bluuebunny/crossref_metadata_2025 huggingface dataset:
Injury to the lateral ankle ligaments of athletes
Authors: Rijke Arie M. , Jones Barrington , Vierhout Pieter A.
Published: June 2007

Twenty of 26 original athletes with injuries to the lateral ligaments of the ankle were reexamined 2 to 5 years following treatment. The functional quality of their an terior talofibular (TF) and calcaneofibular (CF) ligaments was tested by stress examination, using a commercially available stress device, and was compared with the results of stress examination, arthrography, and sur gery at the time of injury.

Surgically treated patients showed a 70% to 100% recovery of the functional properties of the lateral ankle ligaments on comparison with the contralateral, unin jured ankle. Of the six patients treated conservatively With elastic bandages and rest, only one had regained normal function, whereas the others showed minimal or no improvement. Isolated lesions of the anterior TF ligaments, when treated conservatively, may have only a slightly better prognosis than a combined lesion of both anterior TF and CF ligaments in the athletic pop ulation.
Arthroscopic meniscus repair
Authors: Miller Donald B.
Published: June 2007

From February 1982 through July 1987, the author studied 87 patients who had a total of 116 meniscus tears, 96 of which were repaired. Seventy patients (79 meniscus repairs) had postoperative followup ranging from 12 months to 5½ years (mean, 39 months). The patients' ages ranged from 14 to 51 years with a mean age of 22. The time from injury to surgery ranged from 1 week to 6 years. Twenty-five percent of the injuries were considered acute, i.e., less than 6 weeks after the injury, and 75% of the injuries were considered chronic. Nineteen patients (27%) had isolated meniscus injuries. All meniscus repairs were done arthroscopically, using an inside-outside technique. Ligament stabilizing pro cedures were done on all patients who had ACL defi cient knees. Forty-seven patients (67%) had postoper ative documentation including either an arthroscopic examination or an arthrogram done an average of 5 to 6 months after surgery. There was one case of peroneal nerve palsy from which the patient made a complete recovery in 6 months. There was one case of infection/ thrombophlebitis. One patient had paresthesia and numbness along the medial aspect of the left leg cor responding to a saphenous nerve injury. The aim of this investigation was two-fold, consisting of determin ing if an arthroscopic technique could be used success fully to repair acute as well as chronic vertical tears involving the meniscus, and also, evaluating the rela tionship between ACL stability and meniscus healing. The overall success rate of retained menisci following repair was 91 %. The time from injury to repair did not affect meniscus healing. Associated stabilization of ACL deficiencies is imperative in patients undergoing menis cus repair.
Direct, real time measurement of meniscal blood flow
Authors: Swiontkowski Marc F. , Schlehr Frank , Sanders Roy , Limbird Thomas A. , Pou Adrienne , Collins Jerry C.
Published: June 2007

The functional microcirculatory system of the meniscus was investigated in nine sheep using laser Doppler flowmetry (LDF). The highest blood flows recorded were found at the periphery and at the anterior and posterior horns, and this finding was confirmed by india ink injections in five sheep and by meniscal autoradi ographs following intraatrial injection of 20 million Cs46 microspheres in four sheep. LDF provides accurate and reproducible assessment of meniscal blood flow. If adequate probes can be developed, this method offers great promise in the clinical assessment of blood flow within the substance of meniscal tears, thus offering the surgeon initial information in the decision to repair or resect a meniscal tear.
Long-term followup of anterior cruciate ligament reconstruction using the quadriceps tendon substitution for chronic anterior cruciate ligament insufficiency
Authors: Kornblatt Ira , Warren Russell F. , Wickiewicz Thomas L.
Published: June 2007

At The Hospital for Special Surgery, the quadriceps tendon substitution (QTS), as described by Marshall, was performed for ACL insufficiency from 1973 to 1980. A review of the initial 60 patients with a minimum of 4 years followup (average, 5.5 years) has been concluded. Thirty-eight patients returned for examina tions, and 11 returned questionnaires. Associated me dial procedures were performed in 29 of the 38 exam ined patients. Medial meniscus surgery was performed in 86% and lateral meniscus surgery in 28.9%. At followup, giving way, which was the main preoperative complaint, was eliminated in 30/38 examined and 9/11 questionnaire patients (79%). In the examined group, three patients were clear failures and five had mild transient instability. The pivot shift was present in 17 of 38 (45%) patients examined: 21 patients were neg ative, 9 were 1 + or a grind, 8 were 2+, and none were 3+.

We have concluded that the QTS procedure will eliminate symptomatic instability in 79% of our patients, but the high rate of a residual pivot shift (45%) and symptoms of instability (21 %) require the addition of an extraarticular sling procedure. This appears to be re lated to the relatively poor strength characteristics of the tissue used in the QTS substitution.
Skiers' lower leg shaft fracture
Authors: Peter Robin E. , Bachelin Pierre , Fritschy Daniel
Published: June 2007

We report our experience using Sarmiento's method for the conservative treatment of 91 consecutive frac tures of the lower leg. The mean age of the patients in our series was 34 years. One patient had an open fracture. All of the patients were followed and were evaluated clinically and radiographically 6 to 12 months after injury.

After a period of immobilization by traditional methods (traction/long leg cast), the Sarmiento brace was ap plied at a mean of 42 days, allowing early weightbearing and mobilization. The brace was removed at a mean of 90 days. Clinical results were excellent; there was minimal persistence of knee or ankle limitation; 84% of the patients had less than 5 mm of final shortening; 96% had less than 4° of final angulation. Work was resumed at a mean of 103 days. We had one nonunion, which we treated operatively 6 months after injury by osteosynthesis and autologous bone grafting. All of the patients were asked to complete a questionnaire; 51 % responded, with an average followup of 5 years (range, 1 to 10 years). These patients had been able to resume sports activity 8 months after injury; 52% were skiing 1 year after injury, and 96% were satisfied with the treatment method used. One patient complained of persistent pain.
Fractures of the posterolateral tibial plateau
Authors: Waldrop John I. , Macey Theodore I. , Trettin John C. , Bourgeois Warren R. , Hughston Jack C.
Published: June 2007

We reviewed the clinical records and operative notes of 28 patients with fractures of the posterolateral tibial plateau seen at our institution from 1949 to 1982. Five of the 28 patients had chronic depressions of the posterolateral tibial plateau after initial treatment else where. All five were disabled because of significant functional instability when the knee was in flexion. There were 23 acute fractures, of which 4 were initially nondisplaced and treated nonoperatively. One nonop erative patient was lost to followup; the remaining three were rated as having had good or excellent results. Nineteen patients had acute depressed fractures and were treated operatively with open reduction, elevation of the depressed area, and bone grafting, with or without internal fixation. All patients treated operatively at the time of injury were seen for followup from 24 to 145 months postoperatively, with a mean followup of 59 months. One patient was lost to followup; the other 18 were rated using both objective and subjective criteria. Seventeen (94%) achieved a final rating of excellent or good; one patient (6%) achieved a rating of fair.

We have observed these fractures occurring in a younger population and producing significant disability in activities requiring a stable knee in flexion. The depressed posterolateral tibial plateau fracture is best assessed by AP, lateral, and 45° internal oblique views on radiographic examination. Because of continued disability caused by chronic, depressed fractures of this type, we recommend open reduction and bone grafting in acute cases to eliminate instability in flexion. This procedure produces good or excellent results in most cases.
Reconstruction of anterior cruciate ligament with carbon fiber
Authors: Mäkisalo S. , Skutnabb K. , Holmstrom T. , Grönblad M. , Paavolainen P.
Published: June 2007

During a follow-up period of 16 weeks in 18 pigs, macroscopical and histological studies revealed inva sion of fibroblasts and mesenchymal cells around the carbon fiber prosthesis inserted to replace the ACL but scarce tissue ingrowth into the prosthesis proper. There was no adherence of the carbon ligament onto the bony channels. The peak tensile strength of the reconstructed ligament was about one third of the paired normal ACL ligament during the 16 week exper iment.
Measurement of upper extremity torque production and its relationship to throwing speed in the competitive athlete
Authors: Bartlett Lyndon R. , Storey Mitchel D. , Simons Bart D.
Published: June 2007

This study was conducted to establish whether or not a correlation exists between peak torque production of upper extremity (UE) musculature and throwing speed. Eleven professional baseball players were tested for upper extremity peak torque production using a Cybex II Isokinetic Dynamometer. Throwing speed was meas ured with a radar gun. Results of statistical analysis performed on the data indicate a correlation between shoulder adductors and throwing speed.
Biomechanical evaluation of rotator cuff fixation methods
Authors: France E. Paul , Paulos Lonnie E. , Harner Chris D. , Straight Chris B.
Published: June 2007

Initial fixation strength and failure mode for various rotator cuff reattachment techniques (variations of the McLaughlin technique) were evaluated. Repair methods included standard suture (control), reinforced suture [expanded polytetrafluoroethylene (PTFE) patch and polydioxanone (PDS) tape augmentation] and stapling (nonarthroscopic and arthroscopic soft-tissue staples). The average strength of intact rotator cuff tissue (su praspinatus tendon) was also determined. The different rotator cuff repairs, including at least one control, were performed on fresh-frozen human cadaver shoulder pairs. Repairs were tested to failure in pure tension with the shoulder fixed in 60° of abduction. Load and displacement data were normalized to controls, grouped according to failure modes, and statistically analyzed. The two basic failure modes observed were 1) bone failure, or suture tearing through the bone (indicating weak bone stock) and 2) tendon failure, or suture tearing of the rotator cuff. Gross comparisons between intact and repaired tendons indicated that the intact tendon was two to three times stronger than the repaired tendon. Based on the mode of failure and lack of increased strength after repair, the use of staples for cuff attachment is discouraged. PDS tape suture rein forcement did not increase fixation strength. In con trast, PTFE patch suture augmentation demonstrated statistically higher initial failure loads than did the control and was of specific benefit for shoulders with weak bone stock.
The natural history of conservatively treated partial anterior cruciate ligament tears
Authors: Buckley Steven L. , Barrack Robert L. , Alexander A. Herbert
Published: June 2007

Twenty-five patients with arthroscopically proven par tial ACL tears were reviewed. All patients underwent examination under anesthesia and arthroscopy follow ing an acute injury to a previously normal knee. The percentage of tear was estimated during arthroscopy. Postoperatively, patients were treated with early motion and hamstring strengthening. Weightbearing and quad riceps rehabilitation were delayed. A detailed rating of symptoms and function was performed at a minimum of 18 months after injury, using a modification of the AOSSM ACL follow-up form. Neither the estimated percentage of ligament tear, length of followup, nor age at time of injury significantly correlated with clinical score at followup. Thirteen patients underwent partial meniscectomy at the time of original arthroscopy. Their clinical outcome was not different from those without meniscectomy. Two patients (8%) underwent ACL re construction 8 and 64 months after injury, respectively. Overall results were judged as excellent (28%), good (32%), fair (24%), and poor (16%). Only 44% were able to resume sports at their preinjury level, and 72% had activity-related symptoms.
Preoperative instrumented testing of anterior and posterior knee laxity
Authors: Anderson Allen F. , Lipscomb A. Brant
Published: June 2007

A prospective study was performed on 50 patients who were thought or suspected to have cruciate ligament tears. Each patient had a clinical examination preoper atively and under anesthesia and instrumented exami nation using the MedMetric KT-1000 arthrometer, Stry ker knee laxity tester, and Genucom knee analysis. The diagnosis was confirmed by arthrotomy or arthroscopy. Thirty had acute knee injuries (within 2 weeks), 9 had subacute (2 weeks to 3 months), and 11 had chronic injuries. The surgical findings demonstrated that five had other maladies, but no cruciate ligament tears. Two had a partial ACL tear, and the remaining 43 patients had at least one cruciate tear.

The preoperative clinical examination for cruciate lig ament integrity was completely correct in 92%, correct but incomplete in 6%, and incorrect in 2%. Examination under anesthesia was correct in 98%, the KT-1000 was correct in 75% (involved knee minus noninvolved knee was ≥3 mm laxity equal to ACL tear), the Stryker was correct in 75%, and Genucom in 70%. The average laxity of those with ACL tears was 4.4 mm with the KT- 1000, 4.6 mm with the Stryker, and 2.0 mm with the Genucom.

The methods of testing with the Stryker and the KT- 1000 are similar and the laxity recorded in patients with a torn ACL were almost identical. However, the KT- 1000 can be used to identify the quadriceps neutral position and therefore more accurately determine PCL instability. The Genucom has the most versatility, but the laxity recorded in patients with a torn ACL was significantly lower than the other devices. It had the poorest correlation with the clinical Lachman test.

This study suggests that clinical examination by an experienced examiner is the most accurate way to determine cruciate ligament integrity. However, instru mented testing was beneficial. In many cases, confi dence in clinical diagnosis was improved by instru mented confirmation.
External stabilization of the anterior cruciate ligament deficient knee during rehabilitation
Authors: Maltry J.A. , Noble P.C. , Woods G.W. , Alexander J.W. , Feldman G.W. , Tullos H.S.
Published: June 2007

Using cadaveric specimens, we studied the effect of ACL deficiency upon anterior tibial translation during extension of the knee joint. Five knees were loaded via the quadriceps mechanism until flexion angles of 10°, 25°, 40°, and 60° were attained. At each angle, the anterior-posterior position of the tibia was documented with biplane radiography, both before and after division of the ACL. In every specimen, anterior tibial translation increased with loss of the ACL and was greatest at 25° of flexion, where an average displacement of 3.3 mm was observed. Subluxation was not significant at flex ion angles exceeding 60°, regardless of ACL deficiency.

We also examined the effect of an external restraining force on tibial subluxation in the ACL deficient knee. Posteriorly directed forces of 0 N, 45 N (10 pounds), 90 N (20 pounds), 135 N (30 pounds), and 225 N (50 pounds) were applied to the tibia at the level of the tibial tubercle. Anterior subluxation was eliminated through application of forces ranging from a maximum of 106 N (23.6 pounds) at 10° to only 13 N (2.9 pounds) at 60°.
Effect of resistance training on lumbar extension strength
Authors: Pollock Michael L. , Leggett Scott H. , Graves James E. , Jones Arthur , Fulton Michael , Cirulli Joe
Published: June 2007

Development of a new testing machine, which stabilizes the pelvis, allowed us to evaluate the lumbar extensor muscles before and after training. Fifteen healthy sub jects (29.1 ± 8 years of age) trained 1 day per week for 10 weeks and 10 healthy subjects (33.7 ± 16 years of age) acted as controls. Training consisted of 6 to 15 repetitions of full range of motion variable resistance lumbar extension exercise to volitional fatigue and periodic maximal isometric contractions taken at seven angles through a full range of motion. Before and after the 10 week training period, subjects completed a maximum isometric strength test at seven angles through a 72° range of motion (0°, 12°, 24°, 36°, 48°, 60°, and 72° of lumbar flexion). The training group significantly improved in lumbar extension strength at all angles (P ≤ 0.01). The result at 0° (full extension) showed an increase from 180.0 ± 25 Nm to 364.1 ± 43 Nm (+102%) and at 72° (full flexion) from 427.4 ± 44.1 to 607.4 ± 68 (+42%) Nm. Results from the control group showed no change (P ≥ 0.05). The mag nitude of gain shown by the training group reflects the low initial trained state of the lumbar extensor muscles. These data indicate that when the lumbar area is iso lated through pelvic stabilization, the isolated lumbar extensor muscles show an abnormally large potential for strength increase.
Reflex sympathetic imbalance
Authors: Ladd Amy L. , DeHaven Kenneth E. , Thanik Jaimala , Patt Richard B. , Feuerstein Michael
Published: June 2007

Eleven patients (two male, nine female) were treated with epidural sympathetic blockade for reflex sympa thetic imbalance, an incomplete manifestation of reflex sympathetic dystrophy. Each had developed severe pain, sensitivity, and disability disproportionate to as sociated trauma. One patient injured an ankle, and the remaining 10 patients one or both knees (12 knees). Seven patients had undergone previous surgery. All but one had a favorable response to initial blockade. This individual eventually failed treatment despite surgical sympathectomy. Seven have required readministration of a block for clinical relapse. Mean followup was 22 months (range, 10 to 41 months). Five underwent ex tensive psychological testing. All have required adjunc tive forms of therapy including physical therapy, trans cutaneous electrical nerve stimulation (TENS), antiin flammatory or other nonnarcotic agents. Recovery is typically prolonged, particularly if the diagnosis is de layed. Close attention to, and therefore prevention of, situations that trigger its recurrence is essential for successful rehabilitation.
Morphologic and histologic abnormalities in female and male rats treated with anabolic steroids
Authors: Yu-Yahiro Janet A. , Michael Roger H. , Nasrallah David V. , Schofield Brian
Published: June 2007

A two-part study was performed to determine the ef fects of high doses of anabolic steroids on weight, appetite, and organ histology. Initially, 30 white Wistar rats, 15 males and 15 females, were treated weekly with either 0.52 cc of physiologic saline or nandrolone decanoate. After 6 weeks, female treated and control rats had comparable weight gains, but male treated rats were significantly lighter than controls. Rats were sacrificed and organs dissected for histologic prepara tion. Treated male livers had less lipid than control males. The uteri of treated females displayed abnormal vacuolization, stromal edema, and peliosis.

In Part 11, 12 male rats, 6 treated and 6 control, were given the drug or saline in a manner identical to that in Part I. Treated rats had lower weights from Weeks 1 through 6 and ate less than controls. Upon sacrifice, treated rats' kidneys were heavier, and testes and liver were lighter compared to controls. Roentgenographic studies of tibias from Parts I and II showed no significant differences in tibial length or height of growth plate between treated and control groups. In summary, when anabolic steroid use is studied in the rat model, numer ous pathological and anatomical changes occur.
Genucom, KT-1000, and Stryker knee laxity measuring device comparisons
Authors: Highgenboten Carl L. , Jackson Allen , Meske Neil B.
Published: June 2007

Generally, three devices (the Genucom Knee Analysis System, the MEDmetric KT-1000 Arthrometer, and the Stryker Knee Laxity Tester), which have been pre sented in the literature, may be used to assess clinically the amount of knee laxity in an objective manner. This study compared the reproducibility of the anterior and posterior knee laxity values for each and made direct comparisons of the results obtained. Thirty asympto matic subjects were given a test-retest protocol on both legs with all three devices. Devices were tested in a counterbalanced order. Repeatability of test values within devices was variable, but all were acceptable, the lowest being r = 0.74. Analysis of variance (AN- OVA), and correlational analysis revealed that device- specific anterior and posterior laxity values were pro duced. We concluded that each commercially available knee laxity testing device can provide reproducible quantitative measurements of knee laxity; however, due to differences in device sensitivities and functional design, numerical results from one device cannot be generalized to another device.
Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg
Authors: Pedowitz Robert A. , Hargens Alan R. , Mubarak Scott J. , Gershuni David H.
Published: June 2007

One hundred fifty-nine patients were referred to the authors for evaluation of chronic exertional leg pain from 1978 to 1987. The records of 131 patients were complete and available for retrospective review. Forty- five patients were diagnosed as having a chronic com partment syndrome (CCS) and seventy-five patients had the syndrome ruled out by intramuscular pressure recordings. The only significant difference found be tween the two groups on history and physical exami nation was a 45.9% incidence of muscle herniae in the patients with CCS, compared to a 12.9% incidence in those without the syndrome. One-third of the patients with the syndrome and over one-half of those without it reported persistent, moderate to severe pain at 6 month to 9 year followup.

Modified, objective criteria were developed for the diagnosis of CCS. The criteria were based upon the intramuscular pressures recorded with the slit catheter before and after exercise in 210 muscle compartments without CCS. In the presence of appropriate clinical findings, we consider one or more of the following intramuscular pressure criteria to be diagnostic of chronic compartment syndrome of the leg: 1) a preex ercise pressure ≥ 15 mm Hg, 2) a 1 minute postexercise pressure of ≥30 mm Hg, or 3) a 5 minute postexercise pressure ≥20 mm Hg.
The epidemiologic, pathologic, biomechanical, and cinematographic analysis of football-induced cervical spine trauma
Authors: Torg Joseph S. , Vegso Joseph J. , O'Neill Mary Jane , Sennett Brian
Published: June 2007

Epidemiologic, pathologic, biomechanical, and cinema tographic data on head and neck injuries occurring in tackle football have been compiled since 1971 by the National Football Head and Neck Injury Registry. Pre liminary analysis performed in 1975 indicated that the majority of serious cervical spine football injuries were caused by axial loading. Based on this observation, the National Collegiate Athletic Association (NCAA) and National Federation of High School Athletic Associa tions (NFHSAA) implemented rule changes banning "spearing" and the use of the top of the helmet as the initial point of contact in striking an opponent during a tackle or block. Between 1976 and 1987, as a result of these rule changes, the Registry has documented a dramatic decrease in both the total number of cervical spine injuries and those resulting in quadriplegia at both the high school and college level. It is suggested that development and implementation of similar preventative measures based on clearly defined injury mechanisms would decrease injury rates in diving, rugby, ice hockey, trampolining, wrestling, and other high-risk sports as well.
Primary repair with semitendinosus tendon augmentation of acute anterior cruciate ligament injuries
Authors: Sgaglione Nicholas A. , Warren Russell F. , Wickiewicz Thomas L. , Gold David A. , Panariello Robert A.
Published: June 2007

A retrospective review of 72 acute ACL injuries in 70 athletically active patients (50 recreational and 20 com petitive athletes) treated with primary repair and semi tendinosus tendon augmentation was conducted (mean follow-up time, 38.5 months). All patients had open primary multiple loop depth-varying suture repair and semitendinosus tendon augmentation at a mean injury to surgery interval of 9.1 days. Fifty-one cases (70.8%) were supplemented with an extraarticular procedure consisting in all cases of an iliotibial band lateral sling reinforcement. All patients underwent 6 weeks of post operative immobilization followed by a graduated re habilitation regimen lasting a mean 7.2 months. In 22 of the ACL tears, no other associated injury could be defined at arthrotomy, while in 27, significant medial collateral ligament injuries were noted. Lateral meniscal injuries (24) were more commonly noted than medial meniscal injuries (19).

Good to excellent subjective results were reported in 82%, while 77.1 % returned to preinjury sport level and participation without limitation. One patient developed "giving way" symptoms and overall, only four patients did not return to sports participation. Objective exami nation revealed 93.1 % to have a 1 + or less Lachman test and 86.1 % to have a negative pivot shift. Of 60 knees tested, 93.3% had KT-1000 side-to-side differ ence values (measured at 25° ± 5° of flexion with an 89 N load) of ≤3 mm of anterior displacement. A 100 point Hospital for Special Surgery ligament rating score was used with 25 points assigned to subjective, 45 points to objective, and 30 points to functional assess ment. The mean score at followup was 93.1. Analysis of results in patients with or without an extraarticular reinforcement revealed no difference in objective out come.

The incidence of patellofemoral pain was 27.8%. Thirty knees had some degree of loss of range of motion. Loss of terminal flexion was noted in 29, while 5 had loss of terminal extension. No correlation could be found between patellofemoral pain and diminished range of motion. Generalized ligamentous laxity was found in 37.1 % of the patients; this was not associated with a poor result.

This study suggests that primary repair with semiten dinosus tendon augmentation of acute ACL injuries with a graduated rehabilitation regimen provides good subjective, and excellent functional and objective, re sults in active patients that were followed for more than 3 years.
The effects of passive warming on muscle injury
Authors: Strickler Timothy , Malone Terry , Garrett William E.
Published: June 2007

This study investigated the effects of passive warming on the biomechanical properties of the musculotendi nous unit. Paired tibialis anterior (TA) and extensor digitorum longus (EDL) muscles in the rabbit hindlimb were passively heated to different temperatures and then subjected to controlled strain injury. The parame ters examined were: 1) percent increase in length to failure, 2) force to failure, 3) energy absorbed by the musculotendinous unit to failure, and 4) site of failure.

Warmed (39°C ± 0.5°C) TA ( P ≤ 0.01) and EDL ( P ≤ 0.05) muscles achieved a greater increase in length from rest before failing than did their contralateral con trols at 35°C ± 0.5°C. In both the TA and EDL the force at failure was greater at 35°C than at 39°C, although the difference was significant for only the EDL ( P ≤ 0.05). The energy absorbed (area beneath the length-tension curve) by both the TA and EDL was greater at 39°C, but these differences were not signif icant. All muscles failed at the distal musculotendinous junction. These data suggest that passive warming increases the extensibility of the musculotendinous unit and may thereby reduce its susceptibility to strain in jury.
Reconstruction of the anterior cruciate ligament
Authors: Wirth Carl J. , Kohn Dieter
Published: June 2007

A new technique for ACL reconstruction is presented. The middle third of the patellar tendon is anchored to the inner surface of the lateral femoral condyle under direct visual control. The transplant is fixed tibially beneath a bone block removed from the ventral tibial head. Thirty-three patients were evaluated preopera tively and 27 months (range, 24 to 30 months) post operatively. The mean preoperative function score (Lysholm scoring scale) was 72 ± 14 points; the mean postoperative score was 84 ± 13 points. The Lachman test was positive for all patients preoperatively, but the test results in the postoperative follow-up examination were negative—1+ in 31 knees and 2+ in 2 knees. All 33 knees elicited a definite "hard" end point. The post operative KT-1000 measurement for anterior tibial dis placement showed no significant difference between the operated versus the unoperated knee. Before their knee injury all patients had been engaged in sports. At the follow-up examination, 13 patients had made a full return to their former sports activities, 13 were re stricted in their sports activities, and 7 patients no longer participated in sports.
Strain measurement in lateral ankle ligaments
Authors: Colville Mark R. , Marder Richard A. , Boyle John J. , Zarins Bertram
Published: June 2007

We measured strain in the lateral ligaments of 10 human cadaver ankles while moving the ankle joint and apply ing stress in a variety of ways. We studied the anterior talofibular, calcaneofibular, posterior talofibular, ante rior tibiofibular, and posterior tibiofibular ligaments. Strain measurements in the ligaments were recorded continuously while the ankle was moved from dorsiflex ion into plantar flexion. We then repeated measure ments while applying inversion, eversion, internal rota tion, and external rotation forces.

Strain in the anterior talofibular ligament increased when the ankle was moved into greater degrees of plantar flexion, internal rotation, and inversion. Strain in the calcaneofibular ligament increased as the talus was dorsiflexed and inverted. These findings support the concept that the anterior talofibular and calcaneofibular ligaments function together at all positions of ankle flexion to provide lateral ankle stability. We measured maximum strain in the posterior talofibular ligament when the ankle was dorsiflexed and externally rotated. The strain in the anterior and posterior tibiofibular liga ments increased when the ankle was dorsiflexed. Ex ternal rotation increased strain in the anterior tibiofibular ligament and decreased strain in the posterior tibiofib ular ligament.

Based upon strain measurements in the lateral ankle ligaments in various ankle joint positions, we believe the anterior talofibular ligament is most likely to tear if the ankle is inverted in plantar flexion and internally rotated. Theoretically, the calcaneofibular ligament tears primarily in inversion if the ankle is dorsiflexed; the anterior tibiofibular ligament tears in dorsiflexion, especially if combined with external rotation; and the posterior tibiofibular ligament tears with extreme dor siflexion.
Disc degeneration in young gymnasts
Authors: Tertti Minna , Paajanen Hannu , Kujala Urho M. , Alanen Anu , Salmi Toivo T. , Kormano Martti
Published: June 2007

Magnetic resonance imaging (MRI) was performed on 35 young competitive gymnasts and 10 control subjects in order to detect the number of degenerated discs and other lumbar spinal disorders. Lumbar radiographs were obtained from all gymnasts who showed evidence of disc abnormality on MRI. Eleven gymnasts had suf fered from episodes of low back pain during exercises and eight were found to have evidence of back trauma. Only 3 of the 35 gymnasts had MRI evidence of degen erated discs associated with Scheuermann's manifes tations and spondylolysis. Lumbar radiographs con firmed the diagnosis in these three cases. The results indicate that despite the excessive range of motion and strong axial loading of the lumbar spine that are asso ciated with gymnastic maneuvers, incurable primary damage to the intervertebral discs is uncommon in young gymnasts dunng growth.
Suprascapular nerve injuries with isolated paralysis of the infraspinatus
Authors: Black Kevin P. , Lombardo John A.
Published: June 2007

Nerve lesions are frequently overlooked in the differ ential diagnosis of shoulder pain, and there have been few reports in the literature of injuries of the suprascap ular nerve that involve only the infraspinatus. We report four cases of suprascapular nerve injuries which involve solely the infraspinatus in which each patient presented with shoulder pain and weakness. The diagnosis can be suspected by careful history and physical examina tion, but must be confirmed by the appropriate electrical studies. Our patients required 6 months to 1 year to regain full function, and isokinetic testing revealed near normal return of strength. Further diagnostic work-up and surgery may be necessary for those cases which fail to demonstrate satisfactory improvement in the expected time period.
Osteoid osteoma of the femoral neck in the young athlete
Authors: Ahlfeld Steven K. , Makley John T. , Derosa G. Paul , Fisher David A. , Mitchell James Q.
Published: June 2007

The purpose of this paper is to present a progressive diagnostic and management program for osteoid os teoma of the femoral neck in the young athlete. Five young athletes with hip pain secondary to osteoid osteoma are presented. The average age of the pa tients was 15 years old, with an average followup of 4 years. Radioisotope bone scans, computed axial tom ograms, and linear tomograms were valuable diagnos tic aids. All five athletes were treated with a limited excisional biopsy via an anterior approach to the fem oral neck. Associated treatment modalities, such as bone grafting, internal fixation, and cast immobilization, were not necessary. There were no major complica tions. The five young athletes returned to sports at an average of 4 months postoperatively.

Osteoid osteoma of the femoral neck should be in cluded in the differential diagnosis of hip pain in young athletes. A limited excisional biopsy provided a rapid return to sports for the young athlete without the po tential morbidity associated with internal fixation, bone grafting, and cast immobilization.
Turf-toe: An analysis of metatarsophalangeal joint sprains in professional football players
Authors: Rodeo Scott A. , O'Brien Stephen , Warren Russell F. , Barnes Ronnie , Wickiewicz Thomas L. , Dillingham Michael F.
Published: June 2007

Metatarsophalangeal joint injuries of the great toe (turf- toe) are receiving increasing attention in the literature because of the prevalence of synthetic surfaces and lighter, more flexible shoes. Eighty active professional football players were evaluated. The mechanism of injury was hyperextension in 85% of the players. Eighty-three percent reported their initial injury on arti ficial turf ( P < 0.05). Other factors significantly related to the incidence of turf-toe included player age ( P < 0.01), number of years in professional football ( P < 0.01), and range of ankle dorsiflexion ( P < 0.05). Turf- toe injury resulted in significantly decreased range of motion of the first metatarsophalangeal joint ( P < 0.01).
Pathologic synovial plica of the knee
Authors: Amatuzzi Marco M. , Fazzi Aldo , Varella Marta H.
Published: June 2007

Observations of 136 cases of pathologic synovial plica of the knee were analyzed with regard to etiology, symptoms, and the results of conservative treatment. The results obtained with conservative treatment were good in 40% of cases, average in 20%, and poor in 40%. In our opinion, these results justify the treatment of this condition with physical therapy before proceed ing with surgical correction. The objective of physical therapy was to decrease the compressive forces in the anterior compartment of the knee by increasing the structural flexibility of the flexor and extensor muscles. This increase in flexibility was obtained by instituting stretching exercises for the hamstrings, gastrocnemius, and quadriceps.
Surgical correction of the snapping iliopsoas tendon
Authors: Jacobson Thomas , Allen William C.
Published: June 2007

Eighteen patients with 20 symptomatic hips underwent lengthening of the iliopsoas tendon for persistent painful snapping of this "internal" variety of snapping hip. We referred to the pathologic, painful snapping of the ilio psoas in the deep anterior groin as the "internal" snap ping hip. This is in contrast to the more common and better-known "external" snapping that involves the greater trochanter and its overlying soft tissues. The results of our iliopsoas lengthening procedure are pre sented here.

Lengthening of the iliopsoas tendon was accom plished by step cutting of the tendinous portion of the iliopsoas. The pathoanatomy of this poorly understood symptom complex was described in a 1984 paper from this institution and is reviewed here.

Iliopsoas bursography demonstrated a sudden jerk ing movement of the iliopsoas tendon between the anterior inferior iliac spine and iliopectineal eminence, synchronous with the patient's pain and often accom panied by an audible snap. The average preoperative duration of symptoms was 2.9 years, and the average length of postoperative followup was 25 months. All patients, except one, had a marked reduction in the frequency of snapping after tendon lengthening, and 14 of 20 hips had no snapping postoperatively. Of the six patients who had recurrence of snapping, all but one stated that this occurred much less frequently and was much less painful compared to the preoperative state. Two hips required reoperation. Postoperatively, only three patients complained of subjective weakness, and most patients were unlimited in physical activity with return to activities such as competitive football, pole vaulting, and long-distance running.

A frequent complication has been transient or per manent sensory loss of the anterolateral thigh, yet no motor deficits have occurred. An operative approach through a cosmetic transverse inguinal incision, differ ent from our previous approach, is described. Nearly all patients felt that they were much better because of the procedure, and only one patient stated that she would not repeat the procedure for the same problem. We feel that judicious lengthening of the painful snap ping iliopsoas tendon near the brim of the pelvis can be of great benefit to symptomatic patients.
Secondary damage to the knee after isolated injury of the anterior cruciate ligament
Authors: Finsterbush A. , Frankl U. , Matan Y. , Mann G.
Published: June 2007

Between 1978 and 1984, we examined and performed arthroscopy on 1000 consecutive patients. Ninety-eight of the 1000 had isolated ACL damage. These cases do not include patients with initial ACL injuries combined with other intraarticular damage. Diagnosis was by physical and arthroscopic examination. Examination took place an average 13.6 months after injury. Of the 98 isolated ACL injuries, 56 were complete ruptures and 42 were partial ruptures. In most cases of partial rupture, the clinical diagnosis was wrong. "Meniscal damage" was the usual diagnosis in these cases; the true diagnosis was made only by arthroscopic exami nation. Thirty-four of the 98 patients with isolated ACL injuries (30 men and 4 women) developed further intra articular damage. Of these 34, 20 had complete ACL rupture and 14 had partial ACL rupture.

Treatment after primary injury included physiotherapy in all patients and bracing in those whose knee was unstable during daily activities. Reconstructive surgical procedures were not performed in those patients. The time lapse from the primary to the secondary injury varied from 1 month to 20 years, with an average of 28 months. The secondary damage was caused by a secondary injury that was mild (22 cases) or developed insidiously (12 cases).

Five types of secondary damage were observed: partial ACL tears that became complete—11 cases; meniscal tear— 8 cases; loosening and subluxation of the anterior horn of the medial meniscus—14 cases; and fracture or damage to the articular condylar carti lage, with or without bone involvement—11 cases.

It should be emphasized that the secondary damages were at times combined.
Prevention of common overuse injuries by the use of shock absorbing insoles
Authors: Schwellnus Martin P. , Jordaan Gerhard , Noakes Timothy D.
Published: June 2007

Sedentary individuals, particularly new military recruits, who start a physical training program have a substantial risk of developing an overuse injury of the lower limb. In this study we investigated the effect of neoprene insoles on the incidence of overuse injuries during 9 weeks of basic military training. The experimental group consisted of 237 randomly selected new recruits, while 1151 recruits were the control group. Insoles were given to the experimental group and compliance was monitored. A panel of doctors documented and classi fied all injuries occurring during the 9 week period. A total of 54 (22.8%) and 237 (31.9%) injuries were reported in the experimental and control groups, re spectively.

In both groups, the majority of injuries were overuse (experimental group, 90.7%; control group, 86.4%). The mean weekly incidence of total overuse injuries and tibial stress syndrome was significantly lower (P < 0.05) in the experimental group. The mean incidence of stress fractures was lower in the experimental group but not significantly so (0.05 < P < 0.1). This study shows that the incidence of total overuse injuries and tibial stress syndrome during 9 weeks of basic military training can be reduced by wearing insoles.
The stabilizing function of passive shoulder restraints
Authors: Terry Glenn C. , Hammon Dan , France Paul , Norwood Lyle A.
Published: June 2007

The static restraints of the scapulohumeral joint provide stability for the humeral head in the glenoid cavity, limit extremes of motion of the glenohumeral joint, and guide positioning of the humerus during normal shoulder movement.

Eleven fresh-frozen cadaver shoulders of unknown age were attached to a shoulder motion device that allowed measurement of motion in three planes with an accuracy to 0.5°. Four shoulders underwent motion analysis and seven were used for strain gauge analysis of the static scapulohumeral ligamentous restraints.

The results of the motion analysis demonstrated that any attempt at simple motion (flexion, extension, ab duction, internal or external rotation) resulted in coupled motion in two additional planes.

The strain gauge data, expressed as a percent of total tension for each ligament tested, demonstrated a reciprocal tension-sharing relationship among all liga ment components and a transference of tension among these components when original and new joint posi tions were compared.

These data provide an in vitro model of shoulder restraint function to explain primary restraint, tension sharing, and transference of tension functions in the in vivo scapulohumeral joint.

Clinical relevance: These principles of shoulder func tion have application in the treatment of instability and frozen shoulder syndrome, and provide an in vitro model to better understand static restraint function in the throwing mechanism.
Functional biomechanical deficits in running athletes with plantar fasciitis
Authors: Kibler W. Ben , Goldberg Cindy , Chandler T. Jeff
Published: June 2007

Plantar fasciitis is a relatively common injury that occurs in running athletes. The disease entity is a good ex ample of an overloaded process of the plantar fascia at its calcaneal insertion. This study was designed to examine the strength and flexibility findings in the mus cles that are put on tensile load during running, and which are responsible for controlling the forces on the foot during stance and pushoff, thus modifying the overload. Three groups of athletes underwent physical examination, including checking ankle range of motion in plantar flexion and dorsiflexion. Cybex peak torque measurements were taken at 60 and 180 deg/sec. The groups were a control group of 45 athletes with no symptoms, a group that included 43 affected feet with symptomatic plantar fasciitis, and a group that included the 43 unaffected contralateral feet. Analysis of data showed dynamic range of motion deficits in 38 of 43 affected feet, static range of motion deficits in 37 of 43 affected feet, deficits in peak torque at 60 deg/sec in 41 of 43 affected feet, and deficits in peak torque at 180 deg/sec in 37 of 43 affected feet. Statistical com parison of range of motion showed that the group with symptomatic plantar fasciitis was significantly restricted compared to both control and unaffected contralateral feet groups. Statistical comparison of peak torque showed that the symptomatic plantar fasciitis group was significantly lower than both other groups at both velocities. This study documents strength and flexibility deficits in the supporting musculature of the posterior calf and foot that are affected by plantar fasciitis. These anatomical and physiological alterations create a func tional deficit in the normal foot biomechanics. This deficit either causes or contributes to the overt clinical symptoms and should be addressed in the evaluation and treatment of plantar fasciitis.
Analysis of subjective knee complaints using visual analog scales
Authors: Flandry Fred , Hunt Jon P. , Terry Glenn C. , Hughston Jack C.
Published: June 2007

A questionnaire using a system of visual analog scales was developed for analyzing subjective knee com plaints. This system was tested on 117 consecutive patients who had undergone knee surgery and 65 patients at their initial office evaluation of a knee disor der. The validity of and patient affinity for this type of questionnaire was compared with that of three other established subjective evaluation methods.

The visual analog scale system was shown to be valid and comparable to other methods while offering several advantages. It brought greater sensitivity and greater statistical power to data collection and analysis by allowing a broader range of responses than did traditional categorical responses. It removed bias that was introduced by examiner questioning, and it allowed graphic temporal comparisons. Most importantly, pa tient affinity was higher for this type of subjective evaluation than for other methods.
A comparison of the Lysholm and Cincinnati knee scoring questionnaires
Authors: Bollen S. , Orth Frcsed , Seedhom B.B.
Published: June 2007

In a prospective study, we compared the Lysholm and Cincinnati symptom scoring questionnaires for knee ligament injuries in a group of 41 patients with docu mented unilateral anterior cruciate deficiency. The pa tients scored consistently higher on the Lysholm scale than on the Cincinnati for each patient. A linear regres sion analysis produced the relationship of Lysholm = 30 + 0.72 Cincinnati. This illustrates the difficulty of comparing the results from different operative proce dures, but offers an approximate "rate of exchange" for these two commonly used symptom questionnaires.