James R Andrews

American Sports Medicine Institute · The Andrews Institute

Background Long-term outcomes for isolated anterior cruciate ligament (ACL) reconstructions in competitive American football athletes are well reported in the literature, but little data currently exist regarding multiligament knee injury (MLKI) reconstruction outcomes. Purpose To examine patient-reported and return-to-sport outcomes of competitiv...

Background Interval throwing programs (ITP) have been used for decades to enable baseball pitchers to return to competition after injury or surgery by gradually applying load to the throwing arm. Past programs have been based on personal experience; however, advances in our understanding of the biomechanics and workloads of throwing allow for a mor...

Background It is theorized that the lack of a synovial lining after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) contributes to slow ligamentization and possible graft failure. Whether graft maturation and incorporation can be improved with the use of a scaffold requires investigation. Purpose To evaluate the safety and ef...

Background Interval throwing programs are used in rehabilitation of throwing injuries, especially ulnar collateral ligament injuries. Athletes who are rehabilitating begin by throwing on flat ground progressing through increasing distances, number of throws, and intensity of throwing. If the athlete is a baseball pitcher, the flat-ground throwing p...

This project aimed to evaluate long term clinical outcomes following multi-ligament knee reconstruction in competitive American football athletes. We found the majority of athletes were able to successfully return to sport, and that athletes with >2 ligaments involved had similar outcomes to those with only 2 involved ligaments.

Background: While numerous studies exist evaluating the short-term clinical outcomes for patients who have undergone elbow arthroscopy for osteochondritis dissecans (OCD) of the capitellum, the literature on minimum 2-year clinical outcomes for a large cohort of patients is limited. Purpose: /Hypothesis: We hypothesized that clinical outcomes fo...

Background Shoulder pain due to labral tears and biceps tendonitis is commonly found in softball players. Surgical options include labral repair and biceps tenodesis. While past studies are limited by heterogeneous study groups from multiple sports, this is the first study that assesses clinical outcomes and return to play rates for fast-pitch soft...

Purpose: The optimal surgical technique for unstable acromioclavicular (AC) and coracoclavicular (CC) joint injuries has not yet been established. The biomechanical and radiographic effect of the LockDown device, a synthetic ligament for AC joint reconstruction, was evaluated to assess the optimal surgical technique for unstable AC and CC joint in...

Background Ulnar collateral ligament (UCL) tears in the throwing elbow are classified according to grade and location using magnetic resonance arthrography (MRA). However, the frequency of each tear type and the association to age, competition level, and radiographic findings in adolescent baseball pitchers are unknown. Purposes The primary purpos...

Background Autologous platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMC) are being used clinically as therapeutic agents for the treatment of knee osteoarthritis. Purpose/Hypothesis The purpose of this study was to compare the efficacy of BMC and PRP on pain and function in patients with knee osteoarthritis up to 24 months after...

Background Glenohumeral internal rotation deficit (GIRD) and total arc of motion difference (TAMD) have been associated with elbow injuries in throwing athletes. Hypothesis Youth pitchers with elbow pain will have greater GIRD and TAMD compared with youth pitchers without elbow pain. Study Design Cross-sectional study. Level of Evidence Level 3....

Objective: To characterize recurrent instability, return to sport (RTS), and patient-reported outcomes (PROs) after arthroscopic Bankart repair for acute traumatic anterior shoulder instability in National Collegiate Athletic Association (NCAA) and National Football League (NFL) football players. Design: Case series. Setting: Orthopaedic and s...

Background Ulnar collateral ligament (UCL) injuries of the elbow are uncommon in the general population but prevalent in the athletic community, particularly among baseball players. Platelet-rich plasma (PRP) injection therapy has become a popular nonoperative adjuvant treatment for such injuries to help reduce recovery time and avoid surgery. Pur...

Background A lack of lumbopelvic-hip complex (LPHC) stability is often associated with altered pitching mechanics, thus increasing pain and injury susceptibility. The single-leg squat (SLS) is a simple diagnostic tool used to examine LPHC stability. Purpose To examine the relationship between trunk compensatory kinematics during the SLS and kinema...

Kevin Wilk, Christopher Arrigo, and Dr. James Andrews deliver the first editorial of the "new" IJSPT. They reflect on the importance of teamwork in successful outcomes in sports medicine.

A partial rotator cuff tears in a throwing athlete is a complex problem that can lead to debilitating pain and inability to perform their athletic duties. The etiology and pathogenesis of these tears are multi-factorial and still the topic of much debate. It is known that the act of overhead throwing places significant stress on the glenohumeral jo...

The glenohumeral joint is relatively unconstrained and relies on a number of critical, dynamic and static soft tissue stabilizers. The labrum is one of the most important static soft tissue stabilizers and is often associated with pathologic shoulder instability. Combined injury to the superior and anterior labrum is increasingly recognized as a so...

Currently it is hypothesized that increased body mass index may contribute to overuse injuries. Thus, if hip or shoulder range of motion is affected by body mass index, pitchers may be placing additional stress on joints as they seek to pitch at maximal velocity. The purpose of this study was to examine if range of motion at the hips and shoulders...

The primary aims of the study were (1) to examine kinematics and kinetics of those pitching with and without lower extremity pain in collegiate softball pitchers, and (2) to determine if there was an association between the lower extremity pain and lower extremity kinematics, trunk kinematics, and shoulder kinetics in collegiate softball pitchers....

Background: There is a lack of evidence regarding the success of ulnar collateral ligament (UCL) revision reconstruction. Understanding outcomes after UCL revision reconstruction is important in clinical decision making for overhead athletes. Purpose: To evaluate return to play and patient-reported outcomes after UCL revision reconstruction. Stud...

With the lack of pitch count regulation, youth softball pitchers are experiencing unremitting high stresses on the anterior shoulder. The purpose of this study was to examine the association of acute changes in the long head of the biceps tendon with pitching kinematics and kinetics in youth softball pitchers following an acute bout of pitching. Tw...

Background: Baseball pitching injuries are increasing at an alarming rate. While weighted ball throwing programs may be effective at increasing pitching velocity, previous research has identified a 24% injury rate and a 3.3° increase in shoulder external rotation (ER) range of motion (ROM) after performing a 6-week program. However, previous resea...

Background Despite evidence that overuse is the most common mechanism of injury, softball pitchers currently have no pitch count regulations. Pain has been associated with certain pitching pathomechanics, and some reports indicate increased pain following a single pitching bout. Hypothesis/Purpose The purpose of this study was to analyze kinematic...

Objectives: To determine whether increasing pitching distance for adult baseball pitchers would affect their upper extremity kinetics, full-body kinematics, and pitched ball kinematics (ball velocity, duration of ball flight, vertical and horizontal break, strike percentage). Design: Controlled laboratory study. Methods: Twenty-six collegiate...

Background Approximately 47 million people in the United States have been diagnosed with arthritis. Autologous platelet-rich plasma (PRP) injections have been documented to alleviate symptoms related to knee osteoarthritis (OA) in randomized controlled trials, systematic reviews, and meta-analyses. Autologous bone marrow aspirate concentrate (BMC)...

Despite evidence that overuse is the most common mechanism of injury, softball pitchers currently have no pitch count regulations. Pain has been associated with certain pitching pathomechanics, and some reports indicate increased pain following a single pitching bout. Therefore, the purpose of this study was to examine trunk and lower extremity kin...

Objectives: Though pitchers often throw during multiple games in a day, there are currently no pitch count restrictions in softball. The accumulation of high pitch counts over time may contribute to the development of upper extremity pain. The purpose of our study was to examine functional characteristics of shoulder and hip range of motion (ROM),...

Background Injury prevalence has been well described among baseball athletes; similarly, a better understanding of injuries in softball athletes is needed. Purpose To examine shoulder and elbow injury epidemiology among high school softball athletes in the United States. Study Design Descriptive epidemiological study. Methods Injury data were ob...

Friesen, KB, Barfield, JW, Murrah, WM, Dugas, JR, Andrews, JR, and Oliver, GD. The association of upper-body kinematics and earned run average of national collegiate athletic association Division I softball pitchers. J Strength Cond Res XX(X): 000-000, 2019-Although recent literature has increased examination of the association of injury and biomec...

Background: The ulnar collateral ligament (UCL), consisting of 3 bundles, is the primary medial restraint in the elbow. Recent research has demonstrated that ultrasound is an effective modality to evaluate the medial elbow, whereas stress radiography is standard practice in the measurement of medial elbow laxity. This study (1) compared dynamic ult...

The purpose of this study was to determine whether glove arm kinematics during a windmill softball pitch impact pelvic and trunk kinematics as well as pitching arm shoulder kinetics. Thirty-Nine college softball pitchers (20.0±1.4 yrs.; 174.7±6.1 cm; 82.0±13.0 kg; 10.7±2.7 yrs. of experience) threw 3 pitches to a catcher while kinematic and kinetic...

Reconstruction of the lateral ulnar collateral ligament (LUCL) has been successful in treating posterolateral rotatory instability after a dislocation or recurrent subluxation of the elbow. This chapter offers detailed, step-by-step guidance needed to perform the LUCL reconstruction with the modified O’Driscoll technique.

Ulnar collateral ligament (UCL) reconstruction has been successful in treating medial elbow instability due to injury to the anterior band of the UCL in high-level overhead athletes. This chapter offers detailed, step-by-step guidance needed to perform the UCL reconstruction using the modified Jobe technique.

The purpose of this study was to evaluate pitching mechanics between female softball pitchers with upper extremity pain and those without upper extremity pain. Specifically, the trunk, shoulder and elbow kinematics and shoulder kinetics during the change-up softball pitch were examined. Fifty-five collegiate softball pitchers participated, divided...

Background: Emphasis on enhancing baseball pitch velocity has become popular, especially through weighted-ball throwing. However, little is known about the physical effects or safety of these programs. The purpose of this study was to examine the effects of training with weighted baseballs on pitch velocity, passive range of motion (PROM), muscle...

Background: Fastpitch softball is a popular sport for young females. However, data are limited describing youth pitching mechanics. Normative data describing pitching mechanics in the two youngest player pitch leagues are critical to gaining an improved understanding of proper mechanics in an attempt to establish injury prevention programs. Purpo...

Purpose: To evaluate the accuracy of Blumensaat's line (BL) in predicting the tendinous graft length and tibial tunnel length (TTL) in an independent-tunnel anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone (BTB) allograft. Methods: Eighteen ACLRs were performed on cadaveric specimens using an anteromedial portal...

Background The number of adolescent anterior cruciate ligament (ACL) injuries is rising with increased participation in higher level athletics at earlier ages. With an increasing number of primary ACL reconstructions (ACLRs) comes a rise in the incidence of revision ACLRs. Purpose To evaluate the clinical results of revision ACLR across a group of...

Lateral ulnar collateral ligament (LUCL) reconstruction is a commonly used surgical procedure to treat posterolateral rotatory instability (PLRI) of the elbow. We report a 17-year-old right-handed pitcher with symptomatic PLRI after an injury to his LUCL during a baseball game. Having failed 8 months of conservative treatment, a LUCL reconstruction...

Background The number of ulnar collateral ligament (UCL) reconstructions in adolescent athletes has increased over the past 2 decades. Clinical results in this population have not been well studied. Purpose/Hypothesis The purpose of this study was to evaluate the outcomes and return to sport after UCL reconstruction in a large group of adolescent...

Background: Rotator cuff tears are rare injuries in adolescents but cause significant morbidity if unrecognized. Previous literature on rotator cuff repairs in adolescents is limited to small case series, with few data to guide treatment. Hypothesis: Adolescent patients would have excellent functional outcome scores and return to the same level...

Background: Few studies have documented the outcomes of superior labral anterior-posterior (SLAP) repairs in baseball players. Furthermore, the results of these previous studies varied widely and were based on small numbers of patients. Hypothesis/Purpose: The purpose was to report return-to-play (RTP) rates and validated subjective outcome scores...

Elbow injuries in overhead athletes, particularly ulnar collateral ligament (UCL) injuries to baseball pitchers, continue to increase in number. The reasons for these injuries are multifactorial but typically result from a combination of severe and repetitive valgus elbow stress from pitching large volumes and throwing at peak velocities. These fac...

Objectives Rotator cuff tears are rare injuries in adolescents, but can be a cause of significant morbidity if unrecognized. Previous literature on rotator cuff repairs in adolescents is limited to small case series, with little data to guide treatment. The purpose of this study was to investigate the clinical information, demographics, and results...

This article aims to evaluate factors associated with chondral and meniscal lesions in primary and revision anterior cruciate ligament (ACL) reconstructions. ACL reconstructions from 2001 to 2008 at a single institution were retrospectively analyzed. Logistic regression was used to estimate the association between chondral and meniscal injuries and...

Background: A glenohumeral internal rotation (IR) deficit or a total rotational motion (IR plus external rotation [ER]) deficit in the throwing shoulder compared with the nonthrowing shoulder has been shown to increase the risk of shoulder and elbow injuries. After a pitching session, both IR and total rotational motion deficits have been shown to...

Background Prone, supine, and side position exercises are employed to enhance core stability. Hypothesis Overall core muscle activity would be greater in prone position exercises compared with supine and side position exercises. Study Design Controlled laboratory study. Methods Eighteen men and women between 23 and 45 years of age served as subj...

Background: In spite of the bodyblade (BB®) being used in clinical settings during shoulder and trunk rehabilitation and training for 24 years, there are only five known scientific papers that have described muscle recruitment patterns using the BB®. Moreover, there are no known studies that have examined muscle activity differences between males...

Purpose: To determine common mechanisms of anterior cruciate ligament (ACL) injury in baseball players and to quantify the rate of return to play after primary surgical reconstruction and review intermediate clinical outcomes. Methods: Surgical injuries involving the ACL in youth, high school, collegiate, and professional baseball players were q...

Controversy continues whether curveballs are stressful for young baseball pitchers. Furthermore, it is unproven whether professional baseball pitchers have fewer kinematic differences between fastballs and off-speed pitches than lower level pitchers. Kinematic and kinetic data were measured for 111 healthy baseball pitchers (26 youth, 21 high schoo...

Overhead athletes are susceptible to shoulder joint pathology due to the repetitive nature of throwing activities and the unique and sports-specific pattern of the sporting activities. Extreme forces are placed upon the glenohumeral joint as a result of anterior shear forces that approach 50 % body weight that occur as a result of high angular velo...

At the elite level, pitching has been reported as one of the fastest human movements, occurring at angular speeds of 7250°/s. The repetitive nature of overhead throwing can lead to numerous adaptations in the glenohumeral, scapulothoracic, and hip joints. Owing to these unique changes, a comprehensive and sequential rehabilitation program is depend...

The repetitive nature of throwing manifests characteristic adaptive changes to the shoulder, scapulothoracic, and hip/pelvis complexes that result in a set of unique physical traits in the overhead throwing athlete. An effective rehabilitation program is dependent upon an accurate evaluation and differential diagnosis to determine the causative fac...

The overhead throwing motion creates significant valgus and extension moments at the elbow, which can result in unique injury patterns seen in the throwing athlete. These abnormal forces can result in a multitude of distinct injuries, including ulnar collateral ligament tears and sprains, flexor-pronator mass tears and strains, ulnar neuritis, post...

Shoulder injuries from repetitive baseball pitching continue to be a serious, common problem. To determine whether passive range of motion of the glenohumeral joint was predictive of shoulder injury or shoulder surgery in professional baseball pitchers. Cohort study; Level of evidence, 2. Passive range of motion of the glenohumeral joint was assess...

Purpose The purpose of this study was to identify risk factors for revision surgery following primary anterior cruciate ligament (ACL) reconstruction. Methods A retrospective analysis of 2,965 patients who underwent a primary ACL reconstruction were separated into two groups: those who returned to our center for revision of their reconstruction (n...

A relatively high number of active professional baseball pitchers have a history of ulnar collateral ligament reconstruction (UCLr) on their throwing elbow. Controversy exists in the literature about whether professional baseball pitchers regain optimal performance after return from UCLr. It has been suggested that pitchers may have different biome...

Knee injuries, including articular cartilage damage, are common in football players and are potentially career threatening. The rate of return to play (RTP) as well as the factors affecting return after arthroscopic chondroplasty of the knee is performed in National Football League (NFL) athletes are not known. To determine the rate of return to re...

Ulnar collateral ligament (UCL) injuries are most commonly reported in baseball players (particularly in pitchers) but have also been observed in other overhead athletes including javelin, softball, tennis, volleyball, water polo, and gymnastics. Partial injuries have been successfully treated with appropriate nonoperative measures but complete tea...

Background Injuries to the elbow joint in baseball pitchers appear common. There appears to be a correlation between shoulder range of motion and elbow injuries. Purpose To prospectively determine whether decreased ROM of the throwing shoulder is correlated with the onset of elbow injuries in professional baseball pitchers. Study Design Cohort st...

Background: Lateral meniscal injury is a common and possibly career-threatening injury among players in the National Football League (NFL). The rate of return to play (RTP) and factors that affect RTP after lateral meniscal injury in NFL players are currently not defined. Purpose: The aims of this study were to determine the rate of RTP to regul...

The throwing athlete represents a very interesting and challenging patient population to treat. Few other athletes require the unique combination of stability combined with inherent laxity to allow them to achieve peak performance. Treatment of them and their injuries necessitates an understanding of this phenomenon, recognition of common pathologi...

Background: An objective classification system for studying youth baseball players in the U.S.A. was published in 1996. Professional baseball is composed of greater than 25% international players a majority of whom come from five countries. Many youth baseball players are injured in early years play, both in the U.S.A. and internationally. There i...

Background: Ulnar collateral ligament reconstruction (UCLR) has afforded baseball players with excellent results; however, previous studies have described only short-term outcomes. Purpose: To evaluate long-term outcomes after UCLR in baseball players. Study design: Case series; Level of evidence, 4. Methods: All UCLRs performed on competiti...

The overhead athlete presents with a unique profile that may predispose them to specific pathology. Injury to the superior aspect of the glenoid labrum (SLAP lesions) poses a significant challenge to the rehabilitation specialist due to the complex nature and wide variety of etiological factors associated with these lesions. A thorough clinical eva...

Study design: Case report. Background: Traumatic glenohumeral dislocations with concomitant rotator cuff and capsular injuries present a unique and challenging surgical and rehabilitative condition, particularly in the overhead-throwing athlete. Multiple injuries of the shoulder complex create the potential for complications in the course of rec...

Background An olecranon stress fracture is a rare injury associated with valgus extension overload in baseball players. No long-term outcomes studies have been published documenting the results of surgical fixation of olecranon stress fractures with or without concomitant injuries in baseball players. Hypothesis Open reduction and internal fixatio...

Background: A baseball pitcher's ability to maximize ball speed while avoiding shoulder and elbow injuries is an important determinant of a successful career. Pitching injuries are attributed to microtrauma brought about by the repetitive stress of high-magnitude shoulder and elbow kinetics. Hypothesis: Over a number of pitches, variations in ti...

The activities required during overhead sports, particularly during baseball pitching, produce large forces at the elbow joint. Injuries to the elbow joint frequently occur in the overhead athlete because of the large amount of forces observed during the act of throwing, playing tennis, or playing golf. Injuries may result because of repetitive ove...

Although baseball is a relatively safe sport, numerous reports suggest a rapid rise in elbow injury rate among youth baseball pitchers. PUBMED WAS SEARCHED FOR EPIDEMIOLOGIC, BIOMECHANICAL, AND CLINICAL STUDIES OF ELBOW INJURIES IN BASEBALL (KEYWORDS: "youth OR adolescent" AND baseball AND pitching AND "ulnar collateral ligament OR elbow"; publishe...

The ulnar collateral ligament of the elbow (UCL) is frequently injured in throwing athletes, most commonly baseball pitchers. The ligament is reconstructed through bone tunnels using palmaris longus or gracilis autograft. This study highlights the following technique for UCL reconstruction in over 2000 athletes.(2) When conservative management fail...

Cruciate ligament injuries are common and may lead to dysfunction if not rehabilitated. Understanding how to progress anterior cruciate ligament and posterior cruciate ligament loading, early after injury or reconstruction, helps clinicians prescribe rehabilitation exercises in a safe manner to enhance recovery. Commonly prescribed therapeutic exer...

OccurrenceDifferential DiagnosesDiagnostic ThinkingCase HistoryClinical ExaminationSupplemental ExaminationsSpecific Diagnoses-Common InjuriesOther InjuriesDifferential DiagnosesIntroductionGoals and PrinciplesPhase I: Acute PhasePhase II: Intermediate PhasePhase III: Advanced Rehabilitation PhaseReturn to Activity Phase

Ulnar collateral ligament (UCL) reconstruction is frequently performed in throwing athletes, but outcomes of UCL reconstruction requiring excision of bone, either within the substance of or replacing the UCL, have not been studied. Clinical outcome for throwing athletes after UCL reconstruction with gracilis tendon will be less favorable for patien...

Throwing velocity is an important baseball performance variable for baseball pitchers, because greater throwing velocity results in less time for hitters to make a decision to swing. Throwing velocity is also an important baseball performance variable for position players, because greater throwing velocity results in decreased time for a runner to...

Rehabilitation following anterior cruciate ligament surgery continues to change, with the current emphasis being on immediate weight bearing and range of motion, and progressive muscular strengthening, proprioception, dynamic stability, and neuromuscular control drills. The rehabilitation program should be based on scientific and clinical research...

There is a growing body of evidence documenting loads applied to the anterior cruciate ligament (ACL) for weight-bearing and non-weight-bearing exercises. ACL loading has been quantified by inverse dynamics techniques that measure anterior shear force at the tibiofemoral joint (net force primarily restrained by the ACL), ACL strain (defined as chan...

There is concern among sports medicine practitioners that the number of youth baseball pitchers with elbow injuries appears to be increasing. Research points to overuse as the principle risk factor. The risk of elbow pain in youth pitchers is correlated with the number of pitches thrown in a game and in a season. Adolescents who competitively pitch...

Injuries to the elbow joint occur often in athletes. Although less common than injuries to the knee, shoulder, and ankle joints, those to the elbow can present a significant challenge to the sports medicine clinician. Often they are difficult to rehabilitate due to athletes’ unique anatomy and the often excessively high stresses applied to the elbo...

The overhead throwing motion is a high-velocity, extremely stressful athletic movement. Its repetitive nature places tremendous demands on the entire body, frequently resulting in injury to the throwing shoulder. Such injuries, whether managed nonoperatively or surgically, require a multiphased approach beginning with exercises to restore muscular...

Objective: We are often asked to evaluate the postoperative elbow using MRI. In this article, we present both the normal appearance of the reconstructed ulnar collateral ligament (UCL) and a spectrum of UCL graft abnormalities at MR arthrography. Conclusion: The UCL is the primary medial stabilizer of the elbow during flexion and is susceptible...

In 2007 the STOP (Sports Trauma and Overuse Prevention) Sports Injuries campaign was created in response to the dramatic rise in overuse injuries among young athletes. The campaign uses public service announcements, posters, DVDs, brochures, electronic newsletter, an interactive web site and even social media like Facebook and Twitter to educate pe...

Case report. Joint stiffness, also called arthrofibrosis, remains the primary complication following any reconstructive knee surgery. Acute anterior cruciate ligament surgery, performed with concomitant multiple ligamentous repair and/or reconstruction, further increases the likelihood of developing impaired knee motion following surgery. The purpo...

An os subtibiale is an accessory bone separated from the distal medial tibia proper. Subtalar tarsal coalition is a failure of joint formation between the talus and calcaneus during hindfoot maturation. The patient in this case report has large bilateral os subtibiale and subtalar coalitions, which were undiagnosed throughout his soccer career unti...

Controlled laboratory study. To test for kinematic and kinetic differences between baseball pitching from a mound and long-toss on flat ground. Long-toss throws from flat ground are commonly used by baseball pitchers for rehabilitation, conditioning, and training. However, there is controversy over the biomechanics and functionality of such throws....

The risk of elbow or shoulder injury for young baseball pitchers is unknown. PURPOSE/ HYPOTHESIS: The purpose of this study was to quantify the cumulative incidence of throwing injuries in young baseball pitchers who were followed for 10 years. Three hypotheses were tested: Increased amount of pitching, throwing curveballs at a young age, and conco...

Glenohumeral internal rotation deficit (GIRD) indicates a 20° or greater loss of internal rotation of the throwing shoulder compared with the nondominant shoulder. To determine whether GIRD and a deficit in total rotational motion (external rotation + internal rotation) compared with the nonthrowing shoulder correlate with shoulder injuries in prof...