bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior cruciate ligament arthroplasty
Authors: Kieffer David A. , Curnow Robert J. , Southwell Richard B. , Tucker William F. , Kendrick Katherine K.
Published: June 2007

A unique augmentation arthroplasty has evolved from a retrospective review of 150 anterior cruciate ligament (ACL) repairs, extracapsular substitutions, and pes an serine transfers. This coincided with a proposed patho logic relationship seen in surgical exposures of the femoral intercondylar notch. From 1976 to 1983, 544 cases with known ACL insufficiency were selected for study. In 397 subsequent anterior cruciate stabiliza tions arthroplasties were performed. Patients with less than a 2 year followup were not included in this retro spective study. One hundred nine arthroplasties are reported: 80 isolated ACL tears and 29 multiple liga ment injuries.

Statistically significant relationships between elapsed time from ACL tear to surgery and meniscal tears, and elapsed time and degenerative changes in the articular surfaces were seen.

Surgical techinque was arthroplasty, graft harvest, graft placement, graft set, and postoperative care. Functional score followup has occurred for an average of 3 years (range 2 to 5 years). No patient has failed to return to his or her original sport or occupational de mands. Pivot shift, disengagement, or spontaneous rupture of the arthroplasty has not occurred postoper atively. Full participation has occurred with bilateral ACL arthroplasties and arthroplasty performed for previous intraarticular augmentation failure.

The operative success in the preliminary follow-up period was based on: ligamentous substitution, ana tomical placement, femoral intercondylar notch compli ance in full range of motion, revascularization of the ligament substitute, and histologic support of the pro cedure.
Avulsion fracture of the tibial eminence associated with severe medial ligamentous injury in an adolescent
Authors: Hayes James M. , Masear Victoria R.
Published: June 2007

In the presence of open physes, tibial eminence frac tures are usually isolated injuries. However, adults sus taining a fracture of the tibial eminence are more likely to have other associated injuries, most commonly a tear of the medial collateral ligament. A case of an adolescent with a tibial eminence fracture and a com plete tear of the medial collateral ligament is reported. Review of the literature revealed two similar cases in adolescents. If medial instability is demonstrated on valgus stress of the knee in an adolescent with tibial eminence fracture, we believe stress roentgenograms of the knee should be obtained to distinguish between physeal injury and collateral ligament tear.
Anterior dislocation of the shoulder joint sustained through skiing
Authors: Kuriyama Setsuro , Fujimaki Etsuo , Katagiri Tomoo , Uemura Shokichi
Published: June 2007

Over a period of 10 years we have studied 14,952 cases of skiing injuries. Of these, 660 cases (4.5%) were injuries to the shoulder with 291 cases (44.1 %) being anterior dislocations of the shoulder. One hundred forty-three cases revealed an initial dislocation (49.1 %), and 148 cases were recurrent dislocations (50.9%). We examined the arthrography of the dislo cated shoulder in 89 cases. Of these initial dislocations, one-half of the capsular detachment type were redis located, but no redislocation had occurred in the cap sular tear type. In addition, almost all of the recurrent cases were of the capsular detachment type. Thus, through arthrography of the anterior dislocated shoul der, we have been able to discover the mechanism of the dislocation and decide upon the necessary duration and method of fixation of the shoulder after reduction.
Knee stability in orthotic knee braces
Authors: Hofmann Aaron A. , Wyatt Ronald W.B. , Bourne Michael H. , Daniels A.U.
Published: June 2007

The ability of six commercially available orthotic knee braces to stabilize ligamentous injuries of the knee was evaluated using fresh cadaver specimens. Anterior, valgus, and rotational forces were applied to the intact knee, after the anterior cruciate and medial collateral ligaments were cut, and after application of the knee braces. Bony displacement was measured using half pins and an external fixator applied to the tibia and femur. There was a significant difference in brace per formance, most likely due to differences in brace de sign. Of the six braces tested, the 3D 3-Way Brace provided the greatest knee stability.
Patellar and quadriceps tendon ru p tures— jumper's knee
Authors: Kelly Douglas W. , Carter Vincent S. , Jobe Frank W. , Kerlan Robert K.
Published: June 2007

We reviewed 13 patients with end stage jumper's knee, 10 with patellar tendon ruptures, and 3 with ruptures of the quadriceps tendon to evaluate our long-term results in treating these tendon ruptures in an athletic population. The focus was on the natural history, the time until return, and the level of return, to athletic activity. Jumper's knee affected all patients to a varying degree prior to rupture. Basketball was the most com mon sport involved.

At followup, averaging 4½ years, patients underwent functional and clinical, as well as Cybex and roentgen ographic, evaluations. Results indicated patellar tendon ruptures, where the ruptures are complete, have a more favorable prognosis than those of the quadriceps ten don which are incomplete. All of the latter patients continued to have quadriceps tendinitis following repair.

In both groups, the poor results were obtained in patients with chondromalacia and/or patella alta. Cybex testing yielded results of greater than 100% strength in three patients with patellar tendon ruptures, but no patient with quadriceps rupture had comparable test results. There was no apparent relationship between ruptures and cortisone injections.

Patellar and quadriceps tendon ruptures from indirect injury in athletes represent the end stage of jumper's knee and result from repetitive microtrauma. Excellent function usually follows repair of patellar tendon rup tures when surgery is performed early and care is taken to restore normal patellar tendon length. Results of quadriceps ruptures are less satisfactory since these ruptures are usually incomplete and all degenerative tissue may not be involved in the healing response.
Repairable posterior menisco-capsular disruption in anterior cruciate ligament injuries
Authors: Woods G. William , Chapman D. Robert
Published: June 2007

Two hundred thirty-four consecutive patients with a positive Lachman test underwent examination under anesthesia and diagnostic arthroscopy to include com plete evaluation of both posterior menisco-capsular attachments. Knees which had had previous arthrot omy were excluded.

Complete repairable posterior menisco-capsular dis ruptions occurred in 31 of 112 (27.7%) acute cases and 36 of 122 (29.5%) knees in the chronic group. These lesions are not predictable by physical exami nation or by routine clinical grading of instability. Thor ough arthroscopic examination to include direct visual ization of the posterior menisco-capsular junction is necessary for complete diagnosis in anterior cruciate ligament injuries.
The effect of heel pads on the treatment of Achilles tendinitis: A double blind trial
Authors: Lowdon Alison , Bader Daniel L. , Mowat Alastair G.
Published: June 2007

Thirty-three subjects entered a blind-observer, random, prospective study of three forms of conservative treat ment of sports-induced Achilles tendinitis, results being assessed by clinical and biomechanical parameters. Two patient groups received heel pads, ultrasound, and exercises, while the third received only ultrasound and exercises. All three groups showed some improve ment at both 10 day and 2 month assessment, but the claimed benefit of viscoelastic pads widely used by athletes was not substantiated. The more striking bene fit from ultrasound and exercises alone occurred in patients with a shorter history; a comparison of duration of injury in all three groups suggested this was an important factor influencing outcome.

The study has highlighted the need for biomechanical outcome measures as well as for more objective clinical outcome measures in the assessment of physical ther apy.
Muscle belly tear of the triceps
Authors: Aso Kunchi , Torisu Takehiko
Published: June 2007

Triceps injury at the tendo-osseous junction of the olecranon is not uncommon, but a muscle belly tear of the triceps is extremely rare. Two cases of muscle belly tears of triceps are reported. One case was treated surgically and the other conservatively.
Review of meniscal injury and associated sports
Authors: Baker Bruce E. , Peckham Arthur C. , Pupparo Frank , Sanborn John C.
Published: June 2007

Meniscal injuries produce disability in a large portion of the population, and sports injuries are a common cause. Nicholas emphasized the importance of epidemiologic studies in an effort to better define the risk of various sports. There are significant regional differences in sports-related meniscal injuries depending upon the popularity of specific sports. Although publications in the European literature document some of these vari ations, there is little epidemiologic documentation of the variation in specific areas of the United States. Meniscectomies performed in Syracuse, New York, from 1973 to 1982 were reviewed. Sports-related men iscal injuries were tabulated and compared against all other causes.

Our results indicate that the incidence of meniscal injury resulting in meniscectomy is 61 per 100,000 population. The sex ratio was three males to one female. Medial versus lateral meniscus injury was 81 versus 19%. Football had a 75% predominance of medial meniscectomy; basketball, 75%; wrestling, 55%; skiing, 78%; and baseball, 90%. Our data indicate that there are differences in the ratio of medial versus lateral meniscal disruption associated with specific sports activities. Medial meniscal injuries were, never theless, consistently more common in all of our cate gories except wrestling, where the frequency of lateral meniscal tear is nearly equal to that of medial meniscal tear. Additionally, the right knee is at a greater risk of meniscal injury in basketball than in other sports or the general population, and female skiers are at equal or greater risk of meniscal injury compared to male skiers.
The effects of electrical stimulation on the quadriceps during postoperative knee immobilization
Authors: Morrissey Matthew C. , Brewster Clive E. , Shields Clarence L. , Brown Mark
Published: June 2007

Immobilization of the knee after anterior cruciate liga ment (ACL) reconstructon results in marked thigh atro phy and decrease in quadriceps strength that may prolong the rehabilitation program of the injured athlete. Fifteen male volunteers undergoing ACL reconstruction were divided into two groups, stimulation (during im mobilization) and nonstimulation. Measurements of thigh circumference and isometric quadriceps strength were tested preoperatively, immediately after cessation of cast immobilization (6 weeks), and at 9 and 12 weeks postoperatively. The changes in circumference and strength between the first preoperative test and all subsequent tests were compared for statistical signifi cance (Student's t-test, P < 0.5) between the two groups. The decrease in quadriceps strength of the stimulation group during immobilization was signifi cantly less than that of the nonstimulation group, al though later differences between the two groups were not significant. There were no significant differences in thigh atrophy between the two groups. In conclusion, isometric quadriceps torque decreases resulting from immobilization can be significantly lessened by appli cation of electrical stimulation during immobilization. Electrical stimulation to the quadriceps does not sig nificantly alter thigh circumference changes that occur during immobilization.
Pelvic stress fractures in long distance runners
Authors: Noakes Timothy D. , Smith James A. , Lindenberg Graeme , Wills Clive E.
Published: June 2007

We describe five cases of radiographically proven stress fracture of the pubic ramus in serious runners, three of whom were elite female marathoners. In a further two cases in which radiography failed to support the clinical diagnosis, there was bone scintigraphic evidence of stress fracture. Another five cases had the identical clinical presentation, but the diagnosis was not confirmed radiologically and bone scanning was not performed. Most patients experienced persistent groin discomfort during any activity for the first 4 weeks after injury, but all recovered completely after 8 to 12 weeks of rest, in particular, avoidance of running. In common with other studies, we found that the injury occurred in competitive runners, especially females, and was likely to develop during competitive races or intensive training sessions.

We suggest that a diagnosis of pelvic stress fracture or stress fracture syndrome can be made with confi dence, even in the absence of radiographic evidence, if the following three features are present in a long dis tance runner presenting with groin pain: First, activity causes such severe discomfort in the groin that running is impossible. Second, the athlete develops discomfort in the groin when standing unsupported on the leg corresponding to the injured side (positive standing test). In some cases the pain is so severe that standing on one leg is impossible. Third, deep palpation reveals extreme, exquisite nauseating tenderness localized to the pubic ramus and not to the overlying soft tissues. The diagnosis can be confirmed by bone scintigraphy where such facilities exist.
Head and neck injuries in college football: An eight-year analysis
Authors: Albright John P. , Mcauley Edward , Martin Robert K. , Crowley Edward T. , Foster Danny T.
Published: June 2007

The present study documented head and neck injuries in a study group of 342 college football players at a single institution for a period of 8 years. All freshmen players were screened for evidence of: (1) past history of head and neck injuries, and (2) abnormalities of the cervical spine on physical examination and x-ray film. By recording all head injuries and those neck injuries with time loss, incidence rates and patterns of injury incurred in college competition were determined. A total of 175 head and neck injuries were sustained by 100 players over the 8 year period. Those players with abnormal findings on screening examination were twice as likely to have a head or neck injury at some point in their college careers as those players with a normal screening examination. The greater the degree of ab normality on freshman screening examination, the more severe the neck injury in college was likely to be. Twenty-nine percent of all players in the study group sustained a head or neck injury during their college careers. The probability of a subsequent head or neck injury escalated sharply following a single incident. The overall incidence of injury was found to have been dramatically reduced over the 8 years. Influential factors such as legislative rule changes, medical status of recruits, and general coaching philosophies are dis cussed with regard to injury reduction and prevention of head and neck injuries in college football.
Biomechanics of baseball pitching
Authors: Pappas Arthur M. , Zawacki Richard M. , Sullivan Thomas J.
Published: June 2007

Fifteen professional major league pitchers were filmed with high speed cinematography. One hundred forty- seven pitches were analyzed using an electromagnetic digitizer and a microcomputer. Three phases of throw ing were studied: cocking, acceleration, and follow- through. The cocking phase is the period of time be tween the initiation of the windup and the moment at which the shoulder is in maximum external rotation. This phase occurs in approximately 1500 ms, and the shoulder is brought into an extreme position of external rotation. The acceleration phase and the initial stages of the follow-through phase produce extraordinary de mands on the shoulder and elbow. The acceleration phase begins with the throwing shoulder in the position of maximum external rotation and terminates with ball release. This phase occurs in approximately 50 ms, and peak angular velocities averaging 6,180 deg/sec for shoulder internal rotation and 4,595 deg/sec for elbow extension were measured. The follow-through phase begins at ball release and continues until the motion of throwing has ceased. This phase occurs in approximately 350 ms.
Osgood-Schlatter's disease in adolescent athletes
Authors: Kujala Urho M. , Kvist Martti , Heinonen Olli
Published: June 2007

During the period of 1976 to 1981, a total of 412 young athletes contacted the Turku Sports Medical Research Unit's (TSMRU) Outpatient Sports Clinic with 586 com plaints. These records included 68 athletes with Os good-Schlatter's disease (OSD), who were initially pre scribed an average of 2 months' rest from any physical activity causing pain. Symptoms of tibial tuberosity pain occurred first at the average age of 13.1 years. Accord ing to the retrospective questionnaire, the pain caused complete cessation of training for an average of 3.2 months, and the disease interfered with fully effective training for an average of 7.3 months.

According to a retrospective questionnaire given to 389 students (191 girls and 198 boys), 50 (12.9%) had suffered from OSD. Nearly one-half of the students, 193 (49.6%), had been active in sports at the age of 13, and 41 (21.2%) of them had suffered from OSD. In those students who were not active in sports, the incidence was only nine (4.5%; P < 0.001).

The incidence (32%) was higher in the siblings of the OSD patients of TSMRU who were active in sports than in the corresponding student group (21.2%). In a group of 22 patients from the TSMRU who had suffered from Sever's disease (calcaneal apophysitis), the inci dence of OSD (68%) was significantly higher than in students who were active in sports (P < 0.001).
A partially biodegradable material device for repair and reconstruction of injured tendons
Authors: Rodkey William G. , Cabaud H. Edward , Feagin John A. , Perlik Paul C.
Published: June 2007

We assessed the applicability of a partially biodegrad able synthetic material composed of polyglycolic acid (PGA) and dacron to repair or replace severely injured tendons. Adult rabbits underwent complete laceration and repair of one Achilles tendon. Group 1 (N = 8) had end to end tenorrhaphy with size 0 braided polyester suture, and Group 2 ( N = 16) tendons were similarly repaired with the bicomposite designed PGA-dacron device. Group 3 ( N = 16) received laceration and re moval of 1 cm of tissue, and the defect was bridged with the same PGA-dacron material. No postoperative immobilization was applied. Evaluation, consisting of biomechanical testing or histologic inspection, was done at 4 and 8 weeks after tenorrhaphy. All tendons healed, and at 8 weeks the mean maximum load at failure of the repaired tendons was 32.2 ± 3.4 kgf, 40.3 ± 2.4 kgf, and 31.8 ± 3.2kg f for Groups 1, 2, and 3, respectively. Values between groups were not signifi cantly different, but all were significantly less ( P ≤ 0.05) than the strength of the unoperated control tendons (55.8 ± 7.2 kgf). The most noteworthy finding was the lengthening of the repaired tendons, due to scar elon gation at the tenorrhaphy site, that occurred during healing as determined by a landmark placed a fixed distance proximal to the repair site. Group 1 tendons lengthened 22 mm, while Group 2 and 3 tendons in creased by 12.5 mm. Histologically, fibrous tissue in growth into the residual dacron scaffold occurred, but it was inconsistent and inadequate in quality and quan tity to be satisfactory as neotendon. The fibrous tissue did not mature or align in response to load. We con cluded that the PGA-dacron material had adequate strength and physical properties to use both for primary tenorrhaphy and to bridge the tendon defect. However, in our experience this material lacks any significant advantage over other materials available or known to be under evaluation to support neotendon formation when an actual soft tissue defect exists.
Prevention of ankle sprains
Authors: Tropp Hans , Askling Carl , Gillquist Jan
Published: June 2007

Two different methods for the prevention of ankle joint injuries in soccer were tested. Coordination training on an ankle disk improves functional stabilty and postural control, whereas an orthosis provides mechanical sup port. Both techniques reduce the frequency of ankle sprains in soccer players with previous ankle problems. The orthosis is an alternative to taping, and can be used during the rehabilitation period after injury or when playing on uneven ground. Coordination training on an ankle disk ought to be included in the rehabilitation of ankle injuries to prevent functional instability. It may also be done prophylactically by players with previous ankle problems in order to break the vicious circle of recurrent sprains and feeling of giving way.
Correction of abduction
Authors: Freeland Alan E. , Barrett Gene R. , Wheeless Glenn S.
Published: June 2007

Wartenberg described the clinical sign of the abducted extended small finger that can result from ulnar nerve palsy. When this sign occurs in ulnar nerve palsy, it is a result of imbalance created by paralysis of the third volar interosseous muscle allowing the extensor digiti minimi to abduct the small finger as the finger is ex tended. If the third volar interosseous muscle is trau matically avulsed at its insertion and the ulnar nerve is intact, the abductor digiti minimi manus is an additional deforming force.
Avulsion fractures of the pelvis
Authors: Metzmaker Jeffrey N. , Pappas Arthur M.
Published: June 2007

Avulsion fractures of the pelvic apophyses are seen infrequently but they show a consistent pattern in mechanism, patient's age, symptoms, physical findings, and roentgenographic appearance. Some disagree ment exists in the literature concerning the treatment of these fractures. This study indicates that early diag nosis and a carefully directed nonoperative treatment program will produce positive results for avulsion frac tures of the pelvis. Twenty-seven cases of acute avul sion fracture of the pelvis were successfully treated in a directed nonoperative program.
Intracompartmental pressures on exertion in a patient with a popliteal artery entrapment syndrome
Authors: Bell Simon
Published: June 2007

Intracompartmental pressure normally rises during ex ercise. Pressures in the anterior and deep posterior compartments of the leg were shown to decrease on exertion in a patient with a popliteal artery entrapment syndrome.
Medial synovial shelf plica syndrome
Authors: Rovere George D. , Adair Daniel M.
Published: June 2007

Medial synovial shelf plica syndrome is caused by ac quired thickening and inflammation of a commonly present residual embryonic synovial fold. Treatment with a local injection into the plica and surrounding synovium of a steroid and a long-acting local anesthetic was tested in a series of 30 patients to see if more involved and expensive treatment could be avoided. Thirty-one knees were studied and treated prospec tively ; rigid criteria for making the diagnosis were main tained. Twenty-two (73%) patients had complete relief of pain and full return to activity; five patients had some amelioration of their symptoms and partial return to activity; and three patients had poor results. Two of the poor results were secondary to errors in diagnosis, and one was secondary to the presence of mature fibrosis confirmed during subsequent arthroscopic re section. As a control, ten patients were injected with long-acting local anesthetic alone. In all ten, symptoms were relieved only for the duration of the anesthetic. Intraplical steroid injection appears to be a reasonable, prudent, initial step in the treatment of medial synovial shelf plica syndrome. For competitive athletes, it pro vides very short morbidity and the ability to return to full practice and participation in a very short period of time.
The diagnostic accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign, and the pivot shift test in acute and chronic knee injuries
Authors: Katz Jerald W. , Fingeroth Richard J.
Published: June 2007

Eighty-five patients with knee injuries were included in a 4 month retrospective study that compared the rela tive accuracy of the Lachman test, the anterior drawer sign, and the pivot shift test. All examinations were performed under anesthesia and followed by arthros copy, which confirmed 22 injuries. Of all ACL injuries occurring within 2 weeks of arthroscopy (N = 9), the pivot shift test was the most sensitive (88.8%), followed by the Lachman test with a 77.7% sensitivity. The anterior drawer sign was the least sensitive at 22.2%. All had specificities more than 95%. For all injuries of more than 2 weeks (N = 13), the Lachman and pivot shift tests were 84.6% sensitive, while the anterior drawer sign increased to a sensitivity of 53.8%. Again, all were specific to more than 95%. For all ACL injuries, irrespective of age, the Lachman test was 81.8% sen sitive and 96.8% specific; the anterior drawer sign was 40.9% sensitive and 95.2% specific; and the pivot shift was 81.8% sensitive and 98.4% specific. The data support an accurate preoperative diagnosis in ACL deficient knees when the Lachman and pivot shift tests are positive, and essentially rules out this type of injury when these tests are negative. The anterior drawer sign, although widely used, is a poor diagnostic indi cator of ACL injuries, especially in the acute setting.
Sports anemia: A review of the literature
Authors: Carlson Diane L. , Mawdsley Roberta H.
Published: June 2007

Sports anemia has been referred to as an anemic or borderline anemic state in physically active individuals, particularly athletes. This paper is a review of literature on sports anemia, including whom it may affect and its effect on performance, and its diagnosis. In general, sports anemia has been found to be a self-limiting condition and usually does not require treatment.
Open reduction and internal fixation of comminuted radial head fractures
Authors: Sanders Richard A. , French H. Graeme
Published: June 2007

Between November 1981 and November 1984, eight patients with comminuted radial head fractures were treated with open reduction and internal fixation. The recommended treatment for these fractures has been early motion, with or without radial head excision. Ac cording to the AO classification all were B3-1 or B3-2 fractures. All fractures were fixed through Kocher inci sions using Kirschner wires and AO small fragment screws. All patients began motion 7 to 10 days follow ing surgery. In a retrospective study, clinical results were reviewed in six patients with an average followup of 12 months (range, 4 to 40 months). Three patients had associated elbow dislocations, one requiring inter nal fixation of the coronoid process. Loss of range of motion averaged 3° of flexion, 10° of extension, 3° of pronation, and 20° of supination. Cybex testing dem onstrated no significant difference in strength between injured and uninjured extremities. The only complication was a transient posterior interosseous nerve palsy. No patient had evidence of any radial shortening. Our findings suggest that open reduction and internal fixa tion gives satisfactory elbow function and avoids com plications of radial shortening, loss of motion, and wrist symptoms that may subsequently occur following radial head excision.
Injuries to runners: A study of entrants to a 10,000 meter race
Authors: Jacobs Stephen J. , Berson Burton L.
Published: June 2007

As the number of runners has increased dramatically, so has the incidence of running-related injuries. In order to determine what training factors are associated with running-related injuries, as well as what percentage of injured runners seeks professional medical attention, a random sample of entrants to a 10 kilometer race was asked to complete a questionnaire. There were 451 respondents, 355 men and 96 women, with a nonre sponse rate of 12.7%. Nonrespondents did not differ from respondents with regard to age or sex. Forty- seven percent of respondents indicated that they had sustained a running-related injury in the last 2 years. Injured runners differed significantly from noninjured runners in that they were more likely to have (1) run more miles per week, (2) run more days per week, (3) run a faster pace, (4) run more races in the last year, (5) stretched before running, and (6) not participated regularly in other sports. Associated with injury, but not statistically significant, were those who had run mara thons and had done muscle-strengthening exercises. No association was found with regard to the length of time running, running surfaces, part of the foot first contacting the ground, or running intervals, sprints, or hills. Seventy percent of those injured sought profes sional medical care, with 76% of these having a good or excellent recovery from their injuries. Compliance with medical advice correlated well with treatment suc cess.
Operative treatment of posterior shoulder dislocations by posterior glenoidplasty, capsulorrhaphy, and infraspinatus advancement
Authors: Hernandez AL , Drez David
Published: June 2007

Posterior dislocations of the shoulder are rare, compris ing only 4% of shoulder dislocations. Several operative procedures have been described in treating recurrent dislocations, and results have been varied. A retrospec tive review of eight shoulders in eight patients treated by posterior glenoidplasty with capsulorrhaphy and in fraspinatus advancement revealed generally good re sults. Followup ranged from 10 to 114 months, with an average of 36 months. Seven patients were classified as recurrent traumatic dislocators and one as a recur rent atraumatic voluntary dislocator. Results graded as good, fair, and failure were based on pain, range of motion, return to activities, recurrence, and roentgen ograms. Six patients had good results with return to full activity, full range of motion, no pain, no recurrence, and no degenerative changes of roentgenograms. One patient, who has not returned to athletic activities and has occasional pain and limited range of motion, was graded as a fair result. The patient classified as an atraumatic voluntary dislocator has occasional feelings of instability and slight pain with strenuous activity, but has not had a recurrence and has no difficulty with activities of daily living. She was also classified as a fair result. There have been no recurrences or degenerative changes on followup radiographs. Computerized to mography performed on two patients documented a definite change in orientation of the glenoid. We feel that glenoidplasty with capsular reefing and infraspina tus advancement, if performed carefully, provides an excellent operative treatment for recurrent posterior dislocations of the shoulder.
The operative treatment of scapulothoracic bursitis in professional pitchers
Authors: Sisto Domenick J. , Jobe Frank W.
Published: June 2007

Four professional pitchers with resistant scapulotho racic bursitis who have required surgical excision of the thickened bursa are reported. The average time dura tion of symptoms prior to surgery was 18.8 months. Conservative therapy consisting of rest, shoulder ex ercises, antiinflammatory medications, and cortisone injections failed to resolve the bursitis, and each pitcher was unable to compete secondary to pain. The incision was posterior, just distal to the tip of the scapula. The specimens contained cleft-like spaces lined by synovial tissue consistent with a bursa.

All four pitchers returned to professional baseball the year following surgical excision of the bursa. We rec ommend early, aggressive, conservative therapy for scapulothoracic bursitis in the throwing athlete. Pitch ers with a thickened, resistant scapulothoracic bursitis should have the bursa surgically excised.
A mechanical and electromyographical analysis of the effects of various joint counterforce braces on the tennis player
Authors: Groppel Jack L. , Nirschl Robert P.
Published: June 2007

Biomechanical data on most bracing and protective equipment systems is lacking. To better understand the clinical success of counterforce bracing, a biome chanical analysis of braced and unbraced tennis players (serve and backhand strokes) was undertaken. Three- dimensional cinematography and electromyographic techniques were used. Three commonly used counter force braces (lateral elbow, medial elbow, and radial ulnar wrist) were compared with the unbraced condi tion. The overall results basically reveal positive bio mechanical alterations in forearm muscle activity and angular joint acceleration dependent upon the brace and joint area analyzed.
Distal biceps brachii tendon avulsion
Authors: Louis Dean S. , Hankin Fred M. , Eckenrode James F. , Smith Patrick A. , Wojtys Edward M.
Published: June 2007

Rupture of the distal insertion of the biceps brachii may lead to severe functional impairment of the upper ex tremity on the basis of resultant weakness of elbow flexion and supination. When the diagnosis of a post- traumatic distal biceps tendon avulsion is made, a simple method of reattachment is possible and func tionally warranted.
Anterior cruciate ligament allograft transplantation
Authors: Nikolaou Pantelis K. , Seaber Anthony V. , Glisson Richard R. , Ribbeck Beth M. , Bassett Frank H.
Published: June 2007

In recent years much effort has been devoted to finding a satisfactory replacement for the injured ACL. None of the reconstruction techniques used in the past can be considered ideal because of their inability to dupli cate the complex geometry, structure, and function of the ligament. Current advances in allograft transplan tation and cryopreservation have led us to design and implement an experimental model for testing the feasi bility of cryopreserved ACL allotransplantation.

Groups of dogs were used to evaluate the effect of cryopreservation on ligament strength and to compare the relative performance of both autograft and allograft ACL transplants up to 18 months after implantation. The ligaments were examined mechanically, histologi cally, and microangiographically.

The cryopreservation process and duration of stor age had no effect on the biomechanical or structural properties of the ligament. The mechanical integrity of the allografts was similar to that of the autografts, with both achieving nearly 90% of control ligament strength by 36 weeks. Revascularization approached normal by 24 weeks in both autograft and allograft. No evidence of structural degradation or immunological reaction was seen.

Based on these results, we believe that a cryopre served ACL allograft can provide the ideal material for ACL reconstruction. We have outlined a surgical tech nique for harvesting and implanting this graft clinically.
Rotator cuff function during a golf swing
Authors: Jobe Frank W. , Moynes Diane R. , Antonelli Daniel J.
Published: June 2007

A study of bilateral shoulder muscle activity during the golf swing was undertaken using electromyography and high-speed photography. Understanding of the muscle firing patterns could lead to injury prevention and development of appropriate training and condition ing regimens. The swings of seven adult male right- handed professional golfers without shoulder problems were examined. Indwelling electrodes were inserted into the supraspinatus, subscapularis, infraspinatus, latissimus dorsi, pectoralis major, anterior deltoid, mid dle deltoid, and posterior deltoid on the right side. Each subject was allowed to warm up until he felt comfort able. Films of each subject were taken at 450 frames per second. The swing was broken into four segments to which electromyographic signals were synchronized electronically. The EMG tracings were subjected to analog-to-digital conversion and a relative measure of quantity obtained. All tests were repeated on the left side for each subject.

Results indicate that all portions of the deltoid were inactive on the right side throughout the swing. The deltoid was likewise inactive on the left except for a brief spurt from the anterior portion during the millisec onds immediately preceding ball contact. Of the rotator cuff muscles, on the left the supraspinatus fired at a low level throughout the swing, as did the infraspinatus. The latter had a slightly larger burst of activity immedi ately after ball contact. The subscapularis was more active than any other muscle throughout the swing. The cuff muscles on the right side showed as much activity overall as those on the left. In addition, the latissimus dorsi and pectoralis major seemed to provide power bilaterally, with marked activity during the accel eration phase.

Contrary to the information presented in a number of golf instruction manuals, the left shoulder of a right- handed golfer does not provide more "drive" than does the right. To achieve greater distance it would seem that a golfer should concentrate on exercising the ro tator cuff bilaterally as well as the latissimus dorsi and pectoralis major.
Ice hockey injuries
Authors: Sim Franklin H. , Simonet William T. , Melton L. Joseph , Lehn Tracy A.
Published: June 2007

Ice hockey is a team sport that has recently grown in popularity not only in the United States but also in Canada and Europe. With this increase in popularity has come a growing concern about the number and severity of injuries. The world literature on the biome chanics and physiology of ice hockey was reviewed in an attempt to evaluate the forces and mechanisms involved in the game. The influence of rule and equip ment changes on injury patterns was particularly stud ied. Several studies on the epidemiology of injuries, providing data on the types of injuries and the mecha nisms of those injuries, were analyzed to determine the conclusions that could be supported and those that require further study. Possible changes in the patterns and types of injury are outlined.
Gymnastic injuries: The Virginia experience 1982-1983
Authors: Pettrone Frank A. , Ricciardelli Edward
Published: June 2007

Gymnastics has undergone a tremendous increase in popularity largely due to exposure during the Olympics. The injury rate in gymnastics is exceeded only by football, wrestling, and softball. A prospective analysis of club level gymnastic injuries over one season (1982- 83) was conducted. Complete responses from 15 clubs (2,558 participants) were obtained. Parameters of clubs followed were: skill level, student, instructor ratio, safety equipment, and conditioning and warm-up ex ercises. Data obtained from each participant were: injuries sustained, event in which injury occurred, set ting of injury, type of injury, and duration of disability. Results were 62 injuries among 542 competitive and 2,016 noncompetitive level athletes (5.3 per 100 com petitors and 0.7 per 100 beginners). Of the 62 injuries, 51 were acute and 11 chronic. Twenty-one injuries occurred during floor exercises, 13 on beam, 9 on vault, 6 on uneven parallel bars, and 2 on springboard. Acute injuries included 21 sprains, 16 fractures, 6 contusions, 4 dislocations, and 4 muscle strains. A significant find ing was the increased frequency of acute injury seen at dismount. Also there was a positive correlation be tween duration of frequency of practice (fatigue) and injury rate.

We would define a high risk gymnast as one who is 1) performing at an advanced competitive level, 2) performing floor or beam exercises, and 3) practicing more than 20 hours per week.
Breaststroker's knee
Authors: Vizsolyi Peter , Taunton Jack , Robertson Gordon , Filsinger Lynda , Shannon Harry S. , Whittingham Diane , Gleave Martin
Published: June 2007

Competitive swimmers have a high incidence of breast stroke-related knee injuries. Although previous investi gators have implicated the terminal phase of the kick in the injury mechanism, athletes often complain of pain during the initial phase of rearward thrust. Disagree ment in the current literature surrounds the precise anatomical derangement(s) constituting "breaststrok er's knee." The purpose of this investigation was to delineate the epidemiology, anatomy, and pathobiome chanics of breaststroke knee injuries.

Descriptive data were obtained by surveying 391 athletes. An extremely high incidence of knee pain was documented both among breaststroke specialists (73%) and nonbreaststrokers (48%). Age, years of com petitive swimming, and specific training characteristics were positively correlated with knee pain. Both the medial collateral ligament and the inferomedial patellar border were involved.

A further 21 swimmers were assessed in detail using four methods: interview, physical examination, Cybex II isokinetic quadriceps and hamstring testing, and cin ematographic analyses. The interview and physical ex amination data supported the conclusions derived from the descriptive data, while Cybex testing and kinematic film analyses failed to demonstrate statistical differ ences between the injured and noninjured groups.

Although kinematic film analyses did not demonstrate statistical differences between cases and controls, dra matic differences in the injury rate were noted when hip abduction angles at kick initiation were less than 37° or greater than 42°. This bimodal increase in injury rates suggests that modification of hip abduction at kick initiation, in conjunction with altered training regi mens, will lead to a reduction in medial knee joint stress and hence fewer breaststroke injuries.
Computerized recording of visits to an outpatient sports clinic
Authors: Kannus Pekka , Aho Heikki , Järvinen Markku , Nttymäki Seppo
Published: June 2007

At the Tampere Research Station of Sports Medicine (TRSSM) a continuous coding system of patient visits was started on March 1, 1985. The registration form contained 25 variables including all essential informa tion about the patient's identification, sports, time of and reason for the visit, physician, examinations, diag nosis, treatment, and possible further measures. To classify and number the diagnosis, a specific classifi cation of sports injuries and diseases was drawn up. The data were stored and analyzed using a DEC-2060 computer at the University of Tampere.

During 6 months a total of 814 visits were recorded. The three most common sports were soccer, long- distance running, and orienteering. Competitive ath letes totalled 337 (62%); 43 of these were top-ranking athletes.

The most common reasons for visits were problems of the knee (266 visits, 33%), ankle (80, 10%), and low back (71, 9%). Knee sprains accounted for 10% of all visits. Problems related to the musculoskeletal system were the reason for 751 (92%) of all visits. Operative treatment was needed by 49 patients (6%).

The continuous coding system of patient visits at an outpatient sports clinic showed great advantages as a basic data bank for scientific research, annual statistics, and patient identification and filing. The system de scribed has been adopted as part of the daily routine at the TRSSM.
Radionuclide imaging in internal derangements of the knee
Authors: Mooar Pekka , Gregg John , Jacobstein Jerome
Published: June 2007

The clinical specificity and sensitivity of imaging with 99mTC was evaluated prospectively in 104 consecutive patients admitted to the hospital for diagnostic/surgical arthroscopy. Four distinct patterns of radionuclide ac tivity were seen that correlated with observed arthros copic findings. These patterns of activity were seen with 1 ) degenerative joint disease (DJD) or severe ro tational instability, 2) meniscal pathology, 3) fracture of the subchondral plate or full thickness cartilaginous ulceration, and 4) synovitis. Radionuclide imaging was seen to be extremely sensitive and highly specific for all four patterns of activity.

The observed association of subchondral plate injury with meniscal pathology may present an explanation for the observed poor outcome in a limited number of patients following meniscectomy.
Long-term prognosis of nonoperatively treated acute knee distortions having primary hemarthrosis without clinical instability
Authors: Kannus Pekka , Järvinen Markku
Published: June 2007

The purpose of the study was to examine the long- term prognosis of nonoperatively treated acute knee distortions having primary hemarthrosis without clinical instability. A multidimensional follow-up analysis was performed on 84 patients an average 8 years after injury. The analysis included four standardized knee scoring scales for subjective, objective, functional, and radiological evaluations, as well as isokinetic and iso metric strength measurements.

In the great majority of the patients (86%) the long- term results were excellent or good. The main reason for failure was ACL insufficiency, an obvious outcome of overlooked rupture of that ligament in the primary situation.

If the injured knee is indeed stable, if there is no suspicion of ACL injury or patella luxation in the pa tient's history or clinical findings, and if routine radio graphs are negative, primary arthroscopy is not needed. However, a close followup with repeated clin ical examinations and a well-planned rehabilitation pro gram is obligatory.
Anterior stability of the glenohumeral joint
Authors: Cain Paul R. , Mutschler Thomas A. , Fu Freddie H. , Lee S.Kwon
Published: June 2007

This study defines the interaction of the rotator cuff musculature and the glenohumeral ligaments in provid ing anterior stability to the glenohumeral joint. Eight cadaveric shoulders were studied using a testing frame that individually simulated the forces of the subscapu laris, the supraspinatus, and the infraspinatus/teres minor musculature. The application of these forces abducted the humerus to approximately 90°. The cock ing phase of throwing was then simulated through the use of an Instron. With random variation of the rotator cuff forces, we investigated the effects that each force had on the rotation of the humerus and the strain of the inferior glenohumeral ligament. Our results demon strate that the infraspinatus/teres minor muscle group was the most effective in controlling external rotation of the humerus and in reducing ligamentous strain. These observations are pertinent in the treatment of anterior instability syndromes of the shoulder.