Achievements

Purpose: The primary outcome of this study was to estimate the variability among four sports medicine fellows in the preparation of leukocyte-reduced (LR) PRP. In addition, changes in glucose concentration were compared between PRP samples and whole blood. Methods: Four healthy male volunteers each donated 222-mL of blood to allow the four fellows to simultaneously prepare four PRP preparations per volunteer, totaling 16 PRP samples for analysis. The Harvest SmartPrep Clear PRP® kit was utilized to generate the leukocyte-reduced (LR) PRP preparations. A CBC and glucose concentration were obtained from the donated blood and from each of the processed PRP samples. Results: Subjects had a mean age of 35 years. All samples excluded virtually all red and white blood cells in the preparations. The baseline (whole blood) platelet counts ranged from 193 to 268 with a mean of 228.6 k/mm3. The increase in platelet concentration, compared to whole blood between subjects, ranged between 3.1- and 3.71-fold between donors, with a mean of 3.32-fold and standard deviation (SD) of 0.1. The mean increases in platelet concentration, ranged between fellows between 3.25- and 3.47-fold. The SD between fellows ranged from 0.14 to 0.48. The baseline glucose concentrations mean was 92.5 mg/dl. Glucose values in PRP increased between 3.94- and 4.68-fold between donors, with a mean of 4.24-fold and SD of 0.19. Conclusions: The use of the Harvest SmartPrep Clear PRP® system by four sports medicine fellows consistently yielded preparations of LR PRP with at least 3-fold increases in platelets and 4-fold increases in glucose concentrations compared to whole blood. Significance: This is a pilot study to test the variability in LR PRP preparations among sports medicine fellows. Larger sample sizes are needed to determine variability between providers when preparing PRP. These results are similar to prior studies of leukocyte-rich PRP that showed an increase in glucose concentration compared to whole blood.

History: 20F collegiate lacrosse goalie referred by ATC with pain and swelling on the right buttock for 3 months after a fall down stairs. Fall resulted in left 5th metatarsal fracture s/p ORIF. Presented with continued swelling, a 4-7/10, constant, dull non-radiating pain localized to the right buttock. Exacerbated by sitting and alleviated by walking. She had not returned to play. Physical exam: Right buttock: elliptical, fluctuant mass palpated to 19 x 12cm without skin breakdown, warmth or erythema. Normal neurovascular examination of bilateral lower extremities. Normal spinal alignment. ROM of the spine and hip was full and pain-free. No bony tenderness in the lumbar spine or posterior pelvis. Negative dural tension and hip provocation tests. Differential Diagnosis: Hematoma/seroma Myositis ossificans Tumor (sacromas) Vascular mass (AVM, hemangioma) Outcome and return to play: She initially declined surgical referral, returned to cycling prior to undergoing aspiration of 8cc. 2 weeks post-aspiration she returned to running with a 50% reduction in volume at 2 weeks. Fluid gradually re-accumulated after 6 weeks. Surgical consultation was pursued who recommended a repeat aspirations (78-100cc) and surgical fixation in off-season. Discussion: Morel-Lavallée lesions (MLLs) are closed degloving injuries due to shear trauma that disrupt fascial planes creating a potential space. Cases of MLL have been seen in sports injuries in hockey, football, racquetball and cycling. MRI is considered the imaging modality of choice. Ultrasound can show hyperechoic fat nodules and assist in aspiration. Treatments range from observation, compressive wraps, aspiration +/- injection with doxyclycine or talc, liposuction and surgery. Aspiration has shown higher rates of recurrence (if >50cc), leading to a practice guidelines suggesting operative intervention. A delay in diagnosis has been associated with fat necrosis and infections.

Purpose: The primary outcome of this study was to estimate the variability among four sports medicine fellows in the preparation of leukocyte-reduced (LR) PRP. In addition, changes in glucose concentration were compared between PRP samples and whole blood. Methods: Four healthy male volunteers each donated 222-mL of blood to allow the four fellows to simultaneously prepare four PRP preparations per volunteer, totaling 16 PRP samples for analysis. The Harvest SmartPrep Clear PRP® kit was utilized to generate the leukocyte-reduced (LR) PRP preparations. A CBC and glucose concentration were obtained from the donated blood and from each of the processed PRP samples. Results: Subjects had a mean age of 35 years. All samples excluded virtually all red and white blood cells in the preparations. The baseline (whole blood) platelet counts ranged from 193 to 268 with a mean of 228.6 k/mm3. The increase in platelet concentration, compared to whole blood between subjects, ranged between 3.1- and 3.71-fold between donors, with a mean of 3.32-fold and standard deviation (SD) of 0.1. The mean increases in platelet concentration, ranged between fellows between 3.25- and 3.47-fold. The SD between fellows ranged from 0.14 to 0.48. The baseline glucose concentrations mean was 92.5 mg/dl. Glucose values in PRP increased between 3.94- and 4.68-fold between donors, with a mean of 4.24-fold and SD of 0.19. Conclusions: The use of the Harvest SmartPrep Clear PRP® system by four sports medicine fellows consistently yielded preparations of LR PRP with at least 3-fold increases in platelets and 4-fold increases in glucose concentrations compared to whole blood. Significance: This is a pilot study to test the variability in LR PRP preparations among sports medicine fellows. Larger sample sizes are needed to determine variability between providers when preparing PRP. These results are similar to prior studies of leukocyte-rich PRP that showed an increase in glucose concentration compared to whole blood.

Purpose: Previous research of collegiate pitchers has focused on upper extremity injuries, but little is known about lower extremity injuries. The purpose of this study was to assess lower extremity injury rates in collegiate pitchers. Methods: A retrospective chart review of medical records was performed for all male pitchers participating in two Division 1 baseball programs, Seattle University (2009-2010 through 2013-2014 seasons) and the University of Washington (2002-2003 through 2012-2013 seasons). A total of 99 pitchers representing 214 pitcher years, defined as the number of years a pitcher was part of the baseball team, were included in the final analysis. Data collection included pitcher age, height, weight and pitching arm. Injury data was collected on age, body region, diagnosis and laterality. Injuries to the pelvis and caudal were included for analysis. Results: Thirty-seven pitchers reported a total of 45 lower extremity injuries resulting in a risk of injury of 21.0% per pitcher year. Bilateral injuries occurred in five pitchers and three pitchers reported two injuries in the same leg within the same year. The most common injuries were ankle sprains (45%) and hip adductor strains (17.8%), followed by diagnoses of patellar tendonitis, patellofemoral syndrome, tibial contusions, hamstring strains and knee injuries each reported at 8.9% of all injuries. Lower extremity injuries occurred ipsilateral to the throwing arm in 53% of injuries and 26.7% of pitchers with lower extremity injuries reported an injury to their pitching arm within the same year. Conclusions: Lower extremity injuries are common in collegiate pitchers and may occur in the setting of a throwing arm injury. Further research should identify factors that may contribute to lower extremity injuries in this population. Significance: Research and clinical attention focusing only on injuries to the throwing arm neglects other commonly injured aspects of the complex biomechanic movement of pitching in baseball.

HISTORY: A 16 year-old right hand dominant male who is a competitive rower and swimmer presents with 10 months of left shoulder pain that was first noticed after returning to competitive swimming after a 6-month hiatus. He describes the pain as atraumatic, intermittent, progressively worsening and a 3-9/10 anterior “ache”. His pain is noted in the pull phase in rowing, pushups, and pulling aspect of the freestyle. Pain is associated with weakness and crepitus but no paresthesia. He has not been able to continue competitive rowing. Prior workup includes an unremarkable MRI. Previous treatments have included ice, heat, acupuncture, oral and topical NSAIDs, one month of rest and PT without resolution. PHYSICAL EXAMINATION: Muscular build with protracted shoulder position. Full AROM with pain at end range abduction and flexion. Tenderness to palpation over AC joint, subacromial space and bicep tendon area. Strength is 5/ 5 throughout, except trace weakness secondary to pain with external rotation. Positive Speeds, Hawkins, Obriens and Neers tests with palpable popping anteriorly with passive abduction and external rotation. Belly press, lift off and bear hug cause anterior pain. DIFFERENTIAL DIAGNOSIS: 1. Labral pathology 2. AC joint pathology 3. Long head of the bicep tendonopathy 4. RTC tendonopathy 5. Subacromial bursitis/impingement 6. Subcoracoid impingement 7. Bony pathology such as stress fracture or tumor TEST AND RESULTS: MR Arthrogram: normal US: hypoechoic area of distal long head of the bicep tendon and cortical irregularity of the lesser tuberosity with tender sonopalpation. US guided biceps tendon sheath corticosteroid injection for diagnostic and therapeutic purposes resulted in temporary improvement. High resolution CT: 1.1 cm osteochondroma abutting the biceps tendon. FINAL WORKING DIAGNOSIS: Symptomatic osteochondroma causing mechanical irritation of the bicep tendon and surrounding tissues. TREATMENT AND OUTCOMES: Diagnostic arthroscopy and arthroscopic middle glenohumeral ligament repair with initial improvement. At 6 weeks he returned to completing 75% of his swim workouts and competed in a district rowing championship. However at the 9-month mark, his pain gradually returned to pre-surgical character, quality and intensity level. Orthopedic referral for tumor excision is pending.