bluuebunny/crossref_metadata_2025 huggingface dataset:
Instrumented Arthrometry for Diagnosing Partial Versus Complete Anterior Cruciate Ligament Tears
Authors: Rijke Arie M. , Perrin David H. , Goitz Henry T. , McCue Frank C.
Published: June 2007

Nineteen patients with the clinical diagnosis of anterior cruciate ligament injury were examined by KT-1000 ar thrometry before arthroscopy in an effort to differentiate partial from complete tears. To this end, the KT-1000 arthrometer was equipped with a strain gauge and pro cessor that permitted the required force to increase the anterior displacement by 1-mm increments, to be read on a light-emitting diode. The measured force has been plotted against anterior displacement expressed in non linear increments along the x-axis to allow for the vis coelastic nature of the ligament. The results show that stress-strain diagrams of partially torn and completely torn ligaments are similar to those obtained by graded stress radiography. Using arthroscopy as the standard of measurement, partial tears can be differentiated from complete tears with a sensitivity of 80% and a specificity of 100%. The figures for complete tears versus partial tears are 100% and 80%, respectively. Graded arthrom etry with x-y recording of the force-displacement rela tionship that allows for the viscoelastic qualities of liga ment further extends the capabilities of instrumented arthrometry.
Primary Stability of Interference Screw Fixation
Authors: Kohn Dieter , Rose Christoph
Published: June 2007

Interference screw fixation is frequently used in anterior cruciate ligament reconstruction with the bone-patellar tendon-bone graft. There have been no data available about the influence of screw diameter and insertion torque on primary stability. We designed a cadaveric study using paired knees to analyze the comparative effectiveness of 20-mm long screws of different diam eters (9 mm versus 7 mm) and the significance of torque during screw insertion. Testing to failure was performed in a tensiometer with a crosshead speed of 200 mm/ min. After slippage of a bone peg in the 7-mm screw specimens, the experiment was repeated in each speci men with a 9-mm screw fixation. Maximum tensile force was greater at the femoral insertion than at the tibial site. Results of refixations with 9-mm screws were only slightly inferior to the original 9-mm screw fixation speci mens. Our results further showed that the torque can be used as a predictor of the stability of the bone block but cannot be used as an indicator for the strength of the reconstruction. The 7-mm screws are not recom mended for tibial fixation. Failed 7-mm screw fixations can be replaced by 9-mm screws and refixations were successful in our study model.
Soft Tissue Fixation to Bone
Authors: Straight Christopher B. , France E. Paul , Paulos Lonnie E. , Rosenberg Thomas D. , Weiss Jeffrey A.
Published: June 2007

The initial fixation strengths of two spiked-washer de signs were evaluated using human femurs and fascia lata tissue. Fascia lata was attached to the femur using the fixation devices, and then each femur-washer- fascia lata complex was loaded in tension to failure. Load-elongation curves were recorded, the initial failure load, initial failure displacement, stiffness, ultimate load, and ultimate displacement were determined for each test, and failure modes were recorded. Results indi cated that the 6-spike design provided superior initial fixation strength in the 19-mm diameter size. This washer design was then compared with two commer cially available fixation devices: the spiked AO washer and soft tissue fixation plate. Fixation provided by the prototypal washer design was not different in most in stances from that provided by the AO fixation devices. Based on these results, important design characteris tics for soft tissue spiked washers are identified and discussed.
Functional Outcomes in Athletes After Modified Anterior Capsulolabral Reconstruction
Authors: Montgomery William H. , Jobe Frank W.
Published: June 2007

During a 7-month period, 32 consecutive athletes un derwent anterior capsulolabral reconstruction with modifications, consisting of a horizontal capsulotomy (rather than a T-capsulotomy) and suture anchors (rather than drill holes); 31 patients were available for follow-up examinations. At preoperative examinations all patients demonstrated positive relocation tests; 22 were diagnosed with recurrent anterior subluxation and 9 with recurrent anterior dislocation. After surgery, all patients underwent a rehabilitation program. Followup included physical examination, subjective questions, and radiographs. At a minimum of 24 months' followup, results measured by modified Rowe score were 24 pa tients (77%) excellent, 6 (19%) good, and 1 (3%) failure. Eighty-one percent of the patients returned to the same sport at the same level of competition, 13% returned to the same sport at a lower level of competition, and 6% did not return to the preinjury sport. Radiographic analy ses at 2 years' followup revealed all Mitek anchors were well seated in the bone of the glenoid neck. No com plications of the suture anchors occurred. This modifi cation of anterior capsulolabral reconstruction simpli fied the procedure and allowed a more aggressive early rehabilitation program with 97% good or excellent results.
The Biomechanics and Histopathology of Chemically Processed Patellar Tendon Allografts for Anterior Cruciate Ligament Replacement
Authors: Zimmerman Mark C. , Contiliano Joseph H. , Parsons J. Russell , Prewett Ann , Billotti Joseph
Published: June 2007

A study was initiated to examine chemically processed patellar tendon allografts in sheep anterior cruciate liga ment repairs, both mechanically and histologically. One group of animals received frozen, untreated allografts, one group received frozen grafts that were processed with a chloroform-methanol solvent extraction tech nique, and one group received frozen tendons treated with a permeation-enhanced extraction technique. All animals were operated on unilaterally, with the con tralateral knee acting as a normal, intact control. His tologic analysis after 2 months of implantation revealed similar enhanced cellular repopulation in both chemi cally treated ligament allografts compared with the more hypocellular, untreated grafts. At 6 months the chloroform-methanol group demonstrated a more ag gressive chronic cellular response with numerous thick- walled vessels relative to the untreated and permeation- enhanced grafts. Mechanical testing after 6 months of implantation showed statistically similar anterior drawer resistance in all grafted knees, yet the two chemically extracted grafts had significantly less stiffness than un treated anterior cruciate ligament grafts. Both treatment groups also tended to be weaker than the untreated allografts. All anterior cruciate ligament reconstructions showed excessive anterior drawer laxity and, regard less of treatment, had lower strength and less stiffness than normal anterior cruciate ligament tissue at the 6-month period.
Contaminated Rabbit Patellar Tendon Grafts
Authors: Goebel Mark E. , Drez David , Heck Suzy B. , Stoma Mary Kay
Published: June 2007

In Part 1 of our study, 40 central-third bone-patellar tendon-bone grafts were harvested from 20 adult Cali fornia White rabbits under strict sterile conditions. Ten grafts were placed directly into a thioglycolate broth, incubated, and subcultured; no growth was noted in any specimen. The next 6 grafts were contaminated 20 sec onds each with 2 different species of coagulase negative staphylococci. Organisms were grown with cultures obtained from an operating room floor during anterior cruciate ligament reconstruction. Marked growth of both species was noted in all 6 grafts within 24 hours. A subsequent 3 series of 8 grafts each were harvested sterilely, contaminated as described above, and soaked in 1 of 3 solutions 30 minutes before culture. Both 10% povidone-iodine and a triple-antibiotic solu tion (gentamicin, clindamycin, polymyxin) were 100% ineffective as both organisms grew; 4% chlorhexidine gluconate effectively decontaminated 8 grafts in all cases. Part 2 involved contamination of harvested grafts with 5 common, virulent organisms: Staphylococ cus aureus, Escherichia coli, Pseudomonas aerugi nosa, Klebsiella pneumoniae, and Enterococcus fae calis. Elimination of all except Klebsiella pneumoniae was successful with 4% chlorhexidine gluconate alone for 8 grafts. Using a triple-antibiotic solution after chlor hexidine gluconate in 6 grafts eliminated this organism also.
Midfoot Sprains in Collegiate Football Players
Authors: Meyer Scott A. , Callaghan John J. , Albright John P. , Crowley Edward T. , Powell John W.
Published: June 2007

We studied midfoot sprains in collegiate football players to define and document incidence, mechanisms, injury patterns, and disabilities. Twenty-three athletes with 24 injuries from 1987 through 1991, with a mean followup of 30.8 months, were identified for the study. The inju ries occurred in 4% of the football players per year with offensive linemen incurring 29.2% of the injuries. The location of maximal tenderness on physical examina tion was an important prognostic indicator such that in juries with medial and global midfoot tenderness to pal pation had the longest time loss from participation and time until full healing. Lateral midfoot sprains required short periods of disability, and players were able to re turn to participation with the use of an orthosis. Nineteen athletes with 20 injuries responded to a questionnaire. Four players reported residual functional problems. Only 1 of these players had to modify his recreational activities because of pain. The other players remained very active with only mild complaints of pain after high- demand activities. Midfoot sprains were associated with acute disability that required prolonged restriction from competition, but for most players the long-term residual problems were minor.
Use of the Hollywood Impact Base and Standard Stationary Base to Reduce Slidin and Base-Running Injuries in Baseball and Softball
Authors: Sendre Ronald A. , Keating Thomas M. , Hornak James E. , Newitt Paul A.
Published: June 2007

To determine if the use of the Hollywood Impact Base would significantly reduce the frequency of sliding and base-running injuries to baseball and softball players, we recorded injury information for several teams who used these bases and standard stationary bases. The investigators, under the direction of the Central Michi gan University team physician, verified each recorded incident by contacting the injured participant. The sample included interscholastic, intercollegiate, recre ational, and intramural softball and baseball teams. There were 33,153 athlete-exposures with the Holly wood Impact Base in use and 3999 with the standard stationary base over a 2-year period (1990 and 1991). There were four injuries that could be directly attributed to the standard stationary base and only one injury that could be attributed to the Hollywood Impact Base. The results (t = -1.94, P < 0.05) verify that using the Hollywood Impact Base significantly reduced the fre quency of sliding and base-running injuries. The Holly wood Impact Base injury rate of 0.08% per game com pares favorably with the reported breakaway base injury rate. The results of our study verify that the Hollywood Impact Base is similarly effective in reducing the risk of base-related injuries.
A Performance Test Protocol and Scoring Scale for the Evaluation of An kle Injuries
Authors: Kaikkonen Auvo , Kannus Pekka , Järvinen Markku
Published: June 2007

The aim of the study was to introduce and evaluate a standardized test protocol and scoring scale for evalu ation of ankle injuries. After evaluation of 11 different functional ankle tests, questionnaire answers, and re sults of clinical ankle examination, the final test protocol consisted of 3 simple questions describing the subjec tive assessment of the injured ankle, 2 clinical mea surements (range of motion in dorsiflexion, laxity of the ankle joint), 1 ankle test measuring functional stability (walking down a staircase), 2 tests measuring muscle strength (rising on heels and toes), and 1 test measuring balance (balancing on a square beam). Each selected test showed excellent reproducibility when tested with a reference group of 100 uninjured persons. According to the test results of a population of 148 patients with an operatively treated grade III lateral ligament injury of the ankle, each test could significantly differentiate healthy controls and patients with excellent overall healing from those with poor or fair recovery. The final total test score correlated significantly with the isokinetic strength re sults of the ankle, subjective opinion about the recovery, and subjective-functional assessment. The scale pre sented is recommended for studies evaluating func tional recovery after ankle injury.
Patellar Tendon Graft Reconstruction for Midsubstance Anterior Cruciate Ligament Rupture in Junior High School Athletes
Authors: McCarroll John R. , Shelbourne K. Donald , Porter David A. , Rettig Arthur C. , Murray Scott
Published: June 2007

Between 1976 and 1988 we treated 75 junior high athletes who had midsubstance ruptures of the ante rior cruciate ligament and open physes. Thirty-eight children were initially treated conservatively and later had an intraarticular patellar tendon graft reconstruc tion, 2 patients underwent extraarticular reconstruc tion and then later had a patellar tendon graft intraar ticular reconstruction, and 20 children had a patellar tendon graft reconstruction initially. In all 60 pa tients the tibial and femoral tunnels were drilled through the open physes. Minimum followup was 2 years (mean, 4.2). Fifty-five of the 60 children were able to return to their original sports; 5 were active in less strenuous sports. No incidence of abnormal growth related to the intraarticular reconstructive surgery was recorded. Three children tore their an terior cruciate ligament grafts more than 2 years after surgery. Our records showed that conserva tive treatment of the active junior high athlete with an anterior cruciate ligament rupture failed in each case because of recurrent giving way or meniscal tears. Definitive treatment with an intraarticular au togenous patellar tendon graft reconstruction yielded good to excellent results and eliminated subsequent instability episodes and meniscal tears in our study group.
Joint Resurfacing with Cartilage Grown in Situ from Cell-Polymer Structures
Authors: Vacanti Charles A. , Kim WooSeob , Schloo Betsy , Upton Joseph , Vacanti Joseph P.
Published: June 2007

We tested the potential of a new technology developed in our laboratory to create new hyaline cartilage for re surfacing distal femoral joint surfaces of New Zealand White rabbits that had been surgically denuded of ar ticular cartilage. We removed hyaline cartilage from the patellar groove of the distal femurs in 24 rabbits. Chon drocytes isolated from the excised cartilage of 12 of these rabbits (experimentals) were seeded onto syn thetic biocompatible, biodegradable polymers com posed of polyglycolic acid. The cells were labeled in vitro with a thymidine analog, BrdU (5-bromo-2' deoxyuridine). After 1 week in vitro, the cell-polymer structures were implanted onto the denuded surfaces of 12 defects made in the hyaline cartilage of the con tralateral knees of the experimental animals. Twelve control animals received either no implants or implants not containing cells on similar surgical defects. After 7 weeks, we found evidence of new cartilage growth in 11 of the 12 experimental animals and virtually no new car tilage formation in any of the animals in either control group. Immunohistochemical analysis demonstrated the presence of BrdU-labeled chondrocytes in repre sentative specimens.
An Analysis of Rotator Cuff Repair
Authors: Grana William A. , Teague Beverly , King Michelle , Reeves R. Bradley
Published: June 2007

Fifty-four patients who had surgery to repair a chronic rotator cuff tear (54 shoulders) were followed for an av erage of 25.9 months (range, 16 to 43). Forty-nine of 54 patients had at least 20 months of followup. The aver age age of the male patients (N = 37) was 52 (range, 24 to 80) and of the female patients (N = 17) was 56 (range, 38 to 72). All of these patients received a func tional evaluation based on the Shoulder and Elbow Sur gery Society classification system. Forty-eight patients had an individual examination and 33 patients had an isokinetic strength evaluation. There were 43 patients (80%) with a satisfactory functional result and 11 (20%) with an unsatisfactory result. Unsatisfactory results were associated with large and massive tears and de creased postoperative range of motion. Good functional results were obtained by open repair and subacromial decompression for rotator cuff tear. Arthroscopic evalu ation and treatment did not affect the functional out come, but it did increase costs by about $2000 per pa tient. Arthroscopy is useful to define tear size, which may affect the surgical approach, but the arthroscopic treatment of glenohumeral problems did not alter the functional result. The routine use of arthroscopy before rotator cuff repair is costly, not effective, and therefore not recommended.
Surgical Management of Achilles Tendon Overuse Injuries
Authors: Schepsis Anthony A. , Wagner Clayton , Leach Robert E.
Published: June 2007

We studied 79 cases of surgically treated Achilles ten don overuse injuries in 66 patients. Fifty-three (80%) of these patients were competitive or serious recreational runners operated on between 1978 and 1991. There were 49 men and 17 women with a mean age of 33 years (range, 17 to 59). The cases were divided into surgical subgroups based on their site of primary symp toms and abnormalities: paratenonitis (23), tendinosis (partial rupture or degeneration) (15), retrocalcaneal bursitis (24), insertional tendinitis (7), and combined ab normalities (10). Followup included a comprehensive patient questionnaire and office examination. There were 79% satisfactory (51% excellent, 28% good) and 21 % unsatisfactory (17% fair, 4% poor) results. The per centages of satisfactory results in the paratenonitis group (87%) were best and those in the tendinosis group were the worst (67%). Satisfactory results were obtained in 75% of the patients with retrocalcaneal bur sitis and 86% with insertional tendinitis. Seven of the 45 cases with longer than 5-year followup with initially sat isfactory results deteriorated with time and required re operation (16%). Of these, 4 were in the tendinosis group, 2 had retrocalcaneal bursitis, and 1 had paratenonitis. One of the 34 patients followed less than 5 years required reoperation.
The Effect of Thigh and Goniometer Restraints on the Reproducibility of the Genucom Knee Analysis System
Authors: Draganich Louis F. , Sathy Michael R. , Reider Bruce
Published: June 2007

We compared the reproducibility of measurements made with the Genucom knee analysis system using two methods of restraint. The first method was that sug gested by the manufacturer and consisted of clamping the thigh to the examination chair with 70 N of vertical force and 110 N of mediolateral force and used a single elastic strap to secure the electrogoniometer cuff to the leg. In the second, or enhanced, method, the vertical and mediolateral clamping forces were each increased to 156 N, and an additional strap was used to secure the cuff to the leg. Tests performed were the anteroposte rior stress tests at 20° and 90° of knee flexion, and the varus-valgus stress test, the internal-external rotation stress test, and the medial and lateral pivot shift tests at 20°. Five normal subjects were installed and tested on 6 different days with the manufacturer's suggested se curing method and on 12 different days with the en hanced securing method. The enhanced method of re straint resulted in significantly reduced day-to-day variance for all tests performed except the varus-valgus stress test.
An Electromyographic Analysis of the Knee During Functional Activities
Authors: Ciccotti Michael G. , Kerlan Robert K. , Perry Jacquelin , Pink Marilyn
Published: June 2007

This study describes the fine-wire electromyographic profile of the normal knee. Twenty-two subjects with no prior history of knee injury volunteered for the study. Each subject had fine-wire electromyographic eval uation of 8 muscles (vastus medialis oblique, vastus lateralis, rectus femoris, semimembranosus, biceps femoris, tibialis anterior, gastrocnemius, and soleus muscles) while performing 7 functional activities. The percentage of maximum manual test for each muscle during each phase of the activities was used to deter mine means and standard deviations for the group. Walking and ramp and stair ascending and descending produced similar electromyographic profiles. Running and cross-cutting demonstrated unique electromyo graphic profiles with an overall higher muscle activity than the previous 5 activities. A quadriceps-hamstrings muscles' coordinated response was identified consis tently in each activity. These findings illustrate the in tegral nature of each of the 8 examined muscles in knee motion. Furthermore, this study demonstrates a coor dinated response of quadriceps-hamstrings muscles in the normal knee and may more thoroughly define the coordinated activity of these 2 antagonist muscle groups. Finally, this study provides a framework within which various knee conditions can be compared and from which specific rehabilitation recommendations can be generated.
Rupture of Lisfranc's Ligament in Athletes*
Authors: Shapiro Matthew S. , Wascher Daniel C. , Finerman Gerald A. M.
Published: June 2007

Ligamentous injuries to the tarsometatarsal joints are uncommon and usually result from violent trauma to the forefoot. A more subtle tarsometatarsal injury consisting of an isolated diastasis of the first and second tarso metatarsal rays has recently been described. This injury is thought to be caused by a rupture of Lisfranc's liga ment. Nine injuries that occurred during athletics are described. History and physical findings are crucial for arousing the clinician's suspicion for this injury, but con firmation can best be obtained by comparison weight bearing radiographs; the space between the first and second metatarsal bases may be widened 2 to 5 mm. Nonoperative treatment consisting of casting and the use of crutches for 4 to 6 weeks was successful in re turning patients back to athletics; however, the time to return to competition averaged 4 months.
Alternative Management of Midthird Scaphoid Fractures in the Athlete*
Authors: Rettig Arthur C. , Weidenbener Erich J. , Gloyeske Robert
Published: June 2007

The purpose of this retrospective study was to evaluate the effectiveness of two scaphoid fracture treatments in an athletic population. All patients were in-season ath letes with a stable, midthird scaphoid fracture incurred in preseason training or early in the season, or athletes who had a consecutive season sport. Group I athletes ( N = 18) were treated with immediate open reduction and internal fixation with the Herbert screw. Group II athletes (N = 12) were treated nonoperatively with a playing cast. Return to sports averaged 8.0 weeks for Group I and 4.3 weeks for Group II athletes. Six athletes in Group II were able to return to play immediately with the playing cast. Clinical and radiographic healing av eraged 10.8 and 11.2 weeks for Group I and 13.7 and 14.2 weeks for Group II athletes, respectively. In-season athletes with stable midthird scaphoid frac tures can safely achieve early return to sport with a play ing cast or rigid internal fixation with a Herbert screw. These methods of treatment yield comparable union rates with other series and it appears the athletes are not at increased risk for union failure or nonunion secondary to participation in sports.
Survey of Health Care Coverage of High School Football in Southern California
Authors: Vangsness C. Thomas , Hunt Timothy , Uram Meg , Kerlan Robert K.
Published: June 2007

We surveyed 240 high schools about various aspects of the health care coverage of their football athletes. Ap proximately 70% of these schools had team physicians, and more than one third of these had more than 1 team physician. Seventy-two percent of high schools had physician coverage for scheduled games. Practices and scrimmages were not covered. Sixty-nine percent of the schools reported having an athletic trainer for home games. Basic equipment was often lacking. Re cording and tracking of athletic injuries were inconsis tent. An overall team approach for medical coverage was noted. Concern was raised about adequate phy sician or medical coverage with emphasis on greater input from the school administration, community hos pitals, and physicians.
Use of the Suture Anchor in Open Bankart Reconstruction
Authors: Levine William N. , Richmond John C. , Donaldson William R.
Published: June 2007

We previously reported early results of a new technique using a suture anchor to perform a modified Bankart reconstruction. That study included patients from two medical centers and had an average followup of only 1 year. This report includes patients from a single center with followup extended to a mean of 42 months (range, 33 to 61). Between April 1988 and August 1991, 53 patients with recurrent anterior glenohumeral instability underwent modified Bankart reconstruction with the use of a suture anchor. Thirty-two patients met inclusion cri teria (identifiable Bankart lesion, open repair with suture anchors, and minimum followup of 2 years); 4 patients were lost to followup. There have been no complications as a result of this technique. Ninety-three percent of the patients in the study had objectively excellent or good results. There were 2 failures with recurrent anterior dislocation.

The use of a suture anchor can simplify the Bankart reconstruction. At average followup of 3 years, 26 pa tients have returned to presurgery activity levels without recurrent dislocation or subluxation. However, careful attention to anchor placement at the junction of articular cartilage and the glenoid neck is necessary to avoid technical failure.
The Normal and the Painful Shoulders During the Breaststroke
Authors: Ruwe Patrick A. , Pink Marilyn , Jobe Frank W. , Perry Jacquelin , Scovazzo Mary Lynn
Published: June 2007

The purpose of this study was to describe and compare electrical activity patterns in 12 shoulder muscles during the breaststroke in 25 competitive swimmers who had normal shoulders and in 14 who had painful shoulders while they performed this stroke in a pool. The electro myographic analysis was synchronized with high-speed cinematography to discern phases of the breaststroke. Means, standard deviations, and t-tests were done for each phase. The differences in muscle activity between the two groups of swimmers demonstrated an increase in the internal rotators in the group with painful shoul ders. They also demonstrated a decrease in the teres minor, supraspinatus, and the upper trapezius muscles. These factors increase the risk of impingement. Both the serratus anterior and teres minor muscles in the swimmers with normal shoulders consistently fired at or above 15% manual muscle test throughout the breast stroke cycle and were thus subject to fatigue. Based on these results, exercises for the breaststroke swimmer should be directed toward endurance training of the ser ratus anterior and teres minor muscles while balancing the internal and external rotators of the shoulder as well as the deltoid and supraspinatus muscles.
The Influence of Immobilization Versus Exercise on Scar Formation in the Rabbit Patellar Tendon After Excision of the Central Third
Authors: Kamps Bryan S. , Linder Lucinda H. , DeCamp Charles E. , Haut Roger C.
Published: June 2007

There is much discussion about the appropriate timing and intensity of rehabilitation after reconstruction of the anterior cruciate ligament with a patellar tendon au tograft. The purpose of this study was to look at two extremes (complete immobilization and vigorous, forced exercise) on the extent of scar formation and mechanical properties of the host tendon. Three groups of six Flemish Giant rabbits had the central third patellar tendon removed in one limb. Group I was sacrificed immediately after surgery. Group II was exercised on a treadmill for 12 weeks. In Group III the limb was im mobilized for 12 weeks. After 3 months, average length and cross-sectional area from Group II were greater than those of the controls and Group III tendons. Struc tural properties of all test limbs were similar to each other but different from controls. Tensile modulus of Group III tendons did not decrease as much that of Group II tendons. Histology revealed a clear demarca tion between the central defect and host tendon in Group III, whereas Group II tendons remodeled throughout their cross-sections. We propose that early joint mobility produces large multiaxial stresses in origi nal tendon leading to microdamages and repair processes within the entire host tissue. Less aggressive exercise or delay in joint mobility may help control tissue remodeling.
Profiles of Exercise History and Overuse Injuries Among United States Navy Sea, Air, and Land (SEAL) Recruits
Authors: Shwayhat Alfred F. , Linenger Jerry M. , Hofherr Louise K. , Slymen Donald J. , Johnson Chrisanna Weech
Published: June 2007

This prospective study examined running history as a risk factor for subsequent overuse injury in Navy Sea, Air, and Land (SEAL) recruits. Recruits preparing to be Navy SEALs undergo 6 months of rigorous physical training programs, which place these recruits at high risk for developing an overuse injury. We assessed the independent variables of age; prior running frequency, duration, and pace; and training surface. Univariate and multivariate estimates of risk were determined for each variable.

We observed an incidence of 3.4 overuse injuries per 1000 recruit-days. Assessing the physical activity of the recruits in the 6 months before entrance into basic train ing, we found that the recruits who ran at a pace slower than 8 minutes per mile and on softer training surfaces were more likely to sustain an overuse injury during ba sic training, in both univariate and multivariate esti mates of risk. Recruits who ran fewer weekly miles and for shorter durations before basic training were also more likely to sustain an overuse injury according to univariate estimates of risk.

Our findings suggest that risk of overuse injuries can be reduced by adjusting exercise routines before train ing. Running on different type surfaces with a gradual increase in speed, duration, and weekly mileage in the period preceding basic training may reduce risk of overuse injury.
Lunate and Perilunate Dislocations in Professional Football Players
Authors: Raab David J. , Fischer David A. , Quick Donald C.
Published: June 2007

The purpose of this retrospective study was to review the treatment and prognosis of lunate and perilunate carpal dislocations in professional football players in the National Football League over a 5-year period. There were 7 lunate and 3 perilunate dislocations in 10 play ers. The mechanism of injury was hyperextension in 9 of 10 players. Five players were subsequently treated by closed reduction and percutaneous pinning; the oth ers were treated by open reduction and K-wire fixation. No player was treated by cast immobilization alone. In traoperative techniques, postoperative immobilization and protection, return to play, final follow-up physical examination, radiographic evaluation, and complica tions were reviewed. Results of this study clearly dem onstrate that lunate and perilunate carpal dislocations do not mean the end of a career in professional football, although a minimum of 4 weeks of playing time is lost. Treatments varied with respect to open or closed re ductions, placement of pins, casts, and time of immo bilization. None of the variations was clearly superior or detrimental, although four of the five players who re turned to play in the same season were treated by closed reduction with percutaneous pinning.
Magnetic Resonance Imaging of Iliotibial Band Syndrome
Authors: Ekman Evan F. , Pope Thomas , Martin David F. , Curl Walton W.
Published: June 2007

Seven cases of iliotibial band syndrome and the patho anatomic findings of each, as demonstrated by mag netic resonance imaging, are presented. These findings were compared with magnetic resonance imaging scans of 10 age- and sex-matched control knees with out evidence of lateral knee pain. Magnetic resonance imaging signal consistent with fluid was seen deep to the iliotibial band in the region of the lateral femoral epicondyle in five of the seven cases. Additionally, when compared with the control group, patients with iliotibial band syndrome demonstrated a significantly thicker ili otibial band over the lateral femoral epicondyle (P < 0.05). Thickness of the iliotibial band in the disease group was 5.49 ± 2.12 mm, as opposed to 2.52 ± 1.56 mm in the control group. Cadaveric dis sections were performed on 10 normal knees to further elucidate the exact nature of the area under the iliotibial band. A potential space, i.e., a bursa, was found between the iliotibial band and the knee capsule. This series suggests that magnetic resonance imag ing demonstrates objective evidence of iliotibial band syndrome and can be helpful when a definitive diag nosis is essential. Furthermore, correlated with ana tomic dissection, magnetic resonance imaging identi fies this as a problem within a bursa beneath the iliotibial band and not a problem within the knee joint.
Efficacy of Lateral Retinacular Release for Painful Bipartite Patella
Authors: Mori Yujiro , Okumo Hiroyuki , Iketani Hiroshi , Kuroki Yoshikatsu
Published: June 2007

We treated painful bipartite patella with a modified lateral retinacular release technique in 15 patients (16 knees). Bony union of the separated fragment and the patella was obtained in 15 of 16 knees within 8 months of surgery. Sustained traction acting on the patella laterally and proximally is presumed to cause the pain. The surgical technique to reduce this force proved effective not only in relieving the pain but also in achieving bony union. Painful bipartite patella can lead to excessive lateral pressure syndrome or pa tellar compression syndrome, these complications can be effectively treated by this surgical technique. In contrast to conventional treatments, such as ex cision of smaller fragments or osteosynthesis to achieve bony union, the modified lateral retinacular release technique is easy to perform and provides an effective means for relieving patellofemoral pain and achieving bony union.
Repairs by Trephination and Suturing of Longitudinal Injuries in the Avascular Area of the Meniscus in Goats
Authors: Zhongnan Zhang  , Arnold James A. , Williams Tom , McCann Biff
Published: June 2007

Trephination may encourage healing of a tear in the avascular area of the meniscus, but healing may not be complete in unstable tears. We studied trephination with suture of longitudinal injuries in the avascular area of the medial meniscus in 20 goats; samples were studied at 3, 8, and 25 weeks. All 20 tears treated by trephination and suture were completely (4 samples) or partly (16 samples) healed. The average tensile strength of the healed repair was 40.4 kg/cm 2 at 25 weeks. The level of DNA synthesis and tissue ingrowth decreased with time; DNA synthetic activity was also found in the chon drocytes of the menisci treated by suture alone. Only three of the menisci treated by suture alone were partly healed, and the remainder showed no gross evidence of healing. The addition of trephination to the sutured meniscus appears to promote healing of longitudinal injuries in the avascular area and is recommended rather than suturing or trephination alone. Meniscal su ture alone may stabilize the tear and stimulate cell pro liferation for healing, but it appears to be significantly restricted without an adequate blood supply.
Revascularization of a Human Anterior Cruciate Ligament Graft During the First Two Years of Implantation
Authors: Howell Stephen M. , Knox Kirby E. , Farley Timothy E. , Taylor Michael A.
Published: June 2007

The blood supplies of 45 unimpinged, human anterior cruciate ligament grafts were studied during the first 2 years of implantation. Grafts were defined as un impinged by the low signal intensity of the graft ob served on a sagittal proton density magnetic resonance scan. Magnetic resonance imaging with the intravenous contrast agent gadolinium diethylenetriamine pentace tic acid was used to evaluate the blood supply of the hamstring autograft as well as the periligamentous tis sues by assessment of enhancement patterns after ad ministration of the agent. The unimpinged anterior cru ciate ligament graft acquired no discernible blood supply during the 2 years of implantation. The graft re tained the same hypovascular appearance as the nor mal posterior cruciate ligament. In contrast, the periligamentous soft tissues were richly vascularized and covered the graft by 1 month. The viability of an un impinged, human anterior cruciate ligament graft may de pend more on synovial diffusion than on revascularization.
Local Anesthesia for Knee Arthroscopy
Authors: Shapiro Matthew S. , Safran Marc R. , Crockett Heber , Finerman Gerald A. M.
Published: June 2007

We performed a retrospective review of a series of knee arthroscopic procedures that were completed using lo cal, general, or regional anesthesia to evaluate the ef ficacy of these anesthetic techniques. Operative time, complications or failures, procedures successfully per formed, recovery room time and postoperative stay, and patient satisfaction were recorded. Local anesthesia with intravenous sedation compared favorably with the other techniques: operative time was not increased, a large variety of operative procedures were successfully completed, recovery time was significantly shortened, and patient satisfaction remained high. This technique offers several advantages over other types of anesthe sia for knee arthroscopy, including improved cost ef fectiveness.
Intraarticular Lidocaine Versus Intravenous Analgesic for Reduction of Acute Anterior Shoulder Dislocations
Authors: Matthews Daniel E. , Roberts Thomas
Published: June 2007

We performed a prospective, randomized study to evaluate the use of injected lidocaine as an anesthetic for closed reduction of acute anterior shoulder disloca tions. Thirty consecutive patients who presented at the emergency department with acute anterior shoulder dislocations were randomly placed in one of two groups. One group received an intraarticular injection of 20 ml of 1 % lidocaine and the other group, intravenous injec tions of morphine sulfate and midazolam. The groups were compared regarding time of reduction maneuver, difficulty of reduction, subjective pain, complications, and total time spent in the emergency department. The lidocaine provided adequate anesthesia and secondary relief of muscle spasm in 15 of 15 (100%) patients. When compared with the intravenous sedation group, the lidocaine group showed no statistically significant difference in time for reduction maneuver, difficulty of reduction, or subjective pain. The lidocaine group had no complications and had a statistically significant shorter emergency department visit when compared with the intravenous sedation group (mean, 78 minutes versus 186 minutes; P = 0.004). Lidocaine provides excellent anesthesia for patients with uncomplicated anterior shoulder dislocations and can be very benefi cial when sedation is contraindicated. Lidocaine injec tions also proved to be cost effective in our institution, reducing total costs by as much as 62%.
The Effect of Intraarticular Injection of Morphine and Bupivacaine on Postarthroscopic Pain Control
Authors: Ruwe Patrick A. , Klein Irv , Shields Clarence L.
Published: June 2007

This study sought to compare the effects of morphine, bupivacaine, and saline injected into the knee after ar throscopic surgery. In a double-blind, randomized trial, 124 patients received either bupivacaine, morphine, bupivacaine and morphine, or saline at the completion of surgery. Postoperative pain was assessed with a 100-mm visual analog pain scale. Analgesic require ments were calculated, and weightbearing status was recorded. We found that morphine alone injected in traarticularly at the completion of arthroscopic knee sur gery had no significant effect on postoperative pain, need for supplemental analgesia, or weightbearing sta tus. Patients receiving morphine in combination with bupivacaine did not demonstrate any statistically sig nificant improvement over those receiving bupivacaine alone. Therefore, our results failed to show any ben eficial effect of morphine used for postoperative anal gesia, either alone or in combination with bupivacaine. The overall pattern in all patients demonstrated de creased pain scores, decreased analgesic use, and in creased weightbearing status as the observation period progressed. Finally, preoperative pain was correlated with pain at discharge, indicating that the most signifi cant predictor of postoperative pain was preoperative level of discomfort.
Comparison of Open and Arthroscopically Assisted Rotator Cuff Repairs
Authors: Baker Champ L. , Liu Stephen H.
Published: June 2007

Open rotator cuff repair has shown reliable results in terms of pain relief and improved shoulder function. Re cently, however, arthroscopically assisted rotator cuff repair has shown promising preliminary results. We compared the results of these two procedures with re gard to pain, function, range of motion, strength, patient satisfaction, and return to previous activity. Thirty-seven rotator cuff repairs were evaluated in 36 patients with a minimum followup of 2 years. The open repair group comprised 20 shoulders with an average followup of 3.3 years; the arthroscopically assisted repair group com prised 17 shoulders with an average followup of 3.2 years. Overall, the open repair group had 80% good- to-excellent results and 88% patient satisfaction, and the arthroscopically assisted repair group had 85% good-to-excellent results and 92% patient satisfaction. Shoulder flexion and abduction strength, the size of the tear repaired, and the functional outcome did not differ significantly between the two groups. In general, how ever, small and moderate-sized tears (<3 cm) had bet ter functional outcome with arthroscopically assisted re pair. The arthroscopically assisted repair group was hospitalized 1.2 days less and returned to previous ac tivity an average of 1 month earlier. In the surgical treat ment of symptomatic complete rotator cuff tears, arthro scopically assisted rotator cuff repair is as effective as open repair.
The Influence of Muscle Forces and External Loads on Cruciate Ligament Strain
Authors: Dürselen Lutz , Claes Lutz , Kiefer Hartmuth
Published: June 2007

We know it is important to avoid excessive strain on reconstructed ligaments, but we do not know how in dividual muscles affect cruciate ligament strain. To an swer this, we studied the effect of muscle forces and external loads on cruciate ligament strain. Nine cadav eric knee joints were tested in an apparatus that allowed unconstrained knee joint motion. Quadriceps, ham string, and gastrocnemius muscle forces were simu lated. Additionally, external loads were applied such as varus-internal or valgus-external rotation forces. Cru ciate ligament strain was recorded at different knee flex ion angles. Activation of the gastrocnemius muscle sig nificantly (P < 0.05) strained the posterior cruciate ligament at flexion angles larger than 40°. Quadriceps muscle activation significantly strained the anterior cruciate ligament when the knee was flexed 20° to 60° (P < 0.01) and reduced the strain on the posterior cruciate ligament in the same flexion range ( P< 0.05). Activation of the hamstring muscles strained the pos terior cruciate ligament when the knee was flexed 70° to 110° ( P< 0.05). Combined varus and internal rotation forces significantly increased anterior cruciate ligament strain throughout the flexion range (P < 0.05). The re sults suggest that to minimize strain on the ligament after posterior cruciate ligament surgery, strong gas trocnemius muscle contractions should be avoided be yond 30° of knee flexion. The study also calls into ques tion the use of vigorous quadriceps exercises in the range of 20° to 60° of knee flexion after anterior cruciate ligament reconstruction.
Nonoperative Treatment of Acute Anterior Cruciate Ligament Injuries in a Selected Group of Patients
Authors: Buss Daniel D. , Min Robert , Skyhar Michael , Galinat Brian , Warren Russell F. , Wickiewicz Thomas L.
Published: June 2007

Conservative treatment of acute anterior cruciate liga ment injuries was recommended to selected patients, including those with sedentary occupations, low athletic demands, or ages greater than 30 years. Patients with generalized hyperligamentous laxity were excluded. Fifty-five of 61 patients were available at an average followup of 46 months from the time of initial injury. At followup, giving-way symptoms had not occurred in 23 patients (42%); in 22 (40%) giving way occurred occa sionally. Of the 44 patients involved in high- or moderate-demand athletics, 33 (70%) were able to con tinue with moderate-demand sports. Presence of a me dial collateral ligament sprain did not affect the long- term function. Forty-eight percent of the patients scored excellent or good (9 and 18 patients, respectively) on the Hospital for Special Surgery ligament scoring sys tem ; 8 (15%) later chose surgical reconstruction. The remaining 47 patients did not believe that their symp toms were severe enough to warrant any further inter vention. In a group of individuals who are older and relatively inactive, nonoperative management of ante rior cruciate ligament injuries can yield satisfactory re sults, provided the patients are willing to accept a mod est amount of instability and a slight risk of meniscal injury.
Arthrometric Results of Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction using Autograft Patellar Tendon Substitution
Authors: Bach Bernard R. , Jones Greg T. , Hager Cheryl A. , Sweet Fred A. , Luergans Sue
Published: June 2007

Sixty-two patients who underwent arthroscopically as sisted anterior cruciate ligament reconstruction with the middle-third patellar tendon autograft without extraar ticular augmentation were retrospectively reviewed at a minimum 2-year (mean, 37-month) followup. A postop erative KT-1000 arthrometric evaluation revealed a mean maximum manual difference of 0.3 mm (range, -6 to +16). Ninety percent of the patients had a mean maximum difference of ≤3 mm. Three patients had a ≥5 mm mean maximum difference; positive pivot shifts were noted in two of these patients. Despite an early range of motion, early weightbearing protocol without an extraarticular backup, the pivot shift (92% negative) was reliably eliminated at postoperative followup. Ar thrometric parameters were statistically reduced (P < 0.0001) from preoperative status and were consistent with the diagnostic criteria established for normal knees. There was no relationship established in the "tighter" knees (those with negative side-to-side arthrometric dif ferences) and the incidence of knee flexion contractures, patellar pain symptoms, Cybex extension deficit (>20%), functional indices, or postoperative rating scales.