Our last poster is titled Outcomes and Return to Sport Following Arthroscopic Bankart Repair for Anterior Shoulder Instability in Contact versus Non-contact Athletes: A Systematic Review and Meta-Analysis. We’ve spoken a lot about the surgical treatment for anterior shoulder instability on this podcast – most recently with Dr. Brian Lau. That is episode #48 and 49 if you want to check it out.

This study focused on outcomes of arthroscopic Bankart repair for the treatment of anterior shoulder instability, specifically comparing outcomes in contact athletes versus noncontact athletes. This systematic review included 18 studies with 1-year minimum follow-up.

The authors found that contact and noncontact athletes had similar rates of return to sport as well as similar rates of return to preinjury level of play. However, they also found that contact athletes demonstrated significantly greater rates of recurrent instability, at 28% compared to 8% in noncontact athletes. Contact athletes also demonstrated significantly greater need for revision surgery, at 12% compared to 3% in noncontact athletes.

Our next poster is titled Sleep in Orthopaedic Surgeons: A Prospective Longitudinal Study of the Effect of Home Call on Orthopedic Attending and Resident Sleep. Recurrent episodes of partial sleep deprivation resulting from call schedules are commonly seen in physicians. This has been shown to cause decreased mental effectiveness while at work, which corresponds with a blood alcohol level of 0.08%.

Sleep deprivation has been associated with adverse personal health events, with an increased risk of diabetes, heart disease, stroke and risk of death. Additionally, sleep deprivation has been demonstrated to have a negative clinical impact, including decreased surgical performance, increased errors, and greater risks of accidents.

Despite the known negative impacts of poor sleep, the effect of home orthopedic call on surgeon sleep has not been well quantified. The purpose of the study was to quantify the impact of resident and attending physician home call on sleep performance – specifically total sleep, slow-wave sleep and rapid eye movement sleep – as well as heart rate variability.

Sixteen orthopedic residents and 14 attendings at a level 1 academic trauma hospital wore WHOOP 3.0 straps for a period of 1 year. The WHOOP strap is wearable device that tracks all 4 stages of sleep and monitors wake events, efficiency and respiratory rate. The authors recorded total sleep, slow-wave sleep and REM sleep. Slow-wave sleep is considered to be the most restorative sleep stage and plays an important role in growth, memory and immune function.

This study showed that overall, attendings slept significantly less than residents, at 6 hours compared to 6.7 hours. When on home call, resident total sleep decreased by 20%, REM sleep decreased by 12%, and slow-wave sleep decreased by 12%. For attendings, total sleep on-call decreased by 10%, REM sleep decreased by 7% and slow-wave sleep decreased by 4%.

The authors concluded that orthopedic surgery residents and attendings exhibit low baseline sleep, and taking home call reduces this even further. On home call nights, Residents and Attendings experienced a significant decrease in total sleep, REM sleep and short wake sleep. The authors suggested that further research is required in order to determine how to ensure excellent patient care, maximize educational environments and develop strategies for resilience.

Our next poster is titled Characterization of Concussions in the National Basketball Association and the 90-day Period Following Return to Play: Analysis of Musculoskeletal Injury Risk and Player Performance. This study was performed at the Mayo Clinic in Arizona and sought to determine the incidence of musculoskeletal injury in the immediate 90-day period following return to play from concussion. The secondary outcomes were to evaluate player performance within the 90-day. As well as time lost after musculoskeletal injury.

Concussions have steadily garnered increased attention over recent years. We actually did an episode with Dr. Rachel Frank focused on concussions and sideline evaluation. This is episode 98 if you want to go check it out. That episode focused primarily on identifying and appropriately managing concussions. This study aims to evaluate the impact of a concussion on risk of musculoskeletal injury.

Concussions have previously been shown to have persistent neurological effects that may lead to slower reaction times and may compromise postural stability in high-level athletes. Therefore, it stands to reason that a player may be at greater risk for musculoskeletal injury and may exhibit poorer performance upon return from a concussion.

The authors identified NBA players who sustained a concussion between 2015-20 22 using a publicly available database. The database was also queried to identify any musculoskeletal injury in the 90-day period following return to play after the concussion, as well as time lost after the subsequent injury.

Performance statistics were obtained from each players preinjury season and post-injury season. Each concussed player was matched with a non-concussed control player using position, win shares, player efficiency rating and points per game as metrics.

So, what did this study find? A total of 70 concussions were identified during this time period. 70% of concussed players sustained a musculoskeletal injury in the 90-day period following return to play. Compared with controls, the odds of sustaining a musculoskeletal injury in the concussed cohort were 11.3 times greater. There was no significant difference between the type and location of injury, with ankle injuries being the most common in both groups.

Now let’s talk about performance. Interestingly, there were no significant changes in points per game, minutes played per game or true shooting percentage between the concussed and control groups. When compared with the controls, no changes in performance statistics were significantly different. Games missed after subsequent musculoskeletal injury were similar between the concussed and control groups.