April 2024

Rotator Cuff: Where the Sun Doesn’t Shine

The risk for rotator cuff (RC) of the shoulder pain and injury mounts with age and abuse, or non-use, smoking, and maybe just maybe hypovitaminosis D – that is, chronic low levels of vitamin D. Some studies have shown that low D has a significant association with failed RC repair and revision. A study was conducted to determine if low D was, in fact, associated with RC tears independent of age and gender. For more information no RC injuries and management, read what we’ve written here, here,and  here.

Covering a span of 7 years, a surgical group at Brown University compiled the data on 336,320, out of almost 23 million, patients who had low D. They compared their risks for RC tears to a control group that did not have low D. They isolated the low D group by extracting data only from those who did not have any accompanying diseases that could impact one’s D status – such as malabsorption, disease, etc. – and had fulfilled a prescription for vitamin D.

The study group consisted of 64.8% females who, generally, are more apt to have RC damage. Of the 1977 RC tears in the low D group, 1096 were women, 881 were men; in the normal D group, of 842 tears, 361 were in men, 481 in females. Furthermore, while men with low D had similar rates of RC tears as those with normal D, women with low D had significantly higher rates – about 37% more – of RC tears than those with normal D.

Also, after RC repair, more patients with low D, especially women, required manipulation under anesthesia (for frozen shoulder) than did those with normal D. Men with or without low D were equally susceptible to frozen shoulder after RC surgery.

In other words, a healthy RC needs to see the sunlight some of the time! Or eat a more D-rich diet.                                                                                                                     

MSSE Mar. 2024

ACL Injury Rates Keep Women in Check

The anterior cruciate ligament (ACL) of the knee is a critical structure as it stabilizes the knee against excessive rotation and hyperextension. With over 250,000 ACL injuries in mostly younger (<30) athletes, and the downstream impact on the cartilage and lifestyles of those injured, more evidence is needed if scientists are going to reduce risks. Knowing which sports present the most injury risk might help them prevent injury through rules, equipment, or training changes. This multi-institutional study analyzed the data from the NCAA Injury Surveillance Program from 2014-2019 to describe incidence rates by sport, gender, mechanism, history, and event type (practice vs competition.)

There were 729 ACL injuries out of over 8 million athletic exposures (AE: events). Males incurred 406 out of 5 million AE or 0.80/10,000 AE; females incurred 323 injuries out of 3.4 million AE or 0.95/10,000 AE. Most tears occurred during competition, during the regular season.

Football tore up more men’s knees while soccer tore up more women’s knees. Even in the same sports – soccer and basketball – women had higher rates of injury: 4x higher in basketball and softball, and ~3x higher in soccer. Most of these are non-contact injuries except in men’s football and hockey and women’s soccer and ice hockey. Some were reinjuries, as in men’s football and women’s soccer. Time lost from play and competition was similar for both genders – on average around 3 months with surgically repaired athletes requiring more time off (recommended 9 months or longer) while others might have been rehabilitated in less time.         

MSSE Jan. 2024

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