to have a medial meniscal tear.
    Conclusion: ACL tears were rarely isolated injuries in this cohort of professional American football athletes. Bone bruises were almost always present, and additional meniscal, ligamentous, and chondral injuries were also common. MRI findings varied by injury mechanism.
    Language English
    Publishing date 2023-06-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2706251-X
    ISSN 2325-9671
    ISSN 2325-9671
    DOI 10.1177/23259671231169190
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Epidemiology of Stingers in the National Football League, 2015-2019.

    Lamplot, Joseph D / Petit, Camryn / Lee, Rebecca / Mack, Christina D / Herzog, Mackenzie M / Solomon, Gary S / Diekfuss, Jed A / Myer, Greg D / Hammond, Kyle

    Sports health

    2024  , Page(s) 19417381231223413

    Abstract: Background: Transient traumatic neuropraxia of either the brachial plexus or cervical nerve root(s) is commonly described as a "stinger" or "burner" by the athlete. Stingers in American Football commonly occur acutely as isolated injuries; however, ... ...

    Abstract Background: Transient traumatic neuropraxia of either the brachial plexus or cervical nerve root(s) is commonly described as a "stinger" or "burner" by the athlete. Stingers in American Football commonly occur acutely as isolated injuries; however, concomitant injuries, including cervical spine pathologies, have also been reported.
    Hypothesis: Among National Football League (NFL) athletes, the incidence rate of stingers is higher during the regular season than during the preseason and among positions with high velocity impacts such as running backs, linebackers, defensive backs, and receivers.
    Study design: Retrospective epidemiology study.
    Level of evidence: Level 4.
    Methods: Aggregation of all in-game injuries with a clinical impression of "neck brachial plexus stretch" or "neck brachial plexus compression" entered into the NFL injury surveillance database through the centralized league-wide electronic medical record system over 5 years (2015-2019 seasons). Incidence rates per player-play were calculated and reported.
    Results: A total of 691 in-game stingers occurred during the study period, with a mean of 138.2 per year. Average single-season injury risk for incident stinger was 3.74% (95% CI, 3.46%-4.05%). The incidence rate was higher during regular season games than during preseason games (12.26 per 100,000 player-plays [11.30-13.31] vs 8.87 [7.31-10.76],
    Conclusion: In-game stinger incidence was stable across the study period and occurred most frequently in running backs and linebackers. Stingers were more common during the regular season, and most players did not miss time. Concomitant injuries were relatively rare.
    Clinical relevance: An improved understanding of the expected time loss due to stinger and concomitant injuries may provide insight for medical personnel in managing these injuries.
    Language English
    Publishing date 2024-01-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2508802-6
    ISSN 1941-0921 ; 1941-7381
    ISSN (online) 1941-0921
    ISSN 1941-7381
    DOI 10.1177/19417381231223413
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Lower Extremity Strains in the US National Football League, 2015-2019.

    Herzog, Mackenzie M / Weiss, Leigh / Lee, Rebecca Y / Williams, Tyler / Ramsden, Sam / Sills, Allen K / Mack, Christina D

    The American journal of sports medicine

    2023  Volume 51, Issue 8, Page(s) 2176–2185

    Abstract: Background: Lower extremity (LEX) strains, including hamstring, quadriceps, adductor, and calf strains, are among the most common injuries in sports. These injuries lead to high burden, resulting in significant missed participation time.: Purpose: To ...

    Abstract Background: Lower extremity (LEX) strains, including hamstring, quadriceps, adductor, and calf strains, are among the most common injuries in sports. These injuries lead to high burden, resulting in significant missed participation time.
    Purpose: To describe the incidence of LEX strains in professional American football.
    Study design: Descriptive epidemiology study.
    Methods: This study included all players who played in ≥1 National Football League (NFL) game or sustained a LEX strain during participation in the 2015-2019 seasons. LEX strain frequency was calculated by setting (game, practice, conditioning), timing in season (offseason, preseason, regular season, postseason), and roster position. Game incidence rates were calculated for season, roster position, and play type. LEX strains were identified in the standardized leaguewide electronic health record (n = 32 teams).
    Results: Across 5 years, 5780 LEX strains were reported among 2769 players (1-year risk, 26.7%; 95% CI, 26.0%-27.3%); 69% (n = 4015) resulted in time loss. Among all LEX strains, 54.7% were hamstring (n = 3163), 24.1% adductor (n = 1393), 12.6% calf (n = 728), 8.3% quadriceps (n = 477), and 0.3% multiple muscle groups (n = 19). Most were reported during preseason practices (n = 1076; 27%) and regular season games (n = 1060; 26%). The 2-week period of training camp practices comprised 19% of all time-loss strains. Among game injuries, preseason games had the highest rate of LEX strain (2.9/10,000 player-plays; 95% CI, 2.6-3.2). Defensive secondary players accounted for the highest proportion of time-loss LEX strains (27%; n = 1082). In games, punt plays had nearly twice the injury rate of kickoff plays (14.9/1000 plays [95% CI, 13.1-17.0] vs 7.5/1000 plays [95% CI, 6.2-8.9], respectively) and >3 times the rate of pass plays (4.3/1000 plays; 95% CI, 4.0-4.7) and run plays (2.6/1000 plays; 95% CI, 2.3-2.9). In aggregate, LEX strains led to an estimated 16,748 participation days missed each year and a median 12 days missed per injury.
    Conclusion: LEX strains affected 1 in 4 NFL players each year, resulting in a high burden of injury in terms of time lost from practice and competition. Safe return to the NFL season during training camp and reduction of injuries during regular season games are key focuses for future injury reduction.
    MeSH term(s) Humans ; Football/injuries ; Lower Extremity/injuries ; Sprains and Strains/epidemiology ; Quadriceps Muscle/injuries
    Language English
    Publishing date 2023-06-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 197482-8
    ISSN 1552-3365 ; 0363-5465
    ISSN (online) 1552-3365
    ISSN 0363-5465
    DOI 10.1177/03635465231175479
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  5. Article ; Online: Fluoroquinolone Antibiotics and Tendon Injury in Adolescents.

    Ross, Rachael K / Kinlaw, Alan C / Herzog, Mackenzie M / Jonsson Funk, Michele / Gerber, Jeffrey S

    Pediatrics

    2021  Volume 147, Issue 6

    Abstract: Objectives: To estimate the association between fluoroquinolone use and tendon injury in adolescents.: Methods: We conducted an active-comparator, new-user cohort study using population-based claims data from 2000 to 2018. We included adolescents ( ... ...

    Abstract Objectives: To estimate the association between fluoroquinolone use and tendon injury in adolescents.
    Methods: We conducted an active-comparator, new-user cohort study using population-based claims data from 2000 to 2018. We included adolescents (aged 12-18 years) with an outpatient prescription fill for an oral fluoroquinolone or comparator broad-spectrum antibiotic. The primary outcome was Achilles, quadricep, patellar, or tibial tendon rupture identified by diagnosis and procedure codes. Tendinitis was a secondary outcome. We used weighting to adjust for measured confounding and a negative control outcome to assess residual confounding.
    Results: The cohort included 4.4 million adolescents with 7.6 million fills for fluoroquinolone (275 767 fills) or comparator (7 365 684) antibiotics. In the 90 days after the index antibiotic prescription, there were 842 tendon ruptures and 16 750 tendinitis diagnoses (crude rates 0.47 and 9.34 per 1000 person-years, respectively). The weighted 90-day tendon rupture risks were 13.6 per 100 000 fluoroquinolone-treated adolescents and 11.6 per 100 000 comparator-treated adolescents (fluoroquinolone-associated excess risk: 1.9 per 100 000 adolescents; 95% confidence interval -2.6 to 6.4); the corresponding number needed to treat to harm was 52 632. For tendinitis, the weighted 90-day risks were 200.8 per 100 000 fluoroquinolone-treated adolescents and 178.1 per 100 000 comparator-treated adolescents (excess risk: 22.7 per 100 000; 95% confidence interval 4.1 to 41.3); the number needed to treat to harm was 4405.
    Conclusions: The excess risk of tendon rupture associated with fluoroquinolone treatment was extremely small, and these events were rare. The excess risk of tendinitis associated with fluoroquinolone treatment was also small. Other more common potential adverse drug effects may be more important to consider for treatment decision-making, particularly in adolescents without other risk factors for tendon injury.
    MeSH term(s) Adolescent ; Anti-Bacterial Agents/adverse effects ; Cohort Studies ; Female ; Fluoroquinolones/adverse effects ; Humans ; Male ; Tendinopathy/chemically induced ; Tendon Injuries/chemically induced
    Chemical Substances Anti-Bacterial Agents ; Fluoroquinolones
    Language English
    Publishing date 2021-05-14
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2020-033316
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  6. Article: Arthroscopic Labral Reconstruction of the Hip Using Iliotibial Band Allograft and Front-to-Back Fixation Technique.

    White, Brian J / Herzog, Mackenzie M

    Arthroscopy techniques

    2016  Volume 5, Issue 1, Page(s) e89–97

    Abstract: Labral repair has been shown to be an effective treatment option with excellent early outcomes; however, in cases of severe labral damage or when the labral tissue is too large or diminutive, labral repair may be less effective. The purpose of this ... ...

    Abstract Labral repair has been shown to be an effective treatment option with excellent early outcomes; however, in cases of severe labral damage or when the labral tissue is too large or diminutive, labral repair may be less effective. The purpose of this article is to present a modified technique for hip labral reconstruction using iliotibial band allograft tissue and a front-to-back fixation technique. The described technique is modified from the original report of a technique for arthroscopic labral reconstruction. The front-to-back technique allows the surgeon to make a graft that is longer than necessary and cut excess graft after front-to-back fixation, resulting in the correct graft size and a reproducible procedure. Allograft tissue offers several advantages, including the ability to control graft thickness and length, as well as the ability to eliminate donor-site morbidity. This procedure adds to the available techniques for treatment of labral pathology by providing a labral reconstruction technique using allograft tissue.
    Language English
    Publishing date 2016-02-01
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2212-6287
    ISSN 2212-6287
    DOI 10.1016/j.eats.2015.08.009
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  7. Article ; Online: Return to Full Participation Following Concussion in the National Football League, 2015 Through 2020.

    Mack, Christina D / Herzog, Mackenzie M / Solomon, Gary / Putukian, Margot / Lee, Rebecca Y / Matava, Matthew J / Cárdenas, Javier / Theodore, Nicholas / Sills, Allen

    Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine

    2022  Volume 32, Issue 6, Page(s) e605–e613

    Abstract: Objective: Quantify days missed, games missed, injury burden, and time to return to full participation (RTFP) among National Football League (NFL) players who sustained a concussion.: Design: Retrospective cohort study.: Setting: 2015 through 2020 ...

    Abstract Objective: Quantify days missed, games missed, injury burden, and time to return to full participation (RTFP) among National Football League (NFL) players who sustained a concussion.
    Design: Retrospective cohort study.
    Setting: 2015 through 2020 NFL seasons.
    Participants: National Football League players diagnosed with a concussion from 2015 to 2020.
    Interventions: National Football League-mandated graduated RTFP protocol.
    Main outcome measures: Days missed, games missed, burden, and time to RTFP, overall and by position.
    Results: An annual average of 3639 player-days of participation and 255 games were missed across NFL because of concussion. Concussed players missed a median of 9 days (mean = 15.0), a relatively stable metric over 6 years, with slight variation by position. Offensive linemen, tight ends, running backs, and linebackers missed the most days per concussion; defensive secondary, offensive linemen, and wide receivers sustained the highest injury burden. Postconcussion, 59% of players missed one or more scheduled games. Among players concussed in a Sunday game, 38% played in a Sunday game one week later.
    Conclusions: The 9-day median time missed post-concussion may be related to emphasis on graduated phase-based concussion management. No concussed player returned to competition on the day of injury, and less than 40% participated in games the following week. Further work is needed to better understand characteristics of concussions that take longer to return and movement through stages of return.
    MeSH term(s) Humans ; Football/injuries ; Retrospective Studies ; Brain Concussion/diagnosis ; Soccer ; Running
    Language English
    Publishing date 2022-06-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1062530-6
    ISSN 1536-3724 ; 1050-642X
    ISSN (online) 1536-3724
    ISSN 1050-642X
    DOI 10.1097/JSM.0000000000001050
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  8. Article: Epidemiology of Shoulder Instability in the National Football League.

    Anderson, Matthew J J / Mack, Christina D / Herzog, Mackenzie M / Levine, William N

    Orthopaedic journal of sports medicine

    2021  Volume 9, Issue 5, Page(s) 23259671211007743

    Abstract: Background: Shoulder instability is a common and potentially debilitating injury among collision sport athletes that can lead to long-term damage of the glenohumeral joint. Limited data exist regarding instability among elite athletes in the National ... ...

    Abstract Background: Shoulder instability is a common and potentially debilitating injury among collision sport athletes that can lead to long-term damage of the glenohumeral joint. Limited data exist regarding instability among elite athletes in the National Football League (NFL).
    Purpose: To describe the epidemiology of shoulder instability in the NFL from 2012 through 2017.
    Study design: Descriptive epidemiology study.
    Methods: The NFL's injury database was reviewed for shoulder instability injuries resulting in missed time during the study inclusion dates. Injuries were classified by type and direction, as well as timing, setting, and mechanism. Median missed time was determined for the different types and directions of instability. Incidence rates for game-related injuries were calculated based on timing during the season and player position. Finally, the relationship between player position and instability direction was assessed.
    Results: During the 6-year study period, 355 players sustained 403 missed-time shoulder instability injuries. Most injuries occurred during games (65%) via a contact mechanism (85%). The overall incidence rate of game-related instability was 3.6 injuries per 100,000 player-plays and was highest during the preseason (4.9 per 100,000 player-plays). The defensive secondary position accounted for the most injuries, but quarterbacks had the highest incidence rate in games (5.5 per 100,000 player-plays). Excluding unspecified events (n = 128; 32%), 70% (n = 192) of injuries were subluxations and 30% (n = 83) were dislocations; 75% of dislocations were anterior, while subluxations were more evenly distributed between the anterior and posterior directions (45% vs 52%, respectively). Players missed substantially more time after dislocation compared with subluxation (median, 47 days vs 13 days, respectively). When instability direction was known, the majority of instability events among quarterbacks and offensive linemen were posterior (73% and 53%, respectively), while anterior instability was most common for all other positions.
    Conclusion: Shoulder instability is a common injury in the NFL and can result in considerable missed time. Dislocations occur less frequently than subluxations but lead to greater time lost. While most dislocations are anterior, more than half of subluxations are posterior, which is likely the result of repetitive microtrauma to the posterior capsulolabral complex sustained during sport-specific motions such as blocking. The risk of instability varies by player position, and position may also influence instability direction.
    Language English
    Publishing date 2021-05-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2706251-X
    ISSN 2325-9671
    ISSN 2325-9671
    DOI 10.1177/23259671211007743
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  9. Article: Simultaneous acetabular labrum and ligamentum teres reconstruction: a case report.

    White, Brian J / Scoles, Alexandra M / Herzog, Mackenzie M

    Journal of hip preservation surgery

    2018  Volume 5, Issue 2, Page(s) 166–173

    Abstract: This study aims to present the surgical technique for reconstructing both the acetabular labrum and the ligamentum teres and to describe the early outcomes of this procedure in a 15-year-old male with recurrent hip instability. A 15-year-old patient with ...

    Abstract This study aims to present the surgical technique for reconstructing both the acetabular labrum and the ligamentum teres and to describe the early outcomes of this procedure in a 15-year-old male with recurrent hip instability. A 15-year-old patient with recurrent left hip dislocation, hip joint instability and failed non-operative intervention presented following two left hip dislocations. A labral reconstruction was performed utilizing an iliotibial band allograft tissue with a concomitant ligamentum teres reconstruction using a tibialis anterior allograft. The patient was assessed pre- and postoperatively using modified Harris Hip Score, Lower Extremity Functional Scale and Visual Analogue Scale for pain and satisfaction. The patient reported improvement on all measures, including hip stability 14 months following surgery. The patient has not reported any episodes or subjective feelings of instability, has not required further surgical procedures in the hip and has returned to full sports participation. This case report demonstrates a technique for and early outcomes of simultaneous arthroscopic ligamentum teres and acetabular labrum reconstruction in a patient with recurrent hip instability. Short-term outcomes suggest improved hip stability, reduced pain, high patient satisfaction and return to pre-injury activities at 14 months postoperative in this single case report.
    Language English
    Publishing date 2018-02-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 2773022-0
    ISSN 2054-8397
    ISSN 2054-8397
    DOI 10.1093/jhps/hny001
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  10. Article: Labral Reconstruction: When to Perform and How.

    White, Brian J / Herzog, Mackenzie M

    Frontiers in surgery

    2015  Volume 2, Page(s) 27

    Abstract: Over the past decade, the understanding of the anatomy and function of the hip joint has continuously evolved, and surgical treatment options for the hip have significantly progressed. Originally, surgical treatment of the hip primarily involved ... ...

    Abstract Over the past decade, the understanding of the anatomy and function of the hip joint has continuously evolved, and surgical treatment options for the hip have significantly progressed. Originally, surgical treatment of the hip primarily involved resection of damaged tissue. Procedures that maintain and preserve proper hip anatomy, such as labral repair and femoroacetabular impingement correction, have shown superior results, in terms of pain reduction, increased function, and ability to return to activities. Labral reconstruction is a treatment option that uses a graft to reconstruct the native labrum. The technique and outcomes of labral reconstruction have been described relatively recently, and labral reconstruction is a cutting edge procedure that has shown promising early outcomes. The aim of this article is to review the current literature on hip labral reconstruction. We will review the indications for labral reconstruction, surgical technique and graft options, and surgical outcomes that have been described to date. Labral reconstruction provides an alternative treatment option for challenging intra-articular hip problems. Labral reconstruction restores the original anatomy of the hip and has the potential to preserve the longevity of the hip joint. This technique is an important tool in the orthopedic surgeon's arsenal for hip joint treatment and preservation.
    Language English
    Publishing date 2015-07-02
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2773823-1
    ISSN 2296-875X
    ISSN 2296-875X
    DOI 10.3389/fsurg.2015.00027
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