bluuebunny/crossref_metadata_2025 huggingface dataset:
Gymnast Wrist: An Epidemiologic Survey of Ulnar Variance and Stress Changes of the Radial Physis in Elite Female Gymnasts
Authors: De Smet Luc , Claessens Albrecht , Lefevre Johan , Beunen Gaston
Published: June 2007

The ulnar variance in female gymnasts attending the World Championship Artistic Gymnastics Rotterdam 1987 was measured. There was a marked increase in the ulnar length in adult as well as immature gymnast compared with nonathletes. The changes in relative ul nar length were correlated to weight, height, and skel etal age of the athletes. In 10% of the gymnasts' wrists we noted so-called "stress-related changes" of the distal physis of the radius. Repetitive injury and compression of the wrist leads to a premature closure of the distal radial growth plate resulting in secondary ulnar overgrowth.
Surgical Reconstruction of Severe Chronic Posterolateral Complex Injuries of the Knee Using Allograft Tissues
Authors: Noyes Frank R. , Barber-Westin Sue D.
Published: June 2007

We report for the first time a reconstructive procedure of the posterolateral complex using allograft tissue to restore fibular collateral ligament function. The proce dure is designed for knees where insufficient soft tis sues are present and suitable autogenous graft tissues are not available. Twenty consecutive patients were studied; all returned for follow-up evaluation a mean of 42 months (range, 24 to 73) after surgery. The results were evaluated with the use of a comprehensive sub jective and objective system that rated 20 factors. The success rate for the operative procedure was 76% (16 of 21 operations) as judged by knee stability examina tion and stress radiographs. Three of the reconstruc tions showed partial stretching and two failed. There was significant improvement from preoperative to follow-up scores of functional limitations in sports ac tivities (P < 0.05), symptoms (P < 0.01), and overall scores (P < 0.0001). The immediate knee motion and rehabilitation program restored 0° to 135° of motion in all knees and was not deleterious to the reconstructions.
Electromyographic Analysis of the Scapular Muscles During a Golf Swing
Authors: Kao John T. , Pink Marilyn , Jobe Frank W. , Perry Jacquelin
Published: June 2007

To describe the role of the scapular muscles in the golf swing, we studied 15 competitive male golfers. Four muscles were studied bilaterally using dynamic elec tromyography and cinematography. In the trailing arm, the levator scapulae elevates while the rhomboid muscles retract the scapula during takeaway; both then stabilize the scapula through the remainder of the swing. In the leading arm, these muscles retract the scapula during forward swing and acceleration. The tra pezius muscle in the trailing arm also demonstrates high activity during takeaway to aid in scapular retraction. In the leading arm, trapezius activity is high in forward swing and through the remainder of the swing to pro mote scapular retraction. The serratus anterior muscle activity is high in the trailing arm during forward swing and through the remainder of the swing to maximize scapular protraction. In the leading arm, the serratus anterior muscle has constant activity through all phases of the swing, which may explain the clinical scenario of muscle fatigue in high demand golfers. The golf swing and uncoiling action requires that the scapular muscles work in synchrony to maximize swing arc and clubhead speed. This study demonstrates the importance of the scapular muscles in the golf swing and the need for specific strengthening exercises.
A Threshold and Continuum of Injury During Active Stretch of Rabbit Skeletal Muscle
Authors: Hasselman Carl T. , Best Thomas M. , Seaber Anthony V. , Garrett William E.
Published: June 2007

Previous studies of acute muscle injury with active stretch used cyclic stretching or stretching the muscle to complete muscle-tendon dissociation. This study tried to determine minimal force required for skeletal muscle injury with one active stretch to establish an in jury "threshold." Tibialis anterior and extensor digitorum longus rabbit muscles were actively stretched at 10 cm/ sec to 60%, 70%, 80%, or 90% of the force required to passively fail tibialis anterior and extensor digitorum lon gus muscles of the control (contralateral) limb. Maximal isometric contractile force, tensile properties, histology, and electromyography were measures of injury. Both muscles of the 60% group showed no abnormalities in maximal isometric contractile force, tensile properties, histology, or electromyographic activity; 70%, 80%, and 90% groups showed diminished maximal isometric con tractile force, muscle fiber disruption, edema, hemor rhage, and decreased electromyographic maximal volt age amplitude. The 90% group also showed alterations in tensile properties at failure along with connective tis sue damage. Injury site included fiber disruption both at the distal myotendinous junction and muscle belly, with injury noted initially at the distal myotendinous junction in the 70% group. Electromyographic studies showed maximal isometric contractile force and maximal volt age correlated well as indices of damage. This study shows that a threshold and continuum for active stretch- induced injury exist, with muscle fiber disruption occur ring initially and connective tissue disruption occurring only with larger muscle displacements.
Semitendinosus Augmentation of Acute Patellar Tendon Repair with immediate Mobilization
Authors: Larson Roger V. , Simonian Peter T.
Published: June 2007

We report four cases of acute midsubstance rupture of the patellar tendon that were treated with primary sur gical repair along with semitendinosus autograft aug mentation. The goal of this treatment was to allow im mediate mobilization of the knee with a single operative procedure. We also demonstrate a technique for de termining patellar position intraoperatively. Patients were tested for functional performance at an average final followup of 40 months (range, 20 to 66) including hamstring and quadriceps muscle strength evaluation, completion of a functional questionnaire, functional test performance, range of motion assessment, and patellar tendon length measurement. In evaluating the results, all cases were essentially identical to the nonoperated side, except one knee that had multiple associated liga ment injuries. The multitude of injuries to this knee are likely the cause of the discrepancy. Immediate midsub stance patellar tendon repair with semitendinosus aug mentation allowed immediate mobilization, which de creased the recovery period and improved the outcome of rehabilitation. Furthermore, a second surgery for hardware removal was not needed. These two factors— early and improved rehabilitation and the decreased chance of a second surgery—affect the cost of treat ment of this injury. All isolated patellar tendon injuries in the study had excellent function at followup. For these reasons, we recommend this procedure for acute pa tellar tendon ruptures.
Prevention of Arthrofibrosis After Anterior Cruciate Ligament Reconstruction Using the Central Third Patellar Tendon Autograft
Authors: Cosgarea Andrew J. , Sebastianelli Wayne J. , DeHaven Kenneth E.
Published: June 2007

A retrospective analysis was performed to explain the decreasing incidence of postoperative arthrofibrosis of the knee in 191 consecutive patients who had anterior cruciate ligament reconstruction using the central third patellar tendon from 1987 through 1991. Follow-up data were available on 188 patients (98%). Age, sex, time interval from injury, preoperative motion, and concomi tant meniscal repair or partial meniscectomy were evaluated for their significance as risk factors. Twenty- two of 188 patients (12%) developed arthrofibrosis; the incidence was lower when the acute anterior cruciate ligament reconstruction was delayed at least 3 weeks from the injury, and when preoperative extension was 10° or better. Age, sex, preoperative flexion, and need for concomitant meniscal surgery were not risk factors. The postoperative motion protocol evolved during the study period. Group 1 patients were braced in 45° of flexion for 1 week before passive extension was al lowed. In Group 2, motion was started after 48 hours. Group 3 patients were braced in full extension, with mo tion starting within 24 hours. With these changes, the incidence dropped from 23% to 3%. Decreases in the incidence of arthrofibrosis with modifications in opera tive technique and postoperative analgesia were not statistically significant.
Partial Tears of the Anterior Cruciate Ligament
Authors: Lintner David M. , Kamaric Emir , Moseley J. Bruce , Noble Philip C.
Published: June 2007

Eight cadaveric lower extremities were examined by three experienced knee surgeons in blinded fashion. The knees were examined with intact anterior cruciate ligaments, sectioned anteromedial bundles, and completely sec tioned anterior cruciate ligaments to evaluate detectable laxity changes. Lachman, anterior drawer, lateral pivot shift, and KT-1000 arthrometer testing were performed. Optimized biplanar radiography using a defined spatial co ordinate reference system was performed with a 30- pound anterior force at 30° of flexion to confirm clinical findings. Physical examination and arthrometertesting de tected no difference between intact and partially sectioned anterior cruciate ligaments; these ligaments were signifi cantly different than completely sectioned ligaments, with the Lachman test being the most sensitive.

Despite consistent clinical detection of complete sec tioning of the anterior cruciate ligament by both physical examination and arthrometer testing, neither method proved accurate in the diagnosis of isolated tears of the anteromedial bundle, but both did show that partially sectioned anterior cruciate ligament closely resembled intact ligament and differed significantly from com pletely sectioned ligament, as confirmed by radiologic data. Clinically diagnosed "partial tear" is likely to be complete rupture of the anterior cruciate ligament. His torically, clinically diagnosed partial tears of the anterior cruciate ligament have tended to "progress" to symp tomatic instability. Our data imply these patients may have had functionally incompetent ligaments from time of injury and, in fact, were demonstrating the expected natu ral history of an anterior cruciate ligament-deficient knee.
Meniscal Repair
Authors: Miller Mark D. , Ritchie Joseph R. , Gomez Ben A. , Royster R. Marvin , DeLee Jesse C.
Published: June 2007

To evaluate the healing potential of the meniscus, we created a longitudinal medial meniscal tear in both knees of 24 adult goats (48 knees). In all goats, the meniscus was repaired in one knee and left unrepaired in the other. The goats were placed into one of three groups based on the location of the tear and the status of the anterior cruciate ligament. At 6 months' followup, an arthrogram was obtained and the menisci were ex amined. In knees with an intact anterior cruciate liga ment, tears in the peripheral 20% to 25% of the me niscus healed in six of seven repaired menisci, but in only one of seven of the unrepaired menisci. Tears in the peripheral 40% to 50% healed in only one of the eight repaired menisci and in none of the unrepaired menisci. When the anterior cruciate ligament was in cised, tears in the peripheral 20% to 25% of the me niscus healed in only 1 of 8 repaired menisci and in none of the unrepaired menisci; the rest developed into com plex tears. Arthrography was 92% accurate in predicting the status of meniscal repair. This study supports cur rent clinical practices in meniscal repair and empha sizes the importance of tear location and knee stability in successful meniscal repair.
Magnetic Resonance Imaging Evaluation of the Rotator Cuff Tendons in the Asymptomatic Shoulder
Authors: Miniaci Anthony , Dowdy Paul A. , Willits Kevin R. , Vellet A. Dale
Published: June 2007

Thirty shoulders in 20 volunteers (average age, 29 years; range, 17 to 49) with no shoulder symptoms or known abnormalities were scanned using magnetic resonance imaging. All scans were interpreted by one radiologist who was blinded to clinical data. Appearance of rotator cuff tendons on the images was graded. Grade 0 was normal, homogeneous low signal intensity structure. Grade 1 lesion was focal, linear, or diffuse intermediate signal through the tendon. Grade 2 lesion was high signal intensity within the tendon and less than full thickness. Grade 3 was high signal intensity through the full thickness of the tendon. No supraspinatus or infraspinatus tendons were grade 0 (normal); all su praspinatus and infraspinatus tendons had grade 1 changes through the tendons; and 7 of 30 (23%) of the tendons had grade 2 changes. None of the 30 shoulders had grade 3 changes in the rotator cuff tendons. There is a wide array of abnormal magnetic resonance imag ing signals in shoulders of young asymptomatic indi viduals, but they do not have full-thickness rotator cuff tears (grade 3 lesion). Nonenhanced magnetic reso nance imaging may be of limited value in defining rotator cuff injury in a patient with shoulder pain unless a full- thickness rotator cuff tear is suspected clinically.
Meniscal Injuries Associated With Acute Anterior Cruciate Ligament Tears in Alpine Skiers
Authors: Duncan Jewell Brent , Hunter Robert , Purnell Mark , Freeman John
Published: June 2007

We reviewed the records of 315 patients receiving an arthroscopically assisted stabilizing procedure for an acute anterior cruciate ligament injury incurred while alpine skiing to evaluate associated meniscal inju ries. Meniscal injuries were classified by type, loca tion, and treatment of the tear. Of the 317 knees op erated on, all demonstrated an anterior cruciate ligament tear at arthroscopy. Ninety-eight percent of the injuries (310) were diagnosed within 3 days of injury, and 97% (307) were reconstructed within 28 days of injury. All tears occurred in the intrasubstance of the ligament; 32% were isolated injuries and 68% were combined with other injuries. In 159 patients with 170 meniscal tears 141 of the tears (83%) were lateral and 29 (17%) were medial. The injury triad of anterior cruciate ligament-medial collateral ligament- lateral meniscus was seen nine times as often as the anterior cruciate ligament-medial collateral ligament- medial meniscus combination.
Allograft Failure in Cruciate Ligament Reconstruction
Authors: Sterling James C. , Meyers Michael C. , Calvo R. David
Published: June 2007

Previous authors have reported the efficacy of cruciate ligament allograft reconstruction of the knee suggesting that allograft strength is not significantly different than that of autografts. The purpose of this study was to elicit the cause of a higher-than-expected failure rate in cru ciate ligament allograft reconstructions. After clinical di agnoses, 12 male and 6 female patients with cruciate ligament instability underwent intraarticular allograft re construction followed by an aggressive rehabilitation program. Deep-frozen, freeze-dried, ethylene oxide- sterilized, bone-patellar tendon-bone allografts were re hydrated, prestressed, and implanted by an open or ar throscopically assisted technique. Results revealed 6 of 18 failures. Knee instability, postoperative complica tions, and roentgenographic changes were evident. Evaluation of procurement technique showed that graft failure was significantly correlated with time to implan tation. A significant difference in mean time from pro curement and deep freezing to freeze-drying and ster ilization between failed-versus-successful grafts was 265.5 ± 61.9 versus 66.8 ± 43.8 days, respectively. Total mean time of failed grafts from procurement to implantation was significantly greater (528.3 ± 75.1 ver sus 207.3 ± 53.1 days) than for successful grafts. All graft failures came from the same batch number. These findings indicate that cruciate ligament allograft recon struction can be successful; however, longer shelf life negatively affects graft integrity.
Acute Gamekeeper's Thumb
Authors: Downey Daniel J. , Moneim Moheb S. , Omer George E.
Published: June 2007

Ten consecutive patients with 11 complete ulnar col lateral ligament tears who had early surgical repair were evaluated at an average of 42 months' followup. The mean arc of motion at the metacarpophalangeal joint at 50.9° was less than the 73.7° seen in the uninjured thumbs. At the interphalangeal joint, the mean arc of motion in the injured thumb was 101.6° compared with 112.6° on the uninjured side. Ulnar laxity was de creased slightly compared with the contralateral thumb (14.0° versus 15.3°) and radial laxity was 10.3° on both sides. The mean grip strength and key pinch were simi lar between the injured and uninjured sides: grip strength was 32.3 kg in the injured thumbs and 34.0 kg in the uninjured; key pinch was 8.1 kg in the injured thumbs and 8.8 kg in the uninjured. Good stability with slight decrease in motion was obtained in our patients.
The Effect of Elastic Bandages on Human Knee Proprioception in the Uninjured Population
Authors: Perlau Robert , Frank Cyril , Fick Gordon
Published: June 2007

Elastic bandages are often used to treat musculoskel etal disorders, even though there is little scientific evi dence currently to support this generalized practice. We tested the hypothesis that elastic bandages improve proprioception of the bandaged joint during their use, and that this benefit was more than temporary. The un injured human knee was used as a model. Fifty-four volunteers (54 knees), aged 22 to 40 years, were asked to identify a prior set joint angle as their knee was pas sively extended. Each knee was tested without the elas tic bandage, immediately after bandage application, after 1 hour of bandage wear, and finally after removal of the bandage. Results showed that elastic bandages significantly improved knee joint proprioception in the uninjured knee during the entire interval of their use (mean decrease in inaccuracy of 1.0°, equivalent to 25% improvement, P < 0.05), and that this benefit was lost when the bandage was removed. The magnitude of the improvement, or the potential beneficial effect of the bandage, was inversely related to the participant's in herent knee proprioceptive ability, which was demon strated in the test group before the initial application of the bandage.
The Rotator Cuff Opposes Superior Translation of the Humeral Head
Authors: Sharkey Neil A. , Marder Richard A.
Published: June 2007

To determine the influence of rotator cuff muscle activity on humeral head migration relative to the glenoid during active arm elevation we studied five fresh cadaveric shoulders. The shoulder girdles were mounted in an apparatus that simulated contraction of the deltoid and rotator cuff muscles while maintaining the normal scapulothoracic relationship. The arms were abducted using four different configurations of simulated muscle activity: deltoid alone; deltoid and supraspinatus; del toid, infraspinatus, teres minor, and subscapularis; and deltoid, supraspinatus, infraspinatus, teres minor, and subscapularis. For each simulated muscle configura tion the vertical position of the humeral head in relation to the glenoid was determined at 30°, 60°, 90°, and 120° of abduction using digitized anteroposterior radio graphs. Both muscle activity and abduction angle sig nificantly influenced the glenohumeral relationship. With simulated activity of the entire rotator cuff, the geo metric center of the humeral head was centered in the glenoid at 30° but had moved 1.5 mm superiorly by 120°. Abduction without the subscapularis, infraspina tus, and teres minor muscles caused significant supe riorly directed shifts in humeral head position as did ab duction using only the deltoid muscle. These results support the possible use of selective strengthening ex ercises for the infraspinatus, teres minor, and sub scapularis muscles in treatment of the impingement syndrome.
The Effects of Graft Rotation on Attachment Site Separation Distances in Anterior Cruciate Ligament Reconstruction
Authors: Blum Michael F. , Garth William P. , Lemons Jack E.
Published: June 2007

We created a model to see if twisting the graft in an anterior cruciate ligament reconstruction affected the distance separating the femoral and tibial attachments of the perimeter fibers of a patellar tendon graft. Graft bone plugs were simulated by two 12.5-mm diameter Delrin cylinders. Holes, 1 mm in diameter, were placed at the four corners of a centralized rectangle measuring 5 by 10 mm. Graft ligament fibers were represented by color-coded sutures passed through the holes in the modeled bone plugs. This graft model was fixed in tun nels reamed under arthroscopic guidance at the ante rior cruciate ligament attachment sites of the femur and tibia in six fresh-frozen knee specimens. Spring gauges were used to measure indirectly the changes in distance of separation during knee flexion between the femoral and tibial attachments relative to a zero defined at 90° of knee flexion. The tibial cylinder was rotated at 45° increments from 90° external to 180° internal rotation relative to the femoral cylinder and measurements were repeated after each incremental rotation. External ro tation resulted in a statistically significant higher mean separation distance (4.5 mm) for peripheral graft attach ments than internal rotation (2.8 mm) (P = 0.05).
Clinical Experience with the Leeds-Keio Artificial Ligament in Anterior Cruciate Ligament Reconstruction
Authors: Rading Jan , Peterson Lars
Published: June 2007

In this study, 24 consecutive patients with symptomatic chronic anterior cruciate ligament ruptures who had ligament reconstructions with the Leeds-Keio artificial ligament were observed for a minimum of 2 years or until ligament failure, whichever came first. The evalu ation included a clinical examination, Lysholm knee score, and testing with a KT-1000 arthrometer. Within 2 years after surgery three patients underwent reop eration because of a rupture of the artificial ligament leading to instability. Another six patients developed significant subjective instability, even during ordinary activity. Only eight patients had a subjectively stable knee. Eleven patients scored 84 points or less on the Lysholm knee score, and 13 patients scored 85 points or more. The mean difference in anterior translation be tween the reconstructed knee and the opposite knee tested with the KT-1000 arthrometer was 3.7 mm. The high incidence of unstable knees, 9 of 24, due to in sufficiency of the artificial ligament in this 2-year follow-up study strongly suggests that the Leeds-Keio artificial ligament is not an effective device for the reconstruction of the anterior cruciate ligament.
Short-Term Effects of Knee Washout for Osteoarth ritis
Authors: Edelson Richard , Burks Robert T. , Bloebaum Roy D.
Published: June 2007

Twenty-nine knees in 23 patients with symptomatic os teoarthritis underwent washout with lactated Ringer's solution. Two arthroscopic cannulas were placed into the knee under local anesthetic. Three liters of fluid were run through the knee using varying inflow and out flow to alternately inflate and deflate the knee. We ob tained Hospital for Special Surgery knee scores, Knee Society pain and function ratings, and visual analog pain scales before washout and up to 2 years after washout.

At 1 year, the mean Hospital for Special Surgery score increased from 72 to 87, the Knee Society pain rating from 64 to 89, and the Knee Society function rat ing from 62 to 82. Twenty-five knees had a good or excellent result at 1 year. Twenty-one of these were observed at 2 years; 17 had good or excellent results. This study confirms the value of a fluid washout in an arthritic knee for some patients. This may explain some of the symptom relief seen with arthroscopic procedures in this condition.
A Comparison of Intraarticular Morphine and Bupivacaine for Pain Control After Outpatient Knee Arthroscopy
Authors: Jaureguito John W. , Wilcox Joseph F. , Cohn Stephan J. , Thisted Ronald A. , Reider Bruce
Published: June 2007

To determine the duration of pain relief and efficacy of intraarticular morphine compared with bupivacaine after outpatient knee arthroscopy under local anesthe sia, we gave patients one of three postoperative intraar ticular injections: 4 mg morphine, 0.25% bupivacaine, or 0.9% saline. Visual analog scale scores and supple mental pain medication use were recorded at 0 to 30 minutes, 2, 4, 6, 8 to 12, and 24 hours after surgery. The score on the visual analog scale at 24 hours was sig nificantly lower in the morphine group than in the bupi vacaine or control groups. The cumulative amount of pain medication used was significantly lower in the mor phine and bupivacaine groups at 2 to 6 hours after sur gery than in the saline control group. The morphine group used the least supplemental pain medication dur ing the 12 to 24 hour interval ( P = 0.06).

We found that the use of intraarticular morphine or bupivacaine after outpatient knee arthroscopy will de crease the amount of narcotic medication needed for pain relief during the early postoperative period. In ad dition, morphine provided prolonged pain relief up to 24 hours when compared with bupivacaine or placebo, and the patients in the morphine group tended to take less supplemental pain medication during the first postop erative day.
Biomechanical Analysis of Patellar Tendon Allografts as a Function of Donor Age
Authors: Flahiff Charlene M. , Brooks Andrew T. , Hollis J.Marcus , Vander Schilden Jack L. , Nicholas Richard W.
Published: June 2007

We evaluated the biomechanical properties of patellar tendon allografts from donors aged 18 to 55 years. Bone-patellar tendon-bone complexes were harvested from acceptable donors and processed. Fat and soft tissue were removed, and the tendons were sectioned lengthwise leaving the central third. Area measure ments were taken, and mechanical testing was per formed. Specimens were pulled to failure at a rate of 10% of the initial length per second. The force at failure, tensile stress, modulus of elasticity, and percent elon gation were determined for each specimen. There was no significant correlation (P > 0.05) between age and any of the mechanical properties. Load at failure ranged from 2110 to 4650 N, with a mean of 3424 N. Regres sion analysis showed slightly decreasing tensile stress with increasing age, but the correlation was not signifi cant. It appears that patellar tendon allografts from do nors up to age 55 have similar mechanical properties.
The Treatment of Acute Combined Ruptures of the Anterior Cruciate and Medial Ligaments of the Knee
Authors: Noyes Frank R. , Barber-Westin Sue D.
Published: June 2007

We performed a prospective study of 46 patients with ruptures of the anterior cruciate ligament and medial ligamentous structures. All patients had anterior cruci ate ligament allograft reconstructions. Group I com prised 34 patients in whom all of the medial structures were ruptured (parallel and oblique fibers of the super ficial medial collateral ligament and the posteromedial capsule) and were treated operatively. In Group II (12 patients), the superficial medial ligament fibers only were ruptured and these were treated nonoperatively. All patients started an immediate motion and rehabili tation program. Forty-four patients returned for followup at a mean of 5.3 years (range, 2 to 8.9) postoperatively. The results were assessed using the Cincinnati Knee Rating System. At followup, 20 knees (59%) in Group I and 9 knees (73%) in Group II had less than 3 mm of increased displacement on KT-1000 arthrometer test ing (134 N). The overall rate of anterior cruciate liga ment graft failure was 15%: six (18%) in Group I and one (8%) in Group II. No patient had more than 2 mm of increase on valgus stress testing at 5° or 25° of knee flexion. The overall ratings were as follows: Group I, 20 knees (58%) excellent or good and 14 knees (42%) fair or poor; and Group II, 11 knees (91 %) excellent or good and one knee (9%) fair. Knee motion complications and patellofemoral symptoms were common in the patients rated fair or poor in Group I.
Arthroscopic Assessment of the Medial Collateral Ligament Complex of the Elbow
Authors: Field Larry D. , Callaway G. Hadley , O'Brien Stephen J. , Altchek David W.
Published: June 2007

The extent that the medial collateral ligament complex could be visualized by arthroscopy was determined in 10 fresh cadaveric elbows from 10 individuals. We care fully exposed the medial collateral ligament complex through a muscle-splitting incision before performing ar throscopy. The anterior and posterior bundles were identified and marked by placing 4.0 nylon sutures deep to the bundles to aid in arthroscopic visualization. A por tion of the anterior bundle was visible in only one elbow and in that elbow only the most anterior 25% of the anterior bundle was seen. Attempts to visualize the an terior bundle through additional portals were unsuc cessful. Varying the flexion angle of the cadaveric elbow from 0° to 130° also failed to improve visualization. Con versely, the entire posterior bundle, including humeral and ulnar insertion sites, could be seen in all 10 speci mens using the posterior portals. We also noted that direct pressure was placed on the ulnar nerve in all specimens when the arthroscope or any arthroscopic instrument was advanced into the posteromedial gutter in contact with the posterior bundle because of its prox imity immediately adjacent to the ulnar nerve. The in ability to reliably see the anterior bundle and the hu meral or ulnar insertion sites of this ligament may limit the value of the arthroscope when assessing medial collateral ligament injuries. Additionally, great care should be taken when using the arthroscope or other instruments in the posteromedial gutter because the ul nar nerve lies immediately adjacent to the thin posterior bundle and capsule.
Open Versus Closed Chain Kinetic Exercises After Anterior Cruciate Ligament Reconstruction
Authors: Bynum E. Bruce , Barrack Robert L. , Alexander A. Herbert
Published: June 2007

We conducted a prospective, randomized study of open and closed kinetic chain exercises during accelerated rehabilitation after anterior cruciate ligament recon struction to determine if closed kinetic chain exercises are safe and if they offer any advantages over conven tional rehabilitation. The closed kinetic chain group used a length of elastic tubing, the Sport Cord, to per form weightbearing exercises and the open kinetic chain group used conventional physical therapy equip ment. Results are reported with a minimum 1-year fol lowup (mean, 19 months). Pre- and postoperative evaluation included the Lysholm knee function scoring scale, Tegner activity rating scale and KT-1000 ar thrometer measurements. Overall, stability was re stored in over 90% of the knees. Preoperative patel lofemoral pain was reduced significantly; 95% of the patients had a full range of motion. The closed kinetic chain group had lower mean KT-1 000 arthrometer side- to-side differences, less patellofemoral pain, was gen erally more satisfied with the end result, and more often thought they returned to normal daily activities and sports sooner than expected. We concluded that closed kinetic chain exercises are safe and effective and offer some important advantages over open kinetic chain ex ercises. As a result of this study, we now use the closed kinetic chain protocol exclusively after anterior cruciate ligament reconstruction.
The Effect Of Drilling and Soft Tissue Grafting Across Open Growth Plates
Authors: Stadelmaier Denise M. , Arnoczky Steven P. , Dodds Julie , Ross Herb
Published: June 2007

We examined the ability of a soft tissue graft to inhibit the formation of a bony bridge within tunnels drilled across open femoral and tibial growth plates in a canine model. A fascia lata autograft was placed in tunnels drilled across the distal femoral and proximal tibial phy ses in four skeletally immature dogs. Four additional dogs had a similar procedure performed, but the drill holes were left empty. The growth plates were evalu ated at either 2 weeks or 4 months postoperatively using high-resolution radiography and routine histologic study. A bony bridge spanned the growth plate in all nongrafted animals as early as 2 weeks postopera tively. However, the fascia lata autograft prevented bone formation within the tunnels of all grafted animals, which maintained normal growth plate anatomy throughout the length of the study. The results of this study demonstrate that a soft tissue graft of fascia lata placed in drill holes across open growth plates will pre vent the formation of a bony bridge. These findings pro vide basic science support to those clinical studies that report no apparent alteration in growth plate function after the use of intraarticular techniques to reconstruct the anterior cruciate ligament in children and adolescents.
Injuries in Junior A Ice Hockey
Authors: Stuart Michael J. , Smith Aynsley
Published: June 2007

This 3-year prospective cohort observational analysis of elite amateur hockey players ranging in age from 17 to 20 years on a United States Hockey League team de scribes ice hockey injuries using a strict definition of injury, standardized reporting strategies, and diagnosis by a team physician. One hundred forty-two injuries were recorded for an on-ice injury rate of 9.4 per 1000 player hours. A player was 25 times more likely to be injured in a game (96.1 per 1000 player-game hours) than in practice (3.9 per 1000 player-practice hours). Game-related injuries were more frequent in the third period, and practice-related injuries occurred more of ten in the first third of the season. Collisions represented 51% of the total injuries. The most common types of injuries were strains, lacerations, contusions, and sprains. The face and the shoulder were most fre quently injured. A facial laceration was the most com mon injury; acromioclavicular joint sprain was the sec ond most common injury. Facial lacerations typically occurred in games and were stick related. Further re search is necessary to determine if injuries in Junior A amateur ice hockey can be reduced by mandatory full facial protection, enforcement of existing rules, im provement in shoulder pad design, and by focusing more attention on stretching programs.
Radiation Exposure During Fluoroarthroscopically Assisted Anterior Cruciate Reconstruction
Authors: Larson Brad J. , Egbert Julie , Goble E. Marlowe
Published: June 2007

We prospectively evaluated the radiation exposure dur ing 50 consecutive fluoroscopically assisted anterior cruciate ligament reconstructions. Three different meth ods of anterior cruciate ligament reconstruction were performed using either rolled fascia lata allograft or bone-tendon-bone autograft. For the 50 procedures, to tal time using the fluoroscope was 119.61 minutes, or 2.38 minutes per procedure. The 16 primary fascia lata allograft reconstructions averaged 1.38 minutes of fluo roscope use per procedure compared with 4.69 minutes for the two revision allograft fascia lata surgeries, 3.14 minutes per procedure for the 30 primary bone-tendon- bone reconstructions, and 4.18 minutes per procedure for the two surgeries performed with an allograft me niscal transplant. The difference in exposure time be tween the 16 primary allograft fascia lata surgeries and the 30 primary allograft or autograft bone-tendon-bone surgeries was statistically significant. The average ra diation exposure to the surgeon was 0.67 mrem per minute of fluoroscope use. It would take 7463.08 min utes of fluoroscope time, or 11,139 primary fascia lata allograft reconstructions, to exceed the recommended occupational exposure limit of 5000 mrem per year. It appears that the orthopaedic surgeon receives minimal radiation when using the fluoroscope to assist in ante rior cruciate ligament reconstruction, especially when doing a primary fascia lata allograft procedure.
Patellar Taping: A Radiographic Examination of the Medial Glide Technique
Authors: Larsen Bob , Andreasen Eric , Urfer Alex , Mickelson Mick R. , Newhouse Kenneth E.
Published: June 2007

The purpose of this study was to radiographically de termine the effectiveness of the McConnell medial glide patellar taping technique. Twenty apparently healthy men, between ages 18 and 35, participated in this study. Subjects underwent a series of three radiographs in a modified Merchant view. First, a bilateral tangential view of the patellofemoral joints was taken to establish a baseline. Next, the same view was obtained with the experimental knees taped using the McConnell medial glide technique. Subjects then underwent a standard ized exercise protocol to stress the tape and the ac companying knee structures. This was followed by a third view of the patellofemoral joints. Radiographs were measured using the Merchant congruence angle and analyzed statistically with dependent, mean differ ence tests. Results from this study indicate that the Mc Connell medial glide technique was effective in signifi cantly moving the patella medially (P = 0.003), but that the tape was ineffective in maintaining this significance after exercise (P < 0.001). In 3 subjects (15%) of this sample, the tape was ineffective in moving the patella medially in any degree. One interesting finding was that exercise caused a statistically significant (P = 0.016) lateral shift from baseline in the control knees. This may suggest some clinical significance for patellar taping in preventing excessive lateral shift.
Anterior Cruciate Ligament Graft Tensioning in Full Extension
Authors: Nabors Eric D. , Richmond John C. , Vannah William M. , McConville Owen R.
Published: June 2007

The purpose of this study was to determine anterior laxity and graft forces in cadaveric knees after anterior cruciate ligament reconstruction in which the graft is tensioned with the knee in full extension. We also ana lyzed the clinical results from a series of patients who had ligament reconstructions using this technique. We performed anterior cruciate ligament reconstructions on seven fresh cadaveric knees and then measured the anterior laxity, graft set force, and graft tension. We also did a prospective minimum 2-year followup on 57 pa tients who underwent anterior cruciate ligament recon struction. The in vitro data showed average anterior lax ity of 1.1 mm greater than the intact knee with an 89-N anterior force at 30° of knee flexion. Average graft set force was 68 N, and graft tension in extension was 18 N. In the clinical portion of the study, knee laxity improved from 7.5 to 0.8 mm (side-to-side difference at 89 N). The patients' Lysholm and Tegner scores improved from 65 to 90 and 3.9 to 5.6, respectively. Only one patient had a postoperative contracture. The results of this study suggest that graft tensioning in full extension provides a low incidence of flexion deformity, maintaining excel lent functional results and satisfactory biomechanics.
Long-Term Results of Open Meniscal Repair
Authors: DeHaven Kenneth E. , Lohrer William A. , Lovelock James E.
Published: June 2007

The purpose of this study was to document the long- term clinical and radiographic results of open meniscal repair. Thirty consecutive patients, involving 33 open repairs, were evaluated by history, physical examina tion, KT-1000 arthrometer testing, Lysholm II score, Tegner activity score, and weightbearing radiographs. The mean followup was 10.9 years (range, 10.1 to 13). No patients were lost to followup. Seven meniscal re tears (21%) were documented (six demonstrated by re peat arthroscopy and one suspected on clinical evalu ation). Three of 21 (14%) acute repairs (performed within 6 weeks of injury) retore as compared with 4 of 12 (33%) chronic repairs (P = 0.38). None of the 12 menisci in stable knees (<3 mm side-to-side difference in anterior laxity on manual maximum load testing) sus tained retears, compared with 7 of 21 (33%) menisci in nearly stable or unstable knees ( P = 0.03). Standing radiographs revealed no degenerative changes in 22 of 26 (85%) compartments with successful repairs as compared with 3 of 7 (43%) compartments with retorn menisci (P = 0.04). We concluded that the long-term survival rate of repaired menisci was 79%, that in creased retear rates were encountered in unstable knees, and that radiographs provided evidence for the biomechanical function of successful meniscal repairs.
A Method to Help Reduce the Risk of Serious Knee Sprains Incurred in Alpine Skiing
Authors: Ettlinger Carl F. , Johnson Robert J. , Shealy Jasper E.
Published: June 2007

The incidence of severe anterior cruciate ligament sprains was once only a third the current rate. This fact led the authors to believe a means to help reduce the risk of anterior cruciate ligament injury among skiers might be found. Using videotapes of the occurrences of anterior cruciate ligament sprains in alpine skiers and the data associated with more than 1400 anterior cru ciate ligament injuries observed in a 22-year study, the authors identified two common mechanisms of anterior cruciate ligament injury. From this information, a study was designed to determine if training could help reduce the risk of anterior cruciate ligament sprains. During the 1993 to 1994 season, the on-slope staff from 20 ski areas participated in a training program involving view ing videotaped scenes where knee injuries occurred. Data from 22 ski areas, where staff were not exposed to the training, were assembled to form a control group. Data concerning anterior cruciate ligament injuries were collected from both groups for the three seasons 1991 to 1994. A total of 179 serious knee sprains were evalu ated. Serious knee sprains declined by 62% among trained patrollers and instructors compared with the two previous seasons, but no decline occurred in the control group.
A Prospective Study of Ankle Injury Risk Factors
Authors: Baumhauer Judith F. , Alosa Denise M. , Renström Per A. F. H. , Trevino Saul , Beynnon Bruce
Published: June 2007

Many factors are thought to cause ankle ligament in juries. The purpose of this study was to examine injury risk factors prospectively and determine if an abnor mality in any one or a combination of factors identifies an individual, or an ankle, at risk for subsequent inver sion ankle injury. We examined 145 college-aged ath letes before the athletic season and measured gener alized joint laxity, anatomic foot and ankle alignment, ankle ligament stability, and isokinetic strength. These athletes were monitored throughout the season. Fifteen athletes incurred inversion ankle injuries. Statistical analyses were performed using both within-group (un injured versus injured groups) data and within-subject (injured versus uninjured ankles) data. No significant differences were found between the injured ( N = 15) and uninjured ( N = 130) groups in any of the param eters measured. However, the eversion-to-inversion strength ratio was significantly greater for the injured group compared with the uninjured group. Analysis of the within-subject data demonstrated that plantar flex ion strength and the ratio of dorsiflexion to plantar flex ion strength was significantly different for the injured ankle compared with the contralateral uninjured ankle. Individuals with a muscle strength imbalance as meas ured by an elevated eversion-to-inversion ratio exhib ited a higher incidence of inversion ankle sprains. Ankles with greater plantar flexion strength and a smaller dorsiflexion-to-plantar flexion ratio also had a higher incidence of inversion ankle sprains.
Long-Term Followup of Anterior Cruciate Ligament Reconstructions Using Freeze-Dried Fascia Lata Allografts
Authors: Pritchard John C. , Drez David , Moss Michael , Heck Suzy
Published: June 2007

We identified 79 patients who underwent arthroscopi cally assisted intraarticular anterior cruciate ligament reconstruction with freeze-dried fascia lata allografts and an additional lateral extraarticular reconstruction. We were able to contact 62 patients (79%) for follow-up evaluation at an average of 134.5 months. Forty pa tients (51 %) returned for objective evaluation. Lysholm scores at followup averaged 92.3 and Tegner activity scores averaged 5.1. Only four (6%) of the 62 patients contacted reported episodes of full giving way. Thirty (75%) of the 40 patients examined demonstrated 3 mm or less side-to-side difference on KT-1000 arthrometer manual maximum evaluation. Forty-eight (77%) of the 62 patients were participating in sporting activities at final followup. No patient had evidence of graft rejection.
Instrumented Measurement of Patellar Mobility
Authors: Fithian Donald C. , Mishra Dev K. , Balen Paul F. , Stone Mary Lou , Daniel Dale M.
Published: June 2007

To provide an objective analysis of medial and lateral patellofemoral laxity, we examined 94 uninjured athletic subjects and 22 patients with unilateral lateral patellar dislocation. We developed an instrument to measure the compliance of the medial and lateral patellar re straints. The instrument recorded the force- displacement relationship as the patella was pushed medially and laterally. Subtracting the medial displace ment from the lateral displacement at a given force level allowed the tester to assess the peripatellar soft tissue "balance." The results for both the 2.5- and the 5-pound tests were significant. Paired comparisons differenti ated the three groups, with significant differences be tween control and affected ( P = 0.0001), control and contralateral ( P = 0.0036), and affected and contralat eral ( P = 0.0157) knees. The mean result of the lateral minus medial displacement test for our sample popu lation of control subjects was -2.1 mm for the 5-pound test. A negative value in this test indicates that medial displacement exceeds lateral displacement. This find ing was present in 81 % of control subjects. In contrast, the mean result for the patients' affected knees was +3.2 mm for the 5-pound test. Using the value of 0.0 mm as the diagnostic determinant for peripatellar im balance, we found a test sensitivity of 91% and a speci ficity of 81 %.
The Role of Glenohumeral Capsular Ligaments in Internal and External Rotation of the Humerus
Authors: Branch Thomas P. , Lawton Richard L. , lobst Christopher A. , Hutton William C.
Published: June 2007

The purpose of this study was to define the relationship between internal and external rotation of the humerus and the lengths of the anterior and posterior compo nents of the glenohumeral capsuloligamentous com plex. Six cadaveric shoulders (with intact ligaments and humeri) were stripped of all muscles. Each shoulder was mounted in its correct anatomic position. The ex tent of internal and external rotation of the humerus was then measured 36 times (at 10° intervals in a 360° hu meral cone of motion). One component of the gleno humeral capsuloligamentous complex was lengthened, and the humeral rotation was again measured 36 times. The process of lengthening was done by cutting the ligament and replacing it with a beaded chain and catches sutured across the joint. The process of length ening each component was repeated in 12 combina tions, each with a different anterior and posterior com ponent length. Humeral rotation was measured 36 times using a specially designed goniometer. The length of the anterior component of the glenohumeral capsuloligamentous complex most affected external humeral rotation, and the length of the posterior com ponent most affected internal humeral rotation. How ever, the lengths of both the anterior and posterior com ponents shared in limiting rotation at a number of positions.