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DeLee, Drez, & Miller’s Orthopaedic Sports Medicine Principles and Practice FIFTH EDITION DeLee, Drez, & Miller’s Orthopaedic Sports Medicine Principles and Practice Mark D. Miller, MD S. Ward Casscells Professor of Orthopaedic Surgery Head, Division of Sports Medicine University of Virginia Charlottesville, Virginia Adjunctive Clinical Professor and Team Physician James Madison University Harrisonburg, Virginia Stephen R. Thompson, MD, MEd, FRCSC Associate Professor of Sports Medicine Eastern Maine Medical Center University of Maine Bangor, Maine DELEE, DREZ, & MILLER’S ORTHOPAEDIC SPORTS MEDICINE, ISBN: 978-0-323-54473-3 FIFTH EDITION Copyright © 2020 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2015, 2010, 2003, 1994. International Standard Book Number: 978-0-323-54473-3 Senior Content Strategist: Kristine Jones Senior Content Development Specialist: Joan Ryan Publishing Services Manager: Catherine Jackson Senior Project Manager: Amanda Mincher Design Direction: Ryan Cook Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 1600 John F. Kennedy Blvd. Ste 1600 Philadelphia, PA 19103-2899 To sports medicine professionals in every discipline and to athletes at every level and every sport. Without them there would be no sports medicine. And to Drs. Jesse DeLee and David Drez. Thank you for entrusting us to keep your vision alive. MARK D. MILLER For Linden Ellis: You are too young to read this now, and you may choose never to read this later, but it is nonetheless still for you. And, for Shannon. As always, thank you for everything you do, including enabling me to do what I do. STEPHEN R. THOMPSON S E C T I O N E D I TO R S Amiethab A. Aiyer, MD Sanjeev Kakar, MD, FAOA Assistant Professor, Chief Foot and Ankle Service Professor of Orthopaedic Surgery Department of Orthopaedics Mayo Clinic University of Miami, Miller School of Medicine Rochester, Minnesota Miami, Florida Elbow, Wrist, and Hand Leg, Ankle, and Foot Morteza Khodaee, MD, MPH, FACSM, FAAFP Asheesh Bedi, MD Associate Professor Chief, Sports Medicine and Shoulder Surgery University of Colorado School of Medicine Professor of Orthopaedics Department of Family Medicine and Orthopaedics Head Orthopaedic Team Physician Denver, Colorado University of Michigan Medical Ann Arbor, Michigan Basic Principles Bryson Lesniak, MD Associate Professor Stephen F. Brockmeier, MD University of Pittsburgh Medical Center Associate Professor Rooney Sports Complex Department of Orthopaedic Surgery Pittsburgh, Pennsylvania Fellowship Director, University of Virginia Sports Medicine Basic Principles Fellowship University of Virginia School of Medicine Eric C. McCarty, MD Charlottesville, Virginia Chief, Sports Medicine and Shoulder Surgery Shoulder Associate Professor Department of Orthopaedics Rajwinder Deu, MD University of Colorado School of Medicine Assistant Professor Director Sports Medicine, Head Team Physician Department of Orthopaedics University of Colorado Department of Athletics Johns Hopkins University Associate Professor, Adjunct Baltimore, Maryland Department of Integrative Physiology Medical University of Colorado Boulder, Colorado F. Winston Gwathmey, Jr., MD Knee Associate Professor of Orthopaedic Surgery University of Virginia School of Medicine Matthew D. Milewski, MD Charlottesville, Virginia Assistant Professor Pelvis, Hip, and Thigh Division of Sports Medicine Department of Orthopaedic Surgery Joe M. Hart, PhD, ATC Boston Children’s Hospital Associate Professor Boston, Massachusetts Department of Kinesiology Pediatric Sports Medicine University of Virginia Charlottesville, Virginia Francis H. Shen, MD Rehabilitation and Injury Prevention Warren G. Stamp Endowed Professor Division Head, Spine Division Anish R. Kadakia, MD Co-Director, Spine Center Associate Professor of Orthopaedic Surgery Department of Orthopaedic Surgery Northwestern Memorial Hospital University of Virginia Northwestern University Feinberg School of Medicine Charlottesville, Virginia Chicago, Illinois Spine and Head Leg, Ankle, and Foot vi P R E FAC E What’s in a name? In developing and editing the fifth edition of And the non-operative sections have been extensively edited and DeLee, Drez, & Miller’s Orthopaedic Sports Medicine: Principles expanded, to include new information on sports nutrition, psy- and Practices, we considered removing “orthopaedic” from the chological adjustment to athletic injury and genitourinary trauma title. In an effort to keep pace with the rapidly growing specialty in the athlete. of sports medicine that includes internal medicine, pediatrics, Incredibly, there are over 300 contributors to this new edition, rehabilitation medicine, athletic training, as well as orthopedics many of whom are widely regarded as the foremost experts in and many other disciplines, it is essential to expand the book’s their fields. To each of them, we extend heartfelt gratitude for their focus beyond orthopedics and address a more all-inclusive vision willingness to participate and share their knowledge. Similarly, of sports medicine. Regardless of how sports medicine touches we would be remiss if we did not thank our outstanding section your individual practice, this updated version of this classic text- editors: Drs. Bedi, Lesniak, Khodaee, Deu, Hart, Brockmeier, book remains the most comprehensive in the field. Kakar, Gwathmey, McCarty, Kadakia, Aiyer, Shen, and Milewski. As sports medicine continues to evolve, the need to include They did the heavy lifting in the publishing process and we are additional topics is essential. For this fifth edition, one focus is deeply appreciative of their efforts. addressing problems of revision surgery. Important new chapters It remains a distinct honor and pleasure to continue the tra- have been added on revision shoulder instability, revision rotator dition of Drs. Jesse DeLee and David Drez, who first produced cuff, and revision anterior cruciate ligament surgery. Addition- this text in 1994. We hope it enables practitioners to remain ally, we have fine-tuned the organization of chapters under the on the cutting edge of sports medicine to the benefit of the dutiful watch of section editors. The hand section has been revised widest possible spectrum of athletes and patients under our to include more comprehensive chapters on sports-related inju- collective care. ries. The hip section has been updated to reflect the current Mark D. Miller thinking on the hottest new topics in sports medicine, including Stephen R. Thompson new chapters on posterior hip pain and peritrochanteric lesions. vii C O N T R I B U TO R S Kathleen C. Abalos, MD Christian N. Anderson, MD Derek P. Axibal, MD Department of Medicine Orthopaedic Surgeon Department of Orthopedics Beth Israel Deaconess Medical Center Tennessee Orthopaedic Alliance/The University of Colorado School of Medicine Boston, Massachusetts Lipscomb Clinic Aurora, Colorado Nashville, Tennessee Jeffrey S. Abrams, MD Bernard R. Bach Jr., MD Clinical Professor Lindsay M. Andras, MD The Claude Lambert-Helen Thompson School of Graduate Medicine Assistant Professor of Orthopaedic Surgery Professor of Orthopedic Surgery Seton Hall University Children’s Orthopedic Center Rush University Medical Center South Orange, New Jersey Children’s Hospital Los Angeles Chicago, Illinois Clinical Associate Professor Los Angeles, California Penn Medicine Princeton Medical Center Aaron L. Baggish, MD Princeton, New Jersey James R. Andrews, MD Director, Cardiovascular Performance Medical Director Program Julie E. Adams, MD The Andrews Institute Massachusetts General Hospital Professor of Orthopedic Surgery Gulf Breeze, Florida Boston, Massachusetts Mayo Clinic Health System Medical Director Austin, Minnesota and Rochester, Minnesota The American Sports Medicine Institute Wajeeh Bakhsh, MD Birmingham, Alabama Surgical Resident, Department of Bayan Aghdasi, MD Orthopaedics Orthopaedic Surgery Michael Antonis, DO, RDMS, FACEP, University of Rochester Medical Center University of Virginia CAQSM Rochester, New York Charlottesville, Virginia Emergency Medicine & Sports Medicine Georgetown University Christopher P. Bankhead, MD Amiethab A. Aiyer, MD Washington, District of Columbia Resident, Orthopaedic Surgery Assistant Professor, Chief Foot and Ankle University of New Mexico Service Chad A. Asplund, MD, MPH Albuquerque, New Mexico Department of Orthopaedics Director, Athletic Medicine University of Miami, Miller School of Associate Professor, Health and Kinesiology Michael G. Baraga, MD Medicine Georgia Southern University Assistant Professor of Orthopaedics Miami, Florida Statesboro, Georgia UHealth Sports Medicine Institute University of Miami, Miller School of Nourbakhsh Ali, MD Rachid Assina, MD, RPH Medicine Spine Surgeon Assistant Professor Miami, Florida Wellstar Atlanta Medical Center Department of Neurological Surgery Atlanta, Georgia Rutgers–New Jersey Medical School Jonathan Barlow, MD, MS Newark, New Jersey Mayo Clinic David W. Altchek, MD Rochester, Minnesota Co-Chief Emeritus Ashley V. Austin, MD Sports Medicine and Shoulder Service Resident Robert W. Battle, MD Hospital for Special Surgery Family Medicine and Physical Medicine and Team Cardiologist New York, New York Rehabilitation Associate Professor of Medicine and University of Virginia Pediatrics Raj M. Amin, MD Charlottesville, Virginia Department of Cardiology Resident Physician University of Virginia Medical Center Department of Orthopaedic Surgery Luke S. Austin, MD Charlottesville, Virginia The Johns Hopkins Hospital Associate Professor of Orthopaedics Baltimore, Maryland Rothman Institute Matthew Bessette, MD Egg Harbor Township, New Jersey Sports Medicine Fellow Kimberly K. Amrami, MD The Cleveland Clinic Foundation Professor of Radiology John T. Awowale, MD Cleveland, Ohio Chair, Division of Musculoskeletal Radiology Orthopedic Surgery Mayo Clinic University of Wisconsin Hospitals and Thomas M. Best, MD, PhD Rochester, Minnesota Clinics Professor of Orthopaedics University of Wisconsin Research Director of Sports Performance Madison, Wisconsin and Wellness Institute University of Miami Sports Medicine Institute Miami, Florida viii CONTRIBUTORS ix Bruce Beynnon, PhD Stephen F. Brockmeier, MD Jon-Michael E. Caldwell, MD McClure Professor of Musculoskeletal Associate Professor Resident, Department of Orthopedic Research Department of Orthopaedic Surgery Surgery Director of Research Fellowship Director, University of Virginia Columbia University Medical Center Department of Orthopaedics and Sports Medicine Fellowship New York Presbyterian Hospital Rehabilitation University of Virginia School of Medicine New York, New York University of Vermont College of Medicine Charlottesville, Virginia McClure Musculoskeletal Research Center Mary E. Caldwell, DO Burlington, Vermont Jeffrey Brunelli, MD Assistant Professor of Physical Medicine and Assistant Professor of Orthopaedic Surgery Rehabilitation and Sports Medicine Kieran Bhattacharya, BS and Rehabilitation Medical College of Virginia Research Assistant Chief, Sports Medicine and Shoulder Virginia Commonwealth University Department of Orthopaedic Surgery Surgery Richmond, Virginia University of Virginia University of Florida-Jacksonville College of Charlottesville, Virginia Medicine Ryan P. Calfee, MD, MSc Jacksonville, Florida Associate Professor of Orthopedics Debdut Biswas, MD Washington University School of Medicine Hinsdale Orthopaedics Jackie Buell, PhD, RD, CSSD, LD, ATC St. Louis, Missouri Chicago, Illinois Assistant Professor, Clinical Health Sciences and Medical Dietetics Christopher L. Camp, MD Matthew H. Blake, MD The Ohio State University Assistant Professor of Orthopedics Assistant Director, Sports Medicine Columbus, Ohio Mayo Clinic Orthopaedic Sports Medicine Rochester, Minnesota Avera McKennan Hospital and University Alissa J. Burge, MD Health Center Assistant Professor of Radiology John T. Campbell, MD Sioux Falls, South Dakota Weill Cornell Medicine Attending Orthopaedic Surgeon New York, New York Institute for Foot and Ankle Reconstruction Liljiana Bogunovic Mercy Medical Center Assistant Professor Jessica L. Buschmann, MS, RD, CSSD, Baltimore, Maryland Department of Orthopaedic Surgery LD Washington University School of Medicine Clinical Dietician—Board Certified Kevin Caperton, MD St. Louis, Missouri Specialist in Sports Dietetics Sports Department of Orthopedics and Sports Medicine Medicine Margaret Boushell, PhD Nationwide Children’s Hospital Georgetown Orthopedics Department of Biomedical Engineering Columbus, Ohio Georgetown, Texas Biomaterials and Interface Tissue Engineering Laboratory Brian Busconi, MD Robert M. Carlisle, MD Columbia University Medical Center Associate Professor of Orthopaedic Surgery Resident, Orthopaedic Surgery New York Presbyterian Hospital Sports Medicine Greenville Health System New York, New York University of Massachusetts Greenville, South Carolina Worcester, Massachusetts James P. Bradley, MD Rebecca A. Cerrato, MD Clinical Professor Charles A. Bush-Joseph, MD Attending Orthopaedic Surgeon Orthopaedic Surgery Professor of Orthopaedic Surgery Institute for Foot and Ankle Reconstruction University of Pittsburgh Medical Center Division of Sports Medicine Baltimore, Maryland Pittsburgh, Pennsylvania Rush University Medical Center Chicago, Illinois Courtney Chaaban, PT, DPT, SCS William Brady, MD, FAAEM, FACEP Doctoral Student Professor of Medicine and Emergency Kadir Buyukdogan, MD Sports Medicine Research Laboratory Medicine Department of Orthopaedic Surgery Department of Exercise and Sport Science University of Virginia University of Virginia University of North Carolina at Chapel Hill Charlottesville, Virginia Charlottesville, Virginia Chapel Hill, North Carolina Jonathan T. Bravman, MD E. Lyle Cain Jr., MD Jorge Chahla, MD Assistant Professor Founding Partner Regenerative Sports Medicine Fellow Director of Sports Medicine Research Andrews Sports Medicine and Orthopaedic Center for Regenerative Sports Medicine CU Sports Medicine Center Steadman Philippon Research Institute Division of Sports Medicine and Shoulder Fellowship Director Vail, Colorado Surgery American Sports Medicine Institute University of Colorado Birmingham, Alabama Denver, Colorado x CONTRIBUTORS Peter N. Chalmers, MD Philip Chuang, PhD Shannon David, PhD, ATC Assistant Professor Department of Biomedical Engineering Assistant Professor University of Utah Department of Biomaterials and Interface Tissue Coordinator of Clinical Education Orthopaedic Surgery Engineering Laboratory North Dakota State University Salt Lake City, Utah Columbia University Medical Center Fargo, North Dakota New York Presbyterian Hospital Angela K. Chang, MD New York, New York Thomas M. DeBerardino, MD Center for Outcomes-Based Orthopaedic Orthopaedic Surgeon Research Nicholas J. Clark, MD The Orthopaedic Institute Steadman Philippon Research Institute Orthopedic Surgeon Medical Director Vail, Colorado Mayo Clinic Burkhart Research Institute for Rochester, Minnesota Orthopaedics Sonia Chaudhry, MD The San Antonio Orthopaedic Group Assistant Professor of Orthopaedic Surgery John C. Clohisy, MD Co-Director, Combined Baylor College of University of Connecticut School of Professor of Orthopaedic Surgery Medicine and The San Antonio Medicine Washington University School of Medicine Orthopaedic Group, Texas Sports Pediatric Orthopaedic, Hand, and St. Louis, Missouri Medicine Fellowship Microvascular Surgery Professor of Orthopaedic Surgery Connecticut Children’s Medical Center Christopher Coleman, MD Baylor College of Medicine Hartford, Connecticut Department of Radiology San Antonio, Texas University of Colorado Austin W. Chen, MD Aurora, Colorado Richard E. Debski, PhD Hip Preservation and Sports Medicine Professor BoulderCentre for Orthopedics Francisco Contreras, MD Departments of Bioengineering and Boulder, Colorado Department of Radiology Orthopaedic Surgery Academic Faculty Jackson Memorial Hospital University of Pittsburgh American Hip Institute University of Miami Hospital Pittsburgh, Pennsylvania Chicago, Illinois Miami, Florida Marc M. DeHart, MD Edward C. Cheung, MD Joseph D. Cooper, MD Associate Professor of Orthopaedic Surgery Resident Physician Resident, Orthopaedic Surgery Chief of Adult Reconstruction Orthopaedic Surgery University of Southern California UT Health San Antonio University of California, Los Angeles Los Angeles, California San Antonio, Texas Medical Center Los Angeles, California Chris A. Cornett, MD, MPT Arthur Jason De Luigi, DO, MHSA Associate Professor of Orthopaedic Surgery Professor of Rehabilitation Medicine and A. Bobby Chhabra, MD University of Nebraska Medical Center Sports Medicine Lillian T. Pratt Distinguished Professor and Department of Orthopaedic Surgery and Georgetown University School of Medicine Chair Rehabilitation Washington, District of Columbia Orthopaedic Surgery Medical Director Physical/Occupational University of Virginia Health System Therapy Elizabeth R. Dennis, MD, MS Charlottesville, Virginia Co-Medical Director, Spine Program Resident, Department of Orthopedic Nebraska Medicine Surgery Woojin Cho, MD, PhD Omaha, Nebraska Columbia University Medical Center Assistant Professor, Orthopaedic Surgery New York Presbyterian Hospital Albert Einstein College of Medicine Paul S. Corotto, MD New York, New York Chief of Spine Surgery Chief Fellow Orthopaedic Surgery Department of Cardiology John J. Densmore, MD, PhD Research Director University of Virginia Medical Center Associate Professor of Clinical Medicine Multidisciplinary Spine Center Charlottesville, Virginia Division of Hematology/Oncology Montefiore Medical Center University of Virginia New York, New York Ryan P. Coughlin, MD, FRCSC Charlottesville, Virginia Department of Orthopaedic Surgery Joseph N. Chorley, MD Duke University Joshua S. Dines, MD Associate Professor of Pediatrics Durham, North Carolina Sports Medicine and Shoulder Service Baylor College of Medicine Hospital for Special Surgery Houston, Texas Jared A. Crasto, MD New York, New York Resident, Department of Orthopaedic John Jared Christophel, MD, MPH Surgery Benjamin G. Domb, MD Assistant Professor of Otolaryngology— University of Pittsburgh Medical Center Founder Head and Neck Surgery Pittsburgh, Pennsylvania American Hip Institute University of Virginia Chicago, Illinois Charlottesville, Virginia