Table Of ContentDeLee, 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
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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
