Gordon W. Nuber, M.D.

Gordon W. Nuber, M.D.

Gordon W. Nuber, M.D.

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Conditions & Procedures

Procedures

ACL Reconstruction, Arthroscopy, Rotator Cuff Repair

General Information

Gender

Male

Affiliation

NorthShore Medical Group

Expertise

Shoulder Arthroscopy, Knee Arthroscopy, Elbow Arthroscopy

Languages

English

Board Certified

Orthopaedic Surgery

Clinical Service

Sports Medicine

Education, Training & Fellowships

Medical School

Wayne State University School of Medicine, 1978

Internship

McGaw Medical Center of Northwestern University, 1979

Residency

McGaw Medical Center of Northwestern University, 1983

Fellowship

Kerlan-Jobe Orthopaedic Clinic, 1984

Locations

A

NOI NorthShore Orthopedics Chicago

680 N Lake Shore Dr
Ste 924
Chicago, IL 60611
847.866.7846 866.954.5787 fax Get Directions This location is wheelchair accessible.
B

NorthShore Medical Group

2180 Pfingsten Rd.
Suite 3100
Glenview, IL 60026
847.866.7846 866.954.5787 fax Get Directions This location is wheelchair accessible.

Insurance

Commercial Plans - Employer Sponsored
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Cofinity PPO (an Aetna Company)
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Coventry Consumer Choices (C3)
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Health Link HMO
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Health Link-Open Access I, II, III
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Healthcare's Finest Network- FHN 10 & 20
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Healthcare's Finest Network- FHN Platinum
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Healthcare's Finest Network- HFN Community Health Connect Elite
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Humana Advocate Centered EPO
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Humana Advocate Centered HMO
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Multiplan/ PHCS- PHCS Healthy Directions
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UniCare HMO Performance Select
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United Healthcare Options Non-Differential PPO
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Aetna Whole Health Chicago (All Metal Tiers)
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Aetna Whole Health Chicago Bronze Deductible Only HSA Eligible
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Ambetter Balance Care 10+ Vision+ Adult Dental
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Ambetter Balanced Care 1
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Ambetter Balanced Care 1+ Vision+ Adult Dental
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Ambetter Balanced Care 10
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Ambetter Balanced Care 2
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Ambetter Balanced Care 2+ Vision+ Adult Dental
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Ambetter Essential Care 1
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Ambetter Secure Care 1 w/ 3 Free PCP Visits
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Blue Cross Blue Shield Basic 103 Multi-State Plan
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Blue Cross Blue Shield Blue Choice Preferred PPO (Plan #'s 101-107; All Metal Tiers)
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Blue Cross Blue Shield Blue Choice Preferred Security PPO 100
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Blue Cross Blue Shield Blue Precision HMO (Plan #'s 101-103; All Metal Tiers)
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Blue Cross Blue Shield Blue Premier 101 Multi-State Plan
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Blue Cross Blue Shield BlueCare Direct with Advocate (Plan #'s 101-103; All Metal Tiers)
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Blue Cross Blue Shield Solution 102 Multi-State Plan
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Coventry $15 Copay; Silver & Gold
Not Available In 2017
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Coventry Bronze $ 20 Copay
Not Available In 2017
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Coventry Bronze $10 Copay Carelink St. John's
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Coventry Bronze $15 Copay Carelink St. John's
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Coventry Bronze Deductible Only HSA Eligible
Not Available In 2017
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Harken Health - an Affiliate of United Healthcare
Verify physician participation and out of pocket expenses with Harken
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Health Alliance HMO (All Metal Tiers)
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Health Alliance POS (All Metal Tiers)
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Health Alliance PPO (All Metal Tiers)
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Humana Chicago HMOx (All Metal Tiers)
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Land of Lincoln Health Traditional PPO
Plan Ending 9/30/16
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United Healthcare Compass (All Metal Tiers)
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Medicaid
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Aetna Better Health FHP
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Blue Cross Blue Shield Community ICP
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Cigna HealthSpring ICP
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Community Care Alliance- ICP
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Family Health Network- FHP
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Harmony/WellCare FHP Plan
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Humana ICP
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Illinicare Family Health Plan (FHP/ACA)
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Illinicare ICP
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Illinois Department of Public Aid (IDPA)
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Meridian FHP/ACA Expansion
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Molina ICP
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Next Level ACA/FHP
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Aetna Medicare Connect Plus (PPO)/PPO Connect Plus
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Aetna Medicare Standard Plan (PPO)/PPO Standard Plan
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Aetna Medicare Value Plan (HMO)/HMO Value
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Aetna Medicare Value Plan (PPO)/PPO Value Plan
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Aetna Traditional Choice Plan
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Blue Cross Blue Shield Medicare Advantage Basic HMO
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Blue Cross Blue Shield Medicare Advantage Basic Plus HMO-POS
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Blue Cross Blue Shield Medicare Advantage Choice Plus PPO
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Blue Cross Blue Shield Medicare Advantage Choice Premier PPO
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Cigna-HealthSpring Advantage HMO
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Cigna-HealthSpring Premier HMO-POS
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Cigna-HealthSpring Primary HMO
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Cigna-HealthSpring TotalCare HMO-SNP
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Community Care Alliance Complete HMO-D-SNP
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Community Care Alliance HMO
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Harmony/WellCare Health Plan
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Harmony/WellCare RX (HMO)
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Harmony/WellCare Value (HMO-POS)
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Harmony/WellCare-Medicare HMO Plans
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Harmony/WellCare-Medicare Special Needs Plans
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Humana Choice PPO
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Humana Community HMO Diabetes and Heart (SNP Program)
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Humana Gold Plus HMO
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Humana Gold Plus PFFS
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Meridian Medicare Advantage
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Molina Medicare Advantage
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United Healthcare - AARP Medicare Complete
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United Healthcare AARP Medicare Complete Access
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United Healthcare- AARP Medicare Complete Plus (HMO-POS)
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United Healthcare Medicare Advantage Focus
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United Healthcare- Medicare Solutions/Medicare Advantage
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Medicare Medicaid Alignment Initiative (MMAI) Plans
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Aetna Better Health MMAI
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Blue Cross Blue Shield Community MLTSS/LTSS
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Blue Cross Blue Shield Community MMAI
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Cigna-HealthSpring MMAI
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Humana MMAI
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Illinicare MLTSS/LTSS
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Illinicare MMAI
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Meridian MMAI
PRIMARY CARE
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Molina MMAI
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Commercial - Individual Plans
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Aetna Bronze Deductible Only HSA Eligible Savings Plus OAMC PD
Not Available In 2017
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Aetna Bronze Deductible Only HSA Eligible Savings Plus OAMC- PD
Not available for 2017
PRIMARY CARE
SPECIALTY CARE
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Aetna Savings Plus OAMC PD ( All Metal Tiers)
Not available for 2017
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Aetna Savings Plus OAMC PD (All Metal Tiers)
Not Available In 2017
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Aetna Whole Health Chicago (All Metal Tiers)
Not available for 2017
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Aetna Whole Health Chicago Bronze Deductible Only HSA Eligible
Not available for 2017
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Ambetter Balanced Care 1
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Balanced Care 1+ Vision+ Dental
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Balanced Care 10
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Balanced Care 10+ Vision+ Dental
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Balanced Care 2
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Balanced Care 2+ Vision+ Dental
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Essential Care 1
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Secure Care 1 w/ 3 Free PCP Visits
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Choice Preferred PPO (Plan #'s 101-107; All Metal Tiers)
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Choice Preferred Security PPO 100
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Cross Blue Premier 101 Multi-State Plan
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Blue Cross Blue Shield Blue Cross Blue Shield Basic 103 Multi-State Plan
PRIMARY CARE
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Blue Cross Blue Shield Blue Precision HMO (Plan #'s 101-103; All Metal Tiers)
Verify PCP Participation
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Blue Cross Blue Shield Blue Precision Platinum HMO 104
Verify PCP Participation
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Blue Cross Blue Shield BlueCare Direct with Advocate (Plan #'s 101-103; All Metal Tiers)
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Solution 102 Multi-State Plan
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
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Publications

  • The NFL Orthopaedic Surgery Outcomes Database (NO-SOD): The Effect of Common Orthopaedic Procedures on Football Careers.

    The American journal of sports medicine 2016 Jun 16

    Authors: Mai HT, Alvarez AP, Freshman RD, Chun DS, Minhas SV, Patel AA, Nuber GW, Hsu WK
    Abstract
    Injuries are inherent to the sport of American football and often require operative management. Outcomes have been reported for certain surgical procedures in professional athletes in the National Football League (NFL), but there is little information comparing the career effect of these procedures.
    To catalog the postoperative outcomes of orthopaedic procedures in NFL athletes and to compare respective prognoses and effects on careers.
    Case series; Level of evidence, 4.
    Athletes in the NFL undergoing procedures for anterior cruciate ligament (ACL) tears, Achilles tendon tears, patellar tendon tears, cervical disc herniation, lumbar disc herniation, sports hernia, knee articular cartilage repair (microfracture technique), forearm fractures, tibial shaft fractures, and ankle fractures were identified through team injury reports or other public records. Game and performance statistics during the regular season were collected before and after surgery. Statistical analysis was performed with significance accepted as P < .05.
    A total of 559 NFL athletes were included. Overall, 79.4% of NFL athletes returned to play after an orthopaedic procedure. Forearm open reduction and internal fixation (ORIF), sports hernia repair, and tibia intramedullary nailing (IMN) led to significantly higher return-to-play (RTP) rates (90.2%-96.3%), while patellar tendon repair led to a significantly lower rate (50%) (P < .001). Athletes undergoing ACL reconstruction (ACLR), Achilles tendon repair, patellar tendon repair, and ankle fracture ORIF had significant declines in games played at 1 year and recovered to baseline at 2 to 3 years after surgery. Athletes undergoing ACLR, Achilles tendon repair, patellar tendon repair, and tibia IMN had decreased performance in postoperative season 1. Athletes in the Achilles tendon repair and tibia IMN cohorts recovered to baseline performance, while those in the ACLR and patellar tendon repair cohorts demonstrated sustained decreases in performance.
    ACLR, Achilles tendon repair, and patellar tendon repair have the greatest effect on NFL careers, with patellar tendon repair faring worst with respect to the RTP rate, career length after surgery, games played, and performance at 1 year and 2 to 3 years after surgery.
    PMID: 27311414 [PubMed - as supplied by publisher]
  • Preexisting Rotator Cuff Tears as a Predictor of Outcomes in National Football League Athletes.

    Sports health 2016 Mar 4

    Authors: Gibbs DB, Lynch TS, Gombera MM, Saltzman MD, Nuber GW, Schroeder GD, Labelle M, Hollett BP
    Abstract
    A preexisting rotator cuff tear may affect the draft status and career performance of National Football League (NFL) players.
    Preexisting rotator cuff tears decrease a player's draft status, performance, and longevity in the NFL.
    Retrospective cohort study.
    Level 3.
    Medical reports of prospective NFL players during the NFL Scouting Combine from 2003 to 2011 were evaluated to identify players with a previous rotator cuff tear. Athletes were matched to control draftees without documented shoulder pathology by age, position, year drafted, and round drafted. Career statistics and performance scores were calculated.
    Between 2003 and 2011, 2965 consecutive athletes were evaluated. Forty-nine athletes had preexisting rotator cuff tears: 22 athletes underwent surgical intervention for their tear and 27 were treated nonoperatively. Those with a rotator cuff tear were significantly less likely to be drafted than those without a previous injury (55.1% vs 77.5%, P = 0.002). The 27 drafted athletes with preexisting rotator cuff tears started significantly fewer games (23.7 vs 43.0, P = 0.02) and played significantly fewer years (4.3 vs 5.7, P = 0.04) and significantly fewer games (47.1 vs 68.4, P = 0.04) than matched control athletes without rotator cuff tears.
    Athletes with a preexisting rotator cuff tear were less likely to be drafted and had decreased career longevity.
    PMID: 26945020 [PubMed - as supplied by publisher]
  • Common Shoulder Injuries in American Football Athletes.

    Current sports medicine reports

    Authors: Gibbs DB, Lynch TS, Nuber ED, Nuber GW
    Abstract
    American football is a collision sport played by athletes at high speeds. Despite the padding and conditioning in these athletes, the shoulder is a vulnerable joint, and injuries to the shoulder girdle are common at all levels of competitive football. Some of the most common injuries in these athletes include anterior and posterior glenohumeral instability, acromioclavicular pathology (including separation, osteolysis, and osteoarthritis), rotator cuff pathology (including contusions, partial thickness, and full thickness tears), and pectoralis major and minor tears. In this article, we will review the epidemiology and clinical and radiographic workup of these injuries. We also will evaluate the effectiveness of surgical and nonsurgical management specifically related to high school, collegiate, and professional football athletes.
    PMID: 26359844 [PubMed - as supplied by publisher]
  • Different roles of the medial and lateral hamstrings in unloading the anterior cruciate ligament.

    The Knee 2016 Jan

    Authors: Guelich DR, Xu D, Koh JL, Nuber GW, Zhang LQ
    Abstract
    Anterior cruciate ligament injuries are closely associated with excessive loading and motion about the off axes of the knee, i.e. tibial rotation and knee varus/valgus. However, it is not clear about the 3-D mechanical actions of the lateral and medial hamstring muscles and their differences in loading the ACL. The purpose of this study was to investigate the change in anterior cruciate ligament strain induced by loading the lateral and medial hamstrings individually.
    Seven cadaveric knees were investigated using a custom testing apparatus allowing for six degree-of-freedom tibiofemoral motion induced by individual muscle loading. With major muscles crossing the knee loaded moderately, the medial and lateral hamstrings were loaded independently to 200N along their lines of actions at 0°, 30°, 60° and 90° of knee flexion. The induced strain of the anterior cruciate ligament was measured using a differential variable reluctance transducer. Tibiofemoral kinematics was monitored using a six degrees-of-freedom knee goniometer.
    Loading the lateral hamstrings induced significantly more anterior cruciate ligament strain reduction (mean 0.764 [SD 0.63] %) than loading the medial hamstrings (mean 0.007 [0.2] %), (P=0.001 and effect size=0.837) across the knee flexion angles.
    The lateral and medial hamstrings have significantly different effects on anterior cruciate ligament loadings. More effective rehabilitation and training strategies may be developed to strengthen the lateral and medial hamstrings selectively and differentially to reduce anterior cruciate ligament injury and improve post-injury rehabilitation.
    The lateral and medial hamstrings can potentially be strengthened selectively and differentially as a more focused rehabilitation approach to reduce ACL injury and improve post-injury rehabilitation. Different ACL reconstruction procedures with some of them involving the medial hamstrings can be compared to each other for their effect on ACL loading.
    PMID: 26256427 [PubMed - as supplied by publisher]
  • Pre-existing lumbar spine diagnosis as a predictor of outcomes in National Football League athletes.

    The American journal of sports medicine 2015 Apr

    Authors: Schroeder GD, Lynch TS, Gibbs DB, Chow I, LaBelle M, Patel AA, Savage JW, Hsu WK, Nuber GW
    Abstract
    It is currently unknown how pre-existing lumbar spine conditions may affect the medical evaluation, draft status, and subsequent career performance of National Football League (NFL) players.
    To determine if a pre-existing lumbar diagnosis affects a player's draft status or his performance and longevity in the NFL.
    Cohort study; Level 3.
    The investigators evaluated the written medical evaluations and imaging reports of prospective NFL players from a single franchise during the NFL Scouting Combine from 2003 to 2011. Players with a reported lumbar spine diagnosis and with appropriate imaging were included in this study. Athletes were then matched to control draftees without a lumbar spine diagnosis by age, position, year, and round drafted. Career statistics and performance scores were calculated.
    Of a total of 2965 athletes evaluated, 414 were identified as having a pre-existing lumbar spine diagnosis. Players without a lumbar spine diagnosis were more likely to be drafted than were those with a diagnosis (80.2% vs. 61.1%, respectively, P < .001). Drafted athletes with pre-existing lumbar spine injuries had a decrease in the number of years played compared with the matched control group (4.0 vs. 4.3 years, respectively, P = .001), games played (46.5 vs. 50.8, respectively, P = .0001), and games started (28.1 vs. 30.6, respectively, P = .02) but not performance score (1.4 vs. 1.8, respectively, P = .13). Compared with controls, players were less likely to be drafted if they had been diagnosed with spondylosis (62.37% vs. 78.55%), a lumbar herniated disc (60.27% vs. 78.43%), or spondylolysis with or without spondylolisthesis (64.44% vs. 78.15%) (P < .001 for all), but there was no appreciable effect on career performance; however, the diagnosis of spondylolysis was associated with a decrease in career longevity (P < .05). Notably, 2 athletes who had undergone posterior lateral lumbar fusion were drafted. One played in 125 games, and the other is still active and has played in 108 games.
    The data in this study suggest that athletes with pre-existing lumbar spine conditions were less likely to be drafted and that the diagnosis is associated with a decrease in career longevity but not performance. Players with lumbar fusion have achieved successful careers in the NFL.
    PMID: 25617402 [PubMed - as supplied by publisher]
  • The impact of a cervical spine diagnosis on the careers of National Football League athletes.

    Spine 2014 May 20

    Authors: Schroeder GD, Lynch TS, Gibbs DB, Chow I, LaBelle MW, Patel AA, Savage JW, Nuber GW, Hsu WK
    Abstract
    Cohort study.
    To determine the effect of cervical spine pathology on athletes entering the National Football League.
    The association of symptomatic cervical spine pathology with American football athletes has been described; however, it is unknown how preexisting cervical spine pathology affects career performance of a National Football League player.
    The medical evaluations and imaging reports of American football athletes from 2003 to 2011 during the combine were evaluated. Athletes with a cervical spine diagnosis were matched to controls and career statistics were compiled.
    Of a total of 2965 evaluated athletes, 143 players met the inclusion criteria. Athletes who attended the National Football League combine without a cervical spine diagnosis were more likely to be drafted than those with a diagnosis (P = 0.001). Players with a cervical spine diagnosis had a decreased total games played (P = 0.01). There was no difference in the number of games started (P = 0.08) or performance score (P = 0.38). In 10 athletes with a sagittal canal diameter of less than 10 mm, there was no difference in years, games played, games started, or performance score (P > 0.24). No neurological injury occurred during their careers. In 7 players who were drafted with a history of cervical spine surgery (4 anterior cervical discectomy and fusion, 2 foraminotomy, and 1 suboccipital craniectomy with a C1 laminectomy), there was no difference in career longevity or performance when compared with matched controls.
    This study suggests that athletes with preexisting cervical spine pathology were less likely to be drafted than controls. Players with preexisting cervical spine pathology demonstrated a shorter career than those without; however, statistically based performance and numbers of games started were not different. Players with cervical spinal stenosis and those with a history of previous surgery demonstrated no difference in performance-based outcomes and no reports of neurological injury during their careers.
    PMID: 24718072 [PubMed - as supplied by publisher]
  • Acromioclavicular joint injuries in the National Football League: epidemiology and management.

    The American journal of sports medicine 2013 Dec

    Authors: Lynch TS, Saltzman MD, Ghodasra JH, Bilimoria KY, Bowen MK, Nuber GW
    Abstract
    Previous studies investigating acromioclavicular (AC) joint injuries in professional American football players have only been reported on quarterbacks during the 1980s and 1990s. These injuries have not been evaluated across all position players in the National Football League (NFL).
    The purpose of this study was 4-fold: (1) to determine the incidence of AC joint injuries among all NFL position players; (2) to investigate whether player position, competition setting, type of play, and playing surface put an athlete at an increased risk for this type of injury; (3) to determine the incidence of operative and nonoperative management of these injuries; and (4) to compare the time missed for injuries treated nonoperatively to the time missed for injuries requiring surgical intervention.
    Descriptive epidemiological study.
    All documented injuries of the AC joint were retrospectively analyzed using the NFL Injury Surveillance System (NFLISS) over a 12-season period from 2000 through 2011. The data were analyzed by the anatomic location, player position, field conditions, type of play, requirement of surgical management, days missed per injury, and injury incidence.
    Over 12 NFL seasons, there were a total of 2486 shoulder injuries, with 727 (29.2%) of these injuries involving the AC joint. The overall rate of AC joint injuries in these athletes was 26.1 injuries per 10,000 athlete exposures, with the majority of these injuries occurring during game activity on natural grass surfaces (incidence density ratio, 0.79) and most often during passing plays. These injuries occurred most frequently in defensive backs, wide receivers, and special teams players; however, the incidence of these injuries was greatest in quarterbacks (20.9 injuries per 100 players), followed by special teams players (20.7/100) and wide receivers (16.5/100). Overall, these athletes lost a mean of 9.8 days per injury, with quarterbacks losing the most time to injury (mean, 17.3 days). The majority of these injuries were low-grade AC joint sprains that were treated with nonoperative measures; only 13 (1.7%) required surgical management. Players who underwent surgical management lost a mean of 56.2 days.
    Shoulder injuries, particularly those of the AC joint, occur frequently in the NFL. These injuries can result in time lost but rarely require operative management. Quarterbacks had the highest incidence of injury; however, this incidence is lower than in previous investigations that evaluated these injuries during the 1980s and 1990s.
    PMID: 24057030 [PubMed - as supplied by publisher]
  • Nerve block of the infrapatellar branch of the saphenous nerve in knee arthroscopy: a prospective, double-blinded, randomized, placebo-controlled trial.

    The Journal of bone and joint surgery. American volume 2013 Aug 21

    Authors: Hsu LP, Oh S, Nuber GW, Doty R
    Abstract
    With the rising use of outpatient knee arthroscopy over the past decade, interest in peripheral nerve blocks during arthroscopy has increased. Femoral nerve blocks are effective but are associated with an inherent risk of the patient falling postoperatively because of quadriceps weakness. We studied blocks of the infrapatellar branch of the saphenous nerve, which produce analgesia in the knee that is similar to that resulting from a femoral nerve block but without associated quadriceps weakness.
    Thirty-four patients were enrolled into each arm of this prospective, randomized, double-blinded trial comparing 10 mL of 0.25% bupivacaine used as a block of the infrapatellar branch of the saphenous nerve with a placebo during simple knee arthroscopy. Immediate outcome measures included Numeric Rating Scale (NRS) pain scores (0 to 10 points), mobility and discharge times, opioid usage, subjective adverse side effects, and forty-eight-hour anesthesia recovery surveys. Short-term measures included one-week and twelve-week Lysholm knee scores.
    No adverse effects or increased quadriceps weakness were observed following use of the nerve block. Improvement in early NRS scores and subjective nausea (p = 0.03) were detected. Patients for whom the block was successful also had improved twelve-week Lysholm knee scores (p = 0.04). No differences in opioid usage, mobility time, forty-eight-hour anesthesia recovery scores, or one-week Lysholm knee scores were found.
    No significant adverse effect or disadvantage was identified for blocks of the infrapatellar branch of the saphenous nerve used in simple knee arthroscopy. In addition to decreased early NRS scores and nausea, blocks of the infrapatellar branch of the saphenous nerve demonstrated potential benefit at twelve weeks after simple knee arthroscopy.
    PMID: 23965696 [PubMed - as supplied by publisher]
  • Biomechanical comparison of 3 methods to repair pectoralis major ruptures.

    The American journal of sports medicine 2012 Jul

    Authors: Rabuck SJ, Lynch JL, Guo X, Zhang LQ, Edwards SL, Nuber GW, Saltzman MD
    Abstract
    Pectoralis major ruptures are closely associated with weight lifting and participation in sports. The anatomy of the pectoralis major tendon is unique with an elongated thin footprint requiring multiple points of fixation to restore the native anatomy. Multiple options exist for tendon repairs, but the strongest construct has yet to be identified.
    The intent of this study was to compare the load to failure of bone trough, cortical button, and suture anchor repairs of the pectoralis major tendon in the extended and abducted position.
    Controlled laboratory study.
    Thirty fresh-frozen cadaveric shoulders were divided equally into 3 groups based on the repair technique to be performed. Bone mineral density of the surgical neck of the proximal humerus was assessed before each repair. Bone trough, suture anchor, and cortical button repairs were performed as dictated by computerized randomization. Each specimen was loaded to failure and mode of failure was noted.
    The majority of failures occurred through the suture used for tendon repair. One specimen in the bone trough group failed via fracture of the proximal humerus. The suture anchor group failed at the implant in 5 of 9 specimens and through the suture in 4 of 9 specimens. Load to failure was greatest in bone trough repairs at 596 N, followed by cortical button at 494 N, and finally suture anchor repairs with 383 N. Load to failure was significantly greater in the bone trough group when compared with suture anchor repairs (P = .007). No correlation was found between bone mineral density and load to failure.
    Bone trough repair of the pectoralis major tendon was stronger than suture anchor repair.
    Identification of the strongest repair may help guide surgical repair.
    PMID: 22679296 [PubMed - as supplied by publisher]
  • The anterior deltoid's importance in reverse shoulder arthroplasty: a cadaveric biomechanical study.

    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 2013 Mar

    Authors: Schwartz DG, Kang SH, Lynch TS, Edwards S, Nuber G, Zhang LQ, Saltzman M
    Abstract
    Frequently, patients who are candidates for reverse shoulder arthroplasty have had prior surgery that may compromise the anterior deltoid muscle. There have been conflicting reports on the necessity of the anterior deltoid thus it is unclear whether a dysfunctional anterior deltoid muscle is a contraindication to reverse shoulder arthroplasty. The purpose of this study was to determine the 3-dimensional (3D) moment arms for all 6 deltoid segments, and determine the biomechanical significance of the anterior deltoid before and after reverse shoulder arthroplasty.
    Eight cadaveric shoulders were evaluated with a 6-axis force/torque sensor to assess the direction of rotation and 3D moment arms for all 6 segments of the deltoid both before and after placement of a reverse shoulder prosthesis. The 2 segments of anterior deltoid were unloaded sequentially to determine their functional role.
    The 3D moment arms of the deltoid were significantly altered by placement of the reverse shoulder prosthesis. The anterior and middle deltoid abduction moment arms significantly increased after placement of the reverse prosthesis (P < .05). Furthermore, the loss of the anterior deltoid resulted in a significant decrease in both abduction and flexion moments (P < .05).
    The anterior deltoid is important biomechanically for balanced function after a reverse total shoulder arthroplasty. Losing 1 segment of the anterior deltoid may still allow abduction; however, losing both segments of the anterior deltoid may disrupt balanced abduction. Surgeons should be cautious about performing reverse shoulder arthroplasty in patients who do not have a functioning anterior deltoid muscle.
    PMID: 22608931 [PubMed - as supplied by publisher]