bluuebunny/crossref_metadata_2025 huggingface dataset:
The Surgical Treatment of Arthrofibrosis of the Knee
Authors: Cosgarea Andrew J. , DeHaven Kenneth E. , Lovelock James E.
Published: June 2007

Sixty-one lysis of adhesion procedures were performed for arthrofibrosis of the knee between 1981 and 1990. In 43 cases (37 patients) the etiology was prior knee ligament surgery. Ten cases had sustained fractures about the knee and eight had miscellaneous etiologies. Six patients required a second lysis of adhesion pro cedure. A retrospective analysis of the 43 ligament pa tients was undertaken to evaluate the results of surgical treatment. All 43 cases were available for followup at an average of 3.6 years. Surgical indications included flex ion or extension deficits of ≥10° or when motion failed to improve despite 2 months of intense therapy. Follow-up assessment included clinical and radio graphic evaluation. Flexion improved from 83% to 97% of the contralateral side. Extension deficits improved from 14° to 3°. Only 23 of 37 patients (62%) achieved satisfactory functional results. Radiographic evidence of degenerative changes, soft tissue calcification, and patella infera was found in 89%, 51 %, and 9% of the patients, respectively. Patients requiring surgical treat ment for arthrofibrosis after knee ligament surgery achieved excellent motion gains, but functional out come scores were compromised and radiographic find ings were concerning. Patients with the localized an terior intraarticular variant or those undergoing lysis of adhesion surgery sooner than 6 months had outcomes comparable with controls.
Patellar Tendon Versus Doubled Semitendinosus and Gracilis Tendons for Anterior Cruciate Ligament Reconstruction
Authors: Aglietti Paolo , Buzzi Roberto , Zaccherotti Giovanni , De Biase Pietro
Published: June 2007

The results of intraarticular anterior cruciate ligament reconstruction with either the patellar tendon or the semitendinosus and gracilis tendons (four strands) were prospectively compared in a consecutive series of 60 patients with chronic injuries. A single surgeon per formed arthroscopically assisted reconstructions in an alternating sequence. Preoperative and operative data revealed no significant differences between the two groups. After 28 months of followup there were no sig nificant differences in the incidence of symptoms, and recurrent giving way was present in only one knee with semitendinosus and gracilis tendon graft. Return to sport participation was more frequent in the patellar ten don group (80% versus 43%, P < 0.01 ). A minor ex tension loss (≤3°) was more frequent in the patellar tendon group (47% versus 3%, P < 0.001 ). Other dif ferences between the two groups were not significant. KT-2000 arthrometer side-to-side difference of anterior displacement >5 mm at 30 pounds was present in 13% of the knees with patellar tendon grafts and in 20% of those with semitendinosus and gracilis; a patellofemo ral crepitation developed in 17% and 3% of the two groups, respectively. Based on these data we routinely use patellar tendon grafts. Semitendinosus and gracilis tendons are preferred in selected cases: older patients, patients with preexisting patellofemoral problems, and those with failed patellar tendon grafts.
Incidence of Injury in Indoor Soccer
Authors: Lindenfeld Thomas N. , Schmitt David J. , Hendy Mary Pat , Mangine Robert E. , Noyes Frank R.
Published: June 2007

All injuries occurring over a 7-week period at a local indoor soccer arena were documented for analysis of incidence rates. All injury rates were calculated per 100 player-hours. The overall injury rates for male and fe male players were similar, 5.04 and 5.03, respectively. The lowest injury rate was found among the 19- to 24- year-old athletes and the highest injury rate was found among the oldest age group (≥25 years). Collision with another player was the most common activity at the time of injury, accounting for 31 % of all injuries. The most common injury types were sprains and muscle contu sions, both occurring at a rate of 1.1 injuries per 100 player-hours. Male players suffered a significantly higher rate of ankle ligament injuries compared with fe male players (1.24 versus 0.43, P< 0.05), while female players suffered a significantly higher rate of knee liga ment injuries (0.87 versus 0.29, P< 0.01). Goalkeepers had injury rates (4.2) similar to players in nongoalkeeper positions (4.5).
Cruciate Ligament Loading During Isometric Muscle Contractions
Authors: Zavatsky Amy B. , Beard David J. , O'Connor John J.
Published: June 2007

A model of the knee in the sagittal plane was used to investigate the ligament forces resulting when an ex ternal load applied to the tibia resisted either extension or flexion of the knee under increasing isometric quad riceps or hamstrings contractions, respectively. An el ementary mechanical analysis showed which ligament, the anterior or posterior cruciate, was loaded at a given flexion angle and known line of action of the external load. Ligament force, as a proportion of the external load, was also calculated. The results serve as guide lines for the design of injury-specific physical therapy techniques for use after cruciate ligament reconstruc tion.
Sagittal Knee Stability After Anterior Cruciate Ligament Reconstruction with a Patellar Tendon Strip
Authors: Good Lars , Odensten Magnus , Gillquist Jan
Published: June 2007

Tibial anteroposterior displacement after anterior cru ciate ligament reconstruction with a patellartendon graft was followed prospectively for 2 years in 24 patients with an arthrometer. The femoral ligament insertion lo cation, in a lateral projection, and the change in intra articular fixation distance, measured with an isometer, were documented intraoperatively. Two years after sur gery, the overall mean injured-noninjured difference in anteroposterior displacement was 2.0 ± 2.3 mm. All grafts were fixed during surgery at 20° of knee flexion. Patients for whom this angle coincided with the angle of minimum intraarticular fixation distance (Group I), and patients who had a femoral ligament insertion location >2 mm anterior to the center of the normal anterior cru ciate ligament attachment (Group A) showed larger tibial displacement than the other patients. An injured- noninjured difference in tibial anteroposterior displace ment ≥3 mm was classified as failure. Groups I and A failure rates were higher than for the other patients. No correlation was found between anteroposterior dis placement and magnitude of the change in intraarticular fixation distance. We conclude that anterior femoral lo cations lead to larger sagittal play after 2 years than central or posterior locations and that the magnitude of the fixation distance is less important than the pattern.
The Accuracy of the Clinical Examination in the Setting of Posterior Cruciate Ligament Injuries
Authors: Rubinstein Richard A. , Shelbourne K. Donald , McCarroll John R. , VanMeter Charles D. , Rettig Arthur C.
Published: June 2007

Thirty-nine subjects volunteered for this blinded, ran domized, and controlled study to assess the clinical ex amination skills of orthopaedic surgeons with fellowship training in sports medicine. Eighteen of the patients had 19 chronic isolated posterior cruciate ligament tears. The controls were 9 patients with 9 anterior cruci ate ligament-deficient knees, 12 subjects with normal knees, and the contralateral normal knees of the ligament-deficient patients. To eliminate preexamina tion bias, all examiners were blinded from the examin ee's history, identity, and diagnosis. The overall clinical examination accuracy for all orthopaedic surgeons was 96%. The accuracy for detecting a posterior cruciate ligament tear was 96%, with a 90% sensitivity and a 99% specificity. The examination accuracy was higher for grade II and III posterior laxity than for grade I laxity. Eighty-one percent of the time, the examiners agreed on the grade of the posterior cruciate ligament tear for any given patient. The posterior drawer test, which in cluded palpation of the tibia-femur step-off, was the most sensitive and specific clinical test. A thorough and precise physical examination, coupled with a patient history, can be considered diagnostic in the majority of isolated posterior cruciate ligament injuries. With this accuracy level known, the natural history of isolated posterior cruciate ligament tears can be reliably docu mented and studied.
Correlation of Remaining Patellar Tendon Width with Quadriceps Strength After Autogenous Bone-patellar tendon-bone Anterior Cruciate Ligament Reconstruction
Authors: Shelbourne K. Donald , Rubinstein Richard A. , VanMeter Charles D. , McCarroll John R. , Rettig Arthur C.
Published: June 2007

One hundred twenty-one patients were prospectively studied to determine whether the different remaining patellar tendon widths after central 10-mm bone- patellar tendon-bone graft harvest influenced the rate and level of quadriceps strength achieved during reha bilitation. Size of the patellar tendon width, measured at the same location in each patient, ranged from 24 to 35 mm. For this study, patients were grouped according to their remaining tendon size into small (14 to 17 mm; mean, 15.8), medium (18 to 20 mm; mean, 19.2), and large (21 to 25 mm; mean, 22.5) widths. Postopera tively, the patient's isokinetic quadriceps scores were determined at 6 weeks, 3 months, 6 months, and 1 year. At 6 weeks, the small- and medium-width tendon groups were significantly weaker than the large-width tendon group. At 3 months, only the small-width tendon group continued to be significantly weaker than the large- width tendon group. At and beyond 6 months, no sta tistically significant differences were seen between re maining patellar tendon width groups and their isokinetic quadriceps scores. A constant-sized autog enous patellar tendon graft may be harvested for an terior cruciate ligament reconstruction without compro mising ultimate postoperative quadriceps strength recovery.
Deterioration of Mechanical Properties of the Autograft in Controlled Stress-shielded Augmentation Procedures
Authors: Majima Tokifumi , Yasuda Kazunori , Yamamoto Noritaka , Kaneda Kiyoshi , Hayashi Kozaburo
Published: June 2007

Effects of partial and complete stress shielding on me chanical properties and histology of in situ frozen pa tellar tendons were studied in 120 mature female Japa nese White rabbits that were divided into three groups: completely stress-shielded, partially stress-shielded, and sham-operated groups. In the former two groups, tendon tension was reduced to 0% and about 30% of normal force, respectively, with a polyester artificial liga ment. Tensile tests were conducted on patella-patellar tendon-tibia complexes harvested 1, 2, 3, 6, or 12 weeks after surgery. Tensile strength significantly de creased compared with the sham group to 17% and 28% at 3 and 6 weeks, respectively, in the completely stress-shielded group, and to 54% and 63% at 3 and 12 weeks, respectively, in the partially stress-shielded group. Patellar tendon cross-sectional area significantly increased to 156% and 157% at 2 and 3 weeks, re spectively, in the completely stress-shielded group and to 133% at 2 weeks in the partially stress-shielded group, compared with the sham group. Stress shielding significantly changed tensile strength, tangent modulus, and cross-sectional area of in situ frozen patellar ten don ; these changes depended on degree of stress shielding. Histologic observations indicated that remod eling occurred in the patellar tendon while there were no cells in the fascicle.
Observations on the Injury Mechanism of Anterior Cruciate Ligament Tears in Skiers
Authors: Speer Kevin P. , Warren Russell F. , Wickiewicz Thomas L. , Horowitz Lois , Henderson Leon
Published: June 2007

The purpose of this study was to demonstrate the uniqueness of the injury mechanism for acute complete tears of the anterior cruciate ligament in recreational alpine skiers by using patterns of osseous injury as de tected by magnetic resonance imaging. We treated 42 patients (average age, 32 years) who met the following criteria: 1) acute complete anterior cruciate ligament tear incurred during skiing, 2) no history of knee injury, 3) magnetic resonance imaging within 30 days of injury, and 4) arthroscopy and anterior cruciate ligament re construction or both for documentation of all intraarticu lar injury. An osseous injury detected by magnetic reso nance imaging was seen in the lateral femoral condyle in 17 (40%) of the patients and was located over the terminal sulcus in 15 of these patients; only 1 had ar throscopic evidence of chondral injury. Four (10%) of the 42 patients had a bone bruise on the medial femoral condyle; all were located at the extreme posterior mar gin. Thirty-four patients (81 %) had a bone bruise on the lateral tibial plateau; 33 were located at the extreme posterior margin and 27 of these were at the postero lateral tibial rim. Twelve patients (29%) had a bone bruise on the medial tibial plateau; all were located on the posterior margin.
Superior Labrum-Biceps Tendon Complex Lesions of the Shoulder
Authors: Maffet Mark W. , Gartsman Gary M. , Moseley Bruce
Published: June 2007

The detachment of the superior labrum from anterior to posterior has previously been reported. This lesion has been classified into four types. It was our impression that not all superior labrum abnormalities fit into such a classification system and that the mechanism of injury was distinctly different. During a 5-year period, 84 of 712 (11.8%) patients had significant labral abnormalities; 52 of 84 patients (6.2%) had lesions that fit within the clas sification system (Type II, 55%; III 4%; IV, 4%), but 32 of 84 patients (38%) had significant findings that could not be classified. These unclassifiable lesions fit into three distinct categories. Two of three patients de scribed a traction injury to the shoulder. Only 8% sus tained a fall on an outstretched arm; 75% had a pre operative diagnosis of impingement based on consistent history and provocative testing; however, when examined under anesthesia, 43% of the shoul ders were considered to have increased humeral head translation when compared with the other shoulder. Recognition of superior labrum-biceps tendon detach ment should prompt the surgeon to investigate gleno humeral instability as the source of a patient's com plaints.
Osteoarthritis After Arthroscopic Partial Meniscectomy
Authors: Rangger Christoph , Klestil Thomas , Gloetzer Wulf , Kemmler Georg , Benedetto Karl Peter
Published: June 2007

The purpose of this study was radiologic assessment of osteoarthritis after arthroscopic partial meniscectomy. At an average followup of 53.5 months, 284 consecutive patients were retrospectively evaluated clinically and radiologically. Two hundred forty-seven patients had been treated for medial (Group I) and 37 for lateral me niscal tears (Group II). Preoperative radiographs were compared with those at followup and were classified. The results were analyzed statistically. Osteoarthritic changes were classified as being worse in 38% of the patients after medial and in 24% of the patients after lateral arthroscopic partial meniscectomy. Further sub- classification and comparison of patients with or without already existing articular surface damage at the time of arthroscopy were not found to have significant impact on the prevention of osteoarthritic changes. Patients who were older than 40 years of age and who had un dergone arthroscopic partial medial meniscectomy were radiologically classified with a significantly higher rate of osteoarthritis than patients who were younger than 40 years. Partial medial or lateral meniscectomy leads to a significant increase of osteoarthritic changes, even when this intervention is performed arthroscopically.
Drop Leg Lachman Test
Authors: Adler Gerard G. , Hoekman Ronald A. , Beach Diane M.
Published: June 2007

We describe a new method of evaluating anterior cru ciate stability that we call the drop leg Lachman test. This test is performed with the patient supine and the leg to be examined abducted off the side of the table and flexed 25°. The thigh is stabilized to the examining table with one of the examiner's hands, and the patient's foot is held between the examiner's legs. The examiner's free hand provides the anteriorly directed force as done in the Lachman test. A prospective study of 52 patients who were identified as unilaterally anterior cruciate liga ment deficient was conducted. Forty-two subjects were tested while conscious, and 40 subjects were tested under anesthesia. Each subject was examined with a KT-1000 arthrometer. In the conscious group, the drop leg Lachman test resulted in 1.8 mm greater average excursion than the Lachman test. In the anesthetized group, the drop leg Lachman test resulted in 2.4 mm more average translation than the Lachman test. In both groups, the difference between tests was statistically significant. The drop leg Lachman test is physically easier to perform than the Lachman test, and it is a sensitive method of demonstrating anterior laxity in an anterior cruciate ligament-deficient knee.
Goal Post Injuries in Soccer
Authors: Janda David H. , Bir Cynthia , Wild Bart , Olson Steve , Hensinger Robert N.
Published: June 2007

Soccer is the most popular team sport worldwide, with approximately 40 million amateur participants. Most fa talities in soccer are related to player impact with the goal post. This study focuses on two case reports, a laboratory testing phase, and a pilot field testing phase of preventive equipment that can be used around the goal to prevent injury. Horizontal and vertical impact testing in the laboratory revealed impact force was di minished when the goal post was covered with protec tive padding (reduction of 31% and 63%) (P < 0.05). These data showed a statistically significant decrease in force at all temperatures. In the pilot field testing phase of the study, 471 games were monitored. Soccer teams participating in youth, teen, and adult soccer leagues were included in this phase of the study. During the 3-year study, there were seven player collisions with padded goal posts, and no injuries were recorded. The use of padded goal posts within the game of soccer has been documented to reduce the possibility of injury, both in the laboratory phase and in the pilot field testing phase.
The Effect of Femoral Tunnel Position and Graft Tensioning Technique on Posterior Laxity of the Posterior Cruciate Ligament-Reconstructed Knee
Authors: Burns William C. , Draganich Louis F. , Pyevich Michael , Reider Bruce
Published: June 2007

We report the effects of femoral tunnel position and graft tensioning technique on posterior laxity of the posterior cruciate ligament-reconstructed knee. An isometric femoral tunnel site was located using a specially de signed alignment jig. Additional femoral tunnel positions were located 5 mm proximal and distal to the isometric femoral tunnel. With the graft in the proximal femoral tunnel, graft tension decreased as the knee flexed; with the graft in the distal femoral tunnel, graft tension in creased as the knee flexed. When the graft was placed in the isometric femoral tunnel, a nearly isometric graft tension was maintained between 0° and 90° of knee flexion. One technique tested was tensioning the graft at 90° of knee flexion while applying an anterior drawer force of 156 N to the tibia. This technique restored sta tistically normal posterior stability to the posterior cru ciate ligament-deficient knee between 0° and 90° for the distal femoral tunnel position, between 0° and 75° for the isometric tunnel position, and between 0° and 45° for the proximal tunnel position. When the graft was tensioned with the knee in full extension and without the application of an anterior drawer force, posterior trans lation of the reconstructed knee was significantly dif ferent from that of the intact knee between 15° and 90° for all femoral tunnel positions.
Biomechanical Assessment of the Healing Response of the Rabbit Patellar Tendon After Removal of Its Central Third
Authors: Beynnon Bruce D. , Proffer Dirk , Drez David J. , Stankewich Charles J. , Johnson Robert J.
Published: June 2007

The objective of this study was to determine the bio mechanical properties of the healing patellar tendon after removal of its central third. This was accomplished by removing the central third of the patellar tendon from the right limb of 30 mature New Zealand White rabbits. The tendon of the contralateral normal limb served as the unoperated control. The rabbits were separated into five test groups according to healing time: time of sur gery and 1, 2, 3, and 6 months after surgery. The ulti mate failure strength of the patellar tendons with the central third removed was significantly less than the fail ure strength of the contralateral normal patellar tendons at all time intervals after surgery. At the time of surgery, the ultimate failure strength values of the operated pa tellar tendons were on average 53% of the normal patellar tendons, increasing to 72% of normal at 6 months. There was a significant correlation between the ultimate failure strength of the operated tendons and healing time. The positive slope for this regression in dicated that the ultimate failure strength of the operated tendons converged toward normal as healing pro gressed. Failure mode of the operated tendon did not depend on healing time.
Lumbar Transverse Process Fractures in Professional Football Players
Authors: Tewes Douglas P. , Fischer David A. , Quick Donald C. , Zamberletti Fred , Powell John
Published: June 2007

In the general population, fractures of the transverse processes of lumbar vertebrae occur in cases of high- energy blunt trauma, often in motor vehicle accidents. Football players may incur the same fractures, but the circumstances and outcomes are different in this spe cific subgroup. A review of 29 cases among National Football League players reveals that associated vis ceral injuries are rare, and the time lost from sports is only an average of 3.5 weeks.
Strength Profiles and Performance in Masters' Level Swimmers
Authors: Magnusson S. Peter , Constantini Naama W. , McHugh Malachy P. , Gleim Gilbert W.
Published: June 2007

The purpose of this study was to profile shoulder, trunk, and thigh strength and shoulder range of motion in com petitive Masters' level swimmers and to see if these variables were related to swimming performance. Twenty-four Masters' level swimmers (13 men and 11 women) were tested for isometric trunk flexion and ex tension, isokinetic knee extension and flexion, shoulder abduction, internal rotation, external rotation, and su praspinatus muscle strength; shoulder internal and ex ternal rotation range of motion; and 50-yard swimming time. Strength scores were adjusted for weight. The men were significantly stronger than the women in trunk extension and flexion. Shoulder range of motion, shoul der abduction strength, and thigh strength were equal for both the men and the women. The men were stron ger than the women in internal and external shoulder rotation. Conversely, the women tested were signifi cantly stronger than the men in the supraspinatus muscle test. The men were significantly faster than the women in the 50-yard swim. Inverse relationships ex isted between swimming time and trunk flexion, trunk extension, and shoulder internal rotation strength. Trunk flexion strength remained the only significant pre dictive variable of swimming time in a multiple regres sion analysis.
Eccentric and Concentric Strength of the Shoulder and Arm Musculature in Collegiate Baseball Pitchers
Authors: Mikesky Alan E. , Edwards Jeffrey E. , Wigglesworth Janet K. , Kunkel Sanford
Published: June 2007

Many pitching injuries occur during deceleration of the upper extremity when the muscles of the shoulder and arm are acting eccentrically. Published information re garding eccentric muscular strength in baseball pitchers is nonexistent. The purpose of this study was to assess bilateral isokinetic eccentric and concentric muscular strength of the shoulder's external and internal rotator muscles and the elbow's flexor and extensor muscles in a group of collegiate baseball pitchers (N = 25). Iso kinetic strength was assessed at 1.6, 3.7, and 5.2 rad/ sec. Our findings indicate that the internal rotator muscles were always stronger than the external rotator muscles and that the concentric and eccentric external- to-internal strength ratios ranged from 62% to 81 %. The eccentric strength of the shoulder rotator muscles av eraged 114% that of concentric strength. The concen tric and eccentric elbow extension-to-flexion strength ratios ranged from 71 % to 110%; eccentric strength av eraged 33% higher than concentric strength. No differ ences were noted between dominant and nondominant limbs for any of the strength measures or ratios. Clini cally, the findings of this study can serve as a reference during the evaluation, rehabilitation, and conditioning of throwing athletes.
Biomechanical Comparison of Reconstruction Techniques in Simulated Lateral Ankle Ligament Injury
Authors: Marcus Hollis J. , Dale Blasier R. , Flahiff Charlene M. , Hofmann Otto E.
Published: June 2007

Eighteen intact ankles were loaded with inversion- eversion and anterior-posterior forces, and motions of the talus and calcaneus were measured. Ankles were tested in neutral, 15° of dorsiflexion, and 15° of plantar flexion. The anterior talofibular ligament was then sec tioned and testing was repeated. In half the specimens the calcaneofibular ligament was also sectioned fol lowed by repeat testing. The Evans, Watson-Jones, and Chrisman-Snook procedures were performed on each ankle and testing was repeated. With inversion- eversion loading, only the Chrisman-Snook reconstruc tion resulted in a significantly more stable ankle joint complex than in the anterior talofibular ligament cut ankles. All three reconstructions increased ankle sta bility over the anterior talofibular and calcaneofibular ligament cut state. With anterior-posterior loading, all reconstructions resulted in a significantly more stable ankle joint complex than the anterior talofibular ligament cut ankles. The Evans and Chrisman-Snook proce dures resulted in more stability than the anterior talo fibular and calcaneofibular ligament cut ankles. There was no difference in subtalar joint motion with inversion- eversion loading among ankles with the anterior talo fibular ligament cut and those with any of the recon structions. For the anterior talofibular and calca neofibular ligament cut ankles, subtalar joint motion was similar to that in intact ankles after each reconstruction. All three reconstructions resulted in ankles with signifi cantly less subtalar joint motion with anterior-posterior loading than ankles with the anterior talofibular ligament cut or with the anterior talofibular and calcaneofibular ligaments cut. The Chrisman-Snook procedure resulted in ankles with significantly less motion than intact ankles.
Graft Site Morbidity with Autogenous Semitendinosus and Gracilis Tendons
Authors: Yasuda Kazunori , Tsujino Jun , Ohkoshi Yasumitsu , Tanabe Yoshie , Kaneda Kiyoshi
Published: June 2007

To distinguish between morbidity caused by harvesting semitendinosus and gracilis tendons and morbidity as sociated with anterior cruciate ligament reconstruction surgery, we performed a prospective randomized study using 65 patients who underwent anterior cruciate liga ment reconstruction using these tendons. The patients underwent either contralateral ( N = 34) or ipsilateral (N = 31) graft harvest. For the nonoperated knees in the ipsilateral harvest group, isometric and isokinetic strength of the quadriceps and hamstring muscles in creased to approximately 120% of the preoperative value at 12 months after surgery. Compared with these knees, the tendon harvest did not affect quadriceps muscle strength at all. However, harvest did decrease hamstring muscles strength for 9 months after surgery. The graft harvest in the knees with anterior cruciate liga ment reconstruction also did not significantly affect quadriceps muscle strength, but it did significantly de crease hamstring muscles strength only at 1 month. Activity-related soreness at the donor site was rarely restricting and resolved by 3 months. This study dem onstrated that the semitendinosus and gracilis tendon graft is a reasonable choice to minimize the donor site morbidity in ligament reconstruction using autografts.
Deltoid and Syndesmosis Ligament Injury of the Ankle Without Fracture
Authors: Miller Chris D. , Shelton Walter R. , Barrett Gene R. , Savoie F.H. , Dukes Andrea D.
Published: June 2007

Ankle diastasis without fracture is a rare injury with few examples reported. We report on four male patients, aged 16 to 18 years, who sustained this injury playing football. Swelling and tenderness over both the deltoid and syndesmosis ligaments are the most common physical findings. Plain ankle radiographs demon strated lateral talus subluxation in three patients, and a stress radiograph demonstrated subluxation of the talus in one patient. Treatment consisted of reduction and fixation of the syndesmosis with a screw followed by 6 weeks of cast immobilization. Using the scale devel oped by Edwards and DeLee, three patients had ex cellent results and one had a good result. Diagnosis of tears of the deltoid and syndesmosis ligaments without fracture requires a high index of suspicion on the phy sician's part. In patients whose mortise is more than 1 mm subluxated, reduction and screw fixation will produce good results.
Paradoxical Phenomena of the McMurray Test
Authors: Kim Sung-Jae , Min Byoung-Hyoun , Han Dae-Yong
Published: June 2007

We evaluated 200 patients who had a positive McMur ray test and found atypical McMurray test results in 24 patients (12%). These patients revealed pain or click ing or both either in the medial compartment of the knee when the leg was internally rotated or in the lateral compartment of the knee when the leg was externally rotated. The authors analyzed these para doxical findings at arthroscopic examination to identify the relationship between the type of meniscal tear and the direction of leg rotation that elicited the catching and displacement of the torn meniscal portion during the McMurray test. Contrary to conventional McMurray test findings, three different types of meniscal tears were found on the side of the knee where pain or a clicking sound occurred. The three types were 1) an teriorly based posterior oblique tears with anterior dis placement of the meniscus, 2) bucket-handle tears in the posterior half of the menisci, and 3) peripheral detachment of discoid menisci in the posterior half of the torn portions.
Evaluation of the Arthroscopic Valgus Instability Test of the Elbow
Authors: Field Larry D. , Altchek David W.
Published: June 2007

Seven fresh-frozen cadaveric elbows were used to evaluate the extent to which the medial collateral liga ment must be injured before arthroscopic evidence of valgus instability is seen, the amount of ulnohumeral joint opening that does occur after such an injury, and the elbow position that maximizes visualization of this opening. While visualizing the most medial aspect of the ulnohumeral joint arthroscopically through the an terolateral portal, we sequentially sectioned the medial collateral ligament complex until all of the medial liga mentous restraints were cut. A valgus load was applied after each incision, and the extent to which the ulno humeral joint opened was measured. Ulnohumeral joint opening was not visualized in any specimen until complete sectioning of the anterior bundle was per formed. After the anterior bundle was released, 1 or 2 mm of joint opening was present in all specimens. Complete release of the medial collateral ligament led to dramatic increases in medial joint opening in all seven specimens (4 to 10 mm). Varying the angle of elbow flexion from 15° to 120° revealed that visualiza tion of the medial joint opening was best at 60° to 75°. Finally, forearm pronation increased ulnohumeral joint opening and supination decreased joint opening in all specimens. We found that the entire anterior bundle must be sectioned before measurable and reproduc ible medial joint opening can occur.
Rotator Cuff Injury in Contact Athletes
Authors: Blevins Field T. , Hayes William M. , Warren Russell F.
Published: June 2007

The causes and incidence of rotator cuff injuries in patients under the age of 40 has not been clearly established. The present study focuses on a group of 10 male contact athletes with rotator cuff injuries re lated to trauma sustained during football (ages from 24 to 36 years). Symptoms included pain and dysfunction in all 10 patients and a positive shrug sign in 8 of 10. The diagnoses for these patients were two isolated contusions, five partial-thickness tears, and three full- thickness tears. Surgery was performed on all patients after nonoperative treatment failed. Three partial-thick ness tears were arthroscopically debrided. One full- thickness and two partial-thickness tears were repaired using the arthroscopically assisted miniarthrotomy technique. An open repair was performed in two pa tients. Two isolated rotator cuff contusions were arthro scopically debrided. The average followup was 21 months. Nine of 10 athletes returned to active partici pation in football, 7 of these at their preinjury levels. The diagnosis of rotator cuff injury should be consid ered in a contact athlete who has persistent shoulder pain, impingement signs, weakness, and a positive shrug sign. Arthroscopic debridement of the subacro mial space followed by debridement or repair of rotator cuff tears, as clinically indicated, resulted in a marked improvement in function and rapid return to sport for these patients.
Outcomes of the Chrisman-Snook and Modified-Broström Procedures for Chronic Lateral Ankle Instability
Authors: Hennrikus William L. , Mapes Randall C. , Lyons Patrick M. , Lapoint John M.
Published: June 2007

We prospectively and randomly compared the out comes of the Chrisman-Snook and modified-Broström procedures for chronic lateral ankle instability in 40 patients. Both operations provided good or excellent stability in more than 80% of the patients. However, the modified-Broström procedure resulted in higher Sefton scores than the Chrisman-Snook procedure. In addi tion, a statistically significant greater proportion of complications occurred in patients treated with the Chrisman-Snook procedure.
A Retrospective Study of Cervical Spine Injuries in American Rugby, 1970 to 1994
Authors: Wetzler Merrick J. , Akpata Toks , Albert Todd , Foster Timothy E. , Levy Andrew S.
Published: June 2007

We undertook a retrospective study to document and analyze the occurrence of cervical spinal injuries in rugby in the United States from 1970 to 1994. We studied 59 cases (average, 2.36 per year). Thirty jun ior-level players (50.8%) (college or high school), 28 (47.5%) men's club players, and 1 (1.7%) woman player were injured. Fifty-seven injuries (97%) oc curred during games. The incidence of cervical spine injuries is well documented in the United Kingdom and South African literature. However, no study in United States literature discusses the incidence or cause of cervical spine injury in rugby. We found that coaching is less consistent in the United States. Players with more weight and less experience are playing positions that require significant skill. Many players in the United States learn skills in games rather than in practice. In our study, 52.5% (31 of 59) of the injured players were junior-level players. Conversely, in world competition junior-level athletes sustained only 30% to 40% of the cervical spine injuries. Understanding the factors that contribute to cervical spine injuries is paramount in injury prevention. Through this study, we hope to pro mote change in rugby laws and regulations, as has been done in football, to enhance the safety and plea sure of the sport for players, coaches, and spectators.
Effects of Resumption of Loading on Stress-Shielded Autografts After Augmentation Procedures
Authors: Ishida Hirohide , Yasuda Kazunori , Hayashi Kozaburo , Yamamoto Noritaka , Kaneda Kiyoshi
Published: June 2007

An experiment was conducted to verify if resumption of loading (restressing) on autografts after augmentation procedures can recover the mechanical properties of the grafts that were deteriorated by complete stress shielding. One hundred ten Japanese White rabbits were used. After the patellar tendon in each right knee was frozen in situ, tension applied to the tendon was released for an interval in 80 rabbits. These 80 animals were divided into four groups of 20 rabbits. The patellar tendons in these groups were completely shielded from stress for 1, 2, 3, and 6 weeks, respectively. From each group, rabbits were sacrificed immediately before restressing ( N = 5), and after 3 ( N = 5), 6 ( N = 5), and 12 ( N = 5) weeks of restressing. The remaining 30 rabbits underwent sham operations. The results showed that complete stress shielding markedly de creased tensile strength of the patellar tendon. How ever, if restressing was applied within 3 weeks of com plete stress shielding, the once-reduced strength gradually increased to the level of the sham-operated tendons by 12 weeks after the onset of restressing. Restressing applied after 6 weeks of complete stress shielding also increased the strength of the tendon; however, it reached only 65% the strength of the sham- operated tendons at 12 weeks after restressing. The timing to apply stress to grafts should be carefully determined for optimal recovery.
The Effect of Anterior Cruciate Ligament Graft Elongation at the Time of Implantation on the Biomechanical Behavior of the Graft and Knee
Authors: Tohyama Harukazu , Beynnon Bruce D. , Johnson Robert J. , Renström Per A. , Arms Steven W.
Published: June 2007

This investigation determined the effect that anterior cruciate ligament graft elongation at the time of surgi cal reconstruction has on the long-term biomechanical behavior of the graft and knee joint. We chose the canine model for anterior cruciate ligament reconstruc tion, using the medial third of the patellar tendon with attached proximal bone block. Elongation of the graft was measured immediately after graft fixation during passive knee flexion using the Hall effect transducer. The dogs were divided into either Group 1 (graft elon gation behavior within the 95% confidence limits of the normal anterior cruciate ligament) or Group 2 (graft elongation behavior more than the 95% confidence limits of the normal anterior cruciate ligament). All of the dogs were sacrificed 18 months postoperatively, and we evaluated anteroposterior load displacement (i.e., anteroposterior laxity) of the knee and the struc tural properties of the graft. The anteroposterior laxity behavior of the reconstructed knees in Group 2 was significantly more than that of Group 1. Group 2 had significantly less linear stiffness of the graft than Group 1. There was no difference in the ultimate failure load and absorbed energy at failure values of the grafts between Groups 1 and 2. The findings from this inves tigation indicate that the graft elongation behavior at the time of reconstruction is a critical factor that influ
Testing for Isometry During Reconstruction of the Posterior Cruciate Ligament
Authors: Covey D.C. , Sapega Alexander A. , Sherman Gary M.
Published: June 2007

The change in the distance of linear separation be tween each pair of osseous fiber attachment sites of the posterior cruciate ligaments was measured and plotted as a function of the knee flexion angle from 0° to 120°. Data were collected under four sequential test conditions that had in common quadriceps relaxation, absence of tibial rotation forces, and horizontal femoral stabilization. The posterior cruciate ligament fibers were intact or transected (excursion wires left intact) with gravitational joint distraction of the lower leg un constrained or constrained. The small, posterior ob lique fiber region was the most isometric of the four tested fiber regions. Progressively increasing devia tions from isometry were seen in the posterior longitu dinal, central, and anterior fiber regions, in that order. Transection of the posterior cruciate ligament, com bined with unconstrained gravitational distraction of the knee joint, further increased the magnitude of deviation from isometry of the anterior and central fibers, but only changed the pattern of deviation for the more nearly isometric posterior fibers. Under simulated operative conditions, most of the posterior cruciate ligament's anatomic attachment sites exhibit nonisometric behav ior, with near isometry demonstrated only by the rela tively small posterior fiber attachment sites. If isometry alone is used for bone tunnel placement, the large anterior and central fiber regions will be left largely unreconstructed. Because the normal behavior of most of the fibers of the posterior cruciate ligament involves 4 to 6 mm of end-to-end length increase with progres sive knee flexion, this pattern and degree of deviation from isometry should be sought to approximate an anatomic reconstruction of the anterocentral bulk of the ligament.
Functional Treatment of Patellar Dislocation in an Athletic Population
Authors: Garth William P. , Pomphrey Martin , Merrill Keith
Published: June 2007

Fifty-eight athletically active study participants with 69 knees that had experienced patellar dislocations were available for followup after being selected for a func tional rehabilitation program without antecedent immo bilization. Follow-up evaluation was at a minimum of 24 months after onset of treatment and averaged 46.2 months. Good or excellent results occurred in 39 (66%) knees treated after an initial patellar dislocation and in 15 (50%) knees with a chronic history of patellar insta bility. Twenty-six percent of the 69 knees had experi enced recurrent patellar instability at followup. Overall, 42 patients (73%) were satisfied with their knees after this nonsurgical management. Anatomic predisposition and onset of bilateral instability at an early age were found to be significant factors associated with a less favorable outcome.
Differences in Friction and Torsional Resistance in Athletic Shoe-Turf Surface Interfaces
Authors: Heidt Robert S. , Dormer Stephen G. , Cawley Patrick W. , Scranton Pierce E. , Losse Gary , Howard Mark
Published: June 2007

This study evaluated the shoe-surface interaction of 15 football shoes made by 3 manufacturers in both ante rior translation and rotation using a specially designed pneumatic testing system. The shoes included tradi tional cleated football shoes, "court" shoes (basketball- style shoes), molded-cleat shoes, and turf shoes. Un der an 11.35-kg (25-pound) axial load, all shoes were tested on synthetic turf under wet and dry conditions and on natural stadium grass. Test-retest reliability, as calculated using the Pearson Product-Moment Corre lation test, was 0.85 for force of translation and 0.55 for the moment of rotation. The wet versus dry surface values on translation were significantly different for rotation about the tibial axis. Spatting, which is protec tive taping of the ankle and heel applied on the outside of the shoe, resulted in a reduction of forces generated in both translation and rotation. No overall difference between shoes on grass versus AstroTurf was noted. However, there were significant differences for cleated and turf shoes. Shoes tested in conditions for which they were not designed exhibited reproducible exces sive or extreme minimal friction characteristics that may have safety implications. On the basis of this study, we urge shoe manufacturers to display sug gested indications and playing surface conditions for which their shoes are recommended.
Analysis of Skiing Accidents Involving Combined Injuries to the Medial Collateral and Anterior Cruciate Ligaments
Authors: Hull M.L.
Published: June 2007

Two types of ligament injuries common in skiing are the isolated ruptures of the anterior cruciate and rup tures of the medial collateral, either with or without rupture of the anterior cruciate. Based on research related to ligament injury mechanics and two-mode release binding function, the purpose of this paper was to critically assess the ability of two-mode release bind ings to prevent combined medial collateral and anterior cruciate ligament injuries. Making this assessment en tailed several steps. First, I determined the loads typi cally transmitted by the knee during falls in which com bined injuries occurred. Because more than one load was transmitted, the next step was to discern which of the loads was more damaging. Finally, heel-toe type bindings were evaluated for their potential to release in response to damaging loads. I concluded that com bined medial collateral and anterior cruciate ligament injuries typically occur in forward, twisting-type falls in which the primary loads are external axial and valgus moments. An external axial moment is more damaging than a valgus moment, both to the medial collateral ligament when the joint is intact and to the anterior cruciate ligament when the medial collateral ligament is damaged. Because heel-toe type bindings offer re lease sensitivity to this moment, the release level of the toepiece in twist is an important factor in the prevention of these injuries.
Ankle Inversion Injuries
Authors: Konradsen Lars , Voigt Michael , Hojsgaard Charlotte
Published: June 2007

We investigated the role of a muscular defense in the stabilization and protection of the ankle joint against sudden forced inversion. Ten volunteers with mechan ically stable ankles were tested in different standing and walking situations using a trap door model and lower extremity electromyography and electrogoniom eters. Peroneal electromyographic activity was ob served 54 msec after the detection of ankle inversion. This latency was shorter when the ankle was already in inversion and longer with the ankle in eversion. Quad riceps and hamstring muscle electromyographic activ ity occurred 68 msec after the ankle inversion stimulus. Evidence of active eversion was seen 176 msec after sudden inversion. Active changes in knee and hip joint angles occurred even later. In contrast, the trap door rotated 30° in approximately 80 msec. We conclude that the reflex reaction to sudden inversion is initiated at a peripheral level by the inversion motion followed by a reaction pattern mediated by spinal or cortical motor centers. Both peripheral and central reactions, however, seem too slow to protect the ankle in case of sudden inversion occurring at the time of heel contact.
Effects of Initial Graft Tension on Clinical Outcome After Anterior Cruciate Ligament Reconstruction
Authors: Yasuda Kazunori , Tsujino Jun , Tanabe Yoshie , Kaneda Kiyoshi
Published: June 2007

We conducted a prospective, randomized, short-term study to clarify the effects of initial graft tension on clinical outcome after arthroscopically assisted anterior cruciate ligament reconstruction with autogenous dou bled semitendinosus and gracilis tendons connected in series with polyester tapes. Seventy Japanese patients with chronic, "isolated" anterior cruciate ligament tears were entered in the study. The patients were randomly divided into three groups based on initial graft tension: Group 1 (20 N), Group 2 (40 N), or Group 3 (80 N). No statistical differences were noted among the three groups with regard to their background factors. The patients were observed for 2 years or more after sur gery. Postoperatively, the average side-to-side differ ence in anterior laxity was 2.2 ± 2.4 mm in Group 1, 1.4 ± 1.8 mm in Group 2, and 0.6 ± 1.7 mm in Group 3. Analysis of variance testing showed that the post operative laxity in Group 3 was significantly less than that in Group 1. Spearman's rank-order correlation analysis also demonstrated significant correlation be tween the magnitude of initial graft tension and the magnitude of the postoperative laxity. This study dem onstrates that relatively high initial tension (up to 80 N) reduces the postoperative anterior laxity of the knee joint after anterior cruciate ligament reconstruction us ing the doubled autogenous hamstring tendons con nected in series with polyester tapes